Scripps Health

“Offices & positions for which process was used, & year process was begun pursuant to procedures required by tax equity and fiscal responsibility act of 1983 (tefra), scripps health's procedures are as follows: the board of trustees reviews executive compensation for officers and all key employees on an annual basis utilizing comparability data obtained by an external consultant. It is the philosophy of the scripps board of trustees to compensate the corporation's executives fairly relative to the median compensation of peer organizations, considering and making appropriate adjustments for the cost of living in san diego, california and other relevant factors. To accomplish this, the board has adopted a philosophy of targeting executive salaries at approximately the 65th percentile of a national peer group of organizations as determined through an independent outside consultant engaged by the board and will rely on their recommendations using a database of independently collected data. The philosophy states: - for purposes of executive compensation comparisons, scripps will use a national peer group of medical delivery systems of similar revenue size and complexity. The peer group will be reviewed and approved by the human resources and compensation committee. - salaries are targeted at approximately the 65th percentile of the peer group and will reflect the performance of the individual. - total cash compensation is positioned at approximately the 75th percentile of the peer group when maximum level incentives are paid for achievement of maximum level of predetermined objectives agreed upon by the board. - the board selects the 65th percentile for base compensation of peer group adjusted for cost of living of urban west coast market at the 50th percentile (i.e., the 50th percentile of california market is the 65th percentile of national peer market as our executive recruitment market is national). - annually, total cash compensation for each position will not exceed the base salary established for the period plus the maximum incentive percentage payout allowable as determined by the scripps management incentive plan approved by the board of trustees for the respective position. The report from the external consultant engaged to review executive compensation is presented to the human resources and compensation committee on an annual basis and the most recent report was reviewed on january 24, 2018 and march 28, 2018. Review and discussion of such report is documented in the minutes. Form 990, part vi, line 16 joint ventures scripps health has maintained a long standing practice of reviewing all potential joint venture or similar arrangements to ensure that contract terms are consistent with the protection of its tax-exempt status.”

“Availability of documents to the general public financial statements are posted quarterly on the dac (digital assurance certification) website and the municipal securities rulemaking board's (msrb) electronic municipal market access (emma) website in satisfaction of continuing disclosure requirements relating to the organization's tax-exempt debt issuances. The audited financial statements are also attached to this form 990, in accordance with the irs instructions. Scripps health's conflict of interest policy is available upon request.”

“Mission statement founded in 1924 by philanthropist ellen browning scripps, scripps health is a $3.2 billion, private not-for-profit integrated health system in san diego, california. Scripps treats over half a million patients annually through the dedication of 2,600 affiliated physicians and 13,000 employees among its five acute-care hospital campuses, home health care, and an ambulatory care network of clinics, physicians' offices and outpatient centers throughout the san diego region. Recognized as a leader in the prevention, diagnosis and treatment of disease, scripps is also at the forefront of clinical research, genomic medicine, wireless health and graduate medical education. With three highly respected graduate medical education programs, scripps is a long standing member of the association of american medical colleges. More information can be found at www.scripps.org. Today, the health system extends from chula vista to oceanside, with 26 primary and specialty care outpatient centers. A leader in the prevention, diagnosis and treatment of disease, scripps was named by truven in 2013 as one of the top 15 large health systems in the nation for providing high-quality, safe and efficient patient care. On the forefront of genomic medicine and wireless health technology, the organization is dedicated to improving community health while advancing medicine through clinical research and graduate medical education. Scripps has also earned a national reputation as a premier employer, named by fortune magazine as one of america's "100 best companies to work for" every year since 2008. Scripps health's mission statement is as follows: scripps strives to provide superior health services in a caring environment and to make a positive measurable difference in the health of individuals in the communities we serve. We devote our resources to delivering quality, safe, cost-effective, and socially responsible health care services. We advance clinical research, health education, education of physicians and health care professionals, and sponsor graduate medical education. We collaborate with others to deliver the continuum of care that improves the health of our community. Form 990, part iii, line 4a program service accomplishments fulfilling the scripps mission during this fiscal year, scripps devoted $395,361,567 to community benefit programs and services in the areas of uncompensated care, community health services, professional education and health research. Our programs emphasize community-based prevention efforts and use innovative approaches to reach residents at greatest risk for health problems. We make commitments to improve the health of our patients and our san diego communities. As a long-standing member of these communities, and as a not-for-profit community resource, our goal and responsibility are to provide help and assistance for all who come to us for care, and to reach out especially to those who find themselves vulnerable and without support. This responsibility is an intrinsic part of our mission. Through our continued actions and community partnerships, we strive to raise the quality of life in the community as a whole. Assessing community need scripps health has a long history of responding to the health needs of the communities it serves, extending beyond traditional hospital care to address the health care needs of the regions most vulnerable populations. Community health needs assessment (chna) originated from california state wide legislation in the early 1990's. Sb 697 took effect in 1995, which required private non-profit hospitals to submit detailed information to the office of statewide health planning and development (oshpd) on their community benefit contributions. Annual hospital community benefit reports are summarized by oshpd in a report to the legislature, which provides valuable information for government officials to assess the care and services provided to their constituents. The sb 697 requireme”

“Overview and background in may 2015, hasd&ic contracted with the institute for public health (iph) at san diego state university (sdsu) to provide assistance with the collaborative health needs assessment that was officially called the hasd&ic 2016 community health needs assessment (2016 chna). The objective of the 2016 chna is to identify and prioritize the most critical health-related needs in san diego county based on feedback from community residents in high need neighborhoods and quantitative data analysis. The 2016 chna involved a mixed methods approach using the most current quantitative data available and more extensive qualitative outreach. Throughout the process, the iph met bi-weekly with the hasd&ic chna committee to analyze, refine, and interpret results as they were being collected. The results of the 2016 chna will be used to inform and adapt hospital programs and strategies to better meet the health needs of san diego county residents. Community defined for the purposes of this 2016 chna, the service area is defined as the entire county of san diego due to a broad representation of hospitals in the area. Over three million people live in the socially and ethnically diverse county of san diego. Below are selected community statistics: - nearly 15% of san diegans live in households with income below 100% of the federal poverty level. - almost 15% of san diegans aged 25 and older have no high school diploma. - a greater proportion of latinos, african americans, native americans, and individuals of other races live in poverty compared to the overall san diego population. - approximately 46% of households in san diego have housing costs that exceed 30% of their income. - approximately 1 in 7 san diegans are food insecure. - approximately 16% of san diegans aged 5 and older have limited english proficiency and 8.5% are linguistically isolated. Additional information on socioeconomic factors, access to care, health behaviors, and the physical environment can be found in the full scripps 2016 chna report at scripps health 2016 community health needs assessment report. Because of its large geographic size and population, the san diego county health and human services agency (hhsa) organized their service areas into six geographic regions. Central, east, north central, north coastal, north inland and south. When possible, data is presented at a regional level to provide more detailed understanding of the population. Scripps health community served hospitals and health care systems define the community served as those individuals residing within its service area. A hospital or health care system service area includes all residents in a defined geographic area surrounding the hospital. Scripps serves the entire san diego county region with services concentrated in north coastal, north central, central and southern region of san diego. Community outreach efforts are focused in those areas with proximity to a scripps facility. Scripps hosts, sponsors and participates in many community-building events throughout the year. Scripps serves the entire san diego county region with services concentrated in the north coastal, north central, central and southern regions of san diego. Community outreach efforts are focused in those areas with proximity to a scripps facility. Community priority process (chna methodology) the 2016 chna involved a mixed methods approach using the most current quantitative data available and more extensive qualitative outreach. Throughout the process, the iph met bi-weekly with the hasd&ic chna committee to analyze, refine, and interpret results as they were being collected. The results of the 2016 chna will be used to inform and adapt hospital programs and strategies to better meet the health needs of san diego county residents. San diego county is a socially and ethnically diverse community with a population of 3.2 million people. Although the study area for this chna is the entire county, each hospital”

“As a result of this review, the chna committee identified behavioral health as the number one health need in sdc. In addition, cardiovascular disease, 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 with each health need. Within the category of behavioral health, alzheimer's disease, anxiety, drug and alcohol issues, and mood disorders are significant health needs with san diego county. Among the other chronic health needs, hypertension was consistently found to be a significant priority area related to cardiovascular disease, uncontrolled diabetes was an important factor leading to complication related to diabetes, and obesity was often found to co-occur with other conditions and contribute to worsening health status. The impact of the top health needs differed among age groups; with type 2 diabetes, obesity, and anxiety affecting all age groups, drug and alcohol issues affecting teens and adults, and alzheimer's disease, cardiovascular disease, and hypertension affecting older adults. Social determinants of health in addition to the health outcome needs that were identified, social determinants of health were a key theme in all of the community engagement activities. Analysis of results from the community partner discussions and key informant interviews revealed the most commonly associated social determinants of health for each of the top health needs above. Ten social determinants were consistently referenced across the different community engagement activities. The importance of these social determinants was also confirmed by quantitative data. Hospital programs and community collaborations have the potential to impact these social determinants, which are outlined below in order of priority. - food insecurity and access to healthy food - access to care or services - homelessness/housing issues - physical activity - education/knowledge - cultural competency - transportation - insurance issues - stigma - poverty 2016 chna follow up survey, phase 2 the chna committee completed phase 2 of the 2016 chna, which included gathering community feedback on the 2016 chna process and strengthening partnerships around the identified health needs and social determinants. A survey was conducted in the fall of 2016 as a follow-up to the collaborative 2016 community health needs assessment (chna) process that was completed in may of 2016. The purpose was to gather feedback on the identified top four health needs and the top 10 social determinants of health that were identified in the 2016 chna. In addition, organizations were asked about their screening methods for behavioral health issues and methods for identifying social determinants of health. An electronic survey was created and a survey link was emailed to community partners. Due to the fact that community partners were able to forward the email to their colleagues the total response rate was unable to be calculated. The survey was open from october 10th through november 7th, approximately four weeks. A total of 132 respondents completed the survey. Of the 132 respondents that completed the survey, 30 worked in hospitals or hospital-based settings, while the remaining 102 respondents self-identified as working for a range of entities including but not limited to community clinics, not-for-profits, community based organizations, local government, and health insurance plans. In addition to soliciting feedback on the findings, the survey also included questions seeking to determine whether the integration of behavioral health and physical health is being integrated locally, as well as whether organizations are screening for and addressing social determinants of health. Ninety-nine respondents stated that their organization screens patients and clients about their social determinants of he”

“SCRIPPS WILL MONITOR AND EVALUATE THE STRATEGIES LISTED IN THE IMPLEMENTATION PLAN FOR THE PURPOSE OF TRACKING THE IMPLEMENTATION OF THOSE STRATEGIES AS WELL AS DOCUMENT THE ANTICIPATED IMPACT. PLANS TO MONITOR WILL BE TAILORED TO EACH STRATEGY AND WILL INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURE. THE COMPLETE FY17-FY19 IMPLEMENTATION PLAN REPORT IS AVAILABLE ONLINE AT https://www.scripps.org/about-us/scripps-in-the-community/assessing-commun ity-needs. IN SUPPORT OF THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ONGOING COMMUNITY BENEFIT INITIATIVES, A DETAILED DESCRIPTION OF SCRIPPS STRATEGIES AND CORRESPONDING MEASURES/METRICS FOR THE FOUR HEALTH PRIORITY AREAS IDENTIFIED IN THE CHNA CAN BE FOUND AT SCRIPPS.ORG/COMMUNITYBENEFIT. METRICS ARE AS CURRENT AS FY18. DURING THIS FISCAL YEAR, SCRIPPS INVESTED $5,334,683 IN COMMUNITY HEALTH SERVICES (DOES NOT INCLUDE SUBSIDIZED HEALTH). THIS FIGURE REFLECTS THE COST ASSOCIATED WITH PROVIDING SUCH ACTIVITIES, INCLUDING SALARIES, MATERIALS AND SUPPLIES, MINUS REVENUE. SCRIPPS HEALTH STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION WITH A WIDE RANGE OF PARTNERS AND LIKE-MINDED ORGANIZATIONS. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EFFORTS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS AND PARTNER WITH A WIDE VARIETY OF ORGANIZATIONS ON COMMUNITY HEALTH IMPROVEMENT PROGRAMS. IN AN EFFORT TO PROVIDE FOR PEOPLE IN NEED, SCRIPPS SPONSORED/ENGAGED IN THE FOLLOWING PROGRAMS IN FISCAL YEAR 2018. ACCESS TO CARE TWO PRIMARY BARRIERS TO OBTAINING HEALTH CARE, ON BOTH THE LOCAL AND NATIONAL LEVEL, ARE LACK OF HEALTH INSURANCE AND ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS. REDUCED ACCESS TO BASIC HEALTH CARE SERVICES INCREASES ILLNESS, INJURY AND MORTALITY AND IS A MAJOR BURDEN ON HOSPITALS AND HEALTH PROVIDERS, WHO MUST PROVIDE UNCOMPENSATED CARE FOR THE UNINSURED. MORE PEOPLE WITHOUT INSURANCE TRANSLATES INTO HIGHER USE OF EMERGENCY DEPARTMENTS, WHICH BY LAW MUST PROVIDE STABILIZING CARE TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. MERCY OUTREACH SURGICAL TEAM FOR THREE DECADES, MERCY OUTREACH SURGICAL TEAM (M.O.S.T) HAS BEEN CROSSING BORDERS AND CHANGING LIVES. WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. DURING FY18, THE M.O.S.T TEAM SERVED IN THREE OUTREACH MISSION TRIPS. THE M.O.S.T TEAM VOLUNTEERED 2,243 HOURS TO PROVIDE RECONSTRUCTIVE SURGERIES FOR MORE THAN 700 PEOPLE SERVED. THE M.O.S.T PROGRAM CELEBRATED ITS 31ST ANNIVERSARY THIS YEAR. OCTOBER 2017 IN OCTOBER 2017, A TEAM OF 52 M.O.S.T. VOLUNTEERS INCLUDING TWO PLASTIC SURGEONS, ONE UROLOGIST, AND A GENERAL SURGEON TRAVELED OVER 1,500 MILES FROM SAN DIEGO TO LEON, MEXICO. THE TEAM HELPED 164 PATIENTS ON THIS MISSION. APRIL 2018 WITH SO MANY PATIENTS IN NEED, M.O.S.T. RETURNED FOR THEIR SECOND MISSION TO QURETARO, MEXICO IN APRIL 2018. THE TEAMS OF 58 VOLUNTEERS INCLUDED FOUR PLASTIC SURGEONS, ONE GENERAL SURGEON, ONE UROLOGIST, AND ONE OPHTHALMOLOGIST. THE TEAM PROVIDED 271 CHILDREN WITH SERVICES. JUNE 2018 IN JUNE 2018, M.O.S.T TRAVELED TO THE COASTAL CITY OF ENSENADA, MEXICO AT THE INVITATION OF THE LOCAL DESARROLLO INTEGRAL DE LA FAMILIA (DIF), A PROGRAM THAT PROVIDES ASSISTANCE TO FAMILIES LIVING IN POVERTY. THE WEEKEND MISSION WAS FOCUSED ON CORRECTIVE EYE SURGERY AND OPHTHALMOLOGY. THE TEAM PERFORMED 58 LIFE CHANGING SURGERIES AND 20 EYE EXAMS DURING THE 48 HOUR TRIP. SCRIPPS RECUPERATIVE CARE PROGRAM (RCU) THE SCRIPPS/SAN DIEGO RESCUE MISSION RECUPERATIVE CARE UNIT (RCU) PROJECT PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. THE LACK OF FUNDING AND MENTAL ILLNESS, ALONG WITH ALCOHOL AND/OR SUBSTA”

“Because the risk factors associated with the outbreak persist in our community, scripps employee health screens and offers hep a vaccinations to all employees considered at risk, especially those who work in the emergency department, behavioral health and food service. Scripps health community benefit (cb) fund in fy18, scripps health continued to deepen its commitment to philanthropy with its community benefit fund. Over the course of the year, it awarded $221,000 in community grants to programs in san diego (four grants ranging from $10,000 to $120,000). The funded projects address some of san diego countys high priority health needs, seeking to improve access to vital health care services for at risk populations, including the homeless, economically disadvantaged, mentally ill and others. Since the community benefit fund began, scripps has awarded $3.7 million. Programs funded during fy18 include: consumer center for health education and advocacy (cchea) funding provides low income, uninsured mercy clinic and behavioral health patients help obtaining health care benefits, ssi and related services, while reducing uncompensated care expenses at mercy. The project provides advocacy services for time intensive government benefit cases. The consumer center stresses the importance of accessing community-based services for routine health care instead of using the eds and hospital departments. They also emphasize the importance of establishing medical homes. Catholic charities funding provides short term emergency shelter for medically fragile homeless patients being discharged from scripps mercy hospital, san diego. The program is being expanded to scripps mercy hospital, chula vista. Case management and shelter are provided for homeless patients discharged from scripps mercy hospital. While these patients no longer require hospital care, they do need a short term recuperative environment. Patients who demonstrate a willingness to change receive one week in a hotel, along with food and bus fare to pursue a case plan. The focus of the case management is to stabilize the client by helping them connect to more permanent sources of income, housing and other self-reliance measures. The partnership seeks to reduce emergency room recidivism in this population and improve their quality of life. 2-1-1 health care navigation program locally, 2-1-1 san diego was launched in june 2005 as a multilingual and confidential service committed to providing 24/7 access. There was an overwhelming need for a dependable service to help people navigate todays complex health care system. Scripps health has been a longtime supporter of 2-1-1 san diegos health navigation program which creates a record for every person who calls, in order to provide a service that navigates clients through different referrals and tracks their success toward achieving improved social determinants of health. All 2-1-1 staff are trained to identify individuals who are in need of care coordination services, particularly individuals who are having difficulties managing their chronic health conditions. Health navigators are trained to determine client risk using the risk rating scale (rrs). The rrs determines a client's status ranging from "in crisis" to "thriving" using social determinants of health such as housing, nutrition, primary care and health management. Health navigators assess on the following to determine whether a client has decreased in vulnerability for health management: - understanding of prescription medication: does the client understand how and when to take their medicine and do they understand the use/importance of each medication? - health condition management: does the client understand the illness/disease that they have been diagnosed with, what their prognosis is, and what they need to do in order to remain healthy? - health insurance/ medical home: does the client have health insurance and do they know how to utilize it? Does the client have a primary car”

“- 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 affiliate community profile indicate a critical need for culturally competent outreach, especially for hispanic, middle eastern and african american women (susan g. Komen, 2015). - a recent study by the acs found that 42 percent of newly diagnosed cancer cases in the u.s. Are potentially avoidable. Many of the known causes of the cancer - and other non-communicable diseases - are attributable to behavioral factors including tobacco use and excess body weight due to poor dietary habits and lack of physical activity (acs, 2018). - the american society of clinical oncology (asco) emphasizes the importance of patient navigators as part of a multidisciplinary oncology team with the goal of reducing mortality among underserved patients. A patient navigator may assist with various tasks, including: psychosocial support; assistance with treatment decisions; assistance with insurance issues; arrangement of transportation; coordination of additional services (i.e., fertility preservation); and tracking of interventions and outcomes. The navigator works with the patient across the care continuum, ensuring coordination and efficiency of care, and removal of barriers to care (asco, 2016). - according to the nih, clinical trials, a part of clinical research, are at the heart of all medical advances. Clinical trials look at new ways to prevent, detect or treat disease by determining the safety and efficacy of a new test or treatment. Greater clinical trial enrollment benefits medical research and increases the health of future generations as well as improves disease outcomes, quality of life and health of trial participants. Scripps has developed a series of prevention and wellness programs to educate people about the importance of early detection and treatment for some of the most common forms of cancer. At scripps, cancer care is more than just medical treatment, and a wide array of resources are provided such as counseling, support groups, complementary therapies and educational workshops. Here are a few examples of scripps cancer programs during fiscal year 2018: scripps md anderson cancer center directory of community resources scripps collaborates with the community and develops a cancer directory of a comprehensive list of resources available for cancer survivors, their families, and the community. Scripps md anderson green cancer center support groups scripps green hospital support groups offer cancer patients the opportunity to express the emotions that come with a cancer diagnosis and help them cope more effectively with their treatment regimens by support groups that nurture their physical, emotional and spiritual well-being. Scripps md anderson cancer center registered nurse navigator program scripps provided a registered nurse, dedicated to assisting cancer patients and their families with navigating through the journey from diagnosis, treatment and survivorship from cancer. The focus is on education and outreach, as well as, support services in this population. Scripps md anderson cancer center outpatient heredity and cancer genetic counseling program this program provides genetic testing and counseling to cancer patients, along with providing education to health professionals and caregivers. Scripps md anderson cancer center outpatient social worker & liaison prog”

“Scripps polster breast care center (spbcc) scripps polster breast care center (spbcc) sponsors the young womens support group which provide a venue for women under the age of 40 to come together, discuss issues relating to diagnoses and receive support. The groups are offered to women in the san diego community. Topics related to breast health are also offered to the community. American cancer society (acs) making strides against breast cancer scripps health participated and sponsored the making strides against breast cancer walk in the amount of $10,000 to raise money for breast cancer research. A series of educational events are coordinated with the american cancer society awareness months. The events focus on various types of cancer, including breast, lung, cervical, colorectal, skin, ovarian/gynecological and prostate. A registered nurse clinician answers questions and provides educational materials. Susan g. Komen 3 day breast cancer walk first aid support station scripps is the official physical therapy sports medicine crew for the first aid station at the susan g. Komen cancer walk. This vital station provides treatments to those participating such as wound care, orthopedic evaluation treatments, limb and joint taping, assistance with stretching and education. Scripps md anderson cancer center aloha lock cancer wig program this program provides wigs and hair accessories to cancer patients suffering from alopecia or expected to suffer from alopecia. Cardiovascular disease "diseases of the heart" were the second leading cause of death in san diego county in 2016. In addition "cerebrovascular diseases" were the fourth leading cause of death, and essential (hypertension and hypertensive renal disease) was the tenth. Coronary heart disease is the most common form of heart disease. High blood pressure, high cholesterol, and smoking are all risk factors that could lead to cvd and stroke. About half of americans (49%) have at least one of these three risk factors. Risk factors for cardiovascular disease: behaviors: tobacco use, obesity, poor diet that is high in saturated fats, and excessive alcohol use. Conditions: high cholesterol levels, high blood pressure and diabetes. Heredity: genetic factors likely play a role in heart disease and can increase risk. A summary of the magnitude and prevalence of cardiovascular disease is described below: - the scripps 2016 chna continued to identify cardiovascular disease (including cerebrovascular disease/stroke) as a priority health issue affecting members of the communities served by scripps. - according to data presented in the scripps 2016 chna, high blood pressure, high c 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). - heart disease is the leading cause of death for people of most racial/ethnic groups in the united states, including african americans, hispanics and whites. - in 2016, cerebrovascular diseases including stroke were the fourth leading cause of death for san diego county overall. - in 2016, there were 1,362 deaths due to stroke in san diego county , a 17.2 percent increase from 2015. The age-adjusted death rate due to stroke was 38.3 per 100,000 population, which was higher than the hp2020 target of 34.8 deaths per 100,000. - in 2016, there were 6,346 hospitalizations for stroke in san diego county, with an age-adjusted rate of 183 per 100,000 population. The rate of hospitalization for stroke increased 2.8 percent from 2015 to 2016 - the first increase since 2011, when san diego county recorded a stroke rate of 218.4 per 100,000 population. - in 2016, there were 2,371 stroke-related ed visits in san diego county. The age-adjusted rate of ed visits was 68.9 per 100,000 population. - according to 2016-2017 chis data, an estimated 23.9 percent of adults in san diego county were obese,”

“Stroke care programs scripps sponsors a wide variety of stroke related education and awareness programs. These include support groups and education for stroke and brain injury survivors and their loved one. Information and resources are provided, along with skills to help reinforce inner strengths and learn self-care strategies. Support groups offer the ability to develop encouraging peer relationships along with the goal of returning to and continuing a life of meaning and purpose. Student preceptorships at cardiac treatment center scripps provides preceptorships for student rn's, exercise physiologist's and cardiac sonographers. The scripps cardiac treatment center nurses mentor the students through education and modeling. The students learn the roles and responsibilities required of the positions. Ventricular assist device (vad) support group scripps offers a support group for patients with a ventricular assist device. This group provides education and support to those patients and their caregivers/partners. Topics include: safety and proper mechanics required for the device. Joe niekro foundation scripps health provides meeting space for the joe niekro foundation for support groups for patient, families and friends who have been affected with brain aneurysms or hemorrhagic stroke. The program is opened to the public. San diego echo society scripps health provides meeting space to the american society of echocardiography. This is an organization of professionals committed to excellence in cardiovascular ultrasound and its application to patient care through education, advocacy, research, innovation and service to our members and the public. Women heart the national coalition for women with heart disease - support group scripps health provides meeting space for womens heart support group. Women heart's mission is to improve the health and quality of life of women living with or at risk of heart disease, and to advocate for their benefit. Women with heart disease have the opportunity to share their stories, support each other and heal together. Experts are invited to talk to the group about different kinds of heart conditions, heart attack prevention, blood pressure, exercise and nutrition. Educating women about heart health together with women heart national hospital alliance, scripps cardiovascular developed a women and heart disease education program. The efforts educate women on the importance of heart health, provide support groups and advocate for research funding and policies. Senior health chats a wide variety of senior chats are offered at local senior centers in south bay to address education and prevention of heart disease. Some topics include heart health 101, stroke, and a variety of prevention education. A total of 10 presentations are given yearly to more than 223 individuals. The eric paredes save a life foundation each year, 7,000 teens lose their lives due to sudden cardiac arrest (sca). Sca is not a heart attack, it is caused by an abnormality in the hearts electrical system that can easily be detected with a simple ekg. Unfortunately, heart screenings are not part of a regular, well-child exam or pre-participation sports physical. The first symptom of sca could be death. San diego alone loses three to five teens from sca annually. Scripps efforts began when a registered nurse at scripps created the foundation after her 15 year old son, eric passed away from sudden cardiac arrest in 2009. Turning tragedy into an opportunity, the paredes established the organization to prevent sudden cardiac arrest in school-age children and adolescents. As a sponsor for the eric paredes save a life foundation, scripps has held more than 20,000 free cardiac screenings to local teens, including the homeless, uninsured and underinsured. In fy18, scripps made an $8,500 donation to help pay for screenings. In fy18, scripps supported screening events at area high schools and screened 4,915 teens, identifying 42 with abnormalities”

“- according to 2016-2017 chis data, 8.6 percent of adults living in san diego county indicated that they had ever been diagnosed with diabetes, which was lower than the state of california (9.9 percent). Diabetes rates among seniors were particularly high, with 18.8 percent of san diego county adults over 65 reporting that they had ever been diagnosed with diabetes. - according to 2016-2017 chis data, 12.3 percent of san diego county residents had been told by their doctor that they have pre- or borderline diabetes. - according to the cdcs 2017 national diabetes statistics report, 87.5 percent of adults diagnosed with diabetes were overweight or obese. To prevent or delay the onset of diabetes, the cdc recommends lifestyle changes such as losing weight, eating healthier, and getting regular physical activity. The cdc estimates that 30.3 million people in the u.s. Have diabetes. Of those individuals, 1 in 4 is not aware they have the disease (cdc national diabetes statistics report, 2017). The percentage of adults aged 20 and older who have ever been diagnosed with diabetes was 9.4% in 2017 in san diego county and has been steadily rising since 2005 according to the national center for chronic disease prevention and health promotion. Type 2 diabetes is an important target for intervention because hospitalizations due to diabetes related complications are potentially preventable with proper management and a healthy lifestyle. There are three major types of diabetes: type 1, type 2 and gestational. All three types share similar characteristics, the body loses the ability to either make or use insulin. Without enough insulin, glucose stays in the blood, creating dangerous blood sugar levels. Over time, this buildup damages kidneys, heart, nerves, eyes and other organs. Type 2 diabetes, once known as adult onset or noninsulin dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), which is your bodys main source of fuel. With type 2 diabetes, your body either resists the effects of insulin, a hormone that regulates the movement of sugar into your cells or doesnt produce enough insulin to maintain a normal glucose level. If left untreated, type 2 diabetes can be life threatening. Clinical symptoms can include: frequent urination, excessive thirst, extreme hunger, sudden vision changes, unexplained weight loss, extreme fatigue, sores that are slow to heal, and increased number of infections. Type 2 diabetes has reached epidemic proportions, and people of hispanic origin have dramatically higher rates of the disease and the complications that go along with its poor management, including cardiovascular disease, eye disease and limb amputation. In fact, it is estimated that one out of every two hispanic children born in 2000 will develop diabetes in adulthood. This is especially true in the south bay communities in san diego. Specifically, the city of chula vista is home to 26,000 latinos with diagnosed diabetes and tens of thousands more who are undiagnosed, have pre- diabetes and are at high risk of developing diabetes. Some alarming facts about type 2 diabetes: - diabetes is a major cause of heart disease and stroke, and is the 7th leading cause of death in the united states and california. - more than 1 out of 3 adults have prediabetes and 15 to 30% of those with prediabetes will develop type 2 diabetes within 5 years. - nine out of 10 people with prediabetes dont know they have it. Some risk factors for developing diabetes include: - being overweight or obese - having a parent, brother or sister with diabetes. - smoking - having blood pressure measuring 140/90 or higher. - being physically inactive, exercising fewer than three times a week. - a history of gestational diabetes - if you are 65 years of age or older a study by the university of california, los angeles (ucla) center for health policy research found that 13 million adults in california (46 percent) are estimated to have pre”

“Diabetes prevention the ucla center for health policy and research recently published data that revealed nearly half of california adults have prediabetes or diabetes. While the scripps whittier diabetes institute has been providing the best care for people with diabetes for decades, the institute continued with the scripps diabetes prevention program (dpp), which is a yearlong intervention where people with prediabetes meet weekly for 16 weeks, then monthly thereafter. The dpp is an intensive lifestyle intervention program that has been proven to prevent diabetes in large-scale national studies. The primary objective is to lose 5 to 7% of body weight through healthy eating and physical activity. The diabetes prevention program (dpp) has been thoroughly evaluated in nih sponsored randomized controlled trials, and has been found to decrease the number of new cases of diabetes among those with prediabetes by 58%. Among people over age 60, there was a 71% reduction in new cases. In 2018, 212 patients attended 78 scripps dpp orientation sessions. Much of the effort is focused in the south bay for the latino population, which is at higher risk of getting diabetes than their white counterparts. Digital diabetes- me: an adaptive mhealth intervention for underserved hispanics with diabetes diabetes is a fast-growing epidemic, afflicting 29.1 million americans and costing more than $245 billion a year, according to the american diabetes institute. Hispanics face a higher risk of developing the disease 13.9 percent compared with 7.6 percent for non-hispanic whites. The nihs national institute of diabetes and digestive and kidney diseases awarded $2.9 million, the largest nih award to scripps whittier diabetes institute to date, to study an innovative approach to helping hispanics with diabetes better manage their disease. Dulce digital-me provided patients with tools to help them manage their diabetes day to day and improve their health, including text messaging, wireless blood glucose and medication monitoring, diet and exercise assessments, and personalized feedback and goal-setting. This study was conducted in collaboration with neighborhood healthcare, san diego state university and the university of california san diego. The participants received health-related text messages every day for six months and they saw improvements in their blood sugar levels that equaled those resulting from some glucose-lowering medications. The dulce digital clinical trial represents the first randomized controlled study to look at the use of text messages to help underserved hispanics better self-manage their diabetes through glycemic control. The results were published by diabetes care in an online pre-print version of the study, which is scheduled to be published in a future issue of the journal. Healthy living in 2015, scripps began healthy living classes which are open to anyone interested in learning about the benefits of good nutrition, physical activity, and avoiding tobacco. These behaviors can help to prevent the four chronic diseases (lung disease, cancer, type 2 diabetes and, cardiovascular disease) that contribute to 50 percent of all the deaths in the us. The three-class series is held at locations throughout the community. Two hundred and eight people attended healthy living classes that were provided throughout the county, again with special attention to the latino community of the south bay. Scripps whittier diabetes institute professional education and training scripps whittier diabetes institute professional education teams provide state of the art education and training for people who wish to increase their diabetes management knowledge and skills. With the rise in diabetes related devices, there is a great need to equip clinicians with the latest information and clinical skills. The whittiers professional education program is led by a team of experts, including: endocrinologists, nurses, dieticians, psychologists and other diabetes”

“- the hasd&ic and scripps 2016 chna community engagement activities emphasized 10 social determinants of health (sdoh) as having a serious impact on the four priority health issues in san diego county (cardiovascular disease, type 2 diabetes, behavioral health and obesity). These 10 social determinants are: food insecurity and access to healthy food; access to care or services; homeless/housing issues; physical activity; education/knowledge; cultural competency; transportation; insurance issues; stigma; and poverty. - key informant interviews conducted as part of the hasd&ic 2016 chna suggested several health improvement strategies to address the four priority health issues identified for san diego county. These strategies include: behavioral health prevention and stigma reduction; education on disease management and food insecurity; integrating physical and mental health care; better coordination of care; greater cultural competence and diversity; and engagement of patient navigators and case managers in the community. - fruit/vegetable consumption: according to data from california health interview survey, 48.3% of children age 2 and older reported consuming less than five servings of fruits and vegetables a day compared to 47.7% in california overall. Adults age 18 and over reported even less fruit and vegetable consumption. Approximately 70.5% of adults reported eating the recommended amount each day. Unhealthy eating habits are a significant contributing factor to future health issues including obesity and diabetes. - physical inactivity: according to the cdcs national center for chronic disease prevention and health promotion, 14.9% of adults age 20 and older self-reported that they perform no leisure time physical activity. Higher rates of limited leisure time activity were reported at the state and national level (16.6% and 22.6% respectively). For youth results of the fitnessgram physical fitness test show that 29.35% of children in grades 5,7 and 9 ranked within the high risk or needs improvement zones for aerobic capacity for the 20132014 year. The percentage of children that are not in the healthy fitness zone varies among ethnic groups with the lowest being non-hispanic asians at 20.6% and the highest being hispanic or latinos at 42.1%. Although this is smaller than the state average of 36.9%, it is still cause for concern and may lead to significant health issues, such as obesity, diabetes, and poor cardiovascular health. - alcohol consumption: the percentage of adults age 18 and older who self-report heavy alcohol consumption (defined as more than two drinks per day on average for men and one drink per day on average for women) is 17.2% in san diego county according to the behavioral risk factor surveillance system (brfss). Behaviors such as excessive alcohol consumption are detrimental to future health and may illustrate or preclude significant health issues, such as cirrhosis, cancer, and untreated mental and behavioral health needs. - tobacco usage: the bfrss also reports that 12.1% of adults age 18 and older self-reported currently smoking cigarettes some days or every day compare to 18.1% in the united states, adjusted for age. Tobacco use is linked to leading causes of death including cancer and cardiovascular disease. - the hhsas live well san diego (lwsd) 3-4-50 initiative identified three behaviors (poor diet, physical inactivity and tobacco use) that contribute to four chronic conditions (cancer, heart disease/stroke, type 2 diabetes and pulmonary diseases), which result in more than 50 percent of deaths worldwide. In 2015, 54 percent of all deaths in sdc were attributed to 3-4-50 conditions. - in 2016, 16.3 percent of adults ages 18 and older in sdc self-reported eating at fast-food restaurants four or more times each week (chis, 2016). Understanding that personal behaviors play a significant role in an individuals overall health status, scripps has developed a series of prevention and wellness progra”

“Senior programs each month a variety of senior programs are held in partnership with local senior centers, churches, and senior housing. The following programs are conducted as part of scripps mercy hospital chula vistas san diego border area health education center and scripps family medicine residency program. These senior health chats are designed to provide health education to the older adult community. Approximately 20-25 seniors attend these monthly throughout the year. These presentations include a variety of health and age related topics that include nutrition, hearing loss, and maintaining a healthy life style. These presentations are facilitated by various health care professions and residents. Topics are all chosen by the seniors themselves so as to meet their local needs. Also, the health chats provide an interchange between the community members and our medical residents and other health care professionals to foster healthy lifestyles and health prevention. The program are conducted in collaboration with norman park center, congregational towers senior living and st charles nutrition center. Family medicine residents rotate through these programs to learn more about geriatric medicine, health and wellness and overall public health and community training. Over 223 seniors participated in these programs. Patient community services services are offered directly to patients and their family post discharge to decrease the risks of readmission and to increase patient continuity. Support services are referral based and provide assistance with the following: housing/homelessness, senior issues, chronic disease issues, drug/alcohol and mental health, cancer and more. This service is currently only available at the scripps mercy hospital chula vista campus. Since the start of the project in july 2014, 1,539 referrals have been received community health improvement partners (chip) and resident leadership academy model scripps is a partner with chip and collaboratively works on a resident leadership model that has empowered 700+ citizens across the county (and beyond) to affect change in a wide range of community health areas such as public safety, access to healthy foods, and increased opportunities for physical activity. Health education and support groups education and support groups are provided to san diego county residents for a wide variety of health concerns. Topics include, macular degeneration, fall prevention, stroke awareness, menopause, sleep disorders, foot health, bladder and pelvic floor wellness, mental illness, postpartum issues, gynecological cancer, and multiple sclerosis. Prescription take back day prescription drug abuse is a growing problem in the united states. About 54 million people, or more than 20 percent of those aged 12 and older, have used prescription medications such as powerful pain-reducing opioids like oxycodone and hydrocodone for nonmedical reasons at least once in their lifetime, according to the most recent national survey on drug use and health. Every day, 5,750 more americans misuse prescription drugs for the first time. And 62 percent of teens who admit taking medications for non-medical reasons say they got those drugs from medicine cabinets in their homes. Scripps encourages patients to remove expired, unwanted and unused medicines from their homes as quickly as possible and to avoid throwing them into the trash or flushing them down the toilet because this unwittingly risks exposing others to the drugs and damages the environment. The semi-annual event offers a no-questions-asked method to safely dispose of such medications, such as the remainder of the 20-day oxycodone supply from that outpatient procedure last year. Flushing drugs down the toilet can harm the environment. Scripps collaborates with the county of san diego on the prescription drug take back day which provides an opportunity for safe disposal of left over medications. The u.s. Drug enforcement administration, local”

“- 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 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). - the ucla center for health policy research conducted a study highlighting the plight of californias 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). During fiscal year 2018, scripps engaged in the following alzheimers and dementia prevention and treatment activities: senior health and well being programs senior health chats are designed to increase health care information and preventative services for seniors/older adults in the south bay. Each month a variety of senior programs are held at local senior centers, churches and senior housing. Approximately 20-25 seniors attend these monthly throughout the year, these presentations include a variety of health and age related topics that include nutrition, hearing loss, dementia, alzheimers and pain management, nutrition and wellness and maintaining a healthy life style. These presentations are facilitated by various health care professionals and residents. Topics are all chosen by seniors themselves so as to meet their local needs. Also, the health chats provide an interchange between the community members and the medical residents and other health care professionals to foster healthy lifestyles and health prevention. The alzheimers project san diego unites for a cure and care the alzheimers project is a countywide initiative aimed at accelerating the search for a cure and helping the estimated 60,000 san diegans with the disease, along with their caregivers. Participants began meeting in early 2014 to craft a regional roadmap to address the disease, focusing on cure, care, clinical, and public awareness and education initiatives. The board of supervisors approved the roadmap in december 2014 and later voted in support of an implementation timetable. Dr. Michael lobatz from scripps health is a leading participant of this initiative as a co-chairperson of the clinical round table and is a member of the steering committee. The scripps health alzheimers care conference the scripps health alzheimers care conference took place on february 10, 2018 and was offered to health care professionals who care for the patient with or at risk for alzheimers disease and related dementias, in order to support them with the best in advanced tools for screening, evaluating, diagnosing and treating. The care conference addressed statistical national local trends in alzheimers disease and related dementias, focusing on prevalence, mortality, cost and burden to healthcare providers and caregivers. Parkinsons lsvt (lee silverman training) big exercise: scripps provides a maintenance class for those who have completed the lsvt big exercise protocol. This class is taught by a physical therapist and is designed for parkinsons patients to improve strength and mobility for a healthier life. Empowerment parkinsons event scripps offered a conference in 2018 to more than 300 guests where they learned new ways to take control of their health at the empowerment for parkinsons day at marina village. Attendees learned the benefits of exercise and diet change, massage, acupuncture, music therapy and were armed with knowledge to help them make positive changes. Obesity, weight status, nutrition, activity and fitness obesity is an important health need due to its h”

“Participants must have prediabetes and be overweight to enroll. No physician referral is required, although many physicians do refer their patients to this valuable resource. Orientation sessions are held in spanish and english throughout the county. Healthy living program diabetes, heart disease, cancer and respiratory disease are the four most prevalent serious chronic diseases in california. These diseases cause 50 percent of all deaths in san diego and throughout the u.s., and many people have more than one of these conditions. Because lifestyle can play a major role in preventing these chronic illnesses, scripps introduced healthy living, a free, interactive education program to help the san diego community learn about and adopt practical ways to improve three behaviors smoking, poor diet and physical inactivity that contribute to these four diseases. Participants learn how to make healthy food choices using low cost options, make physical activity part of their daily life and learn how to stay motivated and maintain healthy habits. Scripps implements a series of three free sessions that encourage participants to identify and adopt practical ways to improve their health habits. Sessions are offered throughout san diego county in english and spanish, with special emphasis on the latino and underserved communities. Sessions include health screening, healthy cooking tips, and mindful eating and practice sessions. Participants also receive a prediabetes screening; those who score high are then referred to the scripps diabetes prevention program. Promise neighborhood initiative scripps also addresses childhood obesity at the high school level in san diegos south bay communities through its partnership with the promise neighborhood initiative, which implements activities related to the national 5210 campaign. Scripps partners with the promise neighborhood initiative and castle park elementary school to increase education and awareness about healthy lifestyles for students, their parents and school staff. Promise neighborhood developed a wellness committee composed of the school principal, teachers, parents and scripps staff aimed to implement activities that support 5-2-1-0: 5 fruits or more a day, 2 hours or less of screen time, 1 hour of physical activity and 0 sugary juices. School administrators and staff are closely involved in the program, which includes five educational sessions, a health assessment survey and health plan, and support to help the students pass their yearly physical education requirements. Since 2013, more than 400 children and 200 parents have participated in wellness activities on campus. As a result of activities, lesson plans and advocacy for healthy living, the amount of physical activity and consumption of fruits and vegetables by children, parents and staff has increased. Student responses via a 5210 post health assessment survey showed that there was an 80% improvement rate for knowledge after participating in the 5210 sessions. And a 38% improvement rate for behavior after participating in the 5210 sessions. City heights wellness center la maestra family clinic, inc. Joined the city heights wellness center collaborative partnership with scripps mercy hospital and rady childrens hospital as the lease holder of the wellness center starting september 1, 2016. Since its inception in 2002, the city heights wellness center has been a dynamic, community based program developed by scripps mercy hospital and rady childrens hospital, working with residents to improve their lifestyle behaviors and self-sufficiency skills. Multiple not-for-profit and governmental organizations, philanthropic foundations and grassroots groups have joined the effort conducting health promotion and educational activities for community residents. A unique aspect of the city heights wellness center is the teaching kitchen that is known throughout the community as a place where residents and providers come together to cook, discov”

“A summary of the magnitude and prevalence of maternal and child health & high risk pregnancies are described below: - the hasd&ic 2016 chna continued to identify high risk pregnancies as one of the top 15 priority health conditions among san diego county hospitals - in 2016, there were 42,654 live births in sdc overall. The 2016 fetal mortality rate was 3.2 infant deaths per 1,000 live births in the north inland region, 3.4 in the north coastal region, 3.7 in the east region and sdc overall, 3.8 in the central region, 3.9 in the north central region, and 4.3 in the south region.7 - in 2016, 159 infants died before their first birthday in sdc. Infant mortality was higher among male infants (93 deaths) than female infants (66 deaths). African american/black infants had the highest mortality rate (10.7 infant deaths per 1,000 live births) when compared to infants of all other races and ethnicities. Hispanic infants had the second highest mortality rate of 4.5 deaths per 1,000 live births. In addition, there were 3,628 preterm births (less than 37 weeks gestation) in sdc during 2016. Compared to all other races and ethnicities, hispanic mothers had the highest total number of births (16,978), 8.2 percent of which were preterm. Despite having fewer total births than hispanic mothers (1,781), 11.6 percent of births by african american/black mothers were preterm. Similarly, although women ages 25 to 39 had the highest total number of births compared to other age groups, mothers age 40 and above were more likely to give birth preterm compared to younger age groups (45.8 percent preterm births among mothers age 40 and above compared to 15.4 percent preterm births among mothers ages 25 to 39). - in 2016, all sdc regions met the hp2020 national targets for prenatal care, preterm births, low birth weight (lbw) infants, very low birth weight (vlbw) infants and infant mortality. See table 2 for a summary of maternal and infant health indicators in san diego county in 2016 and table 3 for a summary of maternal and infant health indicators by region. Scripps health continued to enhance prenatal education for low income women in san diego county in fiscal year 2018. The following are some examples: community benefit services - offered more than 1,200 maternal child health classes throughout san diego county to enhance parenting skills. Low income women in san diego who were eligible attended classes at no charge or on a sliding fee schedule. - maintained existing prenatal education services in all regions of the county, ensuring that programs continued to demonstrate a satisfaction rating above 90 percent. - provided and supported weekly breastfeeding support groups at six locations throughout san diego county, including three with bilingual services. - offered maternal child health classes throughout the community, such as getting ready for the baby and grand parenting today. - offered the dogs and babies programs quarterly, with more than 40 attendees. - offered a prenatal yoga program for expectant women in san diego county. - offered classes in pelvic floor and postpartum changes for new mothers throughout the community. First 5 and promise neighborhood parenting classes are offered at the scripps mercy hospital chula vista well-being center for parents with infants, toddlers and preschoolers. A wide variety of topics are covered including issues related to health, learning/development, family/safety, advocacy as well as parenting tips. Developmental assessments are conducted by rady childrens hospital. More than 400 services were received for first time mothers including: home visits, referrals received, data entry, follow up phone calls, parenting classes and other support services. A total of 209 parents participated in parenting classes, 180 sessions provided. Maternal child health nursing students scripps perinatal education program supports local nursing students with the opportunity to observe prenatal educational classes. This crit”

“- in 2016, accidents (unintentional injuries) were the fifth leading cause of death for san diego county overall. Unintentional injuries (i.e., motor vehicle accidents, falls, pedestrian-related, firearms, fire/burns, drowning, explosions, poisoning (including drugs and alcohol, gas, cleaners and caustic substances), choking/suffocation, cut/pierce, exposure to electrical current/radiation/fire/smoke, natural disasters and workplace injuries) are one of the leading causes of death for san diego county residents of all ages, regardless of gender, race or region. - between 2012 and 2016, more than 5,700 san diegans died from unintentional injuries. - in 2016, there were 1,071 deaths due to unintentional injury in san diego county the countys age-adjusted death rate due to unintentional injury was 31.1 deaths per 100,000 population. In 2016, unintentional injury accounted for 5.1 percent of total deaths in san diego county. - in 2016, there were 20,247 hospitalizations related to unintentional injury in san diego county. The age-adjusted rate of hospitalizations due to unintentional injury was 589.4 per 100,000 population. - in 2016, there were 169,017 ed discharges related to unintentional injury in sdc. The age-adjusted rate of discharges due to unintentional injury was 5,160.3 per 100,000 population. - cdph injury data reports that in 2016, unintentional injuries caused over 13,000 deaths, 200,000 non-fatal hospitalizations, and 2.3 million non-fatal ed visits (cdph, safe and active communities branch, 2016). - in 2015, the cdc recorded approximately 30.8 million ed visits in the u.s. For unintentional injuries (cdc, 2015). - in 2015, the cdc recorded approximately 30.8 million ed visits in the u.s. For unintentional injuries (cdc, 2015). - in 2016, unintentional injury was the third leading cause of death across all age groups in the u.s., accounting for over 160,000 deaths. Unintentional injury was the leading cause of death in the u.s. For people ages 1 to 44, and the seventh leading cause of death for those over age 65 (cdc, 2018). - according to data from nchs, in 2016, over 130,000 deaths in the u.s. Were attributed to three causes: poisoning (26 percent), motor vehicle traffic accidents (16.9 percent), and falls (16.5 percent). - unintentional injuries are the leading cause of death among children in the u.s., while nonfatal unintentional injuries can result in children having long-term disabilities (lwsd report card on children, families, and community, 2017). - traumatic injury is the leading cause of death among children, with many survivors enduring the consequences of brain and spinal cord injuries. The physical, emotional, psychological and learning problems that affect injured children, along with the associated costs, make reducing traumatic injuries a high priority for health and safety advocates throughout the nation. Educational programs like thinkfirst increase knowledge and awareness of the causes and risk factors of brain and sci, injury prevention measures, and the use of safety habits at an early age (www.thinkfirst.org/kids, 2015). - san diego county has made strides to decrease deaths from unintentional injuries as well as non-fatal unintentional injury rates, though non-fatal unintentional injury rates continue to exceed state and federal rates. Sdc has focused injury prevention efforts on the most vulnerable populations, including children of all ages (especially older children), native american and rural children. Successful interventions include safety campaigns, educational strategies and changes in parenting practices (lwsd report card on children, families, and community, 2017). - according to hp2020, most events resulting in injury, disability or death are predictable and preventable. There are many risk factors for unintentional injury and violence, including individual behaviors and choices, such as alcohol use or risk-taking; physical environment both at home and in the community; access to”

“Trauma awareness conference scripps participates with local agencies giving attendee the opportunity to learn more about trauma services. Education is provided on injury prevention and the latest trauma research. Activities include: concussion prevention, fatal vision goggles, and learning the consequences of distracted driving behavioral health behavioral health is an important health need because it impacts an individuals overall health status and is a comorbidity often associated with multiple chronic conditions, such as diabetes, obesity and asthma. Behavioral health encompasses many different areas including mental health, mental illness and substance abuse. Because of its broadness, it is often difficult to capture the need for behavioral health services with a single measure. An analysis of mortality data in san diego county found that in 2016, alzheimers disease and suicide as the third and ninth leading causes of death in san diego county, respectively. A summary of the magnitude and prevalence of behavioral health is described below: - the scripps 2016 chna continued to identify behavioral health as a priority health issue affecting members of the communities served by scripps. - the hasd&ic 2016 chna identified behavioral health as the top priority health issue for community members in san diego county. - in the hasd&ic 2016 chna mental health issues and alcohol/drug abuse issues were consistently selected by the highest number of hhsa survey participants in all regions as health problems that have the greatest impact on overall community health. In addition, aging concerns including alzheimers disease was cited among the top five most important health needs in all regions in san diego county except the central region. The following categories were found to be important health needs with behavioral health in san diego county: - alzheimers disease (seniors) - anxiety (all age groups) - drug and alcohol issues (teens and adults) - mood disorders (all age groups) - feedback from the behavioral health discussions in the 2016 chna found that high rates of psychotic discharges in ages 25 to 44 were likely linked to underlying substance abuse problems. Although participants agreed with the findings, it was found that hospital coding may potentially underrepresent the prevalence of underlying issues and miss certain conditions. Most notably missing from oshpd data was developmental disorders. The groups also pointed out the importance of emerging data trends. In recent years, discussion participants cited a significant increase in drug-related discharges, particularly methamphetamine (~over 100%). - an analysis of 2016 mortality data for san diego county revealed alzheimers disease and suicide as the third and ninth leading causes of death for san diego county, respectively. - among adults: 14.6% of medicare beneficiaries suffer from depression, 10.3% have seriously considered suicide and 12.4% per 100,000 commit suicide each year. - in 2016, 5,692 individuals were discharged from the emergency department (ed) for self-inflicted injury in san diego county, an age-adjusted rate of 173.20 per 100,000 population. This included 191 individuals ages 65 and older, an age-adjusted rate of 44.37 per 100,000 population. Of these seniors, 90 were hospitalized (20.91 per 100,000 population). During the same year, the age-adjusted death rate due to suicide in san diego county was 11.89 deaths per 100,000 population, or 406 deaths. The rate for seniors was much greater at 18.35 deaths per 100,000 population. Both rates are higher than the hp2020 target of no more than 10.2 deaths per 100,000 population. - according to 2017 data from the office of statewide health planning and development (oshpd), anxiety disorders were the top primary diagnosis for behavioral health-related ed discharges among those ages five to 44 and ages 65 and older. For those ages 45 to 64, the top ed discharge for behavioral health was alcohol-related disorders, f”

“Mental health outreach services, a-visions vocational training program behavioral health services at scripps mercy hospital, in partnership with the san diego chapter of mental health of america established the a-visions vocational training program (social rehabilitation and prevocational services for people living with mental illness) to help decrease the stigma of mental illness and offer volunteer and employment opportunities to persons with mental illness. This supportive employment program provides vocational training for people receiving mental health treatment, potentially leading to greater independence. This year, behavioral health services continued participating in the a-visions program. Since its inception, 577 clients have been enrolled and 96 have been scripps volunteers and 52 have been employed at scripps health. Currently, there are a total of 20 employees and four volunteers participating in this supportive employment program. A-visions participants have been employed on a casual/per diem basis by scripps environmental services, food services and clerical support for health and information services, emergency services, nursing research, human resources, access, behavioral health, credentialing, labor and delivery, laboratory, medical staffing, performance improvement, spiritual care and palliative care services. Paid a-visions candidates typically limit their work to eight hours per week, which allows them to maintain eligibility for the disability benefits, medications and ongoing behavioral healthcare that supports their work. Increasing awareness of mental health issues in fiscal year 2018, scripps behavioral health services improved awareness of mental health issues by providing information and supportive services for more than 900 people at community events. Community health improvement partners (chip) and suicide prevention council the san diego county suicide prevention council (spc) is a collaborative community-wide effort focused on realizing a vision of zero suicides in san diego county. Its goal is to prevent suicide and its devastating consequences in san diego county. Since 2010, with support from the county of san diego behavioral health services, chip provides direct oversight and guidance toward the implementation of the suicide prevention action plan. The core strategies of the spc are: -enhancing collaborations to promote a suicide-free community - conducting needs assessments to identify gaps in suicide prevention services and supports - disseminating vital information on the signs of suicide and effective help-seeking -providing resources to those affected by suicide and suicidal behavior - advancing policies and practices that contribute to the prevention of suicide psychiatric liaison team (plt) the psychiatric liaison team is a mobile psychiatric assessment team. Clinicians provide mental health evaluation and triage services to accurately assess patients and provide them with best and safest community resources to promote ongoing care. The team aims to help people adhere to treatment plans, reduce hospital readmission rates, relieve symptoms and ultimately ensure the long-term stabilization of the patient's mental health. Scripps will continue to provide a dedicated psychiatric liaison team at all scripps hospitals emergency departments and urgent care settings (rancho bernardo and torrey pines). Mi puente/my bridge-scripps mercy hospital chula vista scripps whittier diabetes institute also received a $2.4 million study grant from the nih's national institute of nursing research in 2015 to evaluate mi puente, a program at scripps mercy chula vista hospital that uses a "nurse + volunteer" team approach to help hospitalized hispanic patients with multiple chronic diseases reduce their hospitalizations and improve their day-to-day health and quality of life. Individuals of low socioeconomic (ses) and ethnic minority status, including hispanics, the largest u.s. Ethnic minority group are d”

“Survivors of suicide loss san diego chapter scripps health provides meeting space for members of the survivors of suicide loss san diego chapter. The organization reaches out to and supports people who have lost a loved one to suicide. The goal is to give survivors a place where they can be comfortable expressing themselves, a place to find support, comfort, resources and hope in a judgment-free environment. Scripps drug and alcohol resources there are in excess of 25 million illicit drug users in the us. There are an estimated 136.9 million current drinkers of alcoholic beverages and of those, approximately 23 percent binge drank in the last 30 days and 6.3 percent are considered heavy drinkers. It is estimated there are 8.7 million under-age drinkers. Substance use, particularly opioid misuse, is a health crisis that has reached epidemic proportions both nationally and locally. In san diego, the rate of discharge from emergency departments for chronic substance abuse increased by 559% from 2014-2016; rates for those 65 years and older increased the most by 714%. The rate of discharge for opioid misuse for this age group was even more startling it rose by 1.734% over this two year period. Rates of discharge from emergency departments for acute substance abuse also rose. Rates increased for people of all racial and ethnic backgrounds; however, the most substantial increases (177%) was for blacks. Heavy alcohol consumption is also a problem in san diego. Nearly 20% of all adults ages 18 and older self-report excessive alcohol use. Scripps substance use disorder service (suds) nurses aware of the impact drugs and alcohol can have on our community, scripps has developed innovative ways to treating this destructive disease. Scripps has deployed specialized nurses certified in addiction; they see patients at their bedside and work closely with the patients entire health care team to help facilitate a safe detox while hospitalized. The substance use disorder service (suds) nurses act in a proactive and reactive role in all of the scripps hospitals, helping to identify patients who are at risk, or are currently experiencing withdrawal from addictive substances. This mobile group of specially trained drug and alcohol resource nurses provide education, interventions and discharge placement assistance to patients in the scripps hospitals. The resource nurses work directly with the nursing staff at each of the hospitals in search of patients who may be at risk for alcohol/drug withdrawal and assist with implementing a standardized protocol withdrawal process. Scripps has changed the way we deliver drug and alcohol treatment by collaborating with others to deliver a continuum of care that improves the health of our community. When patients need additional care, scripps has linked itself to two separate treatment programs designed to meet the community needs. Betty ford center in 2016, scripps partnered with the betty ford center, which expanded its drug and alcohol treatment programming into san diego. This treatment center brings world-renowned alcohol and drug rehab to more people through weekday and weeknight outpatient services. Family health centers of san diego family health centers of san diego provides an array of services, including outpatient drug and alcohol treatment along with medication-assisted treatment and harm reduction programs. Their service also include individual counseling and one-on-one support, educational sessions, hiv resting, hepatitis b& c testing and treatment. Opioid stewardship program (osp) the opioid stewardship program has spearheaded multiple projects at scripps to educate patients and providers about the risks of opioids and the benefits of alternative multi-modal pain management options to reduce opioid use. The program has established prescribing standards for opioids, resulting in a 25 percent reduction in the number of opioid pills per prescription at scripps hospitals and outpatient centers in 201”

“Accordingly, food assistance provided by the supplemental nutrition assistance program (snap) known as calfresh in california, significantly reduces the rate and severity of poverty throughout the state (california budget & policy center, 2018). While snap and womens, infants, children (wic) have been successful in assisting low-income children and their families with additional funding for purchasing healthy foods, there is evidence that suggests screening for fi in healthcare settings is the best indicator for patients to access food-related assistance. Scripps health began screening for calfresh in june 2017 through the support of the public resource specialist (prs) team. The prs are experienced staff with strong knowledge of the county programs. They screen all uninsured patients who have received services at any of the five scripps hospital facilities. The in-house application process can take up to 45 minutes as they are screening for multiple programs concurrently. Once an application has been completed, the prs staff submits it to the county via the hospital outstation services (hos) program. Once submitted, a county hos worker is assigned and the prs team tracks the application, advocating for the patients throughout the process that can take up to 45 days to receive an eligibility response. In some instances having to go through the appeal process that may add an additional 30 days. In doing so, the prs team helps patients maneuver a complex application process that otherwise may deter them from seeking much needed acute and preventative care. The team has been successful in having the important conversation about food insecurity with 36% of the patients they have screened in this past fiscal year. The city heights wellness center (chwc) scripps mercy hospital has established a partnership at the city heights wellness center (chwc) with la maestra family clinic and rady childrens hospital to address some of the attributing factors to poor health status for local residents. With la maestra serving as the lead agency, scripps mercy and rady childrens are contributing resources to support operational costs of the center in order to provide capacity for need community linkages. Eligibility workers from la maestra family clinic are available to counsel people and assist filling out applications for food stamp assistance. Chwc not only provides the needed space for the activity, but also actively participates by developing outreach flyers, scheduling community residents, and overall coordination for the class. Applications and assistance for calfresh to supplement food budget and allow families/individuals to buy nutritious food. Scripps mercy wic program the city heights wellness center is home to the scripps mercy hospital-wic program that provides nutrition education and counseling, breastfeeding education and support and food vouchers to pregnant and parenting women, and children 0-5 years of age. Food finders rescuing food, reducing hunger scripps corporate food service partnered with food finders, a multi-regional food bank and food rescue program that connects businesses to charitable institutions in need of donations. Food finders connected scripps with interfaith community services in escondido, which distributes food to people in need. All leftover food from scripps corporate facilities is packaged, picked up each day and transferred to the scripps 4s ranch food and nutrition services freezer for storage. The cost is minimal, as scripps uses the same amount of labor to package the food as it would to dispose of it, and unsold "grab and go" items are already packaged. Interfaith community services picks up the frozen food twice per week and transports it to one of their facilities to help feed the community. Between food donated by scripps and others, interfaith distributes an average of 126,000 hot meals and packed lunches and 23,000 emergency meals, feeding approximately 17,000 people every year. Fostering volu”

“In the past, gaps in the public insurance system and lack of access to affordable private coverage left millions without health insurance, and the number of uninsured americans grew over time, particularly during economic downturns. By 2013, the year before the major coverage provisions of the affordable care act (aca) went into effect, more than 44 million nonelderly individuals lacked coverage. Under the patient protection and affordable care act (aca), millions of californians have gained health coverage. These gains have come either through the expansion of medicaid (called medi-cal in california) to low income adults earning up to 138% of the federal poverty guideline (fpg), or through covered california, the states aca health insurance marketplace, where people earning up to 400% fpg can purchase subsidized insurance coverage. The major coverage expansions of the aca were implemented starting in 2014, and by 2016 the uninured rate among nonelderly californians had fallen from 15.5% to a historic low of 8.5%. (this percentage includes children). Key findings since 2010, generally all age groups experienced a decline in the percent uninsured for both the county and state. The 18-64 year age group experienced the greatest decline in number of people uninsured under the aca. Financial assistance assisting low-income, uninsured patients assisting low-income, uninsured patients the scripps financial assistance policy is consistent with the language of both state (ab774) california hospital fair pricing policy legislation and the internal revenue code (irc) 501(r) regulations. These practices reflect our commitment to assisting low-income and uninsured patients with discounted hospital charges, charity care and flexible billing and debt collection practices. These programs are available to everyone in need, regardless of their race, ethnicity, gender, religion or national origin. Scripps makes every effort to identify patients who may benefit from financial assistance as soon as possible and provide counseling and language interpretation when needed. In addition, scripps does not apply wage garnishment or liens on primary residences as a way of collecting unpaid hospital bills. Eligibility for financial assistance is based on family income and expenses. For low-income, uninsured patients who earn less than twice the federal poverty level (fpl), scripps forgives the entire bill. For those patients who earn between two and four times the fpl, a portion of the bill is forgiven. Patients who qualify for financial assistance are not charged more than scripps discounted financial assistance amount. For 2019, the department of health and human services defined a family of four at 200 percent federal poverty level as $51,500. Professional education & health research quality health care is highly dependent upon health education systems and medical research programs. Without the ability to train and inspire a new generation of health care providers, or to offer continuing education to existing health care professionals, the quality of health care will be greatly diminished. Medical research also plays an important role in improving the community's overall health by developing new and innovative treatments. Each year, scripps allocates resources to advance health care services through clinical research, medical education and health professional education. During fiscal year 2018 (october 2017 to september 2018), scripps invested $26,757,826 in professional training programs and clinical research to enhance service delivery and treatment practices in san diego county. This section highlights some of our professional education and health research activities. Health professions training internships scripps commitment to ongoing learning and health care excellence extends beyond our organization. Our student programs help promote health care careers to a new generation, shape the future workforce and develop future leaders in our community. I”

“This combined experience includes weekly meetings at local schools facilitated by teachers and advisors, as well as monthly meetings at scripps hospital encinitas. The program mentors students on leadership and provides tools for daily challenges. Each year the students work toward a final presentation based on their community service projects related to health care and wellness. The 2018 class touched a variety of topics from mental illness to influenza. More than 100 students, community members and health care specialists attended the young leader in health care final meeting, culminating with student presentations on types of cancer and treatments. Students that participate in the program are eligible to apply to the high school explorer summer internship program. This years 2018 ylhc service project presentation awards were given to: - 1st place: mission vista high school for their presentation on mental health - 2nd place: westview high school for their presentation on alzheimers - 3rd place: francis parker high school for their presentation on influenza - 4th place: san dieguito high school for their presentation on epidemiology - 5th place: canyon crest academy for their presentation on stem cells scripps health graduate medical education for more than 70 years physicians in scripps graduate medical education programs have helped care for underserved populations throughout the region. Scripps has a comprehensive range of graduate medical education programs at scripps mercy hospital, scripps family practice residency program and scripps green hospital. Scripps graduate medical education programs are well-known for excellence, provide a hands-on curriculum that focuses on patient-centered care and offer residencies in a variety of practices, including internal medicine, family medicine, podiatry, pharmacy and palliative care. Scripps has a pharmacy residency program which train residents with doctor of pharmacy degrees. In fy18, scripps had a total of 149 residents and 38 fellows enrolled throughout the scripps health system. More details on these programs are included in the community benefit report. Ucsd/scripps health hospice and palliative medicine fellowship program the ucsd/scripps health hospice and palliative medicine fellowship program is a one-year program designed for physicians who wish to become sub-specialists and have a long-term career in hospice and palliative medicine. In 2017, the hospice program transitioned to the elizabeth hospice and it became the hospice rotation site for the fellowship. This is a unique partnership in which ucsd and scripps health share responsibility for the fellows, with trainees spending equal time in both institutions with all the benefits of both institutions. The program prepares trainees to work in a variety of roles, including leadership positions in the field. Graduates have successfully become hospice medical directors and palliative medicine consultants in outpatient and inpatient settings across the united states. Fellows who complete the ucsd/scripps health program are well equipped to practice in diverse settings, including: acute palliative care units, inpatient consultation, outpatient consultation, patients' homes, and long-term care facilities. Form 990, part vi, line 11 990 review process with the governing body the form 990 was prepared by an outside accounting firm with the support of the corporate finance team with input from human resources, foundation, and legal office. The form 990 was reviewed by the president, legal counsel, chief financial officer, audit committee, human resources and compensation committee prior to filing. In addition, a full copy of the 990 was provided to the board of trustees via email in advance of filing form 990 with the irs. Form 990, part vi, line 12c compliance policy monitoring within 60 days of hire and annually thereafter all supervisors and above; all employees in the supply chain management department, audit & compliance”

“Other changes in net assets joint ventures distribution 1,931,964 transfer from gluck for the gluck llc merger 1,707,949 transfer of endowment funds (7,329,791) other changes in net assets 551,964 change in value in deferred gifts (485,937) rounding (19,007) ------------ total (3,642,858)”

“Description:phys fees-provider svs agrment total fees:xxx-xx-xxxx”

“Description:other purchased svs - non med total fees:83028528”

“Description:physician fees total fees:59072263”

“Description:purchased medical services total fees:27317652”

“Description:all other fees for services total fees:22552736”