Grossmont Hospital Foundation

“The personnel committee of sharp healthcare retains an independent compensation consulting firm to review the total compensation paid to executive management (ceo/president, executive vice president of hospital operations, and senior vice presidents) and compares it to the total compensation paid to similar positions with like institutions. The information is presented to the personnel committee of the board of directors by the independent consultant. The personnel committee is comprised of board members who are not physicians and who are not compensated in any way by the organization. The personnel committee approves the total compensation for the president/chief executive officer and reviews and approves the compensation and compensation salary ranges for the remainder of the executive team. The personnel committee presents its decision to the board of directors. The personnel committee retains minutes of its meetings. The compensation and benefits department engages a third party independent consultant to conduct a compensation study covering officers and key employees. The independent third party compares base salaries to similar positions with like institutions. The information is reviewed by the compensation and benefits department and is presented to the president/chief executive officer, the executive vice president of hospital operations and the appropriate senior vice president for review and approval. The compensation study was last conducted in november/december 2017.”

“Grossmont hospital corporation (fein 33-0449527) has the right to elect directors to grossmont hospital foundation's governing body.”

“Grossmont hospital corporation (fein 33-0449527) approves changes to grossmont hospital foundation's bylaws and approves the election of grossmont hospital foundation board members.”

“The final form 990 is placed on the organization's intranet, prior to the filing date, where it is viewable for comment from all members of the governing body. The review process includes multiple levels of review including key corporate and entity finance department personnel comprised of the director of tax & accounting, vice president of finance, senior vice president and chief financial officer, and entity executive director. Additionally, the organization contracts with ernst & young, an independent accounting firm, for review of the form 990.”

“Grossmont hospital foundation has a written conflict of interest policy which has been reviewed and approved by the grossmont hospital foundation governing board. Grossmont hospital foundation is committed to preventing any participant of the corporation from gaining any personal benefit from information received or from any transaction of sharp. One component of the written conflict of interest policy requires that board members, corporate officers, senior vice presidents and chief executive officer(s) submit a conflict of interest statement annually to legal services/senior vice president of legal services who will review all statements. In addition, all vice presidents and any employees in the purchasing/supply chain, audit and compliance, and case management/discharge planning departments are required to complete an online conflict of interest questionnaire annually that is reviewed by the conflict review committee comprised of employees from sharp's legal, compliance, and internal audit departments. In connection with any transaction or arrangement, which may create an actual or possible conflict of interest, the person shall disclose in writing the existence and nature of his/her financial interest and all material facts. Board members, corporate officers, senior vice presidents, and the chief executive officer(s) shall make such disclosures directly to the chairman of the board, and to the members of the committee with the board designated powers considering the proposed transaction or arrangement. Upon disclosure of the financial interest and all material facts, the board member, corporate officer, senior vice president or the chief executive officer(s) making such disclosures shall leave the board or the committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. In certain instances, such as if someone takes a board seat on a competitor's board of directors or has a role with an organization whereby the information that they may obtain from sharp would put them in a consistent conflict with their two roles, the conflict could call for the individual's removal from the board. The bylaws for the organization provide for the ability to remove directors in accordance with section 5222 of the california corporations code. This can generally be done on a "for cause" or a "no cause" basis by the action of the member.”

“The organization does not make its governing documents available to the general public. POLICIES ARE CONSIDERED PROPRIETARY INFORMATION, HOWEVER IN SHARP HEALTHCARE'S PUBLICLY AVAILABLE CODE OF CONDUCT, SHARP OUTLINES ITS CONFLICT OF INTEREST POLICIES IN A USER FRIENDLY MANNER. THE ANNUAL AUDITED FINANCIAL STATEMENTS OF THE CONSOLIDATED GROUP ARE PUBLISHED ON THE DACBOND.COM WEBSITE (WWW.DACBOND.COM), ARE ATTACHED TO THE FORM 990 FILED FOR EACH OF THE SHARP HOSPITALS, AND ARE AVAILABLE UPON REQUEST. THE ANNUAL AUDITED FINANCIAL STATEMENTS INCLUDE COMBINING SCHEDULES WHICH DISCLOSE THE FINANCIAL RESULTS (BALANCE SHEET, STATEMENT OF OPERATIONS, STATEMENT OF CHANGES IN NET ASSETS) FOR EACH ENTITY OF THE CONSOLIDATED GROUP. QUARTERLY FINANCIAL STATEMENTS OF SHARP'S OBLIGATED GROUP ARE PUBLISHED ON THE DACBOND.COM WEBSITE (WWW.DACBOND.COM).”

“The purpose of this corporation is to provide assistance and support to Grossmont Hospital Corporation in the development of high quality, accessible and affordable inpatient and outpatient services.”

“Grossmont hospital foundation employees' salaries and wages are paid under grossmont hospital corporation's tax id number (ein 33-0449527), and as such are also reported on grossmont hospital corporation's form 990.”

“Pledge write off/return of contribution - -337;”

“Sharp HealthCare Community Benefit Plan and Report Fiscal Year 2018 Section 1 An Overview of Sharp HealthCare For more than 60 years, Sharp HealthCare has made a difference in the lives of San Diegans. As a not-for-profit organization, Sharp places great value on the health and wellness of our expanding community. In everything we do, we are committed to making health care better for those we serve. - Michael Murphy, President and Chief Executive Officer, Sharp HealthCare Sharp HealthCare (Sharp) is an integrated, regional health care delivery system based in San Diego, California. The Sharp system includes four acute care hospitals; three specialty hospitals; three affiliated medical groups; 29 medical centers; six urgent care centers; three skilled nursing facilities; two inpatient rehabilitation centers; home health, hospice, and home infusion programs; numerous outpatient facilities and programs; and a variety of other community health education programs and related services. Sharp also offers individual and group Health Maintenance Organization coverage through Sharp Health Plan (SHP). Serving a population of approximately 3.3 million in San Diego County (SDC), as of September 30, 2018, Sharp is licensed to operate 2,084 beds and has more than 2,700 Sharp-affiliated physicians and 18,000 employees. FOUR ACUTE CARE HOSPITALS: Sharp Chula Vista Medical Center (343 licensed beds) The largest provider of health care services in SDC's fast-growing South Bay, Sharp Chula Vista Medical Center (SCVMC) operates the region's busiest emergency department (ED) and is the closest hospital to the busiest international border in the world. SCVMC is home to the region's most comprehensive heart program, services for orthopedic care, cancer treatment, women's and infant's services, and the only bloodless medicine and surgery center in SDC. Sharp Coronado Hospital and Healthcare Center (181 licensed beds) Sharp Coronado Hospital and Healthcare Center (SCHHC) provides services that include acute, subacute and long-term care, liver care, rehabilitation therapies, orthopedics, and hospice and emergency services. Sharp Grossmont Hospital (524 licensed beds) Sharp Grossmont Hospital (SGH) is the largest provider of health care services in San Diego's East County and has one of the busiest EDs in SDC. SGH is known for outstanding programs in heart care, oncology, orthopedics, rehabilitation, stroke care and women's health. Sharp Memorial Hospital (656 licensed beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in cancer treatment, orthopedics, organ transplantation, bariatric surgery, heart care and rehabilitation. SMH also houses the county's largest emergency and trauma center. THREE SPECIALTY CARE HOSPITALS: Sharp Mary Birch Hospital for Women & Newborns (206 licensed beds) A freestanding women's hospital specializing in labor and delivery services, high-risk pregnancy, obstetrics, gynecology, gynecologic oncology and neonatal intensive care, Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) delivers more babies than any other hospital in California. Sharp Mesa Vista Hospital (158 licensed beds) As the most comprehensive mental health hospital in San Diego, Sharp Mesa Vista Hospital (SMV) provides behavioral health services to treat anxiety, depression, substance abuse, eating disorders, bipolar disorder and more for patients of all ages. Sharp McDonald Center (16 licensed beds) Sharp McDonald Center (SMC) is the only medically supervised substance abuse recovery center in SDC. Offering the most comprehensive hospital-based treatment program in San Diego, SMC provides services such as addiction treatment, medically supervised detoxification and rehabilitation, day treatment, outpatient and inpatient programs, and aftercare. Collectively, the operations of SMH, SMBHWN, SMV and SMC are reported under the not-for-profit public benefit corporation of SMH and are referred to herein as the Sharp Met”

“* Sensitivity to operations * A reluctance to simplify * Preoccupation with failure * Deference to expertise * Resilience Applying high-reliability concepts in an organization begins when leaders at all levels start thinking about how the care they provide could improve. It begins with a culture of safety. With this learning, Sharp is a seven-pillar organization - Quality, Safety, Service, People, Finance, Growth and Community. The foundational elements of Sharp's strategic plan have been enhanced to emphasize Sharp's desire to do no harm. This strategic plan continues Sharp's transformation of the health care experience, focusing on safe, high-quality and efficient care provided in a caring, convenient, cost-effective and accessible manner. The seven pillars listed below are a visible testament to Sharp's commitment to become the best health care system in the universe by achieving excellence in these areas: Quality. Demonstrate and improve clinical excellence and exceed customer expectations. Safety. Keep patients, employees and physicians safe and free from harm. Service. Create exceptional experiences at every touch point for patients and families, enrollees, physicians, partners and team members. People. Create a values-driven culture that attracts, retains and promotes the best people who are committed to Sharp's mission and vision. Finance. Achieve financial results to ensure Sharp's ability to deliver on its mission and vision. Growth. Achieve net revenue growth to enhance market position, sustain infrastructure improvements and support innovative development. Community. Be an exemplary public citizen by improving the health of our community and environment. Awards Below please find a selection of recognitions Sharp has received in recent years: In 2013, 2014, 2016 and 2017, Sharp was recognized as one of the "World's Most Ethical (WME) Companies" by the Ethisphere Institute, the leading business ethics think tank. WME companies are those that truly embrace ethical business practices and demonstrate industry leadership, forcing peers to follow suit or fall behind. Sharp was ranked No. 45 out of 500 large employers on Forbes' 2017 America's Best Employers listing. In 2016, Sharp ranked No. 16 and received the No. 2 spot on the newcomer's list. In 2018, Forbes ranked Sharp No. 25 on its first-ever list of Best Employers for Women and No. 52 on its list of Best Employers for Diversity. Becker's Hospital Review recognized Sharp as one of "150 Top Places to Work in Healthcare" in 2017 and 2018. The list recognizes hospitals, health systems and organizations committed to fulfilling missions, creating outstanding cultures and offering competitive benefits to their employees. From 2013 to 2018, Sharp ranked in the top 10 of the large employers category as one of the "Best Places to Work" for information technology professionals by the International Data Group's Computerworld survey. The list is compiled by evaluating a company's benefits, training, retention, career development, average salary increases, employee surveys, workplace morale and more. In 2015, 2017 and 2018, Sharp ranked first for "San Diego's Best Hospital Group" in the annual San Diego Union-Tribune Readers Poll. In 2017, SMH was ranked "San Diego's Best Hospital" and, in 2018, Sharp's Weight Management Programs ranked first for "Best Weight Loss Clinic/Counseling." Sharp Community Medical Group (SCMG) was ranked "San Diego's Best Medical Group" from 2015 to 2018. Sharp Rees-Stealy Medical Group (SRSMG) was ranked "Best Hearing Aid Store" in 2018 for the second year in a row, as well as first for "Best Audiologist," second for "Best Laser Eye Center" and third for "Best Pharmacy." In 2016 and 2017, SMBHWN was named to The Leapfrog Group's Top Hospitals list, which recognizes facilities that meet the highest standards of patient safety, care quality and efficiency. In 2016, SMH was also recognized as a Top Hospital. SGH, SMH and SMBHWN received MAGNET recognitio”

“From 2013 to 2018, the Press Ganey organization recognized multiple Sharp entities with Guardian of Excellence Awards. Based on one year of data, this designation recognizes recipients that reach the 95th percentile for patient satisfaction, employee engagement, physician engagement surveys or clinical quality. Awarded Sharp entities in the employee engagement category included SCVMC, SCHHC, SGH, SMBHWN, SMH, SMH Outpatient Pavilion (OPP), SMV, Sharp HospiceCare, SRSMG, SCMG and Sharp Home Health, while SMH, SMH OPP and SMBHWN have been awarded for Patient Experience and SCHHC, SMBHWN and SMV have received awards for Physician Engagement. Press Ganey also recognized multiple Sharp entities with the Pinnacle of Excellence Award (formerly named the Beacon of Excellence Award). This award recognizes the top three performing health care organizations that have maintained consistently high levels of excellence over three years in the categories of Patient Experience, Employee Engagement, Physician Engagement and Clinical Quality Performance. In 2013 as well as 2015 through 2017, Press Ganey recognized SMH for patient experience. From 2013 to 2015, Sharp was recognized for Employee Engagement. In 2013, SCHHC and SMV were recognized for Physician Engagement. SHP has maintained a National Committee for Quality Assurance's (NCQA) Private Health Insurance Plan Rating of 4.5 out of 5 each year since 2016, making it one of the highest-rated health plans in the nation. SHP has also maintained the NCQA's highest level "Excellent" Accreditation status for service and clinical quality each year from 2013 to 2018. The NCQA awards accreditation status based on compliance with rigorous requirements and performance on Healthcare Effectiveness Data and Information Set and Consumer Assessment of Healthcare Providers and Systems measures. Covered California is California's official health insurance marketplace, offering individuals and small businesses the ability to purchase health coverage at federally subsidized rates. SHP earned a five-star rating - the highest possible - in Covered California's 2018 Coverage Year Quality Ratings in the categories of "Summary Quality Rating," "Getting the Right Care" and "Plan Services for Members." America's Physician Groups (APG) is a professional association, representing over 300 medical groups, independent practice associations, and integrated health care systems across the nation. APG has awarded its highest level of distinction - "Elite Status" - to SCMG and SRSMG each year from 2010 to 2018. The Women's Choice Award is a symbol of excellence in customer experience awarded by the collective voice of women. In 2018, SGH received the Women's Choice Award as one of America's Best Breast Centers, Best Stroke Centers and Best Hospitals for Heart Care. The Women's Choice Award also recognized SMH and SMBHWN in 2018 among America's Best Hospitals for Bariatric Surgery, Cancer Care, Obstetrics and Patient Experience, as well as among America's Best Breast and Stroke Centers. SCVMC was also recognized as one of America's Best Breast Centers in 2018. In addition, SCHHC has maintained its ranking as one of America's Best 100 Hospitals for Patient Experience from 2012 to 2018. Powered by the San Diego Association of Governments (SANDAG) in cooperation with the 511 transportation information service, iCommute is the Transportation Demand Management program for the San Diego region and encourages use of transportation alternatives to help reduce traffic congestion and greenhouse gas emissions. Sharp received iCommute Diamond Awards - which recognize employers in the San Diego region who have made strides to promote alternative commute choices - in the platinum tier in 2016 and the gold tier in 2017 and 2018. For the fourth year in a row, and the fifth time in six years, Sharp won the top spot in the Mega Employer category in SANDAG's 2016 iCommute Rideshare Corporate Challenge. The annual monthlong challenge encourages”

“In addition, Public Resource Specialists from Sharp's Patient Financial Services (PFS) team offered support to uninsured and underinsured patients at all Sharp hospitals in need of extra guidance on available funding options. These team members performed field calls (home visits) to patients who required assistance with completing the coverage application process after leaving the hospital. SGH's PFS team worked closely with the hospital's Care Transitions Intervention program to evaluate patients for CalFresh - California's Supplemental Nutrition Assistance Program - prior to hospital discharge, which dramatically increased the likelihood that patients will complete CalFresh applications and receive benefits. In February 2017, Sharp's PFS team expanded CalFresh consults to the remainder of Sharp's acute care hospitals. Since 2016, more than 600 Sharp patients have been granted CalFresh benefits. In summer 2015, a pilot program was launched to evaluate eligibility for financial assistance among both insured and unfunded families with babies in the Neonatal Intensive Care Unit (NICU) at SMBHWN. This process included helping families whose newborn had been diagnosed with a devastating medical condition or extremely low birth weight apply for Supplemental Security Income (SSI) to help with the cost of care for their baby both within and outside of the hospital. The program was expanded to SCVMC and SGH in 2017, and since its inception, Public Resource Specialists have assisted more than 260 families through the SSI application process. In addition, Sharp provides post-acute care facilitation for high-risk patients, including the homeless and patients who lack a safe home environment. Patients may receive services such as assistance with transportation and placement; connections to community resources; and financial support for medical equipment and medications. Sharp social workers provide referrals for permanent housing and collaborate with St. Vincent de Paul Village to assist with the SSI application process through HOPE (Homeless Outreach Programs for Entitlement) San Diego - an effort to increase access to SSI for people who are homeless or at risk of homelessness. In addition, Sharp provides support to SSI claims by providing medical records as needed. SCHHC, SCVMC, SGH and SMH continued to collaborate with the San Diego Rescue Mission (SDRM) to provide services to chronically homeless patients. Through the partnership, Sharp discharges homeless patients to the SDRM's Recuperative Care Unit (RCU), a temporary shelter program that addresses the needs of homeless men and women who are newly released from the hospital but require further supervision. Through the RCU, patients receive case management, social work and counseling services as well as referrals for community-based medical and psychiatric services, long-term housing, and other community support programs. This collaboration between Sharp and SDRM provides a safe discharge plan for homeless individuals who require a stable living environment for their continued recovery. Sharp also continued to collaborate with Father Joe's Villages in support of the County of San Diego Aging and Independence Services' Project SOAR (Senior Options, Advocacy and Referrals). This program provides care management services to frail and disabled adults ages 60 years and older who are at risk for nursing home placement, and do not have access to nor qualify for supportive services through other programs. Sharp determines Project SOAR eligibility during its standard eligibility review process for all patients and refers qualified individuals directly to the program. Health Professions Training Internships Students and recent health care graduates are a valuable asset to the community. Sharp demonstrates a deep investment in these potential and newest members of the health care workforce through internships and career pipeline programs. In FY 2018, more than 3,700 student interns dedicated ov”

“The high school curriculum provides students with a variety of service-learning projects and internships focused on careers in health care. Students earn high school diplomas, complete college entrance requirements and have opportunities to earn community college credits, degrees or vocational certificates. The HSHMC program began in 2007 with students on the campuses of SGH and SMH, and expanded to include SMV and SMBHWN in 2009, SCHHC in 2010, and SCVMC in 2011. Students also devote time to various SRSMG sites. Students begin their internship experience with a systemwide orientation to Sharp and their upcoming job-shadowing activities, which consist of two levels of training. Level I of the HSHMC program is the entry level for all students and is conducted over an eight-week period. Through Level I, ninth-grade students shadow primarily non-nursing areas of the hospital as well as complete additional coursework in Infection Control, Medical Ethics, and Introduction to Health Professions. Level II is designed for students in grades 10 through 12 and includes enhanced patient interaction, college-level clinical rotations, and hands-on experience. Level II students are placed in a new assignment each semester for a variety of patient care experiences, and take additional health-related coursework at a community college, including Health 101, Public Health, Psychology and Abnormal Psychology, Realities of Nutrition, Intro to Health Professions and Organizations, and Health and Social Injustice, among other courses. In FY 2018, 342 HSHMC students - including 100 Level I students and 242 Level II students - were supervised for more than 61,500 hours on Sharp campuses. Students rotated through instructional pods in specialty areas, including but not limited to: nursing; emergency services; obstetrics and gynecology; occupational therapy; physical therapy; behavioral health; pediatrics; medical/surgical; rehabilitation; laboratory services; pharmacy; pathology; radiation oncology; radiology; respiratory care; cardiovascular care; spiritual care; wound care; long-term care; endoscopy; engineering; nutrition; infection control; pulmonary services; maternal infant services; NICU; and operations. Students not only had the opportunity to observe patient care, but also received guidance from Sharp staff on career ladder development as well as job and education requirements. In May 2018, the HSHMC program graduated 151 students in its eighth full class. Each year, Sharp reviews and evaluates its collaboration with HSHMC, including the outcomes of students and graduates, to promote long-term sustainability. Sixty-seven percent of HSHMC students are economically disadvantaged, and the school's free and reduced-price meal eligibility rate is higher than the average for both SDC and California. Despite these challenges, HSHMC maintains a 95 percent attendance rate and excels in preparing students for high school graduation, college entrance and a future career. In 2018, 91 percent of the HSHMC graduating class went on to attend two- or four-year colleges, while 83 percent of students said they wanted to pursue a career in health care. In addition, HSHMC has a 98.7 percent graduation rate, which is higher than the state of California's average of 82.7 percent. HSHMC has received numerous awards for its innovation, vision and impact. In 2017, HSHMC received the Schools of Opportunity Gold Recognition - the highest level that can be awarded - by Schools of Opportunity, a project of the National Education Policy Center at the University of Colorado Boulder. This project recognizes public high schools around the nation that engage in research-based practices focused on closing opportunity gaps for student learning. Previously, HSHMC received the 2016 Impact Award from the Classroom for the Future Foundation as the most innovative education program in SDC. HSHMC was also recognized as a U.S. News & World Report Best High Schools bronze award winner”

“Results from post-evaluation surveys collected from these CME-accredited events showed markedly improved confidence and increased the likelihood that providers would engage with patients around food insecurity. Participants also stated an intent to change their professional behavior around recognizing and referring food insecure patients. Additionally, a longitudinal survey of providers who participated in a CME activity showed that 60 percent were interested in learning more about food insecurity and, since the education, 56 percent have followed through to employ food insecurity screening questions for their patients. Providers using food insecurity screening questions are most likely to refer to case management (43 percent) or directly to food resources in the community such as 2-1-1 San Diego, the San Diego Food Bank (Food Bank) or Feeding San Diego (FSD) (33 percent). Further, 38 percent of survey respondents believed this education has positively impacted their patients. Inspired by the CME/Community Benefit initiative, two Sharp medical groups, SCMG and SRSMG, have embarked on a group-wide approach to address food insecurity. SCMG integrated the two validated food insecurity screening questions as part of their electronic health record, and is currently exploring community partnerships to help patients address food insecurity and other social determinants of health (SDOH). In March 2018, SRSMG implemented a text push notification, including validated food insecurity screening questions, and provided case management and community resources to patients identified as food insecure. The CME/Community Benefit food insecurity initiative has both helped change how Sharp cares for its community, as well as delivered positive patient outcomes. Research Sharp Center for Research Innovation is critical to the future of health care. The Sharp Center for Research supports innovation through its commitment to protecting research participants and promoting high quality research initiatives that provide valuable knowledge to the San Diego health care community and positively impact patients and community members. The Sharp Center for Research includes the Human Research Protection Program (HRPP), which includes the Institutional Review Board (IRB) and the Outcomes Research Institute (ORI). Human Research Protection Program and Institutional Review Board The Sharp Center for Research is accredited by the Association for the Accreditation of Human Research Protection Programs (AAHRPP). This accreditation acts as a public affirmation of the HRPP's commitment to following rigorous standards for ethics, quality and protection for human research. To date, Sharp is the only health system in SDC to receive accreditation from the AAHRPP. The Center for Research's HRPP is responsible for the ethical and regulatory compliant oversight of research conducted at Sharp and includes three components: the Sharp organization, the researchers and the IRB. As one of the key components of the HRPP, the IRB seeks to promote a culture of safety and respect for those participating in research for the greater good of the community. All proposed entity research studies with human participants must be reviewed by the IRB in order to protect participant safety and maintain responsible research conduct. In FY 2018, a dedicated IRB committee of 18 - including physicians, nurses, pharmacists and non-scientists - devoted hundreds of hours to the review and analysis of both new and ongoing research studies. Research at Sharp is conducted on all clinical phases of drug and device development, and the populations studied span the life cycle - from newborns to older adults. These clinical trials increase scientific knowledge and enable health care providers to assess the safety and effectiveness of new treatments. At any given time, Sharp participates in approximately 250 clinical trials covering many therapeutic areas, including behavioral health, emergency care, infect”

“In FY 2018, the nine-month program culminated with a community conference and graduation ceremony in November, during which the EBPI fellows and mentors shared project results. Twenty-seven project teams, comprised of mentors and fellows, graduated from the program. Projects addressed issues in clinical practice and patient care including: bladder management in laboring patients, patient handover between caregivers, exclusive breastfeeding, healing touch in the NICU relaxation room for caregivers, prevention of pressure injuries, skin-to-skin care in the NICU, reduction of post-operative delirium, and decrease in discharge time. Volunteer Service Sharp Lends a Hand In FY 2018, Sharp continued its systemwide community service program, Sharp Lends a Hand (SLAH). Sharp team members suggested project ideas that would improve the health and well-being of San Diego in a broad, positive way; rely solely on Sharp for volunteer labor; and support existing nonprofit initiatives, community activities or other programs that serve SDC. SLAH selected 23 volunteer projects for FY 2018: Food Bank; FSD; Mama's Kitchen; San Diego Wreaths Across America; USS Midway Foreign Object Damage (FOD) Walk-down; American Diabetes Association (ADA) Tour de Cure; Promises2Kids; Partnerships with Industry; Ssubi is Hope Greening for Good Project; Special Olympics Regional Fall Games, Bowling Tournament and Annual Spring Games; Habitat for Humanity ReStore; Stand Down for Homeless Veterans; Life Rolls On - They Will Surf Again; I Love a Clean San Diego's Beautify Chula Vista Day, Creek to Bay Cleanup, Clean Cities Initiative Cleanup and Coastal Cleanup Day; the San Diego River Park Foundation's Point Loma Native Plant Garden, San Diego River Garden, and Coastal Habitat Restoration; and River Kids Discovery Days - a joint effort between I Love a Clean San Diego and the San Diego River Park Foundation. More than 3,000 Sharp employees, family members and friends volunteered over 6,700 hours in support of these projects. The Food Bank feeds San Diegans in need, advocates for the hungry, and educates the public about hunger-related issues. Each month, the Food Bank serves 370,000 San Diegans. Backpacks filled with a weekend's supply of food are provided to chronically hungry elementary school children throughout SDC, while Food Bank distribution sites provide boxes of groceries and staple food items to low-income seniors. The Food Bank distributed a total of 28 million pounds of food - the equivalent of 23.3 million meals - during its most recent FY. Over 120 SLAH volunteers gathered at the Food Bank warehouse to help inspect, clean, sort and package donated food as well as assist with assembling boxes and cleaning the facility at more than 15 events between December 2017 and September 2018. FSD, part of the Feeding America network, provides food and resources to a network of neighborhood partners in SDC serving healthy food to more than 63,000 local children, families and seniors every week. FSD relies on the generous support of individuals, corporations, foundations and community groups to sustain critical hunger-relief and nutrition programs throughout the region. Ninety SLAH volunteers helped sort food, prepare bags for distribution, and clean produce for FSD at more than 10 events during FY 2018. Established in 1990, Mama's Kitchen is a community-driven organization that enlists volunteers to help prepare and deliver nutritious meals to community members affected by acquired immunodeficiency syndrome (AIDS) or cancer who are unable to shop or cook for themselves. Mama's Kitchen strives to help its clients stay healthy, preserve their dignity, and keep their families together by providing free culturally appropriate home-delivered meals, pantry services and nutrition education. In December and February, 25 SLAH volunteers helped Mama's Kitchen serve meals to the community by preparing and packaging snack and vegetable items for delivery. In December 2017, SLA”

“SLAH participated in Stand Down for Homeless Veterans, an event sponsored by the Veterans Village of San Diego, to provide community-based social services to veterans without a permanent residence. Over 10 days in May, June and July, approximately 90 volunteers sorted and organized clothing donations as well as set up and worked in the event's clothing tent. In addition, approximately 30 clinical volunteers - including Sharp-affiliated physicians and Sharp nurses, podiatry technicians, pharmacists and licensed pharmacy technicians - provided medical and pharmaceutical services. More than 700 veterans were served through the 2018 Stand Down for Homeless Veterans events. The Life Rolls On Foundation is dedicated to improving the quality of life for young people affected by SCI. Through the organization's award-winning program, They Will Surf Again, paraplegic and quadriplegic community members can experience mobility through surfing with support from adaptive equipment and volunteers. In September, 80 SLAH volunteers assisted They Will Surf Again with event set-up and breakdown, registration, equipment distribution, lunch service and helping surfers on land and in shallow water. In October 2017, 10 SLAH volunteers joined I Love a Clean San Diego and the City of Chula Vista for the 15th annual Beautify Chula Vista Day. Volunteers met at Rice Canyon in Discovery Park and assisted with watering and care of recent plantings, litter removal and additional projects to make the canyon shine. SLAH also partnered with I Love a Clean San Diego for the 16th annual Creek to Bay Cleanup in April, in celebration of Earth Day. Approximately 20 SLAH volunteers participated in this countywide effort to beautify San Diego's beaches, bays, trails, canyons and parks. In August, seven volunteers participated in I Love a Clean San Diego's Clean Cities Initiative Cleanup by sweeping streets along sidewalks in an Imperial Beach neighborhood. In September, 12 volunteers supported I Love a Clean San Diego's California Coastal Cleanup Day to ensure a clean, safe and healthy community by removing litter from open spaces throughout SDC, including Ocean Beach Dog Beach, Chula Vista Marina View Park, Mission Trails Regional Park, Mission Bay, Lake Miramar, Cardiff Seaside Beach, Coronado City Beach and Scripps Pier in La Jolla. Founded in 2001, the San Diego River Park Foundation is a grassroots nonprofit organization that works to protect the greenbelt from the mountains to the ocean along the 52-mile San Diego River. Approximately 30 SLAH volunteers joined the San Diego River Park Foundation to care for California native plants and trees at the Point Loma Native Plant Garden in October, November, June and August, as well as at the San Diego River Garden in Mission Valley in December, July and September. Activities included trail maintenance, watering, pruning and other light gardening projects. In May, eight SLAH volunteers joined the San Diego River Park Foundation's Coastal Habitat Restoration event in Ocean Beach. The team worked to save and restore one of the last remaining coastal dune and wetland habitats in San Diego by removing invasive plants and litter, watering and caring for recent plantings and native plants, and providing trail maintenance. In March, I Love a Clean San Diego and the San Diego River Park Foundation partnered to provide the fourth annual River Kids Discovery Days. Five SLAH volunteers participated in the free event, which provides river education and service events to teach more than 600 children and families about protecting the Earth's natural resources. In addition to these projects, Sharp expanded the SLAH program to include the coordination and promotion of a year-round blood donation effort to provide needed blood to local organizations serving the community. In FY 2018, Sharp committed to collecting at least 1,000 units of blood from Sharp employees, family and friends. Throughout the year, Sharp hosted 42 blood drives at”

“For 10 days in May and June, a Sharp employee traveled to Fiji through MED 4 OUR WORLD, an organization committed to leaving a lasting impact on the communities it serves through health care, renovation and education. The 2018 MED 4 OUR WORLD team consisted of 17 volunteers, including a trauma surgeon, an anesthesiologist, Fijian anesthesiology residents, obstetrician-gynecologists (OB-GYN), a Fijian OB-GYN attending physician, medical students, registered nurses, and other health professionals. Together, the team evaluated over 100 patients and provided more than 30 procedures, including surgery for cervical, uterine and bladder cancer as well as hysterectomies and other gynecological procedures. In addition, the team assisted with the resuscitation and stabilization of premature twins post-delivery. Our One Community/Olmoti Clinic is a nonprofit organization dedicated to providing comprehensive medical care and education to the indigenous Maasai community located in a remote region of northern Tanzania. For three weeks in June, two Sharp team members and a physician treated approximately 300 men, women and children for infected bug bites, broken bones, fire-related falls, and other injuries or illnesses. The team also supported teachers at the organization's primary school, which serves 240 Maasai tribal children. In addition, Sharp and Ssubi is Hope donated more than $150,000 worth of equipment and supplies to support the work of the Olmati Clinic. For three weeks in July and August, a Sharp team member helped lead a team of six PLNU students on a mission trip to Azores, Portugal, with LoveWorks, a short-term mission program committed to sending well-trained, culturally sensitive and flexible teams of student missionaries to serve in challenging and remote areas of the world. The team provided numerous services to the Azorean community, including renovating a local church's thrift store that provides free clothing and supplies to those in need; assisting at health fairs; performing blood pressure checks; answering health-related questions; and referring individuals to local health clinics. Living Room Ministries International is a nonprofit organization dedicated to offering hope and help to rural villages in Kenya through physical, psychological and spiritual care. The organization provides hospice and community-based palliative care services to people with terminal illness, supports families with dying loved ones, and cares for those who lack love and support at the end of life. In September, a Sharp physical therapist traveled with Living Room Ministries International to provide patient care, physical therapy services, staff training and student supervision to approximately 100 Kenyans. Community Walks Heart disease is the leading cause of death in the U.S. Sharp proudly supports the AHA's annual San Diego Heart & Stroke Walk, which promotes physical activity to build healthier lives, free of cardiovascular diseases and stroke. In FY 2018, more than 120 teams from entities across the Sharp system raised funds for the walk through activities such as auctions, prize drawings and a karaoke competition. In September, nearly 1,000 employees, family members and friends represented Sharp during the walk at Balboa Park. For the past 22 years, Sharp has maintained its position as the No. 1 team in San Diego. In 2018, Sharp was the No. 3 team in the AHA Western States Affiliate, raising more than $200,000. To date, Sharp's fundraising efforts have raised more than $3 million in support of the San Diego Heart & Stroke Walk. Sharp Volunteers Volunteers are a critical component of Sharp's dedication to the San Diego community and help make a difference in the lives of others. Sharp provides many volunteer opportunities for individuals of all ages and skill levels to assist with a wide variety of programs, events and initiatives across the Sharp system. This includes devoting time and compassion to patients within Sharp's hospitals; a”

“The following section describes the achievements of various Sharp volunteer programs in FY 2018. Sharp HospiceCare Volunteer Programs Sharp HospiceCare provides a variety of volunteer training opportunities that offer valuable knowledge and experience to volunteers who are often working towards a career in the medical field. Volunteers contribute to Sharp HospiceCare and those it serves by providing companionship to those near the end of life, support for families and caregivers, and assistance with community outreach. Sharp HospiceCare trained approximately 50 new volunteers in FY 2018. Volunteers completed an extensive 24-hour training program to confirm their understanding of and commitment to hospice care prior to beginning their volunteer activities. In addition, five teenagers participated in Sharp HospiceCare's Teen Volunteer program. Through this program, teens completed special projects in Sharp HospiceCare administration, as well as assisted with patients at Sharp HospiceCare's LakeView, ParkView and BonitaView hospice homes. Tasks included grooming and hygiene activities, and simple acts of kindness such as sitting with patients, listening to their stories and holding their hand. Further, nine premedical students from SDSU, UC San Diego and CSUSM volunteered their time by supporting family caregivers in private homes. In September, Sharp Hospice shared information with 20 premedical students at SDSU regarding its volunteer opportunities to enhance the educational experience and ensure ongoing support for hospice patients and their loved ones. Sharp HospiceCare continued to provide the 11th Hour program to ensure that no patient died alone. Through the program, volunteers accompanied patients who were in their final moments of life but did not have family members present. This included holding the patient's hand, reading softly to them and simply remaining by their side. Families who were present with their dying loved one could also receive comfort from a volunteer while their loved one passed away. Twelve volunteers were trained through the 11th Hour program in FY 2018. In FY 2018, Sharp HospiceCare trained six volunteers in integrative therapies to promote relaxation and restful sleep and enhance the quality of life for Sharp HospiceCare patients and their caregivers. Integrative therapies included Healing Touch, a gentle energy therapy that uses the hands to help manage physical, emotional or spiritual pain; Reiki, a Japanese energy healing therapy in which practitioners use their hands on or above the patient's body to facilitate the healing process; aromatherapy; and hand massage. Volunteers also support Sharp HospiceCare's partnership with We Honor Veterans (WHV). WHV is a national program developed by the National Hospice and Palliative Care Organization in collaboration with the VA to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As a WHV partner, Sharp HospiceCare is equipped to provide education and training that qualifies their volunteers to identify and support veteran patients and their caregivers. This includes the Vet-to-Vet Volunteer program, which pairs volunteers who have military experience with veteran patients. The program also honors veteran patients through special pinning ceremonies during which volunteers present them with a WHV pin and a certificate of appreciation for their service. In FY 2018, Sharp HospiceCare held pinning ceremonies for more than 90 Sharp HospiceCare veteran patients as well as pinned nearly 80 veteran community members during community events. Sharp HospiceCare continued to offer the Memory Bear program to support community members who have lost a loved one. Volunteers created teddy bears out of the garments of those who have passed on, which served as special keepsakes and permanent reminders of the grieving individual's loved one. In FY 2018, volunteers dedicated approximately 3,400 hours to sewing more than 850 be”

“Throughout the year, Arts for Healing led art and music activities for hundreds of patients and community members in recognition of various holidays and Sharp events, including Saturday with Santa, a public event hosted each December by the SMH Auxiliary; Valentine's Day; National Hospital Week in May; Cancer Awareness activities in October and June; two Sharp blood drives; and Sharp's annual Disaster Preparedness Expo. Arts for Healing celebrated its 10th anniversary in FY 2018. Throughout the year, more than 50 volunteers and four staff members facilitated art and music activities for approximately 35,000 patients, guests and staff. Since its inception, more than 140,000 patients and their families have benefited from the time and talent provided by the program's dedicated volunteers, licensed therapists and staff. Other Sharp Community Efforts In FY 2018, Sharp engaged in a variety of community service projects to improve the well-being of community members throughout San Diego. Below are just a few examples of these efforts. According to the January 2018 WeAllCount Annual Report, there are nearly 8,600 individuals experiencing homelessness in SDC, nearly 5,000 of whom are unsheltered. This represents a decrease of six percent region-wide from 2017. Since 2011, Sharp has sponsored the Downtown San Diego Partnership's Family Reunification Program, which serves to reduce the number of homeless individuals on the streets of downtown San Diego. Through the program, homeless outreach coordinators from the Downtown San Diego Partnership's Clean & Safe Program identify homeless individuals who will be best served by traveling back home to loved ones. Family and friends are contacted to ensure that the individuals have a place to stay and the support they need to get back on their feet. Once confirmed, the outreach team provides the transportation needed to reconnect with their support system. With Sharp's help, the Family Reunification Program has reunited nearly 2,200 homeless individuals in Downtown San Diego with friends and family across the nation. The University of California, Los Angeles Center for Health Policy and Research's Elder Index states that two in five (41 percent) San Diego seniors will have to choose between buying food and paying rent. Through the Giving Tree program at the Downtown Sharp Senior Health Center, community members and staff donate gift cards to make the holidays brighter for seniors in need. In December 2017, each patient who visited the Downtown Sharp Senior Health Center left with a gift bag and a gift card to a local drug store, grocery store or restaurant. The SGH Engineering Department led a variety of volunteer initiatives in FY 2018. The team continued This Bud's for You, a special program that delivers hand-picked flowers from the campus' abundant gardens to unsuspecting visitors, patients and staff. Through the program, the SGH landscape team grows, cuts, bundles and delivers colorful bouquets to patient rooms as well as offers single-stem roses in a small bud vase to passers-by. In FY 2018, the team delivered two to four vases of flowers with an inspirational quote each week, with as many as six vases or more during peak flower season and upon additional requests. In addition, nearly 40 vases of flowers were delivered to new mothers staying in the hospital on Mother's Day. This Bud's for You also supports the SGH Senior Resource Center and Meals on Wheels partnership by providing floral centerpieces for fundraising events benefitting East County seniors, as well as offers roses for SGH's annual patient remembrance service. Now in its eighth year, the program has become a natural part of the landscape team's day - an act that is simply part of what they do to enhance the experience of hospital visitors and community members. The SGH Engineering Department further extends the spirit of caring through the creation of Cheers Bouquets for patients or visitors who appear to need encouragement,”

“All Ways Green Initiative Sharp is dedicated to minimizing adverse environmental impacts by creating healthy green practices for employees, physicians and patients. Sharp promotes a culture of environmental responsibility through education, outreach, and collaboration with San Diego's earth-friendly businesses to help identify best practices, reduce the costs of green practices, and facilitate the implementation of sustainable initiatives. Sharp's Environmental Policy serves to guide the organization in identifying and implementing green practices within the health care system. Through the All Ways Green initiative, Sharp maintains an environmentally conscious footprint and communicates sustainability throughout the organization and the San Diego community. Sharp's systemwide All Ways Green Committee is responsible for spearheading the organization's sustainability efforts. Sharp's environmental initiatives are concentrated in five domains: (1) energy efficiency, (2) water conservation, (3) waste minimization, (4) sustainable food practices, and (5) commuter solutions. Specialized committees are responsible for each of these domains (see Table 3), while established Green Teams at each Sharp entity are responsible for developing new programs at the local level to educate and motivate Sharp employees to conserve natural resources and reduce, reuse and recycle. Table 3: All Ways Green Committees/Subcommittees and Domains Natural Resource Subcommittee Energy efficiency and water conservation Waste Minimization Committee Waste minimization Food and Nutrition Best Health Committee Sustainable food practices Commuter Solutions Subcommittee Commuter solutions To monitor progress and measure tangible results, All Ways Green utilizes a Sharp-developed report card, which trends each domain's annual performance against a baseline. The report card shows where the desired results have been achieved as well as identifies opportunities for improvement. These opportunities for improvement are used to strategically plan initiatives that engage Sharp's workforce in reducing the organization's carbon footprint. Sharp continues to invest in technology and programs that reduce carbon emissions and minimize waste. Through these efforts, in FY 2018, Sharp hospitals prevented nearly 210,000 pounds of cardboard and plastic from entering landfills, and reduced carbon dioxide emissions by more than 115,000 pounds. Sharp's goals and accomplishments within each All Ways Green committee/subcommittee and domain are described below. Natural Resource Conservation According to the EPA, health care ranks as the country's second most energy intensive industry, emitting roughly eight percent of the nation's greenhouse gas emissions. In the U.S., hospital water use constitutes seven percent of the total water used in commercial and institutional buildings. Sharp's goal is to optimize the use of electricity, gas and water across its facilities, identify and evaluate opportunities for improvement, implement initiatives in the most cost-effective manner, and track progress. A World Health Organization report published in 2017 encouraged hospitals to proactively address the environmental footprint of the health care sector by reducing power consumption, utilizing alternative energy generation, recycling and conserving resources. Sharp's Natural Resource Subcommittee is addressing this call by implementing numerous energy and water conservation initiatives, including infrastructure changes and adopting best practices to ensure its facilities are optimally operated while monitoring and measuring energy and water consumption. The Natural Resource Subcommittee is responsible for communications to employees about the energy-conscious behaviors that can be practiced in the workplace and at home to promote continuous energy and water savings. Sharp was one of the first health care organizations in the county to commit to environmental best practices in information technology.”

“Sharp partners with the Center for Sustainable Energy (CSE) to promote and strengthen its work with the ES. From July to August 2017, a CSE benchmarking coach worked with Sharp facility managers to identify and correct data quality issues in the measurement of Sharp's energy and water consumption. As the result of this endeavor, in December 2017, the CSE featured Sharp in a case study highlighting the organization's dedication to improving the welfare of the environment and the communities it serves. In addition, Sharp's SRSMG Downtown medical office building meets Leadership in Energy and Environmental Design (LEED) silver certification specifications, one of the first medical office buildings of its kind in San Diego. In 2017, Sharp received the Environmental Stewardship Award in the large business category from the BBB, serving San Diego, Orange and Imperial counties. The award recognizes businesses that increase efforts toward a more sustainable footprint and green initiatives. In May 2017, Sharp was named San Diego's Grand Energy Champion by SDG&E in recognition of its continuous commitment to implementing energy efficiency measures. The award specifically noted the particular challenges faced by health care organizations trying to conserve energy, given the need to maintain comfortable, clean and safe environments for patients, visitors and staff, 24 hours a day, seven days a week. Table 4 outlines Sharp's numerous natural resource conservation initiatives. Table 4: Natural Resource Projects by Sharp HealthCare Entity Establish Energy and Water Use Baseline: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Energy Star Participation: SCHHC, SCVMC, SGH, SMH/SMBHWN, SMV/SMC. Air Handler Projects: SCHHC, SMH/SMBHWN. Cogeneration Plant: SGH Drip Irrigation/Landscape Water Reduction Systems: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Drought-Tolerant Landscaping: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Electric Vehicle Charging Stations: SCVMC, System Offices, SMH/SMBHWN, SRSMG. Electronic/Low-flow Faucets: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Energy-efficient Kitchen/Cafe Appliances: SCHHC, SCVMC, SGH, SMH/SMBHWN. Energy-efficient Chillers/ Motors: SCHHC, SCVMC, SGH, SMH/SMBHWN. Faucets and Toilet Retrofits: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. HVAC projects: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Lighting Retrofits to LEDs: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Occupancy Sensors SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Mist Eliminators SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Moisture-sensitive Sprinkler Controls: SCHHC,SGH, SMH/SMBHWN. Plumbing Projects to Address Water Leaks SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Thermostat Control Software & Temperature Setback Projects: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Filtered Water Dispensers to Replace Water Bottles: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Water-efficient Dishwashing/ Equipment Washing/ Chemical Dispensing System: SCHHC, SCVMC, SGH, SMH/SMBHWN. Waste Minimization U.S. hospitals generate an average of 26 pounds of waste per staffed bed each day, approximately 15 percent of which is considered hazardous material. Sharp is committed to significantly reducing waste at each entity and extending the lifespan of local landfills. Sharp's Waste Minimization Committee provides oversight of systemwide waste minimization initiatives, including proper waste segregation and enhanced recycling efforts. Sharp made the following achievements in waste minimization in FY 2018: * Sharp proactively recycled more than 1,700 tons of construction debris from its major building project at SCVMC. * Sharp's single-waste stream recycling program diverted more tha”

“The goal of Sharp's Food and Nutrition Best Health Committee is to promote food sustainability efforts throughout the health care system and within the greater San Diego community. This includes a focus on Sharp's sustainable Mindful Food program to provide education and healthy food options designed to improve the health of Sharp's patients, staff, community and environment. Sharp's Mindful Food program includes the promotion of Meatless Mondays to reduce meat consumption; increased purchases of beef and poultry raised without the routine use of antibiotics; menus that highlight wellness options; participation in Community Supported Agriculture (CSA), a community of individuals who pledge support to a farm operation in order for it to become, either legally or spiritually, the community's farm; increased use of locally sourced fresh, organic and sustainable food; food composting; increased recycling activities; the promotion of sugarless beverages; and the use of post-consumer recycled packaging solutions. Up to 40 percent of food in the U.S. is never eaten and instead goes to waste. In FY 2018, Sodexo teams at SCVMC and SMH were invited by the San Diego Food System Alliance and Smart Kitchens San Diego to participate in LeanPath - a pilot program funded by a City of San Diego grant to combat food waste and facilitate compliance with new composting and recycling laws. LeanPath provides an advanced food waste tracking software system to help kitchen teams measure food prior to discarding or donating in order to prevent pre-consumer food waste (waste generated in the kitchen) as well as post-consumer food waste (food the consumer throws away) from entering the landfill. Since August 2016, SMH, SMV, and SGH have collaborated with the SDRM and the Food Bank in an innovative food recovery program that donates food items that can no longer be used in Sharp's kitchens but are perfectly healthy and nutritious to more than 45 hunger-relief organizations in SDC. In addition, SCVMC's partnership with FSD and SCHHC's partnership with the Food Bank makes Sharp the first health care system in the county to donate food to San Diego's needy at such a wide-scale level. Food recovery efforts benefit the local community by ensuring access to nutritious meals for the food insecure, while also enabling Sharp to save on waste disposal costs and keep food out of landfills. In 2018, Sharp donated almost nine tons of food to these safety-net organizations. Also in 2018, Sharp's imperfect produce program purchased more than 6,500 pounds of less-than-perfect fruits and vegetables per month that are nutrient-rich and full of flavor but would have been thrown away by Sharp's food vendors. Four Sharp hospitals are now participating in composting efforts. SMMC was the first hospital in SDC to participate in the City of San Diego's food scraps composting program in 2012. In 2017, the program expanded to SCVMC in partnership with the City of Chula Vista. Also in 2017, SGH collaborated with Resource Management Group recycling center to begin a composting program, which was expanded to SCHHC in September 2018. Through these programs, food waste at these Sharp sites is processed into a rich compost product and is provided to residents at no charge for volumes of up to two cubic yards. The compost offers several benefits including improving the health and fertility of soil, reducing the need to purchase commercial fertilizers, increasing the soil's ability to retain water and helping the environment by recycling valuable organic materials. In FY 2018, Sharp's composting programs diverted approximately 480,000 pounds of waste from landfills. Sharp's waste-mindful operations, including self-audit checklists, continue to help kitchen teams reduce their carbon footprint between food preparation and cleanup. Sharp is also in the process of eliminating oil fryers in its kitchens. SCHHC and SMMC have already switched to healthier methods of food preparation. SGH and SC”

“Sharp offers bike racks as well as a Bicycle Commuter Benefit, which gives employees who bike to work up to $20 per month to use toward qualified costs associated with bicycle purchase, improvement, repair and storage. Furthermore, Sharp participates in SANDAG's annual Bike to Work Day event each May. In 2018, Sharp employees were once again among almost 10,000 San Diegans who opted to ride their bike to work. Sharp hosted several pit stops, providing food and beverages, at various sites throughout SDC. Sharp also encourages employees to participate in alternate commuting, including SANDAG's iCommute program that can match commuters in an area based on their work schedule, departure location and destination. Employees can monitor their cost and carbon savings resulting from their alternate commuting methods - such as using public transit, carpooling, vanpooling, biking, walking, or telecommuting - and log their miles in an internal tracking tool on Sharp's intranet site, which has replaced SANDAG's discontinued TripTracker. In addition, Sharp is enrolled in SANDAG's Guaranteed Ride Home program which provides commuters who carpool, vanpool, take an express bus, ride the Coaster, or bike to work three or more times a week with a taxi or a rental car in case of an emergency or being stranded at work. Further, Sharp employees can also purchase discounted monthly bus passes. In recognition of Rideshare Month every October, Sharp participates in SANDAG's iCommute Rideshare Corporate Challenge, where employees earn points for replacing their solo drive with a greener commute choice, such as biking, walking, carpooling, vanpooling, and public transit. The annual challenge is instrumental in helping reduce traffic congestion and greenhouse gas emissions throughout the region. Furthering the commitment to better commuting solutions for its employees, Sharp supplies and supports the hardware and software for almost 700 employees who are able to efficiently and effectively telecommute to work. These employees work in areas that do not require an on-site presence, such as information technology support, transcription and human resources. Sharp also provides compressed work schedule options to eligible full-time employees, which enables them to complete the basic eighty-hour biweekly work requirement in less than 10 workdays and thus reduces commute costs, lowers parking demand and helps the environment. Community Education and Outreach Sharp actively educates the community about its sustainability programs. In FY 2018, Sharp participated in the following outreach activities: * Sharp published e-newsletters for employees highlighting its recycling efforts and accomplishments, as well as reminders for proper workplace recycling, carpooling and energy and water conservation. * Sharp held its sixth annual systemwide All Ways Green Earth Week celebration, including Earth Fairs at each Sharp hospital and system office. During the fairs, employees learned how to decrease water, energy and resource consumption, divert waste through recycling, and reduce their carbon footprint by using alternative transportation at work and home. Many of Sharp's key vendors participated in these fairs to help raise awareness of green initiatives and how Sharp is involved in those programs. * Sharp held a community recycling event that included free e-waste recycling and confidential document destruction. The event also included the U.S. Drug Enforcement Agency's Drug Take Back Program, which provides a safe, convenient, and responsible method of drug disposal and educates the general public about the potential for prescription medication abuse. * Sharp participates in San Diego County's Hazmat Stakeholder meetings to discuss best practices for medical waste management with other hospital leaders in SDC. Additional community environmental education and outreach initiatives at Sharp are highlighted in Table 8. Table 8: Environmental Community Education and Outreach”

“Through participation in the U.S. Department of Health & Human Services Public Health Emergency Hospital Preparedness Program (HPP) grant, Sharp created the Sharp HealthCare HPP Disaster Preparedness Partnership. The partnership includes Sharp and other SDC hospitals, health clinics and other health care services providers. The partnership seeks to continually identify and develop relationships with health care entities, nonprofit organizations, law enforcement, military installations and other organizations that serve SDC and are located near partner health care facilities. Through networking, planning and sharing resources, trainings and information, the partners will be better prepared for a collaborative response to an emergency or disaster affecting SDC. In FY 2018, the partnership assisted with training and education of non-hospital health care entities to better prepare them to develop emergency operations plans and responses. Sharp supports safety efforts of the State and the City of San Diego through maintenance and storage of a county decontamination trailer at SGH to be used in response to an event requiring mass decontamination. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that last up to 96 hours in the event of an interruption to the system's normal water supply. In recent years, global endemic events potentially impacted public health in the San Diego community. Sharp continues to collaborate with community agencies, County of San Diego Public Health Services and first responders to develop protocols, provide joint trainings, and establish safe treatment methods and locations. This allows for the delivery of uninterrupted care to the community in the face of public health threats. Employee Wellness: Sharp Best Health Sharp recognizes that improving the health of its team members benefits the health of the broader community. Since 2010, the Sharp Best Health employee wellness program has created initiatives to improve the overall health, safety, happiness and productivity of Sharp's workforce. Each Sharp hospital, SRSMC and corporate location has a dedicated Best Health committee that works to motivate team members to incorporate healthy habits into their lifestyles and support them on their journey to attain their personal health goals. Team members are encouraged to participate in a variety of workplace health initiatives ranging from fitness challenges and weight management programs to health education and events. Sharp Best Health also offers an interactive, web-based health portal, where employees can create a wellness plan and track their progress. Since 2013, Sharp Best Health has offered annual employee health screenings to raise individual awareness of important biometric health measures, educate team members on reducing the risk of related health issues, and encourage employees to track changes in their metrics over time. In FY 2018, nearly 10,000 employees received health screenings for blood pressure, cholesterol, body mass index, blood sugar and tobacco use. Post-screening resources and tools are available for Sharp employees and their family members, including free access to a health coach as well as classes on a variety of health topics, including smoking cessation, healthy food choices, physical activity, stress management and managing the challenges of living with a chronic condition, such as diabetes, high blood pressure, asthma or arthritis. The AHA recommends walking 10,000 steps a day to promote overall health. To align with this goal, Sharp Best Health encourages team members to use Fitbit wireless activity monitors to track their steps, distance, calories burned, sleep patterns and more. By syncing statistics to computers or smartphones, these devices inspire team members to achieve their personal fitness goals one step at a time. Throughout the year, Sharp Best Health held both entity-specific and systemwide Fitbit Step Challenges to encourage”

“Throughout FY 2018, Sharp Best Health continued to provide Wellness on Wheels, a monthly educational event offered to Sharp employees to address the challenge of accessing health resources and programs during work hours. Wellness on Wheels involves "rounding" in staff lounges, hospital units, and nursing stations to promote a new and relevant subject each month. Each session includes an educational component, an interactive activity and a call to action. Wellness on Wheels brings wellness education to employees where they work, accommodating their unique schedules and dedication to patient care. Keeping the experience relevant and quick improves access to wellness resources for busy staff with complex schedules. During FY 2018, Wellness on Wheels topics included holiday food myths, essential oils, mindful eating, yoga poses for relaxation, heart health and common safety hazards. Since 2015, Sharp has provided a systemwide Mindful healthy food initiative in partnership with Sodexo. As part of the Mindful program, Sharp's cafeteria menus were redesigned to include sustainable, nutritious and enticing food options that foster a healthy lifestyle among patients, visitors and staff. In 2018, Sharp continued its partnership with Farm Fresh to You to make customizable boxes of organic, locally-grown produce available for purchase by employees. This CSA service offers a convenient method for employees and their families to incorporate more fruits and vegetables into their diet while supporting local farmers. Weight Watchers offers weight-loss services and products founded on a scientifically-based approach to weight management that encourages healthy eating, increased physical activity and other healthy lifestyle behaviors. Sharp Best Health continued its partnership with Weight Watchers to offer employees a subsidized membership rate to any Weight Watchers program. With program availability at work, in the community and online, this partnership has offered Sharp team members a variety of healthy eating and physical activity options that can be tailored to different lifestyles and schedules. At any given time during FY 2018, approximately 530 Sharp employees were actively using Weight Watchers. Since the program's inception in 2016, participating employees have lost an estimated 4,000 pounds. In addition to providing Weight Watchers at work, during FY 2018, Sharp Best Health partnered with the Sharp Rees-Stealy Center for Health Management to offer free in-person and online nutrition classes to Sharp employees through the New Weigh program. New Weigh is an eight-week weight loss program that emphasizes nutrition education and healthy lifestyle development. Program participants create a semi-structured food plan, and have access to a skilled health coach or RD to ensure continued support and accountability. During FY 2018, 240 Sharp employees completed the New Weigh program. Nearly one in six community members face the threat of hunger every day in SDC. Each month, the Food Bank distributes food to approximately 370,000 children and families, active-duty military, and fixed-income seniors living in poverty. For more than a decade, Sharp has supported the Food Bank's tremendous efforts through a holiday food drive. During the 2017 holiday season, Sharp Best Health and Sharp Community Benefit continued to partner with SuperFood Drive - a San Diego-based organization committed to educating the community about the health benefits of eating nutrient-dense superfoods and ensuring the accessibility of healthy food to all - to provide a "superfood drive," encouraging nonperishable food donations that are also nutritious, sustaining and essential for a healthy life. Through the six-week holiday superfood drive, locations throughout the Sharp system collected more than 2,300 pounds of nutritious food. In addition, Sharp team members donated nearly $1,000 through a Sharp Virtual Food Drive specifically benefiting the Food Bank. Combined, these do”

“* Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; flu vaccinations, telephone reassurance calls and other services for seniors; financial and other support to community clinics to assist in providing and improving access to health services; Project HELP; Meals on Wheels; contribution of time to Stand Down for Homeless Veterans, the San Diego Food Bank and Feeding San Diego; financial and other support to the Sharp Humanitarian Service Program; and other assistance for vulnerable and high-risk community members. * Other Benefits for the Broader Community included health education and information, and participation in community health fairs and events addressing the unique needs of the community as well as providing flu vaccinations, health screenings and support groups to the community. Sharp collaborated with local schools to promote interest in health care careers and made its facilities available for use by community groups at no charge. Sharp executive leadership and staff also actively participated in numerous community organizations, committees and coalitions to improve the health of the community. See Appendix A for a listing of Sharp's involvement in community organizations. In addition, the category included costs associated with planning and operating community benefit programs, such as CHNA development and administration. * Health Research, Education and Training Programs included education and training programs for medical, nursing and other health care students and professionals, as well as supervision and support for students and interns. Time was also devoted to generalizable health-related research projects that were made available to the broader health care community. Economic Value of Community Benefit Provided in FY 2018 In FY 2018, Sharp provided a total of $437,406,616 in community benefit programs and services that were unreimbursed. Table 9 displays a summary of unreimbursed costs based on the categories specifically identified in SB 697. These financial figures represent unreimbursed community benefit costs after the impact of the Medi-Cal Hospital Fee Program. Table 9: Sharp HealthCare Total Community Benefit by SB 697 Category - Estimated FY 2018 Unreimbursed Costs (see Note 1) Medical Care Services: Shortfall in Medi-Cal (see Note 2) - $129,308,822 Shortfall in Medicare (see Note 2) - $248,662,360 Shortfall in San Diego County Indigent Medical Services (CMS) (see Note 2) - $9,201,550 Shortfall in CHAMPVA/TRICARE (see Note 2) - $7,612,667 Shortfall in Workers' Compensation - $29,656 Charity Care (see Note 3) - $24,969,673 Bad Debt (see Note 3) - 6,511,004 Other Benefits for Vulnerable Populations: Patient transportation and other assistance for the needy (see Note 4) - $3,685,141 Other Benefits for the Broader Community: Health education and information, support groups, health fairs, meeting room space, donations of time to community organizations and cost of fundraising for community events (see Note 4) - $1,869,835 Health Research, Education and Training Programs: Education and training programs for students, interns and health care professionals (see Note 4) - $5,555,908 TOTAL - $437,406,616 Table 9 Notes: Note 1 - Economic value is based on unreimbursed costs. Note 2 - Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Note 3 - Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Note 4 - Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased ser”

“Sharp Memorial Hospital: Medical Care Services - $163,867,752 Other Benefits for Vulnerable Populations - $1,323,591 Other Benefits for the Broader Community - $561,771 Health Research, Education and Training Programs - $1,560,948 Total - $167,314,062 Sharp Mesa Vista Hospital and Sharp McDonald Center: Medical Care Services - $19,025,271 Other Benefits for Vulnerable Populations - $448,871 Other Benefits for the Broader Community - $127,420 Health Research, Education and Training Programs - $177,560 Total - $19,779,122 Sharp Health Plan: Medical Care Services - $0 Other Benefits for Vulnerable Populations - $11,767 Other Benefits for the Broader Community - $47,970 Health Research, Education and Training Programs - $10,166 Total - $69,903 ALL ENTITIES: Medical Care Services - $426,295,732 Other Benefits for Vulnerable Populations - $3,685,141 Other Benefits for the Broader Community - $1,869,835 Health Research, Education and Training Programs - $5,555,908 Total - $437,406,616 Section 3 Community Benefit Planning Process Navigating the maze of health care can be daunting to say the least; and Sharp is committed to assisting community members in this process. Because it involves a loved one, the appreciation expressed is extremely meaningful. - Sara Steinhoffer, Vice President of Government Relations, Sharp HealthCare For more than 20 years, Sharp HealthCare (Sharp) has based its community benefit planning on findings from its triennial Community Health Needs Assessment (CHNA) process. CHNA findings are used in combination with the expertise in programs and services of each Sharp hospital, as well as knowledge of the populations and communities served by those hospitals, to provide a foundation for community benefit program planning and implementation. Methodology to Conduct the 2016 Sharp HealthCare Community Health Needs Assessments Sharp has been a longtime partner in the process of identifying and responding to the health needs of the San Diego community. Since 1995, Sharp has participated in a countywide collaborative that includes a broad range of hospitals, health care organizations and community agencies to conduct a triennial CHNA that identifies and prioritizes health needs for San Diego County (SDC). In addition, to address the requirements for not-for-profit hospitals under the Patient Protection and Affordable Care Act, Sharp has developed CHNAs for each of its individually licensed hospitals since 2013. This process gathers both salient hospital data and the perspectives of health leaders and residents in order to identify and prioritize health needs for community members across the county, with a special focus on vulnerable populations. Further, the process seeks to highlight health needs that hospitals could impact through programs, services and collaboration. For the 2016 CHNA process, Sharp actively participated in a collaborative CHNA effort led by the Hospital Association of San Diego and Imperial Counties (HASD&IC) and in contract with the Institute for Public Health (IPH) at San Diego State University. The process and findings of the collaborative HASD&IC 2016 CHNA significantly informed the process and findings of Sharp's individual hospital CHNAs. The complete HASD&IC 2016 CHNA is available for public viewing and download at http://www.hasdic.org. To develop its individual hospital CHNAs, Sharp analyzed hospital-specific data and contracted separately with IPH to conduct community engagement activities expressly for the patients and community members it serves. In accordance with federal regulations, the Sharp Memorial Hospital (SMH) 2016 CHNA also includes needs identified for communities served by Sharp Mary Birch Hospital for Women & Newborns, as the two hospitals share a license, and report all utilization and financial data as a single entity to California's Office of Statewide Health Planning and Development (OSHPD). As such, the SMH 2016 CHNA summarizes the processes and findings for communities”

“The 2016 CHNA process began with a comprehensive scan of recent community health statistics in order to validate the regional significance of the top four health needs identified in the HASD&IC 2013 CHNA. Quantitative data for both the HASD&IC 2016 CHNA and Sharp 2016 CHNAs included 2013 OSHPD demographic data for hospital inpatient, emergency department (ED), and ambulatory care encounters to understand the hospital patient population. Clinic data was also gathered from OSHPD and incorporated in order to provide a more holistic view of health care utilization in SDC. Additional variables analyzed in the 2016 CHNA processes are included in Table 13; variables were analyzed at the ZIP code level wherever possible. Table 13: Data Variables in the HASD&IC and Sharp 2016 CHNAs * Hospital Utilization: Inpatient discharges, ED and ambulatory care encounters * Community Clinic Visits * Demographic Data (socioeconomic indicators) * Mortality and Morbidity Data * Regional Program Data (childhood obesity trends and community resource referral patterns) * Social Determinants of Health and Health Behaviors (education, income, insurance, physical environment, physical activity, diet and substance abuse) Based on the results of the community health statistics scan and feedback from community partners received during the 2016 CHNA planning process, a number of community engagement activities were conducted across SDC, as well as specific to Sharp patents, in order to provide a more comprehensive understanding of identified health needs, including their associated SDOH and potential system and policy changes that may positively impact them. In addition, a detailed analysis of how the top health needs impact the health of San Diego residents was conducted. The types of community engagement activities conducted as part of the collaborative HASD&IC 2016 CHNA included key informant interviews, facilitated discussions with care coordinators (community partner discussions), and community resident input through a Health Access and Navigation Survey In addition, Sharp contracted with IPH to collect additional community input through three primary methods: facilitated discussions, key informant interviews, and the Health Access and Navigation Survey with patients and community members. This input focused on behavioral health, cancer, cardiovascular health, diabetes, high-risk pregnancy, senior health and the needs of highly vulnerable patients and community members. In addition, Sharp conducted specific outreach to community promotores, and members of Sharp's Patient Family Advisory Councils - community members who are also current or former Sharp patients. More than 40 Sharp providers and nearly 150 Sharp patients or community members were reached through these engagement efforts. Findings The collaborative HASD&IC 2016 CHNA prioritized the top health needs for SDC through application of the following five criteria: 1. Magnitude or Prevalence 2. Severity 3. Health Disparities 4. Trends 5. Community Concern Using these criteria, IPH created a summary matrix for review by the CHNA Committee. As a result, the CHNA Committee identified behavioral health as the number one health need in SDC. In addition, cardiovascular disease, Type 2 diabetes and obesity were identified as having equal importance due to their interrelatedness. Health needs were further broken down into priority areas due to the overwhelming agreement among all data sources and in recognition of the complexities within each health need. As the HASD&IC 2016 CHNA process included robust representation from the communities served by Sharp, the findings of the prioritization process applied to the same four priority health needs identified for Sharp (behavioral health, cardiovascular, Type 2 diabetes and obesity). In addition, findings from Sharp's 2016 CHNAs continued to prioritize cancer, high-risk pregnancy and senior health among the top health needs for its community. In addition, analys”

“Medical Care Services: Shortfall in Medi-Cal, financial support for on-site workers to process Medi-Cal eligibility forms (Note 1) - $44,130,366 Shortfall in Medicare (Note 1) - $70,831,019 Shortfall in San Diego County Indigent Medical Services (Note 1) - $106,439 Shortfall in CHAMPVA/TRICARE (Note 1) - $1,496,367 Charity Care (Note 2) - $8,367,684 Bad Debt (Note 2) - $711,158 Other Benefits for Vulnerable Populations: Patient transportation, Project HELP and other assistance for the needy (Note 3) - $1,157,648 Other Benefits for the Broader Community: Health education and information, health screenings, health fairs, flu vaccinations, support groups, meeting room space, donations of time to community organizations and cost of fundraising for community events (Note 3) - $559,470 Health Research, Education and Training Programs: Education and training programs for students, interns and health care professionals (Note 3) - $1,564,765 TOTAL - $128,924,916 NOTES: Note 1 - Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Note 2 - Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Note 3 - Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. Key highlights: * Medical Care Services included uncompensated care for patients who were unable to pay for services and the unreimbursed costs of public programs such as Medi-Cal, Medicare and CHAMPVA/TRICARE. In FY 2018, the State of California and the Centers for Medicare and Medicaid Services approved a Medi-Cal Hospital Fee Program for the time period of January 1, 2017, through June 30, 2019. This resulted in recognition of net supplemental revenues for SGH totaling $13.2 million in FY 2018. This reimbursement helped offset prior years' unreimbursed medical care services; however, the additional funds recorded in FY 2018 understate the true unreimbursed medical care services performed for the past fiscal year. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; comprehensive prenatal clinical and social services to low-income, low-literacy women with Medi-Cal benefits; financial and other support to Neighborhood Healthcare; Project HELP, which provides funding for specific needs (e.g., medications, etc.) to assist lower-income patients; flu vaccination clinics for high-risk adults, including seniors; contribution of time to Stand Down for Homeless Veterans, Mama's Kitchen, Feeding San Diego (FSD), Ssubi is Hope and the San Diego Food Bank (Food Bank); the Sharp Humanitarian Service Program; support for Meals on Wheels San Diego County; the provision of durable medical equipment (DME); support services for discharged homeless patients in partnership with San Diego Rescue Mission (SDRM); the Care Transitions Intervention (CTI) program; and other assistance for vulnerable and high-risk community members. * Other Benefits for the Broader Community included health education and information on a variety of topics; support groups; participation in community health fairs and events; health screenings for stroke, blood pressure, diabetes, fall prevention, hand mobility (arthritis, carpal tunnel, trigger finger, etc.), lung function and carotid artery disease; community education and resources provided by the SGH cancer patient navigator program; and specialized education and flu vaccinations offered through the SGH Senior Resource Center. SGH also collaborated wi”

“Food Stamps/SNAP Benefits: Households - 11.0% Families with Children - 10.5% Eligibility by Federal Poverty Level: Population below or at 130% FPL - 20.1% Population below or at 138% FPL - 21.7% Population 139% to 350% FPL - 34.1% Source: County of San Diego HHSA, Public Health Services, Community Health Statistics Unit, 2018. Demographic Profiles, 2016, and U.S. Census Bureau, American Community Survey 2012-2016. In SDC's east region in 2016, 93.5 percent of children ages zero to 17, 81.6 percent of young adults ages 18 to 24, 82.2 percent of adults ages 25 to 44, 88.5 percent of adults ages 45 to 64, and 98.7 percent of seniors ages 65 and older had health insurance. In SDC's east region in 2016, health insurance coverage for each age group was lower than the Healthy People 2020 (HP2020) national target of 100 percent health insurance coverage for all individuals under age 65. See Table 28 for details. Table 28: Health Insurance Coverage in SDC's East Region, 2016 Children 0 to 17 years: Current Rate - 93.5% HP2020 Target - 100% Young adults 18 to 24 years: Current Rate - 81.6% HP2020 Target - 100% Adults 25 to 44 years: Current Rate - 82.2% HP2020 Target - 100% Adults 45 to 64 years: Current Rate - 88.5% HP2020 Target - 100% Seniors 65+ years: Current Rate - 98.7% HP2020 Target - 100% Source: County of San Diego HHSA, Public Health Services, Community Health Statistics Unit, 2018. Demographic Profiles, 2016, and U.S. Census Bureau, American Community Survey 2012-2016. According to the California Health Interview Survey (CHIS), 34.4 percent of the east region population was covered by Medi-Cal. See Table 29 for details. Table 29: Medi-Cal (Medicaid) Coverage in SDC's East Region, 2016-2017 Covered by Medi-Cal - 34.4% Not covered by Medi-Cal - 65.6% Source: 2016-2017 CHIS CHIS data also revealed that 15.3 percent of individuals in the east region did not have a usual place to go when sick or in need of health advice (see Table 30).9 Table 30: Regular Source of Medical Care in SDC's East Region, 2016-2017 Has a usual source of care: Current Rate - 84.7% HP2020 Target - 100% Has no usual source of care Current Rate - 15.3% HP2020 Target - 0% Source: 2016-2017 CHIS Cancer and diseases of the heart were the top two leading causes of death in SDC's east region in 2016. See Table 31 for a summary of leading causes of death in the east region. For additional demographic and health data for communities served by SGH, please refer to the SGH 2016 CHNA at http://www.sharp.com/about/community/community-health-needs-assessments.cfm. Table 31: Leading Causes of Death in SDC's East Region, 2016 Malignant Neoplasms (Overall Cancer): Number of Deaths - 977 Percent of Total Deaths - 24.1% Diseases of the Heart: Number of Deaths - 929 Percent of Total Deaths - 22.9% Cerebrovascular Diseases: Number of Deaths - 254 Percent of Total Deaths - 6.3% Chronic Lower Respiratory Diseases: Number of Deaths - 230 Percent of Total Deaths - 5.7% Accidents/Unintentional Injuries: Number of Deaths - 220 Percent of Total Deaths - 5.4% Alzheimer's Disease: Number of Deaths - 207 Percent of Total Deaths - 5.1% Diabetes Mellitus: Number of Deaths - 143 Percent of Total Deaths - 3.5% Chronic Liver Disease and Cirrhosis: Number of Deaths - 95 Percent of Total Deaths - 2.3% Essential Hypertension and Hypertensive Renal Disease: Number of Deaths - 83 Percent of Total Deaths - 2.0% Intentional Self-Harm (Suicide): Number of Deaths - 74 Percent of Total Deaths - 1.8% All Other Causes: Number of Deaths - 842 Percent of Total Deaths - 20.9% Total Deaths Number of Deaths - 4,054 Percent of Total Deaths - 100.0% Source: County of San Diego Health and Human Services Agency (HHSA), Public Health Services, Community Health Statistics Unit, 2018 Community Benefit Planning Process In addition to the steps outlined in Section 3: Community Benefit Planning Process regarding community benefit planning, SGH: * Incorporates community priorities and community input into its strategi”

“Identified Community Need: Education, Support and Screening for Stroke Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2016 CHNA continued to identify cardiovascular disease (including cerebrovascular disease/stroke) as one of six priority health issues affecting members of the communities served by SGH. * The HASD&IC 2016 CHNA continued to identify cardiovascular disease (including cerebrovascular disease/stroke) as one of the top four priority health issues for community members in SDC. * According to data presented in the SGH 2016 CHNA, high blood pressure, high cholesterol and smoking are all risk factors that could lead to cardiovascular disease and stroke. About half of all Americans (47 percent) have at least one of these three risk factors. Additional risk factors include alcohol use, obesity, physical inactivity, poor diet, diabetes and genetic factors (CDC, 2015). * In 2016, cerebrovascular diseases including stroke were the third leading cause of death for SDC's east region. * In 2016, there were 254 deaths due to stroke in SDC's east region. The region's age-adjusted death rate due to stroke was 44.3 per 100,000 population. This rate was the highest among all SDC regions and was higher than the HP2020 target of 34.8 deaths per 100,000. * In 2016, there were 1,272 hospitalizations due to stroke in SDC's east region. The region's age-adjusted rate of hospitalizations for stroke was 228.3 per 100,000 population - the highest among all SDC regions. * In 2016, there were 394 stroke-related ED discharges in SDC's east region, a 38 percent increase from 2015. The age-adjusted rate of discharge was 72 per 100,000 population. * According to 2016-2017 CHIS data, an estimated 33.7 percent of east region adults were obese, 12.4 percent smoked cigarettes, and 64.3 percent did not regularly walk for transportation, fun, or exercise. In 2016, 17.9 percent reported eating fast food four or more times in the past week. The rates for all of these activities were higher in the east region than SDC overall. * The National Institute of Neurological Disorders and Stroke (NINDS) reports that 25 percent of people who recover from their first stroke will have another stroke within five years (NINDS, 2016). * The CDC estimates that up to 80 percent of strokes are preventable through the recognition of early signs/symptoms and the elimination of stroke risk factors. * According to the CDC, healthy lifestyle choices can help prevent stroke. Behaviors that can mitigate the risk of stroke include choosing a healthy diet full of fruits and vegetables, maintaining a healthy weight, engaging in at least 2.5 hours of moderate-intensity aerobic physical activity each week, refraining from or quitting smoking, and limiting alcohol intake (CDC, 2018). Objective * Provide stroke education, support and screening services for the east region of SDC FY 2018 Report of Activities SGH is recognized with advanced certification by the Joint Commission as a Primary Stroke Center and was recertified in June 2016. The program is nationally recognized for its outreach, education and thorough screening procedures, as well as documentation of its success rate. SGH is a recipient of the American Heart Association (AHA)/American Stroke Association's (ASA) Get With The Guidelines (GWTG) - Stroke Gold Plus Quality Achievement Award for excellence in stroke care as well as the Target: Stroke Elite Honor Roll designation. The AHA/ASA's GWTG is a national effort focused on ensuring the use of evidence-based therapies to improve outcomes for stroke patients. The AHA/ASA's Target: Stroke Elite Honor Roll designation focuses on improving the timeliness of intravenous tissue plasminogen activator (IV t-PA) administration to eligible patients. In FY 2018, the SGH Stroke Center provided stroke education and screenings at 11 community events in SDC's east r”

“In addition, SGH actively participated in the quarterly San Diego County Stroke Consortium, a collaborative effort to improve stroke care and discuss issues impacting stroke care in SDC. SGH also continued its 13-year collaboration with the County of San Diego Emergency Medical Services (EMS) to provide data for the SDC stroke registry. FY 2019 Plan SGH Stroke Center will do the following: * Participate in stroke screening and education events in the east region of SDC * Provide education for individuals with identified stroke risk factors * Offer a stroke support group in conjunction with the hospital's Outpatient Rehabilitation Department * Continue to participate in Strike Out Stroke Night at the Padres * Continue to participate in the San Diego County Stroke Consortium with other SDC hospitals * Continue to provide data to the SDC stroke registry * Provide at least one physician speaking event on stroke care and prevention * Provide stroke education and screenings at the Sharp Women's Health Conference * Participate in Sharp's partnership with the City of San Diego to provide stroke education and resources to employees and residents in the city's nine districts Identified Community Need: Heart and Vascular Disease Education and Screening Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2016 CHNA continued to identify cardiovascular disease as one of six priority health issues affecting members of the communities served by SGH. * The HASD&IC 2016 CHNA continued to identify cardiovascular disease as one of the top four priority health issues for community members in SDC. * Data analysis in the 2016 CHNAs revealed a higher rate of hospital discharges due to cardiovascular disease in more vulnerable communities within SDC's east region, such as El Cajon and Jacumba (Dignity Health, SanGIS, Office of Statewide Health Planning and Development (OSHPD) & SpeedTrack Inc., 2015). * A cardiovascular health key informant interview conducted as part of the SGH 2016 CHNA process identified the following important issues facing cardiology patients: access to care, obtaining medications, understanding diet, understanding symptoms, and communicating their needs to providers. * The key informant interview identified the following as effective strategies for cardiology patients: taking time to teach patients about their disease and self-management; building relationships with patients; providing educational materials; Backline (a text messaging service connecting patients and providers) numbers for providers; education for general practitioners; and including a trained addictions specialist on the care team. * In addition, the cardiovascular health key informant interview identified the following risk factors for heart disease: diabetes, lack of social support, substance use disorders, financial issues, transportation, and lack of health education. Addiction is of particular concern, as nearly all SGH cardiology patients under age 55 have substance use issues. * According to the SGH 2016 CHNA, high blood pressure, high cholesterol and smoking are all risk factors that could lead to cardiovascular disease and stroke. * In 2016, heart disease was the second leading cause of death for SDC's east region. * In 2016, there were 568 deaths due to coronary heart disease (CHD) in SDC's east region. The region's age-adjusted death rate due to heart disease was 98.5 per 100,000 population. This was higher than the age-adjusted death rate for SDC overall (81.7 deaths per 100,000 population), but below the HP2020 target (103.4 deaths per 100,000 population). * In 2016, there were 1,100 hospitalizations due to CHD in SDC's east region. The age-adjusted rate of hospitalization for heart disease was 191.9 per 100,000 population, which is higher than the age-adjusted rate for SDC overall (171.2 per 100,000 population). * In 2016, there”

“Throughout the year, SGH provided expert speakers on heart disease and heart failure at professional conferences and events. This included SGH's ninth annual Heart and Vascular Conference in October, a two-day event where more than 300 health care professionals - including physicians, nurses and allied health workers caring for patients with cardiovascular disease - received education on advances in cardiovascular care at the Rancho Bernardo Inn. In November and May, SGH participated in the 13th and 14th semiannual meetings of Southern California VOICe (Vascular Outcomes Improvement Collaborative), which included more than 30 regional vascular physicians, nurses, epidemiologists, scientists and research personnel working together to collect and analyze vascular data in an effort to improve patient care. SGH shared its expertise on the use of data processes to improve outcomes, compliance to standards, and care. SGH continued to participate in programs to improve the care and outcomes of individuals with heart and vascular disease. To help improve care for acutely ill patients in SDC, SGH provided data on STEMI (ST-elevation myocardial infarction or acute heart attack) to the County of San Diego EMS. SGH participated in the quarterly County of San Diego EMS Advisory Council for STEMI hosted by Sharp at its corporate office location. Additionally, SGH provided its Peripheral Vascular Disease Rehabilitation Program to provide education and coaching on exercise, diet and medication to keep patients - particularly low-income patients - at the highest functional level. The program is partially funded by donations to the Grossmont Hospital Foundation to help defray the cost for patients with limited resources. Throughout FY 2018, SGH-affiliated cardiologists shared heart-related information with local news outlets, including KUSI News; Everyday Health, a consumer health website; and The East County Californian. Topics included aspirin and heart health, cannabis and heart heath, and sex after a heart attack. SGH's cardiac team is committed to supporting future health care leaders through active participation in student training and internship programs. In FY 2018, the team spent more than 450 hours mentoring more than 30 students from Azusa Pacific University (APU), San Diego State University (SDSU), University of California (UC), San Diego, Grossmont College, National University and Western University of Health Sciences, including students with an interest in a career as a nurse or cardiovascular technologist. FY 2019 Plan SGH will do the following: * Provide a free monthly CHF class and support group * Provide free bimonthly Heart and Vascular Risk Factor Education classes * Provide cardiac and vascular risk factor education and screening at community events * Provide one cardiac health lecture and a Cardiovascular Expo for community members * Pursue additional research opportunities to benefit patients and community members * As invited, offer educational speakers to the professional community on topics such as performance improvements in CHF and acute myocardial infarction, and cardiovascular treatment options * Provide a conference on heart and vascular disease for community physicians and other health care professionals * Continue to provide student learning opportunities, including a new internship module for exercise physiology and kinesiology students * Continue to provide data on STEMI to the County of San Diego EMS * Continue to provide the Peripheral Vascular Disease Rehabilitation Program Identified Community Need: Diabetes Education, Prevention and Support Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2016 CHNA continued to identify Type 2 diabetes as one of six priority health issues affecting members of the communities served by SGH. * The HASD&IC 2016 CHNA continued to identify Type 2 diabetes”

“* The CDC-approved Diabetes Prevention Program (DPP) is an evidence-based, cost-effective intervention to help people decrease their risk of developing diabetes by making healthy lifestyle changes. According to the California Department of Public Health (CDPH), in 2018, California mandated the DPP be covered under Medi-Cal for all beneficiaries who have prediabetes or a high risk of developing Type 2 diabetes. By funding the DPP, California will help create partnerships between community-based organizations, private insurers, health care providers, employers, academia and government agencies with the goal to reduce the incidence of prediabetes and Type 2 diabetes statewide (CDPH, 2018). Objectives * Provide diabetes education, prevention and support in the east region of SDC * Collaborate with community organizations and projects to provide diabetes education to SDC's vulnerable populations * Participate in local and national professional conferences to share best practices in diabetes treatment and control with the broader health care community FY 2018 Report of Activities The SGH Diabetes Education Program is recognized by the American Diabetes Association (ADA) for meeting national standards for excellence and quality in diabetes education covering blood sugar monitoring, medication and nutritional counseling as well as insulin pump and other device training. The program provides individuals and their support systems with the skills needed to successfully self-manage various conditions, including prediabetes, gestational diabetes, and Type 1 and Type 2 diabetes. Small group and one-on-one education options are offered in English and Spanish. In FY 2018, the Sharp Diabetes Education Program provided diabetes education and support to approximately 1,000 attendees at the Sharp Women's Health Conference. This included diabetes risk assessments using the ADA's Diabetes Risk Test questionnaire as well as resources on prediabetes; navigating the road to prevention; the signs, symptoms and complications of diabetes; and diabetes self-management. In addition, two diabetes educators presented on controlling blood sugar levels, prediabetes, and diabetes risk factors, symptoms and complications. Attendees were also educated about metabolic syndrome - a group of conditions including increased blood pressure, high blood sugar, abnormal cholesterol levels, and excess body fat around the waist that occur together, increasing an individual's risk of heart disease, stroke and diabetes. The Sharp Diabetes Education Program also provided fundraising and team participation for the ADA's Step Out Walk to Stop Diabetes held at the Embarcadero Marina Park South in October. The Sharp Diabetes Education Program provided education to various community groups throughout the year. In collaboration with the SGH Senior Resource Center, the program provided a lecture on diabetes and the power of lifestyle change to nearly 20 senior community members at the Dr. William C. Herrick Community Health Care Library. The Sharp Diabetes Education Program also participated in Sharp's partnership with the City of San Diego to provide diabetes resources and education on nutrition, including how food groups and serving size affect blood sugar levels, to nearly 20 community members at Skyline Hills Branch Library. In January, the SGH Diabetes Education Program provided diabetes awareness education to approximately 25 community members at the Kiwanis Club of El Cajon Valley. Additionally, in February, the SGH Diabetes Education Program educated approximately 25 community members on the basics of diabetes at New Life Church of the Nazarene in El Cajon. The Sharp Diabetes Education Program continued to collaborate with Family Health Centers of San Diego (FHCSD) to provide education to diabetic patients at multiple FHCSD sitesth el ything on SSI program?ilar to NICU navigators in next section.o vulnerable populatiosn? , including those in the east region, through the organ”

“In FY 2018, the Sharp Diabetes Education Program supported the professional health care community through participation in various conferences and meetings. At the Liberty Station Conference Center in May, the Sharp Diabetes Education Program presented to more than 150 health professionals during Sharp's Obesity Crisis Conference titled Practical Approaches to the Care of the Obese Patient. The team's presentation covered insulin use in the obese patient, including the origin and purpose of insulin, the effects of different kinds of insulin, the significance of accurate timing of insulin administration, and treatment options. In June, the Sharp Diabetes Education Program attended the ADA's 78th Scientific Sessions conference in Orlando, Florida. The conference theme was Diabetes Breakthroughs Happen Here, which taught more than 14,000 international attendees about the most significant advances in diabetes care and research. Also in June, the Sharp Diabetes Education Program provided a poster presentation to approximately 75 attendees at Sharp's fourth annual Interprofessional Research & Innovation Conference. The presentation, titled Designing and Implementing a Competency-Based Skills Fair to Improve Home Health Nurses' Knowledge, highlighted a project aimed at improving patient care and diabetes knowledge among nurses. In addition, in August, the Sharp Diabetes Education Program presented on The Diabetes Injectable Pen Laboratory - A Novel Approach to Improve Home Health Nurses' Diabetes Knowledge to approximately 60 health professionals at the American Association of Diabetes Educators' 2018 Annual Conference in Baltimore, Maryland. The presentation described a study that demonstrated statistically significant improvements in knowledge and confidence levels among registered nurses (RNs) and licensed vocational nurses using diabetes medication pens. In November, the Sharp Diabetes Education Program hosted a diabetes conference designed for physicians, nurses, pharmacists, laboratorians, clinical and managerial leaders and other community health professionals interested in optimizing inpatient diabetes care. The conference provided 150 participants with specific tools and strategies for creating a culture that supports and encourages emerging therapeutic trends in glycemic management in a hospital setting. Topics included the advantages and disadvantages of pump therapy; pump therapy as a method of insulin delivery; differences in the treatment of Type 1 and Type 2 diabetes; diabetes risk factors; causes of diabetes patients not taking their medications; and the interventions required to improve patient handover from hospital to primary care. Further, in FY 2018, the Sharp Diabetes Education program provided diabetes education to 20 nurse practitioner students at SDSU, while the SGH Diabetes Education Program mentored a dietetic intern from the San Diego Women, Infants and Children (WIC) program. FY 2019 Plan The SGH Diabetes Education Program will do the following: * Provide community members with prediabetes and diabetes information at various community venues in SDC's east region * Explore additional collaborations to assist and educate food insecure community members * Participate in Sharp's partnership with the City of San Diego to provide diabetes education and resources to employees and residents in the city's nine districts * Continue to foster relationships and collaborate with FHCSD to provide education and resources to their diabetic patients * Continue to provide gestational services and resources to underserved pregnant women, both at the hospital and in collaboration with community clinics * Participate in Tour de Cure - the ADA's signature fundraising event to fight diabetes and its burdens * Maintain up-to-date resources to support community members with diabetes treatment and prevention, particularly foreign language and culturally appropriate resources for diverse populations * Continue to participate in loc”

“* In 2013, an estimated 62,000 San Diegans ages 55 and over were living with ADOD. One quarter of these residents lived in the east region. Between 2013 and 2030, the number of east region residents living with ADOD is projected to increase by 39.7 percent (Alzheimer's Disease and Other Dementias in San Diego County, HHSA, 2016). * In 2016, an estimated 54.9 percent of SDC's east region residents ages 65 and older reported that they were vaccinated for influenza in the past 12 months (CHIS, 2016). In 2016, 17 percent of the influenza hospitalizations and 6 of the 11 influenza deaths in the east region occurred among residents ages 65 and older. The age-adjusted rate of influenza death among this group was 8.5 per 100,000, higher than the rate for SDC overall (6 per 100,000) (HHSA, 2016). * Research shows that caregiving can have serious physical and mental health consequences. According to findings from the Stress in America survey described in a report titled Valuing the Invaluable, caregivers to older relatives report poorer health and higher stress levels than the general population. Fifty-five percent of surveyed caregivers reported feeling overwhelmed by the amount of care their family member needs (AARP Public Policy Institute, updated July 2015). * According to AARP, more than 40 million people in the U.S. act as unpaid caregivers to people ages 65 and older. More than 10 million of these caregivers are Millennials with separate full- or part-time jobs, and 1 in 3 employed Millennial caregivers earns less than $30,000 per year (AARP, 2018). * According to a report from the National Alliance for Caregiving (NAC) and AARP titled Caregiving in the U.S. 2015, 60 percent of unpaid caregivers are female, and nearly 1 in 10 caregivers are ages 75 or older (AARP and NAC, 2015). * The UCLA Center for Health Policy Research conducted a study highlighting the plight of California's "hidden poor," finding 772,000 seniors who live in the gap between the FPL and the Elder Economic Security Standard. The highest proportion of seniors living in this gap includes renters, Latinos, women and grandparents raising grandchildren (Padilla-Frausto & Wallace, 2015). Objectives * Provide a variety of senior health education and screening programs * Produce and mail quarterly activity calendars to community members * Provide daily telephone reassurance/safety check calls to ensure the safety of homebound seniors and disabled adults in SDC's east region * In collaboration with community partners, offer seasonal flu vaccination clinics at convenient locations for seniors and high-risk adults in the community * Serve as a referral resource to additional support services in the community for senior residents in SDC's east region * Provide education and community resources to caregivers * Maintain and grow partnerships with community organizations to expand community outreach and provide seniors and caregivers with updated information on available services and resources FY 2018 Report of Activities Sharp Senior Resource Centers meet the unique needs of seniors and their caregivers by connecting them to a variety of free and low-cost programs and services through email, phone and in-person consultations. The Sharp Senior Resource Centers' compassionate staff and volunteers provide personalized support and clear, accurate information regarding health education and screenings, community referrals and caregiver resources. In FY 2018, the SGH Senior Resource Center developed and mailed quarterly calendars of its programs and services to more than 6,600 households in SDC's east region. In addition, the SGH Senior Resource Center distributed approximately 4,000 Vials of Life, which are small vinyl sleeves that can be magnetically placed on a refrigerator to provide emergency personnel with critical medical information for seniors and disabled people. The SGH Senior Resource Center provides a telephone reassurance and safety check program for isolated or hom”

“At The San Diego Union-Tribune's CaregiverSD community expo in June, the SGH Senior Resource Center provided Vials of Life, senior resources and information about its services to approximately 300 community members. The SGH Senior Resource Center also offered Vials of Life, caregiver and community resources, and information about its services to more than 700 seniors at the AIS Aging Summit 2018 and the Burr Heart & Vascular Center community open house. In April, the SGH Senior Resource Center partnered with Sharp HospiceCare and the City of La Mesa to provide a conference titled Healthy and Safe Aging for community seniors and their families. Held at the La Mesa Community Center, the free conference provided approximately 100 attendees with educational presentations from a marriage and family therapist, attorney, nurse practitioner, ACP specialist, and other experts on how to plan for a healthy, safe and mindful future. In September, the Sharp Senior Resource Centers collaborated with the Caregiver Coalition of San Diego to provide the Caregiving for Someone With Dementia: Caregiver Conference at the La Mesa Community Center. Nearly 100 community members attended the free conference, which included a resource fair and presentations from experts on a variety of topics to help care for loved ones. Throughout the year, the SGH Senior Resource Center both hosted and participated in health fairs and events throughout SDC's east region. This included the provision of blood pressure screenings and educational resources to more than 2,400 community seniors and caregivers at the Lakeside Community Center, Meadowbrook Mobile Home Estates in Santee, El Cajon Fire Department, George L. Stevens Senior Center, La Mesa Community Center, San Diego LGBT (Lesbian, Gay, Bisexual and Transgender) Community Center, JFS College Avenue Center, La Vida Real senior community, Grossmont Center, Cameron Family YMCA in Santee, Balboa Park, Liberty Station in Point Loma, Town and Country San Diego and SGH. The SGH Senior Resource Center continued to provide seasonal flu vaccines in selected community settings. In FY 2018, the SGH Senior Resource Center provided more than 440 seasonal flu vaccinations at nine community sites, including the Lemon Grove Senior Center, JFS College Avenue Center, La Mesa Community Center, Lakeside Community Center, Salvation Army of El Cajon, Journey Community Church, food banks in Santee and Spring Valley, and SGH. In addition to providing flu vaccinations at these sites, the SGH Senior Resource Center offered activity calendars detailing upcoming blood pressure and flu clinics, health screenings and community senior programs as well as provided Vials of Life and information regarding telephone reassurance calls. Further, seniors, caregivers, individuals who are homeless or at risk of homelessness, individuals with chronic illnesses, and high-risk adults with limited access to care, including those without transportation, were notified about flu vaccine events through activity calendars, collaborative outreach conducted by the flu clinic site, Sharp.com, and paper and electronic newspaper notices. Throughout the year, the SGH Senior Resource Center maintained active relationships with organizations that enhance professional networking and provide quality programming for seniors in SDC's east region. Organizations included the Caregiver Coalition of San Diego (the Caregiver Education Committee), ECSSP, ECAN, AIS Health Promotion Committee and Meals on Wheels Greater San Diego East County Advisory Board. Further, in order to avoid unnecessary visits to the emergency room and the potential risks of hospitalization, SGH is a part of the Alzheimer's Response Team (ART) in East County, which links medical first-responders, social workers, Sheriff's deputies and other professionals to individuals living with dementia, to ensure proper assistance as well as the most appropriate services during an emergency. Launched in July by the C”

“* According to 2017 Sharp oncology data, 14 percent of the 274 SGH cancer patients who received the cancer psychosocial distress screening scored at a range of moderate to severe distress and were referred to internal or external resources, such as social workers or community cancer resources. * The most frequently observed cancers at SGH in 2017 were (in rank order): breast, lung, colorectal, prostate, gynecological and lymphoma. In total, there were 1,231 new cases of cancer at SGH in 2017. * In 2016, cancer was the leading cause of death in SDC's east region and was responsible for 24.1 percent of all deaths. * There were 977 deaths due to cancer (all types) in SDC's east region in 2016. The region's age-adjusted death rate due to cancer was 173.1 deaths per 100,000 population, which is higher than the overall SDC age-adjusted rate of 146.6 per 100,000 population and the HP2020 target of 161.4 deaths per 100,000 population. * In 2016, the east region's age-adjusted death rates were higher than the rates for SDC overall in 12 of the 15 most common cancers: bladder, brain, colorectal, female breast and reproductive, kidney, leukemia, liver, lung, melanoma of the skin, non-melanoma skin cancer, and prostate. * In 2016, 20.8 percent of all cancer deaths in SDC's east region were due to lung cancer, 9.8 percent to colorectal cancer, 8.6 percent to female breast cancer, 7.3 percent to prostate cancer, 6.1 percent to pancreatic cancer, and 5.4 percent to female reproductive cancer. * In 2016, the age-adjusted mortality rate of female breast cancer in the east region was 26.6 per 100,000 women, which exceeds the rate for SDC overall (20 per 100,000 women), and the HP2020 target of 20.7 breast cancer deaths per 100,000 women. * According to the American Cancer Society (ACS) Cancer Statistics Center, in 2018 there will be an estimated 29,360 new cases of breast cancer and 4,500 breast cancer deaths for females in California. * According to the 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile, in SDC there were 46.1 late-stage cases of breast cancer per 100,000 women, exceeding the HP2020 target of 42.4 cases per 100,000 women. The report projects that SDC will meet the HP2020 target within five years. * The 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile also reported that, in 2013, breast cancer mortality rates in SDC were highest among African American women, at 27.7 deaths per 100,000. This exceeded the mortality rate for Caucasian (23.9), Latina (17.3) and Asian/Pacific Islander (13.2). * According to the ACS 2017 California Cancer Facts & Figures report, 72.4 percent of breast cancer cases among non-Hispanic white women in SDC were diagnosed at an early stage, compared to 69.3 percent of African American cases, 68.1 percent of Hispanic cases and 70.4 percent of Asian/Pacific Islander cases. Data suggests that early breast cancer detection resources are needed in minority communities. * According to 2015-2016 CHIS data, 85.7 percent of women in SDC's east region ages 50 to 74 reported having a mammogram in the past two years. This exceeds the HP2020 target of 81.1 percent for breast cancer screenings. Approximately 4.9 percent of SDC east region women in this age range reported that they have never had a mammogram. * According to findings from the ACS 2018 Cancer Facts & Figures report, screening offers the ability for secondary prevention by detecting cancer early. For example, the 39 percent decrease in the female breast cancer death rate between 1989 and 2015 is attributed to improvements in early detection, namely screening and increased awareness. In addition, over the past three decades, five-year relative survival rates for all cancers combined increased by 20 percent among whites and 24 percent among blacks, reflecting earlier diagnosis for some cancers as well as improvements in treatment (ACS, 2018). * Study findings from the 2015 Susan G. Komen for the Cure San Diego Affilia”

“In FY 2018, the SGH Cancer Center provided a variety of free support groups for approximately 90 community members impacted by cancer. Offered twice monthly, the breast cancer support group allowed women in all stages of breast cancer - from recent diagnosis, to treatment and survivorship - to share experiences and discover coping strategies. A general cancer support group was offered monthly to meet the educational and emotional needs of people living with any kind of cancer. This group provided encouragement and hope in a safe environment as well as an opportunity to share experiences and coping strategies during any phase of treatment. The weekly Art and Chat support group offered cancer patients, survivors and their loved ones a combination of conversation and relaxing drawing methods to increase focus, creativity, self-confidence and personal well-being. The SGH Cancer Center also offered a monthly Man Cave support group for men with cancer, which provided a safe and comfortable setting to explore important issues that can arise when coping with any type of cancer, including work, relationships, family and regaining control over life. Furthering its support for those with cancer, the SGH Cancer Center continued to provide the Wall of Hope and Inspiration - a special art installation created in 2015 for patients and visitors to write words of wisdom, advice and encouragement to those with cancer. In addition, in FY 2018, SGH Cancer patients participated in the Swallows project in which more than 30 patients and loved ones painted unique aluminum birds that represent what healing looks like to them. The birds were assembled into a flight of swallows over the entrance of the medical oncology and radiation oncology areas as a symbol of hope and a successful journey. The SGH Cancer Center continued to host educational classes at no cost for patients and community members facing cancer. Through the monthly Lunch and Learn Cancer Education series, community members, patients and families were invited to hear local experts speak about a unique cancer-related topic each month, such as managing anxiety, leaving a legacy, making healthy habits stick, mindful eating, importance of exercise, cancer prevention lifestyle, and strategies for successful survivorship. Attendees were also invited to participate in a question-and-answer session while enjoying a complimentary lunch. The series reached an average of eight to 12 individuals per session in FY 2018. The SGH Cancer Center also provided meeting space for the ACS' Look Good Feel Better classes, which teach women techniques to manage the appearance-related side effects of cancer treatment (e.g., hair loss, etc.) and boost self-confidence. Classes included a complimentary makeup kit and instruction from a licensed beauty professional on makeup application, skin care, and wearing wigs and headwear. Four classes were offered at the SGH Cancer Center in FY 2018, reaching more than 30 women. Throughout the year, the SGH Cancer Center offered free workshops for patients and community members. This included free monthly ACP workshops provided in collaboration with Sharp's ACP program. Led by a trained ACP facilitator, the workshops provided nearly 15 community members with an overview of the ACP process, basic tools to help define their personal health care choices, communication tips to begin the conversation with loved ones, and guidance on completing an advance health care directive. The SGH Cancer Center also offered three rotational monthly workshops including: a Relaxation and Quieting the Mind workshop to help cancer patients and their loved ones manage the stress, anxiety and difficult emotions that may accompany a cancer diagnosis; a Chemo Brain Workshop: Improving Memory and Concentration for patients experiencing memory problems related to chemotherapy and other cancer treatments; and a Scanxiety: Managing the Fear of Cancer Recurrence workshop to assist patients in understanding”

“Throughout FY 2018, SGH helped raise community awareness of cancer through television interviews on KPBS, FOX 5 San Diego, CBS 8/CW San Diego and KUSI News as well as through KPBS Public Radio 89.5 and live stream. Through these outlets, information was shared by a medical social worker, SGH Cancer Center staff and hospital physicians from a variety of specialties, including oncology and gastroenterology. Topics included lung cancer in individuals who have never smoked; coffee and its possible cancer risk link to acrylamide, a chemical byproduct created when coffee beans are roasted; a groundbreaking new study that found that women with early-stage breast cancer may be able to avoid chemotherapy; and scanxiety. During a Facebook Live question-and-answer session in March, a gastroenterologist shared simple ways people can reduce their risk of colon cancer, including engaging in moderate amounts of exercise and getting screened, as well as the preventive benefits of aspirin therapy. Another Facebook Live question and answer session focused on reducing the risk of breast cancer and was held during breast cancer awareness month in October. The Sharp Cancer Centers (SCVMC, SGH, and SMH) conduct oncology clinical trials to support the discovery of new and improved treatments to help individuals overcome cancer and to enhance scientific knowledge for the larger health and research communities. In FY 2018, the Sharp Cancer Centers approached and evaluated 3,680 patients for participation in oncology clinical trials. As a result, 207 patients were enrolled in cancer research studies. In FY 2018, clinical trials focused on multiple types of cancer, including but not limited to brain, breast, colon, head and neck, lung, lymphoma, melanoma, ovarian and prostate. FY 2019 Plan The SGH Cancer Center will do the following: * Provide cancer education, resources and breast self-exam demonstrations at community health fairs and events, as well as through social media * Continue to provide a free biweekly breast cancer support group * Provide free community support groups, including an art-themed group as well as groups for men with cancer and those with advanced cancer and their caregivers * Provide monthly workshops on managing scanxiety, relaxation and chemo brain as well as a multi-session couples communication workshop for newly diagnosed cancer patients * Continue to host a free monthly Lunch and Learn educational series for cancer patients, survivors and their loved ones * Provide free meeting space for four Look Good Feel Better classes to help female cancer patients manage appearance-related side effects of cancer treatment * Continue to provide ongoing personalized education, information, support and guidance to cancer patients and their loved ones * Provide education and resources to the community by patient navigators for breast, colon, brain and gynecologic cancers, and cancer patients with complex care needs * Connect individuals to community resources to help them manage their illness * In collaboration with the Sharp ACP program, continue to provide an ACP workshop for patients and community members with cancer and their loved ones * Provide legacy planning workshops on various topics, including creating memory boxes, scrapbooks, writing a life story and ethical wills * Screen and enroll cancer patients in clinical trials for research studies * Provide education on cancer and available treatments through community residents and community physician lectures * Provide internships to National University radiation therapy students * Provide a free seminar to educate community members about lifestyle choices for reducing breast cancer risk * Continue to partner with community clinics to share best practices in the care of cancer patients and to help patients establish medical services Identified Community Need: Women's, Prenatal and Postpartum Health Services and Education Rationale references the findings of the SGH 2016 CHNA, HASD&IC”

“* Findings from the CDPH's 2018 Maternal and Infant Health Assessment indicated that in 2015, 20.5 percent of California mothers experienced depressive symptoms during pregnancy or postpartum. Black and Latina women, women with low socioeconomic status, and Medi-Cal insured women are all at higher risk for depressive symptoms during pregnancy and the postpartum period (California Task Force on the Status of Maternal Mental Health Care, 2018). * Maternal depression is the most common pregnancy complication, occurring more frequently than gestational diabetes and preeclampsia combined. Untreated maternal mental health disorders have serious consequences, including adverse birth outcomes, impaired bonding between mother and infant, childhood behavioral problems, and increased stress on families (California Task Force on Status of Maternal Mental Health Care, 2017). * Screening for maternal mental health disorders is currently not routine, and treatment for identified cases occurs less than 15 percent of the time. Untreated maternal depression costs California an estimated $2.25 billion each year in lost income and productivity and negative health outcomes for children (California Task Force on Status of Maternal Mental Health Care, 2017). * The American Psychological Association (APA) identifies several risk factors for developing postpartum depression, including: a change in hormone levels after birth; prior experience with or family history of depression, anxiety or mental illness; stress related to caring for a newborn; having a baby who is difficult to comfort, or who has challenging sleep and hunger needs; having a baby with special needs; first-time, very young or older motherhood; emotional stressors such as the death of a loved one or family problems; financial or employment issues; and isolation or lack of social support (APA, 2016). * According to the CDC, maternal health conditions that are not addressed before pregnancy can lead to complications for the mother and the infant. Several health-related factors known to cause adverse pregnancy outcomes include uncontrolled diabetes around the time of conception, obesity, smoking during pregnancy and high blood pressure (CDC, 2017). * Factors associated with preterm birth include maternal age, race, socioeconomic status, tobacco and alcohol use, substance abuse, stress, high blood pressure, prior pre-term births, carrying more than one baby, infection and late prenatal care (CDC, 2017). * Preterm birth results in $26 billion in avoidable medical and societal costs each year (March of Dimes, 2017). * According to the National Center on Substance Abuse and Child Welfare, an estimated 15 percent of infants are affected by prenatal alcohol or illicit drug exposure each year. Substance use during pregnancy increases the risk of negative health outcomes, such as stillbirth, miscarriage, LBW, preterm birth, birth deformities, behavioral impairments and withdrawal syndrome (Substance Abuse and Mental Health Services Administration, 2017). Objectives * Conduct outreach and education activities for women on a variety of health topics, including prenatal care and parenting skills * Demonstrate best practices in breastfeeding and maternity care, and provide education and support to new mothers on the importance of breastfeeding * Collaborate with community organizations to help raise awareness of women's health issues and services, as well as to provide low-income and underserved women in the San Diego community with critical prenatal services * Participate in professional associations related to women's services and prenatal health and disseminate research FY 2018 Report of Activities In FY 2018, the SGH Women's Health Center provided education, outreach and support to help meet the unique needs of women, mothers and newborns throughout the community. Free support groups assisted women and families with the challenges and adaptations of having a newborn. Offered twice per week, the br”

“The SGH Prenatal Clinic offers a variety of prenatal support for high-risk and underserved women in SDC. Throughout FY 2018, SGH Prenatal Clinic midwives provided in-kind help at Neighborhood Health Centers in El Cajon to support the underserved population in SDC's east region. This included nearly 1,000 hours of care for pregnant women, with midwife coverage five days per week. The SGH Prenatal Clinic also continued to participate in the CDPH Comprehensive Perinatal Services Program to offer comprehensive prenatal clinical and social services to low-income, low-literacy women with Medi-Cal benefits. Services included health education, nutritional guidance, and psychological and social issue support as well as translation services for non-English-speaking women. Nutrition classes were offered to help reduce the number of women who meet the criteria for gestational diabetes. Women with a current diabetes diagnosis were referred to the SGH Diabetes Education Program, while those with nutrition issues were referred to an SGH registered dietitian (RD) or the SGH Diabetes Education Program as appropriate. At-risk women with elevated BMIs received education and glucometers in order to measure their blood sugar and prevent the development of gestational diabetes. In addition, education on gestational diabetes was provided to pregnant members of the community. The SGH Women's Health Center continued its partnership with Vista Hill ParentCare to assist chemically dependent (addicted) women with psychological and social issues during pregnancy. These approaches have been shown to reduce both LBW rates and health care costs for women and infants. The SGH Women's Health Center also provided women with referrals to a variety of community resources, including, but not limited to California Teratogen Information Service (CTIS), WIC, and the County of San Diego Public Health Nursing. In FY 2018, the SGH Women's Health Center participated in and partnered with several community organizations and advisory boards for maternal and child health, including WIC; CTIS; Partnership for Smoke-Free Families; San Diego County Breastfeeding Coalition Advisory Board; Beacon Council's Patient Safety Collaborative; ACNL; the regional Perinatal Care Network; the local chapter of AWHONN; California Maternal Quality Care Collaborative; California Perinatal Quality Care Collaborative; American Association of Critical-Care Nurses - Clinical Scene Investigator Academy; and the County of San Diego Public Health Nursing Advisory Board. FY 2019 Plan SGH will do the following: * Provide free breastfeeding, postpartum and new parent support groups * Provide parenting education classes * Participate in wellness events for women with a focus on lifestyle tips to enhance overall health * Share evidence-based maternity care practices through presentations at professional conferences * Provide prenatal clinical and social services as well as education to vulnerable community clinic patients through the SGH Prenatal Clinic * Provide a NICU graduate reunion for former NICU patients and their family members Identified Community Need: Health Education and Wellness Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2016 CHNA identified behavioral health, cardiovascular disease, Type 2 diabetes, obesity, cancer and senior health as six priority health issues affecting members of the communities served by SGH. * The HASD&IC 2016 CHNA process continued to identify the following among the top priority health conditions in SDC hospitals: diabetes, obesity, cardiovascular disease and stroke, mental health and mental disorders, unintentional injury, high-risk pregnancy, asthma, cancer, back pain, infectious disease and respiratory diseases. * The HASD&IC and SGH 2016 CHNA community engagement activities emphasized 10 social determinants of health (SDOH) as having a”

“In FY 2018, SGH RDs offered more than 100 community members nutrition handouts and healthy food samples, as well as answered nutrition-related questions at multiple community events, including Sempra/San Diego Gas & Electric's employee health fair, SGH's Burr Heart & Vascular Center Community Open House and a National Nutrition Month table located at the SGH cafeteria. In January, an SGH RD presented on eating well in the new year to nearly 20 seniors at the Dr. William C. Herrick Community Health Care Library. In addition, an SGH RD presented on mindful eating to nearly 50 community members at the SGH Cancer Center and San Diego Oasis. SGH helped increase awareness about current news and trends impacting the health and safety of community members through television interviews on KUSI News, KPBS, FOX 5 San Diego and CBS 8/CW San Diego; printed articles in The San Diego Union-Tribune, The East County Californian and El Latino San Diego; websites including RT: For Decision Makers in Respiratory Care, MyFitnessPal online blog, Bustle digital magazine and Everyday Health - a consumer health website; and various radio stations. Information was shared through these outlets by a bereavement counselor, RD and medical social worker, as well as hospital physicians from a variety of specialties, including emergency medicine, sleep medicine, neurology, psychiatry, general surgery, bariatric surgery, cardiology, gastroenterology and oncology. Topics included, but were not limited to: aspirin and heart health; cannabis and heart health; sex after a heart attack; the Awake Video-Assisted Thoracic Surgery option for patients deemed inoperable; skin cancer and the Hispanic community; lung cancer in nonsmokers; symptoms and prevention of heat-related illnesses; sleep patterns and mood changes during warm San Diego nights; strategies to cope with lack of sleep; first aid tips after encountering a wild animal; the health benefits of eating fish as a child; fecal transplants; unexpected differences between grieving and depression; tips to prepare for surgery; minimally-invasive weight loss options; and the mental and physical health benefits of owning and caring for a dog. Throughout FY 2018, staff at SGH regularly led or attended various health boards, committees, and advisory and work groups. Community and professional groups included CAHHS Committee on Volunteer Services and Directors' Coordinating Council, Cameron Family YMCA, County of San Diego EMCC, Grossmont Healthcare District's Independent Citizens' Bond Oversight Committee, San Diego East County Chamber of Commerce, California Hospital Association (CHA) Workforce Committee, CHA San Diego Association of Directors of Volunteer Services, San Diego-Imperial County Council of Hospital Volunteers, Santee-Lakeside Rotary Club, Lantern Crest Senior Living Advisory Board, AHA, Health Sciences High and Middle College (HSHMC) Board, California Academy of Nutrition and Dietetics - San Diego District, Association of Fundraising Professionals - San Diego Chapter, California Society for Clinical Social Work Professionals, National Association of Orthopedic Nurses, Emergency Nurses Association - San Diego Chapter, County Service Area - 69 Advisory Board, Grossmont Healthcare District Community Grants and Sponsorships Committee, HASD&IC, Grossmont College Occupational Therapy Assistant Advisory Board, Angels Foster Family Network, La Mesa Parks and Recreation, and San Diego Freedom Ranch. FY 2019 Plan SGH will do the following: * Continue to provide health and wellness offerings to community members at a variety of community events and other sites * Continue to provide health and wellness education through local news sources Identified Community Need: Prevention of Unintentional Injuries Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The HASD&IC 2016 CHNA continued to identify unintentio”

“Objectives * Offer an injury and violence prevention program for children, adolescents and young adults in SDC's east region * Offer talks and opportunities to Health and Science Pipeline Initiative (HASPI) high school students around injury and violence prevention and health care career readiness FY 2018 Report of Activities Sharp's ThinkFirst/Sharp on Survival program is a chapter of the ThinkFirst National Injury Prevention Foundation, a nonprofit organization dedicated to preventing brain, spinal cord, and other traumatic injuries through education, research and advocacy. In FY 2018, ThinkFirst/Sharp on Survival provided injury prevention education in a variety of settings to approximately 3,000 East County residents. More than 1,400 of these residents were students in grades nine through 12 who are part of the HASPI program. HASPI is a collaborative network of educators, community organizations and health care industry representatives all working together to increase health and medical career awareness, improve science proficiency in schools and prepare students for future health care careers. Through the partnership and financial support from HASPI, the ThinkFirst/Sharp on Survival program offered schools in SDC's east region a variety of services including classroom presentations, small assemblies and offsite learning expos. HASPI school-site programs consisted of one- to two-hour classes on topics such as the modes of injury, disability awareness, and the anatomy and physiology of the brain and spinal cord. These programs were enhanced by powerful personal testimonies from individuals with traumatic brain injury (TBI) or SCI, known as Voices for Injury Prevention (VIPs). In FY 2018, ThinkFirst/Sharp on Survival expanded its delivery of HASPI education within East County through presentations to 65 students at Mountain Empire High School, located in the rural backcountry of southeastern SDC. Also through the HASPI program, in FY 2018, a dozen students from West Hills High School interested in pursuing careers in physical rehabilitation participated in a half-day, interactive tour of the SMH Rehabilitation Center. Students rotated through five stations that provided hands-on experiences in adapted dressing techniques, wheelchair mobility and various memory and problem-solving activities used in therapy. The experience allowed them to gain a better understanding of physical rehabilitation, as well as the challenges that patients face following a life-changing event. With grant funding from the Grossmont Healthcare District (GHD), ThinkFirst/Sharp on Survival provided further outreach to East County schools through presentations reaching more than 70 students at Avocado Elementary School. Presentations were provided to students during three assemblies that focused on conveying the permanence of injuries, TBI, SCI and disabilities. In addition, a group of fourth graders received education on booster seat safety. Following the presentations, students engaged in hands-on learning and disability education through exploration of wheelchair accessible vans. This activity aimed to show students that individuals are more alike than different, regardless of physical ability. ThinkFirst/Sharp on Survival also presented on injury prevention, TBI, SCI and disability awareness to approximately 900 college students in SDSU's Disability in Society course. The class is open to a variety of majors, enabling ThinkFirst/Sharp on Survival to reach a broad audience of young adults. After the presentation, students had the opportunity to ask questions related to the challenges nonprofit organizations face when conducting public health education and outreach. In July, ThinkFirst/Sharp on Survival presented to 20 members of the Casa De Oro, El Cajon and Sunrise Optimist Clubs. As longtime residents of these communities and ongoing supporters of ThinkFirst San Diego, these members request a special guest presentation every few years to learn about”

“* Total employment in California is projected to increase by 6.5 percent between 2014 and 2024, adding an additional 9.8 million people. The health care and social assistance sector is expected to be the fastest growing service industry, increasing its employment share from 12 percent in 2014 to 13.6 percent in 2024. Occupations and industries related to health care are projected to add the most new jobs, with an increase of 2.3 million jobs (BLS, 2015). * Half of the occupations projected to grow fastest in the U.S. from 2016 to 2026 are in the health care sector. Among the top 10 fastest growing occupations in all sectors, BLS projects a 37.3 percent increase in physician assistants, a 36.1 percent increase in nurse practitioners, a 31 percent increase in physical therapist assistants, and a 47.3 percent increase in home health aides. The demand for home health aides will almost double by 2026, driven by an aging population that will require greater assistance with daily activities (BLS, 2018). * As of 2015, SDC was one of 26 counties in California designated as a Registered Nurse Shortage Area by the California Healthcare Workforce Policy Commission (OSHPD Healthcare Atlas, 2017). * The U.S. Department of Health and Human Services Bureau of Health Workforce (BHW) projects that California will face a shortage of 44,500 full-time nurses by 2030 if current levels of health care are maintained ? the most severe shortage among all states (BHW, 2017). * The California Health Care Almanac reported that in 2015, 44 percent of the employed RN workforce was over the age of 50. As this age group approaches retirement, it will be critical to train younger RNs to handle the turnover (California Health Care Foundation (CHCF), 2017). * The BLS projects employment of more than 400,000 RNs in California in 2026, which would be an increase of 15 percent from 2016. Compared to other health care practitioners and technical health care operators, RNs are projected to have the most opportunity for employment in 2020 (BLS, 2018). * According to forecasts performed by the Healthforce Center at the University of California, San Francisco (UCSF), the demand for primary care clinicians in California will increase 12 to 17 percent by 2030. These forecasts predict that the southern border region will experience some of the highest levels of clinician shortages in the state. UCSF recommends a comprehensive and holistic targeted strategy to enhance the education pipeline, improve recruitment and retention, maximize the existing workforce, and leverage workforce data (UCSF, 2017-2018). * An increased demand for a diverse and culturally and linguistically competent workforce is projected for the health care industry. Therefore, it is important for the industry to start creating a workforce pipeline in collaboration with high schools and postsecondary educational sectors, as well as policy makers, educators, health care leaders and the local community. Long-term investment in creating mentorship, on-the-job shadowing, volunteer and internship opportunities for high school students will help prepare them for college and a career, build a strong and diverse health care workforce, and prevent future industry workforce shortages (Employer-Defined Value: Improving the Connection Between Health Care Employers and Schools to Increase Work-Based Learning Opportunities for High School Students, CHA, 2015). Objectives * Collaborate with local middle and high schools to provide opportunities for students to explore health care professions * Collaborate with local colleges and universities to provide professional development lectures to students from local colleges and universities * Offer professional development opportunities for community health professionals FY 2018 Report of Activities Throughout the academic year, SGH provided more than 840 students from colleges and universities throughout San Diego with various placement and professional development opportuniti”

“In FY 2018, SGH sponsored Ethics in Business, a program of the San Diego East County Chamber of Commerce and the GUHSD Career Technical Education Department. The program is designed to train high school students to become principled leaders through curriculum and case studies focusing on good ethical behavior and is the result of a cooperative effort by a group of business, education and community leaders. SGH staff were on-site to assist during the event, which was attended by approximately 200 high school students. With health care workforce shortages on the rise, SGH created the I Inspire program, a weeklong program that encourages high school students from underrepresented backgrounds to consider careers in health care and learn about nursing directly from those in the field. To qualify for the program, students must be in good academic standing and enter their senior year within SDC's east region. Applicants must also have permanent resident status or U.S. citizenship, and speak fluent English in addition to either Arabic, Farsi, Kurdish, Turkish or Dari. SGH partnered with License to Freedom, a local nonprofit that advocates for and empowers immigrants and refugees in SDC, to recruit participants. Students shadowed nurses in outpatient, acute and critical care; women's health and surgical services; and administrative settings. In addition, daily meet-and-greet luncheons with representatives from local colleges and universities including PLNU, National University, USD and others exposed students to a wide variety of nursing programs and degrees, as well as the processes for pursuing each educational track. Lastly, students created community-based education projects on topics chosen from the CHNA. In small groups, the students performed research and created poster presentations and handouts on obesity, mental health, diabetes and heart health and shared these projects at both SGH and a community health fair in El Cajon. SGH and SMH continued to provide one of only two mobile intensive care nurse (MICN) training programs in SDC. Together, the hospitals offered extensive six-week training programs for San Diego base station MICN emergency nurses. Participants received certification through the County of San Diego EMS upon successful completion of a 48-hour classroom component, a passing score of 85 percent or higher on the County of San Diego EMS final examination of SDC protocols, and completion of mandatory ride-along hours in a paramedic unit. In addition, as a radio base station, the Sharp Prehospital/EMS department provided two continuing education Joint Base Regional Care Conferences for local EMS personnel and MICN trained RNs throughout SDC. FY 2019 Plan SGH will do the following: * In collaboration with GUHSD, participate in the HESI * Continue to participate in the HSHMC program * Continue to provide internship and professional development opportunities to college and university students throughout San Diego * Continue to collaborate with local universities to provide professional development lectures for students * Continue to offer HealthCare Towne to middle and junior high school students Identified Community Need: Support During the Transition of Care Process for High-Risk, Underserved and Underfunded Patients Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * As part of the SGH 2016 CHNA process, discussions with Sharp's Community-based Care Transitions Program (CCTP)/CTI staff identified the following strategies for improving the health of SDC's vulnerable, high-risk, or medically underserved patients: coaching; educating patients about their disease and the health care system; providing education tailored to specific cultural and linguistic groups; providing transportation, support, hope and love; and providing a personal health record with resources and information about their medications. * A k”

“* According to the same report, ED visits resulting in inpatient psychiatric admissions increased 30 percent from 2010 to 2015. More robust community behavioral health services for low-income and uninsured patients may decrease unnecessary ED use (CHCF, 2018). Objectives * Connect high-risk, underfunded patients and community members to local resources and organizations for low-cost medical equipment, housing options and follow-up care * Assist economically disadvantaged individuals through transportation and financial assistance for pharmaceuticals * Collaborate with community organizations to provide services to chronically homeless individuals * Through the CTI program, provide high-risk, under- and unfunded patients with health coaching, support and resources that address SDOH to ensure a safe transition home and continued health and safety FY 2018 Report of Activities In FY 2018, SGH continued to provide post-acute care facilitation for high-risk patients, including individuals who were homeless or without a safe home environment. Individuals received referrals to and assistance from a variety of local resources and organizations. These groups provided support with transportation, placement, medical equipment, medications, outpatient dialysis and nursing home stays. SGH referred high-risk patients, families and community members to churches, shelters and other community resources for food, safe shelter and other resources. For unemployed, uninsured and underinsured patients, or for those who simply cannot afford the expense of DME, including a wheelchair, walker or cane due to a fixed income, SGH has committed to providing medically necessary equipment for high-risk patients upon discharge. SGH case managers and social workers actively seek DME donations from the community and SGH Volunteer Services, providing nearly 300 DME items in 2018. In addition, SGH paid nearly $46,000 for uninsured patients to receive continued short-term rehabilitative care in a skilled nursing facility (SNF) to improve patient mobility and stability. To assist economically disadvantaged individuals, SGH provided more than $198,000 in free medications, transportation, lodging and financial assistance through its Project HELP funds. These funds assisted nearly 6,800 individuals in FY 2018. In addition, SGH pharmacists assisted more than 400 economically disadvantaged patients with outpatient prescriptions valued at more than $228,000. In addition, SGH continued to collaborate with community organizations to provide services to chronically homeless patients. Through its collaboration with the SDRM, SGH discharged chronically homeless patients or patients who have exhausted other community housing resources to the SDRM's Recuperative Care Unit. This program allows chronically homeless patients to receive follow-up medical care through SGH in a safe and secure space, and also provides psychiatric care, behavioral health care, substance abuse counseling and guidance from the SDRM's programs in order to help patients recuperate and get back on their feet. The SDRM assists patients with FSD and CalFresh applications; connects patients to community resources, including St. Paul's PACE and JFS; assists with permanent housing; provides programs that support continued sobriety and residential treatment; and collaborates with St. Vincent de Paul Village to assist with the SSI application process through HOPE (Homeless Outreach Program for Entitlement) San Diego - an effort to increase access to SSI for people who are homeless or at risk of homelessness. Further, in collaboration with Sharp Global Patient Services, SGH transferred three homeless hospice patients to their native countries and reunited them with family and friends. Beginning in 2014, SGH piloted the CTI program for its high-risk, vulnerable populations, including Medi-Cal, Medi-Cal pending/presumptive, self-pay, no-pay, refugee populations, homeless and Medicare A or B only patients. Modeled af”

“The CTI program's partnership with 2-1-1's Health Navigation Program has proven to be one of the most innovative and impactful collaborations of the CTI program, and truly a best practice in delivering care to community members facing inequities. 2-1-1's Health Navigation Program provides in-depth care coordination to better connect, empower, educate and advocate for clients with health needs. 2-1-1 Health Navigators work with community members experiencing issues in accessing care, managing chronic conditions, and those who are uninsured or underinsured. Health Navigators assess specific needs, which are unique to the individual's health condition and situation; refer and educate them about options and community resources; and advocate on their behalf when needed. Health Navigators ensure access and utilization of the services that community members are referred to and then conduct follow-up communication with them over time. Through the partnership between SGH and 2-1-1, CTI patients are referred to the 2-1-1 Health Navigation Program to address health and social needs and leverage 2-1-1's enrollment services, housing coordination and advocacy. At intake and again at completion of care coordination, 2-1-1 uses a risk rating scale to measure and address: changes in vulnerability related to SDOH (access to food, housing, transportation, etc.); hospital readmission risk; and patient satisfaction and patient self-efficacy to both demonstrate program impact and identify areas for improvement. Based on the rating scale, patients fall into one of six categories that allow the Health Navigators to tailor the services to the individual and connect patients with the appropriate community resources. CTI patients referred to 2-1-1 are assessed on a variety of measures such as housing, nutrition, primary care, health management, social support, activities of daily living, ambulance use, transportation, income and employment. The risk assessment tool has identified the top needs as housing, food assistance and primary care services. Funded by the Grossmont Hospital Foundation, the CTI program's partnership with 2-1-1 continues to successfully demonstrate the value of SDOH support for high-risk patients post hospital discharge. In FY 2018, nearly 80 patients were referred to 2-1-1. In the third year of this partnership, 100 percent of CTI patients that completed 2-1-1 Health Navigation reduced their vulnerability in at least one SDOH domain (e.g., housing, nutrition, etc.). In its second full year of implementation, the partnership with 2-1-1 continued to demonstrate significant decreases in vulnerability in the domains of nutrition and housing. In addition, the partnership has had a significant impact on readmission rates among participants. In the second year of the program, the readmission rate for CTI patients who completed the 2-1-1 Health Navigation Program was 10.8 percent, a dramatic decrease from the readmission rate of nearly 30 percent, associated with patients who qualify for CTI, but do not enroll in the program. In addition, survey outcomes from the partnership revealed that 96 percent of CTI patients expressed confidence in the care plan to manage their health following completion of the 2-1-1 Health Navigation Program. These outcomes support the ultimate goal of the CTI program - to empower patients and community members with resources and skills to maintain their health and well-being. FY 2019 Plan SGH will do the following: * Continue to provide post-acute care facilitation to high-risk patients * Continue and expand the DME donations project to improve access to necessary medical equipment for high-risk patients who cannot afford DME * Continue to administer Project HELP funds to those in need * Continue to collaborate with community organizations to provide medical care, financial assistance, and psychiatric and social services to chronically homeless patients * Continue to provide high-risk, Medi-Cal and unfunded patie”

“* Health Research, Education and Training Programs included time devoted to education and training for health care professionals and student and intern supervision. Definition of Community Sharp HospiceCare is located at 8881 Fletcher Parkway in La Mesa, ZIP code 91942. Sharp HospiceCare provides comprehensive end-of-life hospice care, specialized palliative care and compassionate support to patients and families throughout SDC. For Sharp's 2016 CHNA process, the Dignity Health/Truven Health Community Need Index (CNI) was utilized to identify vulnerable communities within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States of America (U.S.) based on specific barriers to health care access, including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care, and preventable hospitalizations. According to the CNI, communities served by Sharp HospiceCare with especially high need include, but are not limited to, East San Diego, City Heights, North Park, the College Area, and Downtown San Diego. Description of Community Health In 2018, there were 485,911 residents ages 65 and older in SDC, representing 14.6 percent of the population. Between 2018 and 2023, it is anticipated that SDC's senior population will grow by 22.6 percent. In 2016, 14 percent of the SDC population reported living below 100 percent of the federal poverty level (FPL). The county's unemployment rate was 7.5 percent and 5 percent of households received Supplemental Security Income. According to data from the San Diego Hunger Coalition, one in seven, or 15 percent of the SDC population experienced food insecurity. An additional one in five San Diegans were food secure but relied on supplemental nutrition assistance to support their food budget. In 2016, 21 percent of households in SDC participated in Supplemental Nutrition Assistance Program (SNAP) benefits, while 23.3 percent of those below 138 percent of the FPL were eligible for such benefits.2 Please refer to Table 32 for SNAP participation and eligibility in SDC. Table 32: Food Stamps/SNAP Benefit Participation and Eligibility Estimates for SDC, 2016 Food Stamps/SNAP Benefits: Households - 7.0% Families with Children - 7.1% Eligibility by Federal Poverty Level: Population below or at 130% FPL - 19.5% Population below or at 138% FPL - 21.0% Population 139% to 350% FPL - 32.7% Source: County of San Diego HHSA, Public Health Services, Community Health Statistics Unit, 2018. Demographic Profiles, 2016, and U.S. Census Bureau, American Community Survey 2012-2016. In SDC in 2016, 93.8 percent of children ages zero to 17, 80.3 percent of young adults ages 18 to 24, 81.1 percent of adults ages 25 to 44, 87.4 percent of adults ages 45 to 64, and 98.5 percent of seniors ages 65 and older had health insurance. Health insurance coverage for each age group was lower than the Healthy People 2020 (HP2020) national target of 100 percent health insurance coverage for all individuals under age 65. See Table 33 for health insurance coverage in SDC in 2016. Table 33: Health Insurance Coverage in SDC, 2016 Children 0 to 17 years: Current Rate - 93.8% HP2020 Target - 100% Young adults 18 to 24 years: Current Rate - 80.3% HP2020 Target - 100% Adults 25 to 44 years: Current Rate - 81.1% HP2020 Target - 100% Adults 45 to 64 years: Current Rate - 87.4% HP2020 Target - 100% Seniors 65+ years Current Rate - 98.5% HP2020 Target - 100% Source: County of San Diego HHSA, Public Health Services, Community Health Statistics Unit, 2018. Demographic Profiles, 2016, and U.S. Census Bureau, American Community Survey 2012-2016. According to the California Health Interview Survey (CHIS), 25.8 percent of SDC's population was covered by Medi-Cal. See Table 34 for details. Table 34: Medi-Cal (Medicaid) Coverage in SDC, 2016-2017 Covered by Medi-Cal - 25.8% Not covered by Medi-Cal - 74.2% Source: 2016-2017 CHIS CHIS data”

“Identified Community Need: End-of-Life and Advanced Illness Management Education for Community Members Rationale references the findings of Sharp's 2016 CHNAs, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * In Sharp's 2016 CHNAs, senior health was identified as one of the priority health issues for community members served by Sharp. * As part of Sharp's 2016 CHNAs, discussions with nurses and social workers from Sharp's Senior Health Centers identified the following challenges to improving the health of seniors in SDC: access to care issues due to aging; decreased driving or loss of support system; difficulty purchasing medications due to financial issues; lack of transportation or lack of motivation; difficulty understanding medical instructions; inability to recognize a health problem exists; memory issues; and the perception that health issues and loneliness are a normal part of aging. * In 2016, the top 10 leading causes of death among adults ages 65 and older in SDC were (in rank order): overall cancer, Alzheimer's disease and other dementias, coronary heart disease (CHD), stroke, chronic obstructive pulmonary disease/chronic lower respiratory diseases, overall hypertensive diseases, diabetes, unintentional injuries, Parkinson's disease and falls. * In 2016, hospitalization rates among seniors were higher than the general population due to CHD, stroke, chronic lower respiratory diseases, nonfatal unintentional injuries (including falls), overall cancer and arthritis. * According to 2017 CHIS data, 37.2 percent of SDC adults ages 18 to 64 living at 200 percent of the FPL reported that they were not able to afford enough food. * According to the World Health Organization, chronic diseases are responsible for 71 percent of all deaths globally. Risk factors for chronic diseases include socioeconomic status, diet, tobacco use and physical activity level (World Health Organization, 2018). Nearly 60 percent of Americans now live with at least one chronic condition, while 42 percent have more than one (RAND Corporation, 2017). * Nearly two-thirds of California seniors on Medicare had two or more chronic conditions in 2012, and more than one-third had four or more. These seniors have an increased need for care and higher risk for mortality as well as poorer day-to-day functioning (California Health Care Almanac Beds for Boomers Report, 2015). * While chronic diseases place significant burdens on individuals and health care systems, community-taught self-management of symptoms is possible. Managing symptoms of chronic diseases can improve quality of life and reduce health care costs (National Council on Aging, 2018). * According to a 2018 report from the California Task Force on Family Caregiving, there are 4.5 million Californians providing unpaid care to individuals ages 18 and older. Informal caregivers face many challenges in this role, including balancing employment with caregiving; accessing culturally relevant and competent services; paying for supportive services; and attending to their own health and well-being (California Task Force on Family Caregiving, 2018). * According to AARP, more than 40 million people in the U.S. currently act as unpaid caregivers to people ages 65 and older. More than 10 million of these caregivers are millennials with separate part- or full-time jobs, and one in three employed millennial caregivers earns less than $30,000 per year (AARP, 2018). * According to a report from the National Alliance for Caregiving (NAC) and AARP titled Caregiving in the U.S. 2015, 60 percent of unpaid caregivers are female, and nearly 1 in 10 caregivers are ages 75 or older (AARP and NAC, 2015). * About 6 in 10 caregivers assist with medical/nursing tasks for their loved one, and 42 percent of these caregivers are performing those tasks without any formal training. According to Caregiving in the U.S. 2015, 84 percent of caregivers report that they could us”

“Sharp HospiceCare supports the San Diego community in the areas of end-of-life care, aging and caregiving through participation in a variety of local organizations including SDCCEOLC, SDRHCC, San Diego County HVP, San Diego Chapter of the HPNA, San Diego POLST Coalition/SDCCC, Caregiver Coalition of San Diego, SoCAN, South Bay Senior Providers and ECSSP. In partnership with these and other community organizations, in FY 2018, Sharp HospiceCare reached nearly 3,000 community members through free education and outreach on a variety of end-of-life and AIM topics, including hospice, palliative care and caregiving, at community health fairs, conferences and other events. Locations included churches, senior living centers, and community health agencies and organizations throughout SDC. In October, Sharp HospiceCare helped plan and facilitate the San Diego Community Action Network (SanDi-CAN) 11th annual community conference at the Balboa Park Club titled Planning Ahead: Ensuring Your Decisions Will Be Honored. The free event helped approximately 100 seniors and family members identify their end-of-life values and goals of care, and learn the communication skills necessary to make informed health care planning decisions. In April, Sharp HospiceCare partnered with the Sharp Senior Resource Centers to provide two aging conferences for community seniors, family members and caregivers, titled Healthy and Safe Aging. Held at the Point Loma Community Presbyterian Church and the La Mesa Community Center, the free conferences educated more than 200 attendees about planning for a healthy, safe and mindful future. In August, Sharp HospiceCare and SCVMC hosted a similar conference at Fredericka Manor Retirement Community in Chula Vista that reached approximately 100 community members. Sharp HospiceCare partnered with the Caregiver Coalition of San Diego to offer free conferences to approximately 200 community members who provide care for a friend or family member. Conferences included What Every Caregiver Should Know: A Guided Tour, held at the Solana Beach Presbyterian Church in July; Three P's of Caregiving: Purpose, Preparedness and Providers, held at St. Paul's Plaza in August; and Caring for Someone With Dementia: Caregiver Conference, held at the La Mesa Community Center in September. The conferences included resource fairs as well as presentations on various caregiving topics, including but not limited to brain health and dementia; avoiding caregiver burnout; communication and denial; letting go of self-expectations; emotional aspects of caregiving; fall prevention and safety; understanding care options; essential documents; and paying for care. Sharp HospiceCare provided end-of-life and AIM education and resources to more than 2,000 community members at a variety of health fairs and events throughout the year. Senior and caregiver-oriented events included Spring Into Healthy Living at the McGrath Family YMCA; Lakeside Senior Health Fair; ECSSP's 19th annual Senior Health Fair; SanDi-CAN and So-CAN Interactive Technology & Health Fair; Summer Senior Resource Event at the Mira Mesa Senior Center; a health fair at Paradise Village retirement community; County of San Diego Aging & Independence Services Aging Summit 2018; Beyond the Sky Solutions' annual Female Care Providers Conference; and The San Diego Union Tribune's Successful Aging Expo and Caregiver SD Community Expo. Outreach at additional community events took place at the Sharp Women's Health Conference; La Maestra Community Health Centers' City Heights Health Fair; San Diego Gas & Electric's bi-annual employee health fair; SCVMC's Changing Minds, Minds Matter South County mental health fair; Parkinson's Association of San Diego 2018 Step by Step Walk; University of California, San Diego Women's Conference; and the open house at the SGH Burr Heart and Vascular Center. In addition, throughout the year, Sharp HospiceCare provided end-of-life and AIM presentations and resources to nea”

“* Achieve WHV Partner Level IV to improve access to and quality of care for community veterans * Continue to provide a wig donation program Identified Community Need: Advance Care Planning Education and Outreach to Community Members and Health Care Professionals Rationale references the findings of Sharp's 2016 CHNAs, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The Sharp 2016 CHNAs identify care at the end of life as a critical issue for the senior population. * Discussions held with Sharp cancer patient navigators as part of Sharp's 2016 CHNAs indicated the following major challenges to helping oncology patients: difficulty having end-of-life conversations, which may be due to cultural variation, or lack of physician experience with palliative care; and few individuals having an advance directive. * According to the CDC, Americans have gained an average of 30 additional years in lifespan over the last century. Americans now experience mortality at a much later age and largely due to chronic disease. Planning for end-of-life care increases individual autonomy, ensures individuals feel their voice is heard, and relieves stress for those surrounding elderly individuals. In 2017, only 30 percent of Americans had advance care plans. With the largest generation of Americans now aging, education on end-of-life care is a public health issue (CDC, 2017). * A 2017 systematic review published in Health Affairs found that 36.7 percent of Americans had completed an advance directive, and 29.3 percent had living wills. Factors contributing to low ACP completion include: tedious legal formalities in executing an advance directive; initial lack of clinician support for advance care directives, which is perpetuated in provider culture today; and the lack of depth and tailoring of advance directives to fully represent patients' preferences (Kuldeep et al., 2017). * According to research published in the Public Library of Science's peer-reviewed journal PLOS One, barriers to ACP include: competing work demands among clinicians; the emotional and interactional nature of patient-clinician and patient-family conversations around ACP; cultural views on death; language differences, socioeconomic status and social isolation of the patient; and structural difficulties in implementing an ACP-focused framework of care within health care organizations. Proper training and support for clinicians is essential to facilitate increased ACP within health care organizations (Lund, Richardson, & May, 2015). * Despite evidence that ACP can improve the quality of the end of life, it is most likely to be completed by white, socially integrated, higher income adults compared to other demographic groups. Advance directive completion rates are two to three times higher among whites when compared to blacks and Latinos, underscoring a need to expand public awareness and access to ACP. Community-based initiatives to increase conversations around ACP - especially socially, culturally, religiously and language-tailored programs - may help offer resources and leadership to previously underserved populations (Gerontological Society of America, 2017). * While 92 percent of Americans say it's important to discuss their wishes for end-of-life care, only 32 percent have had such a conversation. In addition, 95 percent of Americans say they would be willing to talk about their wishes, and 53 percent even say they'd be relieved to discuss it (The Conversation Project National Survey, 2018). * A Consumer Reports survey of 2,015 adults suggests that Americans would prefer to die at home: 86 percent said they would consider receiving end-of-life-care at home, but just 36 percent said the same about getting that care in a hospital. Despite this, about 60 percent of Americans die in acute care hospitals, 20 percent in nursing homes and only 20 percent at home (Stanford School of Medicine - Palliative Care, 2014). * Advanc”

“Since 2014, Sharp has offered its own Advance Health Care Directive to guide the public in outlining their health care decisions. The document is publicly available on Sharp's website in both English and Spanish and uses easy-to-read language to describe what an advance directive is and how and why to complete one. The form allows individuals to put their health care wishes into writing and appropriately sign the advance directive. With this witnessed signature, the advance directive becomes a legal document that identifies the appropriate informed substitute decision maker and serves as a tool for health care decision-making. Additional contact information is provided for community members who are interested in speaking with a Sharp ACP facilitator. Throughout FY 2018, the Sharp ACP team provided approximately 80 phone and in-person consultations to community members seeking guidance with identifying their personal goals of care and health care preferences, appointing an appropriate health care agent, and completing an advance directive. In FY 2018, the Sharp ACP team engaged more than 1,100 community members in education on ACP and POLST. Education was provided for a variety of senior and caregiver audiences, including SGH's Club 65; Silvercrest Senior Residence; La Costa Glen retirement community; senior community members in collaboration with the SGH Senior Resource Center; East County Senior Health & Information Fair at the La Mesa Community Center; County of San Diego Aging & Independence Services 2018 Aging Summit; Sharp Senior Resource Centers' Senior Health & Information Fair; Caregiver Coalition's Caregiving Conference at St. Paul's Plaza; and Sharp Aging Conferences at the La Mesa Community Center, Fredericka Manor Retirement Community and Point Loma Community Presbyterian Church. Education for additional community groups and sites included City of Chula Vista employees, including the public works and police departments; U.S. Customs and Border Protection employees and their family members; Rotary Club of El Cajon; ACP Community Education Forum at Scripps Mercy Hospital; SDCCEOLC's Practical Planning for End of Life Care event; Salvation Army Escondido Corps; SGH Congestive Heart Failure Class and Support Group; SGH Better Breather's Club; SCVMC Heart Health Expos; annual ACP seminar at SCVMC; and the Sharp Disaster Preparedness Expo. Sharp HospiceCare honored National Healthcare Decisions Day (NHDD) in FY 2018, which is a nationwide initiative celebrated every April to educate adults of all ages about the importance of ACP. Team members provided NHDD presentations at a variety of community events and sites throughout the month, including the Oasis adult learning center in La Mesa; Oasis San Diego Woman's Club; San Diego LGBT Lesbian, Gay, Bisexual and Transgender) Community Center; La Mesa Adult Enrichment Center; Santa Sophia Catholic Church; Golden Age Garden Apartments; SCHHC Community Wellness Fair; Norman Park Senior Center; Sharp Aging Conference at the La Mesa Community Center and Point Loma Community Presbyterian Church; Wellness Wednesdays at the Dr. William C. Herrick Community Health Care Library; Sharp Women's Health Conference; and the San Diego Post-Acute Care Collaborative. Sharp HospiceCare reached more than 600 community members through these NHDD presentations. Sharp's ACP team reached an additional 30 community members through free ACP workshops in FY 2018, including a monthly workshop at the David and Donna Long Center for Cancer Treatment at SGH as well as workshops at the Laurel Amtower Cancer Institute at SMH in February and June. During the workshops, individuals impacted by cancer received guidance on identifying their personal health care choices, communicating their wishes to loved ones and developing their advance directive. Gaps in ACP exist among underserved populations. In FY 2018, Sharp HospiceCare was one of 50 sites across the country selected to receive grant funding from the Hosp”

“FY 2019 Plan Sharp HospiceCare will do the following: * Provide free ACP and POLST education and outreach to community members through phone and in-person consultations * Collaborate with community organizations to provide educational classes and events to raise community awareness of ACP * Both independently and in collaboration with SDCCC and SDCCEOLC, provide community events to promote the importance of ACP in honor of NHDD * Continue to provide ACP education and outreach to local, state and national health care professionals * Serve as a community resource regarding the End of Life Option Act * Continue to collaborate with community partners to provide community members with access to advance directive and POLST forms through the San Diego Healthcare Information Exchange * Continue to participate in the CHCF's POLST eRegistry initiative with CCCC and EMSA * As participants in Sharp's ACP Work Group, update Sharp's Advance Health Care Directive to include simplified language and new interactive and video-based components Identified Community Need: Health Professions and Student Education and Training Rationale references the findings of Sharp's 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * According to the 2017 San Diego Workforce Partnership (SDWP) Health Care Priority Sector report, the health care industry in SDC experienced a 44 percent increase in employment growth between 2006 and 2016, higher than the 38 percent growth rate seen by the state of California (SDWP, 2017). * In its Employment Projections - 2016-2026 report, the U.S. Bureau of Labor Statistics (BLS) projects that health care support occupations and health care practitioners/ technical occupations will contribute about one-fifth of all new jobs and account for almost half of the 30 fastest growing occupations. Several factors leading to the increased demand for these professions include: projected population growth in the next decade; an aging U.S. population; more people living with chronic conditions, such as diabetes or obesity; improvements in medicine and technology; and federal health insurance reform, which has increased the total number of Americans with health insurance coverage (BLS, 2016). * Total employment in California is projected to increase by 6.5 percent from 2014 to 2024, adding an additional 9.8 million people. The health care and social assistance sector is expected to be the fastest growing service industry, increasing its employment share from 12 percent in 2014 to 13.6 percent in 2024. Occupations and industries related to health care are projected to add the most new jobs, with an increase of 2.3 million jobs (BLS, 2015). * Half of the occupations projected to grow fastest in the U.S. from 2016 to 2026 are in the health care sector. Among the top 10 fastest growing occupations in all sectors, BLS projects a 37.3 percent increase in physician assistants, a 36.1 percent increase in nurse practitioners, a 31 percent increase in physical therapist assistants, and a 47.3 percent increase in home health aides. The demand for home health aides will almost double by 2026, driven by an aging population that will require greater assistance with daily activities (BLS, 2018). * As of 2015, SDC was one of 26 counties in California designated as a Registered Nurse Shortage Area by the California Healthcare Workforce Policy Commission (OSHPD Healthcare Atlas, 2017). * The BLS projects employment of more than 400,000 RNs in California in 2026, which would be an increase of 15 percent from 2016. Compared to other health care practitioners and technical health care operators, RNs are projected to have the most opportunity for employment in 2020 (BLS, 2018). * An increased demand for a diverse and culturally and linguistically competent workforce is projected for the health care industry. Therefore, it is important for the industry to start creating a workforce pipeline in col”

“Objectives * Provide education and training opportunities around end-of-life care and ACP for students and interns * Through education, training and outreach, guide local, state and national health care organizations in the development and implementation of appropriate services for the needs of the aging population, including individuals in need of AIM * Maintain active relationships and leadership roles with local and national organizations FY 2018 Report of Activities In FY 2018, Sharp HospiceCare provided training opportunities for students studying nursing, pharmacy and ancillary disciplines. Academic institution partners included CSUSM, Chapman University School of Pharmacy, Grand Canyon University, Keck Graduate Institute, Lake Erie College of Osteopathic Medicine, San Diego State University (SDSU), Touro University and Western Governors University. Students shadowed nurses and providers during their work day, including at Sharp HospiceCare's hospice homes. Sharp HospiceCare supports San Diego's future health care workforce through classroom-based lectures designed to enhance students' understanding of hospice and palliative care. In FY 2018, education was provided to approximately 225 nursing students from Azusa Pacific University, University of San Diego and CSUSM, as well as to more than 50 social work students from SDSU. Topics included ACP, POLST, goals of care, hospice, palliative care, bioethics and bereavement. In addition, in November, the ACP team supported the professional development of a religious studies professor from SDSU through the provision of education on improving communication at the end of life. Sharp HospiceCare leadership provided education, training and outreach to more than 1,500 local, state and national health professionals throughout the year. These efforts sought to guide industry professionals in achieving person-centered, coordinated care through the advancement of innovative hospice and palliative care initiatives. Audiences included the National Association of ACOs Conference; Baptist MD Anderson Cancer Center; Center to Advance Palliative Care National Seminar; Coalition to Transform Advanced Care National Summit; St. Joseph Home Health; CCCC Annual Summit; Health Insight End of Life Care Summit; San Diego Academy of Family Physicians Annual Symposium; a continuing medical education event hosted by MCE Conferences; and Dignity Health. Presentation topics included palliative care, AIM, geriatric frailty, prognostication and innovative approaches in advanced illness care. In addition, in FY 2018, Sharp HospiceCare leadership continued to serve on the board of directors for NHPCO and CHAPCA. Underscoring Sharp HospiceCare's commitment to quality end-of-life care for San Diego veterans, the Sharp HospiceCare interdisciplinary team is trained in ELNEC (End-of-Life Nursing Education Consortium) for Veterans. Administered by the American Association of Colleges of Nursing, the ELNEC project is a national education initiative to improve palliative care. Through Train-the-Trainer courses, the ELNEC for Veterans project trains a core of expert nursing educators on how to provide better palliative care for veterans with life-threatening illness so that they can continue to teach this essential information to practicing nurses and other health care professionals. In March, Sharp HospiceCare partnered with the San Diego County HVP to provide a two-day ELNEC for Veterans Train-the-Trainer course for 50 health professionals, including end-of-life and palliative care staff from the VASDHS as well as individuals from local hospices and community organizations. In addition, as part of its WHV commitment to meet the unique end-of-life needs of veterans and their families, Sharp HospiceCare presented on the WHV program to approximately 150 attendees of the CSU Institute for Palliative Care at CSUSM and SDCCC's High Tech High Touch palliative care conference in June. FY 2019 Plan Sharp HospiceCare will do”

“* According to a study published in the Journal of Pain and Symptom Management, caregivers who receive support and resources from health professionals prior to the death of their loved one may report a more positive death experience for the care recipient, as well as greater satisfaction with the clinical care team. Pre-bereavement interventions may also affect caregivers' level of grief as well as physical and mental health following their loved one's death (Aoun et al, 2018). Objectives * Provide bereavement education, resources, counseling and support to community members who have lost loved ones * Provide individuals and their families with referrals to community services FY 2018 Report of Activities Sharp HospiceCare offers a variety of bereavement services to help grieving community members cope with the loss of a loved one. Services include professional bereavement counseling for individuals and families as well as free community education, support groups and monthly newsletter mailings. In FY 2018, Sharp HospiceCare's licensed clinical therapists with specific training in grief and loss devoted more than 2,600 hours to home, office and phone bereavement counseling with people who have lost loved ones. Referrals to community counselors, mental health services, bereavement support services and other community resources were also provided as needed. Sharp HospiceCare continued to offer the Healing After Loss and the Widow's and Widower's bereavement support groups, which reached nearly 400 community members in FY 2018. Offered quarterly, the groups consisted of eight-week sessions facilitated by skilled mental health care professionals with a specialization in the needs of the bereaved. The Healing After Loss support group focused on addressing the concerns of adults who were grieving the loss of a loved one. Weekly themes included Introduction to the Grief Process; Strategies for Coping with Grief; Communicating with Family and Friends; Experiencing Anger in Grief; Guilt, Regret and Forgiveness; Differentiating Natural Grief and Depression; Use of Ceremony and Ritual to Promote Healing; and Who Am I Now?/What Does Healing Look Like?. The Widow's and Widower's support group addressed concerns of men and women who lost their spouse or partner. Participants had the opportunity to share their emotional challenges and learn coping skills from group members facing similar life situations. In recognition of Mother's Day and Father's Day, in May, Sharp HospiceCare hosted classes and support groups for adults who have lost a parent. Held at the Peninsula Family YMCA and the Grossmont Healthcare District, two Remembering Our Parents classes highlighted the unique aspects of parent loss, coping strategies and how to discover a sense of hope. Designed for adults who lost a parent within the past three to 18 months, a three-session Parent Loss support group offered coping strategies and the opportunity for participants to discuss the impact their parents had on their lives. Nearly 30 community members attended these support groups. In addition, in July and August, Sharp HospiceCare provided 30 community members with education on coping skills during bereavement support groups hosted by the John D. Spreckels Center in Coronado. Sharp HospiceCare supported approximately 150 community members grieving the loss of a loved one during the 2017 holiday season. In November, Sharp HospiceCare held its annual Healing Through the Holidays event at Sharp's system office, which included presentations on understanding grief, improving coping skills, exploring the spiritual meaning of the holidays in the face of grief, and reviving hope. That same month, two similar events titled Coping with Grief During the Holiday Season were held at the Point Loma Community Presbyterian Church and the Grossmont Healthcare District. These events provided practical suggestions for community members to manage the painful feelings of loss that often arise during the”

“* California Hospital Association (CHA) * CHA Board of Trustees * CHA Center for Behavioral Health * CHA Emergency Management Advisory Committee * CHA Hospital Quality Institute Regional Quality Leaders Network * CHA San Diego Association of Directors of Volunteer Services * CHA Workforce Committee * California Immunization Coalition * California Library Association * California Maternal Quality Care Collaborative * California Perinatal Quality Care Collaborative * California Society for Clinical Social Work Professionals * California State University San Marcos * California Teratogen Information Service * Cameron Family YMCA * CHIP Behavioral Health Work Team * Chula Vista Chamber of Commerce * Chula Vista Community Collaborative * Chula Vista Police Foundation * City of Chula Vista * City of San Diego * City of San Diego Park & Recreation * Clairemont Lutheran Church * Community Center for the Blind and Visually Impaired * Consortium for Nursing Excellence, San Diego * Coronado Chamber of Commerce * Coronado Public Library * Coronado SAFE (Student and Family Enrichment) * Coronado Senior Center Planning Committee * Council of Women's and Infants' Specialty Hospitals * County Service Area - 69 Advisory Board * Doors of Change * Downtown San Diego Partnership * East County Action Network * East County Senior Service Providers * Emergency Nurses Association - San Diego Chapter * Employee Assistance Professionals Association * EMSTA College * Family Health Centers of San Diego * Father Joe's Villages * Feeding San Diego * Friends of Scott Foundation * Gary and Mary West Senior Wellness Center * George G. Glenner Alzheimer's Family Centers, Inc. * Girl Scouts San Diego * Grossmont College Occupational Therapy Assistant Advisory Board * Grossmont College Respiratory Advisory Committee * Grossmont Healthcare District Community Grants and Sponsorships Committee * Grossmont Healthcare District Independent Citizens' Bond Oversight Committee * Grossmont Imaging LLC Board * Grossmont Union High School District * Hands United for Children * Health and Science Pipeline Initiative * Health Care Communicators Board * Health Industry Collaboration Effort, Inc. * Health Insurance Counseling and Advocacy Program * Health Sciences High and Middle College (HSHMC) * Healthy Chula Vista Advisory Commission * Helix Charter High School * Hidden Heroes campaign * Home Start, Inc. * Hospice and Palliative Nurses Association - San Diego Chapter * Hospital Association of San Diego and Imperial Counties (HASD&IC) * HASD&IC Community Health Needs Assessment Advisory Group * HSHMC Board * Hunger Advocacy Network * I Love a Clean San Diego * Inner City Action Network * Institute for Public Health, San Diego State University (IPH) * Integrative Therapies Collaborative * International Association of Eating Disorders Professionals * The Jacobs & Cushman San Diego Food Bank * Jewish Family Service of San Diego (JFS) * JFS Behavioral Health Committee * JFS Public Affairs Committee * Kiwanis Club of Bonita * La Maestra Community Health Centers * La Mesa Lion's Club * La Mesa Parks and Recreation * Lantern Crest Senior Living Advisory Board * Las Damas de San Diego International Nonprofit Organization * Las Patronas * Las Primeras * Life Rolls On * Live Well San Diego Check Your Mood Committee * Live Well San Diego - South Region * Lightbridge Hospice * Mama's Kitchen * March of Dimes * Meals on Wheels San Diego County * Meals on Wheels Greater San Diego East County Advisory Board * Mental Health America * Miracle Babies * MRI Joint Venture Board * National Active and Retired Federal Employees Association * National Alliance on Mental Illness * National Association of Hispanic Nurses, San Diego Chapter * National Association of Perinatal Social Workers * National Association of Neonatal Nurses * National Association of Orthopedic Nurses * National Hospice and Palliative Care Organization * National Institute for Children's Health Quality * National University * Ne”

“Form 5471 has been filed on behalf of Grossmont Hospital Foundation by Sharp HealthCare (FEIN 95-6077327).”