Sharp Memorial Hospital

“BOARD OF DIRECTORS MEMBER STEPHEN CUSHMAN AND BOARD OF DIRECTORS MEMBER LORI MOORE - Family relationship”

“Sharp HealthCare (FEIN 95-6077327) is the sole member of Sharp Memorial Hospital.”

“Sharp HealthCare, as the sole member of the corporation, has the right to elect and remove most board members.”

“Sharp Healthcare, as the sole member of the corporation, has the right to elect and remove most board members. Sharp Healthcare also retains the approval rights afforded members for certain significant transactions (e.g. dissolution or sale or transfer of all or substantially all of the assets).”

“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 Accounting & Tax, Vice President of Finance, Senior Vice President and Chief Financial Officer, and entity Chief Financial Officer. Additionally, the organization contracts with Ernst & Young, an independent accounting firm, for review of the Form 990.”

“Sharp Memorial Hospital has a written conflict of interest policy which has been reviewed and approved by the Sharp Memorial Hospital governing board. Sharp Memorial Hospital 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 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 2016.”

“The Compensation 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 Compensation Committee of the Board of Directors by the independent consultant. The Compensation Committee is comprised of Board members who are not physicians and who are not compensated in any way by the organization. The Compensation Committee creates and approves the organization's Executive Compensation Philosophies and Strategies statement and as part of this approves the total compensation for the President/Chief Executive Officer and reviews and approves the total compensation recommendations for the remaining executive team. The Compensation Committee presents its decision to the Board of Directors. The Compensation 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 2016.”

“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).”

“Independent Contractors are paid under Sharp HealthCare's tax identification number (95-6077327) and are reported on Sharp HealthCare's tax return.”

“- Total Revenue: 393215, Related or Exempt Function Revenue: 393215, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;”

“- Total Revenue: 440970, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 440970;”

“Sharp HealthCare Community Benefit Plan and Report Fiscal Year 2017 Section 1 An Overview of Sharp HealthCare We're an organization filled with passionate, determined and caring people, who have grown our health care system into the remarkable place that it is. Each day, these professionals recognize and celebrate the purpose of their work and the impact it has on our neighbors, friends and family in the community. - Michael W. Murphy, President and Chief Executive Officer, Sharp HealthCare Sharp HealthCare (Sharp or SHC) 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; 24 medical centers; five 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 (HMO) coverage through Sharp Health Plan (SHP). Serving a population of approximately 3.3 million in San Diego County (SDC), as of September 30, 2017, Sharp is licensed to operate 2,084 beds and has more than 2,600 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, sub-acute 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 r”

“The corporation shall, at all times, operate a hospital under the name Donald N. Sharp Memorial Community Hospital. The purpose of the corporation shall be to promote and to oversee the quality of care rendered in the hospital; to act as the governing board authority in matters of medical staff relations, clinical issues, credentialing, physician discipline and Joint Commission on Accreditation of Hospital requirements; and to establish policies to support those purposes.”

“Pillars of Excellence In support of Sharp's organizational commitment to transform the health care experience, Sharp's Pillars of Excellence serve as a guide for its team members, providing framework and alignment for everything Sharp does. In 2014, Sharp made an important decision regarding these pillars as part of its continued journey toward excellence. Each year, Sharp incorporates cycles of learning into its strategic planning process. In 2014, Sharp's Executive Steering and Board of Directors enhanced Sharp's safety focus, further driving the organization's emphasis on its culture of safety and incorporating the commitment to become a High Reliability Organization (HRO) in all aspects of the organization. At the core of HROs are five key concepts: * 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: 1. Demonstrate and improve clinical excellence and exceed customer expectations. 2. Keep patients, employees and physicians safe and free from harm. 3. Create exceptional experiences at every touch point for patients and families, enrollees, physicians, partners and team members. 4. Create a values-driven culture that attracts, retains and promotes the best people who are committed to Sharp's mission and vision. 5. Achieve financial results to ensure Sharp's ability to deliver on its mission and vision. 6. Achieve net revenue growth to enhance market position, sustain infrastructure improvements and support innovative development. 7. 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. Sharp was also ranked No. 52 out of 250 organizations on Forbes' 2017 America's Best Employers for Diversity and was the only hospital system listed in San Diego. In 2017, Sharp was recognized as one of "150 Top Places to Work in Healthcare" by Becker's Hospital Review. The list recognizes hospitals, health systems and organizations committed to fulfilling missions, creating outstanding cultures and offering competitive benefits to their employees. In 2015 and 2017, Sharp ranked first for "San Diego's Best Hospital Group" in the annual San Diego Union-Tribune Readers Poll. Sharp ranked second in this category in 2016. SMH ranked first for "San Diego's Best Hospital" in 2017 while ranking second in this category in 2016. Also in 2016, SMBHWN and SGH ranked third and fourth, respectively, for "San Diego's Best Hospital." From 2015 to 2017, Sharp Community Medical Group (SCMG) ranked first as "San Diego's Best Medical Group." In 2016, SRSMG ranked third for "San Diego's Best”

“SRSMG was recognized by the Centers for Disease Control and Prevention (CDC) as a 2017 Million Hearts Hypertension Control Champion for achieving blood pressure control for at least 70 percent of its adult patients with hypertension. From 2013 to 2017, the Press Ganey organization recognized multiple SHC entities with Guardian of Excellence Awards(r). 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 SHC entities included SCVMC, SCHHC, SGH, SMBHWN, SMH, SMH Outpatient Pavilion (OPP), SMV, SHC, Sharp HospiceCare, SRSMG, SCMG and Sharp Home Health for Employee Engagement; SMH and SMBHWN for Patient Experience; and SCHHC, SMBHWN and SMV for Physician Engagement. Press Ganey also recognized multiple SHC entities with the Pinnacle of Excellence Award(r) (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 Press Ganey categories of Patient Experience, Employee Engagement, Physician Engagement and Clinical Quality Performance. In 2013 and 2015 through 2017, Press Ganey recognized SMH for patient experience. From 2013 to 2015, SHC was recognized for Employee Engagement. In 2013, SCHHC and SMV were recognized for Physician Engagement. SHP's 2016-2017 National Committee for Quality Assurance's (NCQA) Private Health Insurance Rankings rating increased from a 4 to 4.5 out of 5, making it one of the highest-rated health plans in the nation. SHP was also ranked a top 100 U.S. health plan and a top three California health plan from 2014 to 2015, which rated health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. SHP also received the highest level "Excellent" Accreditation status from the NCQA each year from 2013 to 2015. The NCQA awards accreditation status is based on compliance with rigorous requirements and performance on Healthcare Effectiveness Data and Information Set and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. In addition, SHP was rated highest in California among reporting California health plans in the rating categories of Rating of the Health Plan, Rating of Health Care, Rating of Personal Doctor, and Rating of Health Promotion and Education in NCQA's 2015 Quality Compass/CAHPS survey, which provides state, regional and national benchmarks as well as individual plan performance. From 2013 to 2017, 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. The Women's Choice Award(r) is a symbol of excellence in customer experience awarded by the collective voice of women. SGH received a Women's Choice Award(r) as one of America's Best Hospitals for Cancer Care in 2015, Obstetrics in 2016 and Heart Care in 2017. SMH and SGH received a Women's Choice Award(r) as one of America's Best Stroke Centers in 2017. In 2015, SMBHWN received the award as one of America's Best Hospitals for Obstetrics. The Women's Choice Award(r) also ranked SCHHC, SCVMC and SMH amongst America's 100 Best Hospitals for Patient Experience in 2017. In addition, SMH received the award as one of America's Best Hospitals for Bariatric Surgery in 2017. 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 the San Diego Association of Governments' (SANDAG) iCommute 2016 Rideshare Corporate Challenge. The annual month-long challenge encourages the replacement of solo drivers with sustainable carpool, vanpool, bike, walk, or”

“Also in 2017, Sharp supported and provided payment options to high-risk, uninsured and underinsured patients at all Sharp hospitals who were unable to meet their financial responsibility after health insurance. Through the Maximum Out of Pocket Program, team members met with patients to help them better understand their health insurance benefits and how to access care during their hospital stay, as well as provided payment options. 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. The Public Resource Specialists performed field calls (home visits) to patients who left the hospital and required assistance with completing the coverage application process. SGH's PFS team worked closely with the hospital's Care Transitions Intervention program to evaluate patients for CalFresh, the Supplemental Nutrition Assistance Program in California, prior to hospital discharge, dramatically increasing the likelihood that patients complete CalFresh applications and receive benefits. In FY 2017, SGH's PFS team completed 687 CalFresh applications and 405 patients were granted CalFresh benefits. In February 2017, Sharp's PFS team expanded this program to the remainder of Sharp's acute care hospitals. In summer 2015, a pilot program was launched at SMBHWN to evaluate both insured and unfunded families with Neonatal Intensive Care Unit (NICU) babies for financial assistance. 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 newborn both within and outside of the hospital. Public Resource Specialists have assisted more than 150 families through the SSI application process. In addition, Sharp provides post-acute care facilitation for high-risk patients, including the homeless and patients lacking 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. SCHHC, SGH and SMH work with the San Diego Rescue Mission (SDRM) to identify homeless patients, or patients who have exhausted other community housing resources, who have a continuing medical need after hospital discharge. Once referred to the SDRM's Recuperative Care Unit, patients receive follow-up medical care through Sharp in a safe environment, and may also receive psychiatric care, assistance scheduling specialty appointments, support with CalFresh applications, and connections to community resources, including programs that support continued sobriety and residential treatment. In addition, a social worker provides referrals for permanent housing and collaborates 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. Sharp is committed to providing medical records to support an SSI claim free of charge. 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 2017, nearly 4,600 student interns dedicated more than 650,000 hours within the Sharp system. Sharp provided education and training for students in a variety of disciplines, including nursing students (e.g., critical care, medical/surgical, behavioral health, women's services, cardiac services and hospice) and allied health professions such as rehabilitation therapies (speech, physical and occupational therapy), pharmacy, respiratory therapy, imaging,”

“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. In FY 2017, 432 HSHMC students - including 162 Level I students and 270 Level II students - were supervised for more than 97,700 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; endoscopy; engineering; nutrition; infection control; pulmonary services; 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 2017, the HSHMC program graduated 161 students in its seventh full class. Each year, Sharp reviews and evaluates its collaboration with HSHMC, including the outcomes of students and graduates, to promote long-term sustainability. Although many HSHMC students face financial hardship - the free and reduced-price meal eligibility rate is higher than the averages for SDC and California - the school excels in preparing students for high school graduation, college entrance and a future career. In 2017, 90 percent of the HSHMC graduating class went on to attend two- or four-year college, while 80 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 California's 83.2 percent state average. HSHMC received the 2016 Impact Award from the Classroom for the Future Foundation as the most innovative education program in SDC. Each year, the Classroom for the Future Foundation awards education programs across SDC in four categories: innovate, inspire, achieve and impact. HSHMC was also recognized as a U.S. News & World Report Best High Schools bronze award winner in 2014, 2016 and 2017. The California Department of Education recognized HSHMC as a 2015 California Gold Ribbon School for its outstanding education programs and practices, and as a Title I Academic Achieving school for demonstrating success in significantly reducing the gap between high- and low-performing students. HSHMC was also recognized with a 2015 Model Professional Learning Community at Work(tm) Award by Solution Tree for its sustained success in raising student achievement. Professional Learning Communities are schools and districts in which educators recognize the key to improved learning for students is ongoing, job-embedded education for the adults who serve those students. HSHMC was one in approximately 200 schools and districts in the U.S. and Canada - and the first school in SDC - to receive this honor. In addition, HSHMC was a 2014 National School Safety Advocacy Council award winner. Lectures and Continuing Education Sharp contributes to the academic development of students at colleges and universities throughout San Diego. In FY 2017, Sharp staff pro”

“Outcomes Research Institute Since its inception in 2010, Sharp's ORI seeks to measure the long-term results of care to continue to develop and promote best practices in health care delivery. The ORI enables Sharp to develop and disseminate new knowledge to the larger health care community, and help improve the quality of care delivery across SDC. The ORI collaborates with Sharp team members to facilitate the design of patient-centered outcomes research projects; assist with study protocol development, data collection and analysis; explore funding mechanisms for research projects; and facilitate IRB application submissions. The ORI seeks guidance and expertise from the local and national academic community on how to effectively conduct outcomes research to improve patient and community health. This networking has resulted in collaborative research partnerships with investigators at SDSU and National University. In addition, in FY 2017, ORI research studies were presented at various professional conferences, including the Health Care Systems Research Network Conference in San Diego, the Cardiovascular Disease and Stroke Scientific Sessions in Arlington, Virginia, and the Academy Health Annual Research Meeting in New Orleans, Louisiana. Presentations included Utilizing Data Analytics and Innovation Partnerships to Reduce Hospital Readmissions; Influence of Ethnic and Gender Diversity in Quality of Care for Patients Receiving Treatment for Acute Myocardial Infarction; and Impact of Behavioral Health Data in Improving Prediction of Hospital Patient Readmissions. Beginning in September 2016, the ORI expanded its capabilities by adding a full-time postdoctoral clinical psychology fellowship position and a half-time practicum placement for a predoctoral graduate student. Based on the successful contributions of these programs, the ORI has hired a full-time clinical psychologist, renewed the graduate student practicum placement, and will offer new research training experiences for three psychology undergraduate students in FY 2018. Evidence-Based Practice Institute Sharp participates in the Evidence-Based Practice Institute (EBPI), which prepares teams of staff fellows and mentors to change and improve clinical practice and patient care through identifying a care problem, developing a plan to solve it and incorporating this new knowledge into practice. The EBPI is part of the Consortium for Nursing Excellence, San Diego, which promotes evidence-based practices in the nursing community. The consortium is a partnership between Sharp, Scripps Health, Palomar Health, Rady Children's Hospital - San Diego, UC San Diego Health, U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, Elizabeth Hospice, PLNU, SDSU, APU and USD. Sharp actively supports the EBPI by providing instructors and mentors as well as administrative coordination. The EBPI includes six full-day class sessions featuring group activities, self-directed learning programs outside of the classroom, and structured mentorship throughout the program. EBPI fellows and mentors partner with one another through a variety of learning strategies. Mentors facilitate the process of conducting an evidence-based practice change and navigating the hospital system to support the fellows through the process of evidence-based practice. Mentors also assist fellows in working collaboratively with other key hospital leadership personnel. In FY 2017, the nine-month program culminated with a community conference and graduation ceremony in November, during which the EBPI fellows and mentors shared project results. Forty-six attendees, including 23 fellows and 23 mentors, graduated from the program. Projects addressed the following issues in clinical practice and patient care: post-operative spine mobilization; reduction of anxiety for hospitalized patients undergoing caesarean section; nurse-physician rounding; the impact of wall art in the psychiatric intensive care unit; early mobiliz”

“Doors of Change is a nonprofit organization dedicated to solving youth homelessness through empowerment and self-sufficiency. Through its Taking Music & Art to the Streets program, Doors of Change provides homeless youth with free music and art lessons, haircuts, hot meals, clothing, chiropractic care and social services. On eight days in February, June, and August, 35 SLAH volunteers served homeless youth at the Episcopal Church Center in Ocean Beach by sorting clothing and hygiene products, making sandwiches, and cleaning up after the program. Promises2Kids provides current and former foster youth in SDC with the tools, opportunities and guidance they need to grow into healthy, happy and successful adults. In June and July, 20 SLAH volunteers supported the Guardian Scholars and Camp Connect programs by assembling goody bags, packing boxes, and assisting with inventory, as well as assembling care packages for college students raised in the foster care system. The Ssubi is Hope Greening for Good project collects discarded but safe and usable supplies from U.S. hospitals and distributes them to clinics around the world that have little or no medical resources. In addition to providing life-changing and life-saving services to people in underserved countries, the project has protected the environment by keeping more than one million pounds of medical surplus out of local landfills. On 20 days between October 2016 and September 2017, 265 SLAH volunteers joined the Greening for Good project to evaluate, sort, label and prepare medical materials for shipment. The Special Olympics Southern California - San Diego County program offers free, year-round sports training and competition for children and adults with intellectual disabilities. In May 2017, 25 SLAH volunteers supported the program's basketball competition during the Regional Spring Games at Carlsbad High School. Volunteers served as athlete escorts as well as assisted with score-keeping, time-keeping and the awards ceremony. In addition to building homes in partnership with local people in need, San Diego Habitat for Humanity operates two ReStore retail centers with a wide variety of new or gently used building materials and home furnishings for public purchase. The ReStore centers provide affordable merchandise to customers while helping fund the construction of Habitat homes throughout SDC. On two days in August and September, 20 volunteers organized donated items and took inventory of stock for the Mission Valley ReStore retail center. 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 June and July, approximately 120 volunteers sorted and organized clothing donations as well as set up and worked in the event's clothing tent. In addition, approximately 60 clinical volunteers - including Sharp-affiliated physicians and Sharp nurses, podiatry technicians, pharmacists and licensed pharmacy technicians - provided medical and pharmaceutical services. More than 900 veterans were served through the 2017 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, an estimated 60 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 celebration of Earth Day, in April, SLAH partnered with I Love a Clean San Diego for the 15th annual Creek to Bay Cleanup. Approximately 35 SLAH volunteers participated in this countywide effort to beautify San Diego's beaches, bays, trails, canyons and p”

“The Alegado Foundation is a San Diego-based medical mission organization determined to help children, the sick and the aged through the provision of medical services, and donations of medical supplies, children's books, toys and sports equipment. In March, a Sharp team member joined the Alegado Foundation on a medical mission to the southern Philippines. Alongside local doctors, nurses, dentists, elementary school teachers and Philippine military personnel, the team provided free medicine, medical consultations, dental services and minor surgical procedures to approximately 275 patients over a two-day period. The team also fed and read to local children and provided free haircuts for youth and senior citizens. Random Acts of Kindness Life (RAKlife) is a nonprofit organization dedicated to developing a global culture that incorporates random acts of kindness into daily life to help those less fortunate around the world. For 10 days in April, a Sharp team member participated in a RAKlife trip to the Mai Chau District in Northwestern Vietnam, where the team built a small house and a clean water basin for a local family. In February, another Sharp team member visited Vietnam for two weeks through Prisoners of Hope, a ministry offered through the Rock Church Global Outreach program. The mission team provided a variety of medical and optometry services for approximately 1,190 medical patients and 800 optometry patients, including prisoners, orphans, the disabled, and those living in poverty. Since 1934, Liga International (The Flying Doctors of Mercy) has provided free health care and education to the people of the Mexican state of Sinaloa. In March and April, a Sharp nurse traveled to the city of El Fuerte, Sinaloa, to assist with admitting, operating and recovery for approximately 30 local patient surgeries. In May, a Sharp nurse participated in a 10-day mission trip to Lima, Peru, through CardioStart International - a global volunteer organization that brings specialized cardiac care teams to underserved regions. The team, which included a cardiac surgeon, anesthesiologist, cardiologist, respiratory therapist, nurses and support staff, performed surgery for eight children with congenital heart defects as well as provided advanced cardiac education to help local medical teams improve surgical outcomes and patient care. Also in May, a Sharp team member helped co-lead a team of eight PLNU students on a mission trip to Armenia 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 Armenian families, including: donating clothing to the impoverished; repainting local schools; helping a local church move to a larger facility; and encouraging local churches in their ministry to women, children and teens. Community Walks Heart disease is the leading cause of death in the U.S. For the past 21 years, Sharp has proudly supported the AHA's annual San Diego Heart & Stroke Walk, which promotes physical activity to build healthier lives, free of cardiovascular diseases and stroke. In September 2017, approximately 960 walkers represented Sharp at the 2017 San Diego Heart & Stroke Walk held at Balboa Park. More than 120 teams, representing entities across the Sharp system, raised funds for the walk through numerous activities, such as auctions, drawings for prizes and a karaoke competition. Sharp has maintained its position as the No. 1 team in San Diego for the past 21 years and was the No. 2 team in the AHA Western States Affiliate for the third year in a row, raising more than $217,700 and setting a SHC fundraising record. To date, Sharp has raised more than $3 million through its San Diego Heart & Stroke Walk fundraising efforts. Sharp Volunteers Volunteers are a critical component of Sharp's dedication to the San Diego community and help make a difference in the”

“Approximately 50 new hospice volunteers were trained in FY 2017. 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, seven teenagers participated in Sharp HospiceCare's Teen Volunteer program. In 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, seven premedical students from SDSU, UC San Diego and CSUSM volunteered time by supporting family caregivers in private homes. 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 as their loved one passed away. Ten volunteers were trained through the 11th Hour program in FY 2017. In FY 2017, Sharp HospiceCare trained 12 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 help 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 aims to pair volunteers who have military experience with veteran patients, as well as honors veteran patients through special pinning ceremonies. In FY 2017, Sharp HospiceCare held two pinning ceremonies during which volunteers presented a WHV pin and a certificate of appreciation to approximately 90 Sharp HospiceCare veteran patients as well as more than 50 veteran community members. Sharp HospiceCare continued to offer the Memory Bear program to support community members who have lost a loved one. Through the program, 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 2017, volunteers dedicated nearly 2,700 hours to sewing more than 670 bears for approximately 240 families. Sharp HospiceCare recognizes the valuable impact that volunteers have on the experience of its patients, family and caregivers. In light of this recognition, Sharp HospiceCare offered a monthly continuing education support group to enhance the skills of its volunteers. In addition, Sharp HospiceCare honored its volunteers during National Volunteer Week in April, and National Hospice and Palliative Care Month in November. Sharp Metropolitan Medical Campus (SMH, SMBHWN, SMV, SMC) Volunteer Programs Through the Community Care Partner (CCP) program at SMH, hospital volunteers are hand-selected and trained to serve and comfort patients without family or friends present during their hospital stay. Activities may include reading, writing letters, taking walks, playing”

“Other Sharp Community Efforts In FY 2017, 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 2017 WeAllCount Annual Report, there were 9,116 individuals experiencing homelessness in SDC, which represents an increase of 5 percent region-wide from 2016. 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. 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 more than 1,000 homeless individuals in Downtown San Diego with friends and family across the nation. Diapers are expensive - a month's supply can cost up to $100 per child - and cannot be purchased with CalFresh or Women, Infants, and Children (WIC) benefits. As a result, parents with limited economic resources may change diapers less frequently than recommended and unintentionally place their infant at risk. In FY 2017, Sharp worked with Assemblywoman Lorena Gonzalez, SDG&E and hundreds of organizations and citizens across San Diego to help struggling families cope with a serious challenge - the cost of diapers - by donating diapers to the Food Bank's new Diaper Bank Program. The Diaper Drive, hosted by SDG&E, netted more than 27,000 diapers for families in need, nearly tripling the goal of 10,000 diapers. Sharp employees showed their support for this cause by donating more than 6,500 diapers. The SGH Engineering Department led a variety of volunteer initiatives in FY 2017. 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 2017, the team delivered three to four vases of flowers with an inspirational quote each week, with as many as eight vases or more during peak flower season and upon additional requests. In addition, nearly 40 vases of flowers were delivered to new mothers 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 their fundraising events to benefit East County seniors, as well as offers roses for SGH's annual patient remembrance service. Now in its seventh 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. The SGH Engineering Department further extends the spirit of caring through the creation of Cheers Bouquets for patients or visitors that appear to need encouragement or cheer, as well as to recognize patient birthdays, anniversaries and other special moments. With help from Sodexo - the hospital's food service, housekeeping and engineering vendor - a bouquet is quickly assembled (with balloons, ribbon, a Sodexo Care Bear and/or football) and delivered to the individual. In FY 2017, the team assembled up to 10 Cheers Bouquets per month, including bouquets for more than 40 new fathers on Father's Day weekend. For the past seven years, the SGH Engineering Department, landscape team and Auxiliary have collaborated with local businesses to bring The Shirt Off Our Backs Program to community members in ne”

“For the past three years, SCVMC has supported Operation Gobble Thanksgiving Turkey Distribution, an event started by Assemblywoman Lorena Gonzalez. In 2016, Operation Gobble provided Thanksgiving turkeys to 30 patients from the Barnhart Cancer Center's Medical and Radiation oncology departments. In addition, in December, SCVMC partnered with a Chula Vista chapter of Optimist International for a Holiday Bike Giveaway. Optimist International is a worldwide volunteer organization that helps develop children to their full potential. The Holiday Bike Giveaway program helped provide bicycles to nine children of cancer patients as Christmas gifts. All Ways Green Initiative As San Diego's largest private employer and leading health care provider, Sharp has long been committed to improving the health of the environment and therefore the communities it serves. Sharp recognizes the connection between a healthy environment and individual health and well-being, and 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(tm) 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 green efforts. Sharp's active environmental initiatives are concentrated in five domains: (1) energy efficiency, (2) water conservation,(3) waste minimization, (4), commuter solutions, and (5) sustainable food practices. Specialized committees/subcommittees are responsible for each of these domains (see Table 3), while established Green Teams at each Sharp entity are responsiblefor developing new programs that educate and motivate Sharp employees to conserve natural resources and reduce, reuse and recycle. Table 3: All Ways Green(tm) 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(tm) utilizes a customized report card, which evaluates each domain's annual performance against a baseline. The report card is designed to show where the desired results have been achieved and where improvements are still needed. Entity Green Teams utilize the report card to communicate the initiative results to all staff and to establish more effective sustainability practices. 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, and hospital water use constitutes seven percent of the total water used in commercial and institutional buildings in the U.S. 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. The EPA states that 30 percent of the health care sector's current energy use could be reduced without sacrificing quality of care through a shift toward energy efficiency and use of renewable energy sources. Sharp's Natural Resource Subcommittee has responded to this challenge by implementing numerous energy and water conservation initiat”

“To demonstrate its ongoing commitment to reducing energy consumption on a national level, in FY 2017 Sharp joined Practice Greenhealth's Healthier Hospitals Lean Energy Challenge - an initiative that provides support and guidance for hospitals that aspire to reduce energy consumption, increase energy efficiency, and save significantly on energy costs. All Sharp hospitals engage in the EPA's ES database and monitor their ES scores on a monthly basis, thus following an international standard for energy efficiency created by the EPA. Buildings that are certified by ES must earn a 75 or higher on the EPA's energy performance scale, indicating that the building performs better than at least 75 percent of similar buildings nationwide without sacrifices in comfort or quality. According to the EPA, buildings that qualify for the ES typically use 35 percent or less energy than buildings of similar size and function. As a result of Sharp's commitment to superior energy performance and responsible use of natural resources, SCHHC and SCVMC received the ES certification in 2017 (SCHHC first earned the ES certification in 2007, and then again each year from 2010 through 2013, while SCVMC received ES certification from 2009 to 2011, 2013 and 2015). 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 in San Diego of its kind. Additional energy conservation initiatives at Sharp are outlined in Table 4. 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 ES 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, System Offices, SMH/SMBHWN Energy-efficient Chillers/ Motors - SCHHC, SCVMC, System Offices, SMH/SMBHWN Faucets and Toilet Retrofits - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Heating, Ventilation and Air Conditioning projects- SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Natural Resource Project - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Light-emitting Diode (LED) - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Lighting Occupancy Sensors - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Lighting Retrofits - 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 - System Services 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 enhancing recycling efforts. Sharp made the following achieve”

“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. Additional sustainability initiatives implemented by Sharp are described below. * 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 and SCHHC recently partnered with FSD, making 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 2017, Sharp donated 18,300 pounds of food to these safety-net organizations. * In FY 2017, Sharp's composting programs diverted approximately 442,000 pounds of waste from landfills. SMMC was the first group of hospitals in SDC to participate in the city's food scraps composting program in 2012. In 2017, the program expanded to SCVMC with its engagement of the City of Chula Vista. Also in 2017, SGH collaborated with Resource Management Group recycling center to begin a composting program. Through these programs, food waste at these three Sharp sites is processed into a rich compost product and 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. According to the City of San Diego, such waste diversion programs contribute to the extension of the landfill's lifespan from 2012 to at least 2022. * Launched in 2016, a soup stock program at SMH turns previously unused vegetable scraps into soup stock and saves, on average, 174 pounds of food each week. In addition, SCHHC saves an average of 45 pounds of food through its soup stock program. * In 2017, Sharp's imperfect produce program purchased more than 20,000 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. The imperfect produce program is currently in effect at SCVMC with plans to expand across the system. * In 2017, Sharp's cooking oil recycling program collected more than 6,000 pounds of oil, which is converted into safe biodiesel oil. * SCHHC, SMH and SMV continued to operate the first county-approved hospital-based organic gardens. Produce from the gardens is used in meals served at the hospital cafes. * Sharp's waste-mindful operations, including self-audit checklists, continue to help kitchen teams reduce their carbon footprint between food preparation and cleanup. In recognition of these initiatives, the San Diego Food System Alliance awarded Sharp a”

“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. In addition, Sharp participates in the SANDAG Bike to Work Day event every year in May. During the 2017 challenge, Sharp employees were among almost 10,000 San Diegans who opted to ride their bike to work. Sharp supported community cyclists by hosting food and beverage pit stops at various sites throughout SDC. Sharp also encourages employees to participate in the SANDAG iCommute RideMatcher vanpool and carpool program, which can help employees find convenient ride share partners and promote sustainable commuting. Using iCommute's TripTracker, employees can monitor the cost and carbon savings resulting from their alternate commuting methods. 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. 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. In FY 2017, 84 organizations in SDC - representing more than 200,000 employees - competed in the challenge. Sharp won the top spot in the Mega Employer category for the fourth year in a row and for the fifth time in six years. 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 500 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. Sharp's ongoing efforts to promote alternative commute choices in the workplace has led to recognition as a SANDAG iCommute Diamond Award recipient consistently between 2001 and 2010, and again from 2013 through 2017. Community Education and Outreach Sharp actively educates the community about its sustainability programs. In FY 2017, 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(tm) Earth Week celebration, including Earth Fairs at each Sharp hospital and system office. During the fairs, employees learned how they can 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 the 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. * In recognition of America Recycles Day, Sharp created a video for all Sharp employees to view on the intranet. Th”

“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 SCVMC, SCHHC, SGH, SMH, SRSMG Urgent Care Centers and Clinics, San Diego's Ronald McDonald House, Rady Children's Hospital, Scripps Mercy Hospital Chula Vista, Kaiser Permanente San Diego and Zion Medical Centers, Alvarado Hospital Medical Center, Paradise Valley Hospital, UC San Diego Health, Palomar Health, Health Center Partners of Southern California, Naval Air Station North Island/Naval Medical Services, San Diego County Sheriff's Department and Marine Corps Air Station Miramar Fire Department. 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 the sharing of resources, trainings and information, members of the partnership are better prepared for a coordinated response to an emergency or disaster affecting SDC. 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 a mass decontamination event. 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 September, Sharp hosted its sixth annual Disaster Preparedness Expo to educate San Diego residents on effective disaster preparedness and response in the event of an earthquake, fire, power outage or other emergency. Held at Liberty Station, the free event provided more than 700 community members with a variety of disaster exhibitors, demonstrations and displays as well as education on personal and family disaster planning. In recent years, endemic events occurring across the globe have had the potential to impact public health in the local San Diego community. Sharp has continued to partner 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 preparation has allowed for the continued 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 wellness initiatives to improve the overall health, safety, happiness and productivity of Sharp's workforce. Each Sharp hospital, SRSMG 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 2017, 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”

“New in 2017, Sharp Best Health introduced Wellness on Wheels, a monthly educational event offered to Sharp employees to address the challenge of accessing online 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 allows staff who were previously unable to receive wellness resources to access these benefits. Sharp has established 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 2017, Sharp partnered 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(r) offers weight-loss services and products founded on a scientifically based approach to weight management that encourages healthy eating, increased physical activity and healthy weight management behaviors. Sharp Best Health continued its partnership with Weight Watchers(r) to offer Sharp team members a subsidized membership rate to any Weight Watchers(r) 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 2017, approximately 720 Sharp employees were actively using Weight Watchers(r). Since the program was deployed in 2016, participating employees have lost an estimated 3,000 pounds. In addition to providing Weight Watchers(r) at work, during FY 2017 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 registered dietitian to ensure continued support and accountability. During FY 2017, 210 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 2016 holiday season, Sharp Best Health and Sharp Community Benefit collaborated to take this effort a step further. In partnership 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 - Sharp transformed its traditional food drives to "superfood drives," encouraging nonperishable food donations that are also nutritious, sustaining and essential for a healthy life. Through the six-week holiday superfood drive at locations throughout the Sharp system, Sharp doubled its number of food drive sites from earlier holiday seasons, and collected more than 3,000 pounds of nutritious food - an increase of 90 percent compared to previous years. In addition, Sharp team members donated nearly $2,900 through a new Sha”

“* Medical Care Services included uncompensated care for patients who are unable to pay for services, and the unreimbursed costs of public programs such as Medi-Cal, Medicare, San Diego County Indigent Medical Services, Civilian Health and Medical Program of the United States of America Department of Veterans Affairs (CHAMPVA), and TRICARE - the regionally managed health care program for active-duty, National Guard and Reserve members, retirees, their loved ones and survivors; and unreimbursed costs of workers' compensation programs. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; flu vaccinations and 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 2017 In FY 2017, Sharp provided a total of $415,307,122 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. Table 9: Sharp HealthCare Total Community Benefit - FY 2017 (Economic value is based on unreimbursed costs) Medical Care Services: Shortfall in Medi-Cal - $140,198,987 Note: 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. Shortfall in Medicare - $222,539,275 Note: 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. Shortfall in San Diego County Indigent Medical Services - $7,999,688 Note: 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. Shortfall in CHAMPVA/TRICARE - $6,179,147 Note: Methodology for c”

“Table 12: Detailed Economic Value of SB 697 Categories - Estimated FY 2017 Unreimbursed Costs Sharp Chula Vista Medical Center: Medical Care Services - $78,695,427 Other Benefits for Vulnerable Populations- $322,813 Other Benefits for the Broader Community - $218,217 Health Research, Education and Training Programs - $995,185 Total - $80,231,642 Sharp Coronado Hospital and Healthcare Center: Medical Care Services - $16,678,892 Other Benefits for Vulnerable Populations- $37,305 Other Benefits for the Broader Community - $55,596 Health Research, Education and Training Programs - $273,797 Total - $17,045,590 Sharp Grossmont Hospital: Medical Care Services - $115,474,253 Other Benefits for Vulnerable Populations- $834,124 Other Benefits for the Broader Community - $551,723 Health Research, Education and Training Programs - $1,203,579 Total - $118,063,679 Sharp Mary Birch Hospital for Women & Newborns: Medical Care Services - $10,872,953 Other Benefits for Vulnerable Populations- $45,688 Other Benefits for the Broader Community - $90,276 Health Research, Education and Training Programs - $197,558 Total - $11,206,475 Sharp Memorial Hospital: Medical Care Services - $167,900,539 Other Benefits for Vulnerable Populations- $1,018,661 Other Benefits for the Broader Community - $443,956 Health Research, Education and Training Programs - $1,303,146 Total - $170,666,302 Sharp Mesa Vista Hospital and Sharp McDonald Center: Medical Care Services - $16,871,457 Other Benefits for Vulnerable Populations- $522,956 Other Benefits for the Broader Community - $278,986 Health Research, Education and Training Programs - $350,815 Total - $18,024,214 Sharp Health Plan: Other Benefits for Vulnerable Populations- $21,488 Other Benefits for the Broader Community - $41,566 Health Research, Education and Training Programs - $6,166 Total - $69,220 Section 3 Community Benefit Planning Process An exceptional community citizen is practical as well as visionary; a great leader. Someone who can collaborate at multiple levels during a difficult time for the greater good. - Stacey Hrountas, Chief Executive Officer, Sharp Rees-Stealy Medical Group 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”

“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 Secondary Data Variables 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. 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 promoters, and members of Sharp's Patient Family Advisory Councils - community members who are also current or former Sharp patients. 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, analysis of feedback from the 2016 CHNA community engagement activities identified SDOH to be a key theme among community health needs. Ten SDOH were consistently referenced across the different community engagement activities conducted in both HASD&IC's and Sharp's CHNAs. The importance of these SDOH was also confirmed by quantitative data. Hospital programs and community collaborations have the potential to”

“Education and training programs for students, interns and health care professionals - $1,851,519 Note: 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. Section 5 Sharp Mary Birch Hospital for Women & Newborns Giving back to the community is rewarding on a personal level, but it's also more than that. It's the reward of knowing you are part of something larger than yourself and that you are an integral part of something meaningful. - Nicole Giangregorio, Manager of Women's Support Programs, Sharp Mary Birch Hospital for Women & Newborns FY 2017 Community Benefit Program Highlights Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) provided a total of $11,206,475 in community benefit in FY 2017. See Table 30 for a summary of unreimbursed costs based on the categories specifically identified in Senate Bill 697 (SB 697), for the distribution of SMBHWN's community benefit among those categories. Table 30: Economic Value of Community Benefit Provided Sharp Mary Birch Hospital for Women & Newborns - Estimated FY 2017 Unreimbursed Costs Medical Care Services: Shortfall in Medi-Cal - $7,857,930 Note: 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. Shortfall in Medicare - $1,081,498 Note: 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. Shortfall in CHAMPVA/TRICARE - $828,297 Note: 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. Shortfall in Workers' Compensation - $218 Note: 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. Charity Care - $703,337 Note: 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. Bad Debt - $401,673 Note: 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. Other Benefits for Vulnerable Populations, Broader Community, and Health Research, Education and Training Programs: Patient transportation and other assistance for the needy - $45,688 Note: 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. Health education and information, support groups, health fairs, meetin”

“According to the CNI, communities served by SMBHWN with especially high need include, but are not limited to, Southeast San Diego, East San Diego, City Heights, North Park and National City. Description of Community Health In SDC in 2016, 99.7 percent of surveyed children ages zero to 11, 99.5 percent of surveyed children ages 12 to 17, and 90.8 percent of surveyed adults ages 18 to 64 had health insurance, which fall short of the Healthy People 2020 (HP2020) national target of 100 percent health insurance coverage for all individuals under age 65. In SDC in 2016, 14.5 percent of adults ages 18 to 64 did not have a usual source of care and 10.6 percent of these adults had health insurance. In addition, 25.3 percent of adults without a usual source of care reported fair or poor health outcomes. See Table 31 for a summary of key indicators of access to care and Table 32 for data regarding Medi-Cal eligibility. In 2015, the unemployment rate for SDC was 10.3 percent. Further, 40.7 percent of adults ages 18 to 64 living at 200 percent below the federal poverty level reported as food insecure (lack of access to healthy food). Table 31: Health Care Access in SDC, 2016 Current Health Insurance Coverage: Children 0 to 11 Years: Rate - 99.7%, HP2020 Target - 100% Children 12 to 17 Years: Rate - 99.5%, HP2020 Target - 100% Adults 18 to 64 Years: Rate - 90.8%, HP2020 Target - 100% Regular Source of Medical Care: Children 0 to 11 Years: Rate - 96.7%, HP2020 Target - 100% Children 12 to 17 Years: Rate - 74.1%, HP2020 Target - 100% Adults 18 to 64 Years: Rate - 85.5%, HP2020 Target - 89.4% Not Currently Insured: Adults 18 to 64 Years: Rate - 9.2%, HP2020 Target - N/A Source: 2016 California Health Interview Survey (CHIS) Table 32: Medi-Cal (Medicaid) Eligibility Among Uninsured in SDC (Adults Ages 18 to 64 Years), 2016 Medi-Cal Eligible - 13.9% Not Eligible - 86.1% Source: 2016 CHIS. This information is sourced from the 2016 CHIS Health Profile for SDC, provided by the UCLA Center for Health Policy Research. Starting in 2013, the California state budget required children enrolled in the Healthy Families Program to transition enrollment into Medi-Cal. Formerly, this table included Healthy Family eligibility in San Diego County using pre-ACA data. The Affordable Care Act now determines financial eligibility for Medi-Cal using Modified-Adjusted Gross Income, based on income and number of persons in the household. In 2013, there were 43,627 live births in SDC overall. In 2011, fetal mortality in SDC overall was 4.2 fetal deaths per 1,000 live births plus fetal deaths, meeting the HP2020 national target of less than 5.6 fetal deaths per 1,000 live births plus fetal deaths. In 2011, the fetal mortality rate was 4.8 (fetal deaths per 1,000 live births plus fetal deaths) in the north coastal region, 2.8 in the north central region, 5.1 in the central region, 3.8 in the south region, 3.0 in the east region and 5.4 in the north inland region. In 2011, all SDC regions met the HP2020 national target of less than 5.6 fetal deaths per 1,000 live births plus fetal deaths. In 2013, 199 infants in SDC died before their first birthday, an infant mortality rate of 4.6 per 1,000 live births. Infant mortality was higher among male infants (108 deaths) than female infants (91 deaths). Hispanic infants had the highest mortality rate when compared to infants of all other races and ethnicities. In addition, there were 3,624 preterm births (less than 37 weeks gestation) in SDC during 2013. When compared to all other groups, preterm births were more common among male infants, and among mothers ages 25 to 34 or of Hispanic ethnicity. In 2013, 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 33 for a summary of maternal and infant health indicators in SDC in 2013 and Table 34 for a summary of maternal and infant health indicators by reg”

“SMBHWN is a specialty hospital providing care for expectant mothers and newborns as well as women's services. Therefore, in alignment with these identified needs, the following pages detail programs that specifically address high-risk pregnancy, including reducing the incidence of neonatal morbidity and mortality associated with high-risk pregnancy and preterm delivery. As a specialty hospital, SMBHWN lacks the resources to comprehensively address the elements of community education and support for cardiovascular disease, Type 2 diabetes, obesity, senior health or behavioral health. Consequently, the programs and services that attend to these health issues are addressed through the programs and services provided by SMH. The community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. For additional details on SMBHWN programs that specifically address the needs identified in the 2016 CHNA, please refer to SMH's implementation strategy available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through further analysis of SMBHWN's community programs and consultation with its service line leaders and executives, this section also addresses the following priority health needs for community members served by SMBHWN: * Reducing the incidence of neonatal morbidity and mortality associated with high-risk pregnancy and preterm delivery * Meeting the needs of new mothers and their families * Health professions education and training, and collaboration with local schools to promote interest in health care careers For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the need, objective(s), FY 2017 Report of Activities conducted in support of the objective(s), and Fiscal Year 2018 (FY 2018) Plan. Identified Community Need: Reducing the Incidence of Neonatal Morbidity and Mortality Associated With High-Risk Pregnancy and Preterm Delivery Rationale references the findings of the SMH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMH 2016 CHNA identified high-risk pregnancy as one of seven priority health issues for community members served by SMBHWN. * The HASD&IC 2016 CHNA process continued to identify high-risk pregnancy among priority health conditions observed in San Diego hospitals. * As part of the SMH 2016 CHNA, discussions with Sharp social workers who work with high-risk pregnancies identified the following health-related issues or needs for high-risk pregnant women: anxiety; childcare; depression; diabetes (gestational and brittle); the emotional impact of hospitalization on both the patient and their family; high blood pressure; isolation for non-English speakers; pre-term labor requiring bed rest or hospital stay; and stress, helplessness and lack of control over one's body. * According to research presented in the SMH 2016 CHNA, risk factors for high-risk pregnancy include: advanced maternal age (ages 35 years and older) lifestyle choices such as smoking, alcohol consumption or the use of illegal drugs; medical history including prior high-risk pregnancies or deliveries, fetal genetic conditions or family history of genetic conditions; underlying conditions such as diabetes, high blood pressure, obesity and epilepsy; and multiple pregnancies. * A 2015 report from the Children's Initiative titled San Diego County Report Card on Children and Families identified the following barriers to utilization of prenatal care: financial barriers, such as a lack of health insurance; the context of care, such as biased treatment from providers or a lack of cultural competence; and issues surrounding access to care, such as transportation, difficulty obtaining an appoint”

“SMBHWN continued to support Miracle Babies, a volunteer-driven nonprofit organization that provides support and financial assistance to families with critically ill newborns in the neonatal intensive care unit (NICU) as well as education, prevention and medical care to enhance the well-being of women, children and families. In FY 2017, SMBHWN raised approximately $5,000 for the organization through participation in the annual Miracle Babies Gala and 5K Walk. SMBHWN also provided fundraising support for the 2017 San Diego Heart & Stroke Walk as well as for March of Dimes, a nonprofit organization dedicated to preventing birth defects, premature birth and infant mortality through community and global outreach programs and research. Further, in April, SMBHWN team members participated in Sharp's annual Women's Health Conference where they provided information about the hospital's community programs and services as well as presented on lifestyle factors to help optimize reproductive health and technological advances to help assess and manage fertility. In 2013, the Sharp Mary Birch NRI was launched to discover new, leading-edge treatments and practices in newborn care, and disseminate its research findings to improve outcomes for at-risk newborns throughout the world. Led by a multidisciplinary team of physicians, nurses, respiratory therapists, researchers and data analysts, the NRI has completed more than 30 clinical trials with nearly 1,650 newborns participating. This includes a study demonstrating that delayed umbilical cord clamping provides babies with additional health benefits, which contributed to a recommendation by The American Congress of Obstetricians and Gynecologists to standardize the practice. The NRI values the perspective of the community in shaping the future of NICU care. Through its Parent Advisory Board (PAB), parents and grandparents of infants who have been in the NICU offer the NRI their unique point-of-view as parents of a NICU baby, including feedback on proposed and current clinical trials to help ensure that other parents will understand and feel comfortable participating in them. The NRI shares its expertise and groundbreaking research developments throughout the greater health care and research communities. In March 2017, the NRI presented at Neo-Resus, an international conference featuring world experts who discuss clinical research and current practices in neonatal resuscitation. In FY 2017, the NRI continued to offer a Bedside Ultrasound Training for Neonatologists course - a multiweek training that consists of hands-on, one-on-one training sessions and expert lectures on theoretical and practical ultrasound technique for neonatologists. Open to local, regional, national and international neonatologists, the course is one of only a few similar training programs in the country. Further, the NRI's newsletter - NRI News - is published twice per year to communicate current NRI studies and updates to the medical community. The NRI's medical discoveries have been featured on multiple news networks, including ABC, CBS, CNN, KNSD, KPBS, KSWB, and more, while its research findings have been shared in several distinguished medical journals, including Journal of Pediatrics, American Journal of Perinatology, and Frontiers in Pediatrics, among others. The NRI has received funding support from personal donations as well as from various foundations and organizations including Gerber Foundation, Hartwell Foundation, Thrasher Research Fund, Little Giraffe Foundation and Will Rogers Institute. In addition, the NRI has received three grants from the National Institutes of Health, including most recently in March 2017 to support its leadership of a multi-site international study analyzing umbilical cord milking versus delayed cord clamping - the largest and most comprehensive study of its kind. In addition to its groundbreaking research, the NRI works closely with SMBHWN's Nemeth NICU Follow-Up Clinic, which provide”

“* Maternal depression is the most common complication of pregnancy in the U.S. Findings from the California Department of Public Health's 2012-2013 Maternal and Infant Health Assessment indicated that 21.5 percent of California mothers experienced depressive symptoms during pregnancy or postpartum (California Task Force on the 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 problems; and isolation or lack of social support (APA, 2016). * Most maternal and infant deaths occur during the postnatal period - the days and weeks following childbirth - yet this is the most neglected period for the provision of quality care. Evidence-based postnatal care practices include timing of discharge from a health facility after birth, postnatal contacts including assessment of mother and baby, exclusive breastfeeding, cord care, and counseling on the physiological process of recovery after birth (World Health Organization (WHO), 2013). Objectives * Demonstrate best practices in breastfeeding and maternity care * Provide education and support to new mothers on the importance of breastfeeding * Provide postpartum education and support to new mothers and their families * Provide NICU-specific support services to new mothers and their families FY 2017 Report of Activities In November 2015, SMBHWN received Baby-Friendly USA Designation through the Baby-Friendly Hospital Initiative - a global program launched by the WHO and the United Nations Children's Fund to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother-baby bonding. The five-year designation was earned through participation in the NICHQ Best Fed Beginnings Learning Collaborative, supported by the CDC, and through implementation of the 10 Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes. SMBHWN received this designation in partnership with First 5 San Diego, which provided grant funding needed to fulfill the staff training hours required for the designation. Approximately 620 registered nurses (RNs) at SMBHWN have completed the required competency training to achieve and maintain Baby-Friendly USA Designation. Since the hospital started its Baby-Friendly journey in 2011, the rate of exclusive breastfeeding at discharge has increased from a baseline average of 47 percent to 64 percent in FY 2017. In FY 2017, SMBHWN served nearly 1,800 new mothers through a free breastfeeding support group. Facilitated by an experienced lactation educator, the group was offered three times per week to teach participants techniques to improve breastfeeding and allow participants to share their personal breastfeeding joys and challenges. SMBHWN continued to provide its free weekly NICU breastfeeding support group - the Mother's Milk Club - for all mothers in the community whose baby spent any length of time in the NICU. Approximately 200 mothers received support and counseling for topics of concern, including milk supply, latching, sleeping, the stress of having a baby who is experiencing problems and any other concerns of the group. The mothers also had the opportunity to share their own experiences, feed and show off their babies, and measure and track their baby's growth. SMBHWN continued to offer the Baby and Me Time support group to ensure new parents safely transition from giving birth at the hospital to returning home. Understanding that it c”

“For the past 21 years, SMBHWN has hosted the NICU Little Graduate Reunion for babies and families who have spent time in the hospital's NICU. The event provides a special opportunity for families to reunite with the team members who cared for them during their stay, and celebrate the health of their child. The same families often return to the reunion year after year, with many of the graduates now in their teens. To accommodate growing attendance, the FY 2017 Little Graduate Reunion was held off-campus for the first time at the Naval Training Center in Liberty Station. Nearly 600 parents, grandparents, siblings and NICU graduates enjoyed a variety of activities, including a bounce house, bubble station, music, face painting, photo booth, and games for all ages. In summer 2015, SMBHWN launched a program to evaluate eligibility for Supplemental Security Income (SSI) for newborns who have been diagnosed with a disabling medical condition or extremely LBW. This benefit is offered to both unfunded patients as well as insured families to assist with the cost of care for their newborn. Since the inception of the program, approximately 150 families have been referred to Public Resource Specialists for assistance with the SSI application process. FY 2018 Plan SMBHWN will do the following: * Continue to implement evidence-based breastfeeding practices as a Baby-Friendly USA designated hospital * Continue to offer free postpartum, breastfeeding, and new-parent support groups to new mothers and their families * Continue to offer a variety of educational classes for new mothers and their families * Continue to provide the NICU Little Graduate Reunion to former NICU patients and their families * Continue to evaluate eligibility of high-risk newborns for SSI benefits and provide referrals for application assistance Identified Community Need: Health Professions Education and Training, and Collaboration with Local Schools to Promote Interest in Health Care Careers Rationale references the findings of the SMH 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). * The same report indicated that the six fastest-growing health care occupations in SDC between 2013 and 2016 were physician's assistants (22 percent), medical assistants (18 percent), health care social workers (15 percent), home health aides (13 percent), licensed vocational nurses (12 percent), and medical and clinical lab technicians (11 percent). RNs accounted for 1,366 added jobs during this period, which was the largest increase in total jobs among all health care occupations (SDWP, 2017). * The Health Care Priority Sector report also found that health care employers identified RNs, physicians and surgeons, and health technicians as the most difficult positions to fill. The most frequently cited reason for hiring difficulties were lack of experience, small applicant pools, and insufficient non-technical skills (SDWP, 2017). * A 2014 SDWP labor market analysis indicated an increase in the number of health care training providers in SDC, but a shortage of clinical training facilities where applicants can gain necessary experience. The scarcity of clinical facilities offering prerequisite training has made it increasingly difficult for employers to find qualified workers. * The 2017 SDWP Nonprofit Sector Employment Trends and Career Opportunities report recommends that nonprofit sector health care training and education programs in SDC emphasize soft skills such as being a team player, interpersonal and communication skills, big-picture thinking with the ability to plan and forecast, problem solving, and the ability to adapt to a”

“In FY 2017, SMBHWN completed its 10th year of participation in the Health Sciences High and Middle College (HSHMC) program, providing valuable health care experience, including job requirements and career ladder development, to ninth through 12th grade students. During a 16-week period, 60 HSHMC students devoted 15,360 hours to rotations with maternal infant services, the post-anesthesia care unit, the NICU and the transport team. In September, SMBHWN and SMH collaborated to provide the Nursing Career Development Fair to support the professional development of students who are interested in pursuing a career in nursing as well as nurses within the community. Held at the SMMC, the fair provided more than 180 attendees with advice and coaching from professional nurses as well as information on financial aid and scholarships, clinical certifications, student loan forgiveness and medical library services. In addition, representatives from more than a dozen California and State universities offered information about their nursing and allied health programs. SMBHWN team members supported local and national conferences throughout the year. In August, team members participated in Sharp's 2017 Adult and Neonatal Pulmonary Care Conference, an annual event providing expert education on current trends and advances in pulmonary and critical care medicine. SMBHWN also presented on sudden unexpected infant collapse at the AWHONN California Section Conference in February, as well as on perinatal loss at the national AWHONN Convention in June. In addition, SMBHWN team members provided trainings to community professionals, including an RPS Maternal Newborn Care course and fetal heart monitoring course for community nurses, as well as a training to prepare San Diego paramedics to safely assess and treat obstetrical trauma patients. In FY 2017, SMBHWN continued to learn and share its expertise with staff at other hospitals and health agencies through participation in organizations such as AWHONN, CWISH, SCANN, Perinatal Social Work Cluster, Sigma Theta Tau International Honor Society of Nursing, ACNL, RPS and the NICHQ Best Fed Beginnings Learning Collaborative. FY 2018 Plan SMBHWN will do the following: * Continue to serve as a training site for health professions students * Continue to participate in the HSHMC program * Continue to participate in local and national collaboratives and share specialty expertise at professional conferences SMBHWN Program and Service Highlights * Antenatal Diagnostic Center * Cord blood banking * Doula program * Gynecologic oncology * High-risk pregnancy care (Perinatal Special Care Unit) * Lactation services * Labor and delivery * Level III Neonatal Intensive Care Unit * Maternal Infant Services Unit * Mother's Milk Bank * NICU and PSCU Navigator Programs * Neonatal Research Institute * New Beginnings Boutique & Gift Shop * Obstetrical and women's triage services * Pregnancy, childbirth and parent education programs * Prenatal Diagnostic Center * Spiritual care services, including Arts for Healing * Women's and infants' pathology services * Women's surgery, including minimally invasive robotic gynecology surgery Section 6 Sharp Memorial Hospital It's gratifying to see the positive impact we're having on our community each day. I work beside exceptional people, and it makes me proud to see all they do to help improve the health and lives of our neighbors. - Tim Smith, Chief Executive Officer, Sharp Memorial Hospital FY 2017 Community Benefit Program Highlights Sharp Memorial Hospital (SMH) provided a total of $170,666,302 in community benefit in Fiscal Year 2017 (FY 2017). See Table 35 for a summary of unreimbursed costs based on the categories specifically identified in Senate Bill 697 (SB 697), for the distribution of SMH's community benefit among those categories. Table 35: Economic Value of Community Benefit Provided Sharp Memorial Hospital - Estimated FY 2017 Unreimbursed Costs Medical Care Services: Shortfall”

“* Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; flu vaccinations and specialized education and information for seniors offered by the SMH Senior Resource Center and Sharp Senior Health Centers; Project HELP; contribution of time to Stand Down for Homeless Veterans, Ssubi is Hope, Doors of Change, Promises2Kids, Kitchens for Good, Feeding San Diego and the San Diego Food Bank (Food Bank); the Sharp Humanitarian Service Program; support services for discharged homeless patients in partnership with San Diego Rescue Mission (SDRM); and other assistance for vulnerable and high-risk community members. * Other Benefits for the Broader Community included education and resources on a variety of health topics; participation in community health fairs and events; support groups; health screenings for diabetes, stroke, osteoporosis, blood pressure, depression, body composition, hearing, balance and gait, hand mobility, musculoskeletal health; and community education and resources provided by the Laurel Amtower Cancer Institute at SMH Patient Navigator program. In addition, SMH donated meeting room space to community groups as well as collaborated with local schools to promote student interest in health care careers. SMH staff actively participated in community boards, committees and other civic organizations, including the American Heart Association (AHA), Health Sciences High and Middle College (HSHMC) Board, American College of Healthcare Executives, San Diego Organization of Healthcare Leaders, Association of California Nurse Leaders, Emergency Nurses Association - San Diego Chapter, Association for Clinical Pastoral Education, Community Health Improvement Partners (CHIP) Health Literacy San Diego Task Force, Hospital Association of San Diego and Imperial Counties (HASD&IC), County of San Diego Emergency Medical Care Committee, San Diego County Stroke Consortium, San Diego Blood Bank, Serving Seniors, Community Center for the Blind and Visually Impaired, Aging and Disability Resource Connection, Caregiver Coalition of San Diego, San Diego County Council on Aging (SDCCOA), and various universities and colleges in San Diego County (SDC). See Appendix A for a listing of Sharp HealthCare's (Sharp's or SHC's) involvement in community organizations in FY 2017. The category also incorporated costs associated with community benefit planning and administration, including community health needs assessment (CHNA) development and participation. * Health Research, Education and Training Programs included time devoted to education and training of health care professionals, student and intern supervision, and time devoted to generalizable health-related research projects that were made available to the broader health care community. Definition of Community * SMH is located at 7901 Frost Street in San Diego, ZIP code 92123. * Sharp Memorial Outpatient Pavilion (OPP) is located at 3075 Health Center Drive in San Diego, ZIP code 92123. SMH serves the entire county of San Diego; however, the primary communities served by the hospital include the City of San Diego, Chula Vista, the East County region and North Inland communities surrounding Rancho Bernardo. For SMH'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 SMH 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 SDC in 2016, 99.7 p”

“* Incorporates community priorities and community relations into its strategic plan and develops service-line-specific goals * Estimates an annual budget for community programs and services, based on community needs, previous years' experience and current funding levels * Consults with representatives from a variety of departments to discuss, plan and implement community activities Priority Community Needs Addressed in Community Benefit Report - SMH 2016 CHNA SMH completed its most recent CHNA in September 2016. SMH's 2016 CHNA was significantly influenced by the collaborative HASD&IC 2016 CHNA process and findings, and details on those processes are available in Section 3: Community Benefit Planning Process of this report. In accordance with federal regulations, the SMH 2016 CHNA also includes needs identified for communities served by Sharp Mary Birch Hospital for Women & Newborns (SMBHWN), as the two hospitals share a license, and report all utilization and financial data as a single entity to the Office of Statewide Health Planning and Development (OSHPD). In addition, this year SMH completed its most current implementation strategy - a description of SMH programs designed to address the priority health needs identified in the 2016 CHNA. The most recent CHNA and implementation strategy for SMH are available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through the SMH 2016 CHNA, the following priority health needs were identified for the communities served by SMH: * Behavioral Health (Mental Health) * Cancer * Cardiovascular Disease * Diabetes, Type 2 * High-Risk Pregnancy * Obesity * Senior Health The following pages detail SMH programs, activities and services that specifically address cardiovascular disease (as part of health education and wellness; includes stroke), cancer, diabetes and senior health. SMH does not have the resources to comprehensively address the elements of community education and support in behavioral health. Consequently, the community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. High-risk pregnancy services are addressed at SMBHWN, a specialty hospital providing care for expectant mothers, newborns and women in SDC. Please see Section 5 of this report for details on SMBHWN's activities that address this identified community need. Obesity is addressed through general nutrition and exercise education and resources provided at SMH as well as programs that address a healthy lifestyle as part of care for heart disease, cancer, diabetes and other health issues influenced by healthy weight and exercise. Sharp Rees-Stealy Medical Group (SRSMG) clinics throughout SDC provide structured weight management and health education programs to community members, such as smoking cessation and stress management; long-term support for weight management and fat loss; and personalized weight-loss programs. For additional details on SMH programs that specifically address the needs identified in the 2016 CHNA, please refer to SMH's implementation strategy available at http://www.sharp.com/about/community/health-needs-assessments.cfm. In addition, through further analysis of SMH's community programs and consultation with SMH's service line leaders and other team members, this section also addresses the following priority health needs for community members served by SMH: * General community health education and wellness * Prevention of unintentional injuries * Health professions education and training, and promotion of interest in health care careers * Support during the transition of care for high-risk, underserved patients with complex medical needs For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the ne”

“* 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 prediabetes or undiagnosed diabetes, while another 2.5 million (9 percent) have already been diagnosed with diabetes (UCLA Center for Health Policy Research, 2016). * The CDC estimates that 30.2 million people in the U.S. have diabetes. Of those individuals, 23 million have been diagnosed while 7.2 million are undiagnosed (National Diabetes Statistics Report, 2017). * According to the CDC, prevention efforts such as the Diabetes Prevention Program can cut the risk of developing diabetes by more than half. However, California has been slow to devote state money to such programs. A report by the California State Auditor found that in 2012-2013, California's per capita funding for diabetes prevention was the lowest in the nation at just three cents per person (California State Auditor, 2015). * According to the American Diabetes Association (ADA), diabetes treatment costs California approximately $27.6 billion per year, with Medi-Cal and Medicare bearing the majority of the state's burden (ADA, 2015). Objectives * Provide diabetes education and screening in the central and north central regions 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 2017 Report of Activities The SMH Diabetes Education Program is recognized by the ADA for meeting national standards for excellence and quality in diabetes education. The program provides individuals and their support system with the skills needed to successfully self-manage their diabetes. Small group and one-on-one education options are offered in English and Spanish. At the Sharp Women's Health Conference, the SHC Diabetes Education Program provided diabetes risk assessments using the ADA's Diabetes Risk Test questionnaire as well as offered resources on prediabetes, diabetes management and nutrition to approximately 1,000 attendees. Also at the conference, a diabetes educator presented on how to control blood sugar levels, diabetes risk factors, behaviors that can reduce the risk of complications, and the long-term investments needed for successful management. The SHC 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 SMH Diabetes Education Program provided education and lectures to a variety of community groups in FY 2017. This included a lecture on nutrition, healthy eating and diabetes control to nearly 50 community members at the SMV East County Outpatient Mental Health Services site; education on diabetes awareness and healthy eating to more than 20 senior community members at the Gary and Mary West Senior Wellness Center; and education on diabetes and the power of lifestyle change to more than 10 community members at the Peninsula Family YMCA in Point Loma. The SMH Diabetes Education Program is actively involved with San Diego's renal health community. In FY 2017, the SMH Diabetes Education Program collaborated with the Balboa Institute of Transplantation to provide ongoing education and support to community members who have undergone kidney transplant or experienced kidney disease. In addition, the SHC Diabetes Education Program continued to collaborate with Family Health Centers of San Diego (FHCSD) to provide diabetes education to FHCSD diabetic patients at multiple sites throughout SDC, including those in SDC's central region, through FHCSD's Diabetes Management Care Coordination Project (DMCCP). DMCCP provides FHCSD diabetes patients with weekly group health and nutrition education, healthy cooking demonstrations, physical activity classes, and one”

“FY 2018 Plan The SMH Diabetes Education Program will do the following: * Provide community members with prediabetes and diabetes information at various community venues in SDC * 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 provide community members support with diabetes treatment and prevention, particularly foreign language and culturally appropriate resources for diverse populations * Continue to participate in local and national professional conferences - including those held by the ADA, American Association of Diabetes Educators and the San Diego Association of Diabetes Educators - to share best practices in diabetes treatment and control with the broader health care community * Conduct educational outpatient and inpatient symposiums for health care professionals Identified Community Need: Education, Support and Screening for Stroke Rationale references the findings of the SMH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMH 2016 CHNA continued to identify cardiovascular disease (including cerebrovascular disease/stroke) as one of seven priority health issues affecting members of the communities served by SMH. * 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 SMH 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 2015, stroke was the fifth leading cause of death for SDC overall. * In 2015, there were 1,162 deaths due to stroke in SDC. The age-adjusted death rate due to stroke was 33.3 per 100,000 population, which was lower than the HP2020 target of 34.8 deaths per 100,000 population. * In 2015, there were 6,013 hospitalizations for stroke in SDC, with an age-adjusted rate of 178.1 per 100,000 population. This rate has decreased for five straight years. * In 2015, there were 1,906 stroke-related ED visits in SDC. The age-adjusted rate of ED visits was 56.3 per 100,000 population. * According to the 2012 HHSA report titled Critical Pathways: The Disease Continuum, the most common risk factors associated with stroke include physical inactivity, tobacco use, alcohol or drug use, poor nutrition, poor medical care, stress, depression, high cholesterol and diabetes. * According to 2016 CHIS data, an estimated 25.3 percent of adults in SDC were obese, 9.3 percent smoked cigarettes, 33.9 percent reported binge drinking in the past year, 16.3 percent reported eating fast food four or more times in the past week, and 58.5 percent did not regularly walk for transportation, fun, or exercise. * 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. * 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 5 years (NINDS, 2016). Objective * Provide stroke educati”

“* The HASD&IC 2016 CHNA continued to identify dementia and Alzheimer's disease among the top 15 priority health conditions seen in SDC hospitals. * As part of the SMH 2016 CHNA, discussions with nurses and social workers at 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. * Sharp senior health discussions held as part of the SMH 2016 CHNA process identified the most common health-related issues or needs as: anxiety; cardiac disease; cognitive impairment and dementia; depression; diabetes; psychosis and chronic mental illness (specific to the population served by the Downtown Senior Health Center); hypertension; increased need for caregivers; isolation, contributing to poor diet, bad habits, and depression; loss of purpose; and substance abuse, particularly for prescription drugs. * Seniors participating in the SMH 2016 CHNA Health Access and Navigation Survey prioritized the following barriers to accessing health care: understanding health insurance, including confusing terms; knowing where to go for care, especially understanding when to use the ED, urgent care and primary care; using health insurance, including understanding health care costs/bills and knowing what services are covered; getting health insurance; and follow-up care, including understanding next steps and finding available appointments. * In 2015, Alzheimer's disease was the third leading cause of death in SDC. * In 2015, the top 10 leading causes of death among seniors ages 65 and older in SDC were (in rank order): overall cancer, Alzheimer's disease and other dementias (ADOD), CHD, stroke, chronic obstructive pulmonary disease (COPD)/chronic lower respiratory diseases, overall hypertensive diseases, diabetes, unintentional injuries, Parkinson's disease and falls. * In 2015, 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. * The top three causes of ED utilization among SDC residents ages 65 years and older in 2015 were falls, overall hypertensive diseases, and COPD. * In 2012, 71,655 calls were made to 911 for seniors in need of emergency medical care in SDC, which represents a call for one out of every five seniors. Seniors in SDC use the 911 system at higher rates than any other age group (HHSA, 2015). * According to the CDC, 2.8 million older adults are treated in the ED for falls every year. One in five falls causes a serious injury, such as broken bones or a head injury. These injuries may result in serious mobility issues and difficulty with everyday tasks or living independently. The direct medical costs for fall injuries are estimated at $31 billion annually (CDC, 2017). * In 2013, an estimated 62,000 San Diegans age 55 years and older were living with ADOD, which accounted for 8.3 percent of this age group. Assuming current trends continue, by 2030 nearly 94,000 residents 55 years and older will be living with ADOD, which is a 51 percent increase from 2013 (Alzheimer's Disease and Other Dementias in San Diego County, HHSA, 2016). * In 2016, an estimated 71.4 percent of SDC residents ages 65 and older reported that they were vaccinated for influenza in the past 12 months (CHIS, 2016). In 2015, 60 out of the 61 recorded influenza deaths in SDC occurred among those 65 and older. The age-adjusted rate of influenza death among this group was 14.5 per 100,000 population (HHSA, 2015). * Research shows that caregiving can have serious physical and mental health consequ”

“In FY 2017, the SMH Senior Resource Center reached nearly 1,100 individuals through participation in 11 community health fairs, conferences and seminars. In October, the SMH Senior Resource Center hosted its annual Senior Health and Information Fair at Point Loma Community Presbyterian Church. The event offered free flu shots, health screenings, health information, Vials of Life and community resources to approximately 200 seniors and family caregivers. Also in October, the SMH Senior Resource Center provided resources and information about Alzheimer's disease, eye health and advances in arthritis treatment to nearly 50 community members at the SDCCOA Head, Shoulders, Knees and Toes Health Fair held at First United Methodist Church in Mission Valley. In May, the SMH Senior Resource Center provided blood pressure screenings, Vials of Life, and caregiver and community resources to lesbian, gay, bisexual and transgender (LGBT) seniors at the San Diego LGBT Community Center's Senior Resource Fair. The SMH Senior Resource Center also provided community resources to more than 60 seniors, family members, social workers and case managers at the SDCCOA Living Well Health Expo held at First United Methodist Church in September. In addition, the SMH Senior Resource Center participated in the Games Day event at All Souls Episcopal Church, an annual fundraiser for the Peninsula Shepherd Center, which provided information, referrals, transportation and outreach to more than 110 seniors in Point Loma. In FY 2017, the Sharp Senior Resource Centers helped sponsor two conferences for nearly 170 community members who were providing care for a friend or family member. In May, the Sharp Senior Resource Centers collaborated with the Caregiver Coalition of San Diego to provide the Finding the Balance in Caregiving conference at the Chinese Community Center in Tierrasanta. The conference provided education from a social worker, caregiving expert, registered nurse and attorney on a variety of legal and practical caregiving topics, as well as provided a resource fair for caregivers and their loved ones. In August, the Sharp Senior Resource Centers partnered with the Caregiver Coalition of San Diego and National Alliance on Mental Illness to provide a conference at First United Methodist Church called A Day for Caregivers: Caring for an Adult Loved One with Mental Health Challenges. This conference provided presentations about self-care, the group wisdom of caregivers, communication skills, legal issues and peer recovery programs, as well as a resource fair. In June, the SMH Senior Resource Center served more than 230 community members at the County of San Diego Aging and Independence Services (AIS) 2017 Vital Aging conference held at Liberty Station. The event included presentations on maintaining health through balanced nutrition, exercising for a purpose, caring for yourself while caring for others, and brain health, as well as offered resource exhibitors, including information from the SMH Senior Resource Center on Vials of Life, screening events and programs for seniors and caregivers. In October, the SMH Senior Resource Center participated in San Diego Community Action Network's (SanDi-CAN) Planning Ahead - Crucial Conversations conference at Balboa Park. Approximately 70 seniors and their family members attended the free conference where they received education to help them identify their end-of-life values and goals of care and acquire the communication skills necessary to make informed health care decisions. The conference also included a resource fair as well as provided information about California's End-of-Life Options Act, a new law that permits terminally ill adult patients to request and receive doctor-prescribed medication to end life. In July, the SMH Senior Resource Center offered health, wellness and community resources to 100 community members at SanDi-CAN's Wellness & Resource Expo at the War Memorial Building in Balboa Park. In Apr”

“In April, Sharp Senior Health Centers provided education on seniors and isolation during an interview with Newsradio 600 KOGO. In addition, the Sharp Senior Health Centers' collaborated with the Health Insurance Counseling and Advocacy Program (HICAP) - which ensures ongoing networking among community professionals and quality programs for seniors. The collaboration with HICAP included the provision of ongoing counseling and education by a HICAP representative to community members at the Sharp Senior Health Center Clairemont. HICAP staff offered objective counseling on Medicare rights, benefits and insurance policy options to address seniors' questions and concerns. The Sharp Senior Health Centers continued to partner with the Food Bank to host quarterly Senior Nutrition & Wellness Classes at both Sharp Senior Health Center locations. Instructed by the Food Bank's registered dietitian, the six-week program consisted of hour-long classes that taught seniors the fundamentals of nutrition, including how to read nutrition labels, prepare healthy meals on a budget, and reduce salt and sugar intake, as well as senior-friendly exercises. In addition to receiving vital health and nutrition education, the Food Bank provided attendees with free fresh produce and referrals to Food Bank programs as needed. Evaluation tools included pre- and post-survey questions - in English and Spanish - that used validated items specific to the class population. In FY 2017, 25 seniors graduated from the Senior Nutrition & Wellness Classes. Twelve percent of participants identified as food insecure (lack of access to healthy food) through a validated, two-item food insecurity screening tool. More than 80 percent of graduates reported increased consumption of fresh fruits and vegetables since taking the classes and 55 percent reported a decrease in sugary beverage intake. In addition, more than a third of graduates reported increasing their exercise frequency to more than five times per week and more than 35 percent reported that the classes improved their exercise habits. Further, every participant agreed that they would recommend the classes to a friend. Throughout the year, the SMH Senior Resource Center and Sharp Senior Health Centers maintained active relationships with numerous community organizations, including the Peninsula Shepherd Senior Center, Serving Seniors (including the Potiker Family Senior Residence and the Gary and Mary West Senior Wellness Center), Bayside Community Center, Westminster Tower (senior housing), Jewish Family Service of San Diego, Caregiver Coalition of San Diego, AIS, Adult Protective Services, Southern Caregiver Resource Center, Alzheimer's San Diego, SanDi-CAN, SDCCOA, National Active and Retired Federal Employees Association, Community Center for the Blind and Visually Impaired, Cabrillo Credit Union Supervisory Committee and HICAP. FY 2018 Plan The SMH Senior Resource Center and the Sharp Senior Health Centers will do the following: * Provide information, resources and support to address relevant concerns of seniors and caregivers in the community, including senior mental health issues, ACP, memory loss, advanced illness management, caregiving, senior services, nutrition, healthy aging, and balance and fall prevention * Provide community health information and resources through educational programs, monthly blood pressure clinics, and a variety of health screening opportunities * Produce and distribute quarterly calendars for approximately 3,000 San Diego households, highlighting events of interest to seniors and family caregivers * Provide 3,000 Vials of Life to community seniors * Provide seasonal flu vaccinations at five sites to seniors and community members who face challenges in accessing care, specifically high-risk adults * Participate in a pilot project to provide hepatitis A education and vaccinations in partnership with the County, as well as provide hepatitis A information to flu clinic attendees * Partic”

“* 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). * Obesity increases the risk of many health conditions, including: CHD, stroke, Type 2 diabetes and various cancers. Obesity is also linked to environmental factors, such as accessibility and affordability of fresh foods, park availability, social cohesion and neighborhood safety (UCLA Center for Health Policy Research, 2015). * According to the CDC, some of the leading causes of preventable death include obesity-related conditions, such as heart disease, stroke, Type 2 diabetes, and certain types of cancer. In 2015-2016, 39.8 percent of Americans were obese (CDC, 2017). * In 2015, the number of arthritis-related hospitalizations in SDC totaled 9,170 - an age-adjusted rate of 266.1 per 100,000 population. * According to the National Institutes of Health (NIH), more than 53 million people in the U.S. either already have osteoporosis or are at high risk due to low bone mass. Along with the financial costs, osteoporosis can reduce quality of life for many people who suffer fractures. It can also affect the lives of family members and friends who serve as caregivers (NIH, 2016-2017). Objectives * Host educational classes and support groups for the community on a variety of health and wellness topics * Offer health literacy resources through the Cushman Wellness Center Community Health Library and outreach at community events * Participate in community-sponsored events and support nonprofit health organizations FY 2017 Report of Activities Throughout the year, the OPP and various SMH departments offered a range of community health education classes and support groups. In FY 2017, classrooms were booked for more than 1,300 hours and served more than 3,000 patients and community members. Classes covered various aspects of health and wellness, including diabetes, cancer, integrative medicine (e.g., healing touch, acupuncture, guided imagery and reflexology), relaxation skills, suicide awareness, and parenting and childbirth. Support groups provided an outlet for community members to share their personal experiences and advice for coping with various challenges, including cancer, stroke, heart transplantation, heart failure, needs of new mothers and families, and nutrition and relapse following bariatric surgery. Further, Sharp Rehabilitation Services (Sharp Rehab) offered weekly adaptive yoga classes for people with physical limitations as well as various support groups at the Sharp Allison deRose Rehabilitation Center, including Women on Wheels (WOW) support group, the Men's Spinal Cord Injury (SCI) support group and the Sharp Players. Facilitated by two Sharp Rehab social workers, the WOW support group strives to empower women with mobility impairments. In FY 2017, approximately 75 group members gathered monthly to share their thoughts and feelings about their current life challenges, victories and visions. WOW also arranged art therapy sessions, summer parties, lunch outings and museum visits for its members. With a network of numerous disabled women and community partners, WOW is the only support group strictly for women with mobility impairments in SDC. Sixteen individuals participated in the Sharp Players weekly support group in FY 2017, which uses music and drama to facilitate emotional healing and support for individuals with a range of conditions, including brain injury, SCI, spina bifida, cerebral palsy, post-encephalitis, multiple sclerosis, amputation, mental illness, blindness, cancer and stroke. Throughout the year, members performed for approximately 200 community members at St. Paul's Villa assisted living community, San Diego Brain Injury Foundation, Merrill Gardens retirement home, and the Point Loma Community Presbyterian Church Senior Program. Further, the monthly Men's SCI support group offered guest speakers and special outings for its members in FY 2017, including a”

“* Continue to increase awareness of the Cushman Wellness Center Community Health Library and its resources * Provide health education, screenings and first-aid stations at community events * Provide coordination, support and fundraising activities for local nonprofit organizations Identified Community Need: Cancer Education and Patient Navigator Services Rationale references the findings of the SMH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMH 2016 CHNA identified cancer as one of seven top priority health issues for community members served by SMH. * The HASD&IC 2016 CHNA continued to identify various types of cancer among the top priority health conditions seen in SDC hospitals. * Sharp cancer navigator discussions conducted as part of the SMH 2016 CHNA process identified the following chief concerns for cancer patients in SDC: cultural differences and language barriers between patient and provider; health literacy; financial issues; knowing where to go for care; availability of reliable transportation; difficulty with end-of-life conversations; and lack of advance care directives among cancer patients. * According to 2016 Sharp oncology data, 539 (37 percent) of the 1,457 SMH 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 SMH in 2016 were (in rank order): breast cancer, female (gynecology) genitourinary cancer, lung cancer, prostate cancer, and colorectal cancer. In total, there were 2,468 new cases of cancer at SMH in 2016. * The cancer key informant interview conducted as part of the SMH 2016 CHNA process identified access to insurance, access to appropriate care, and language barriers for non-English speakers as major challenges facing oncology patients. Additional issues include financial, legal and survivorship issues; emotional, sexual and body image issues; lack of a social network leading to increased need for transportation, in-home support and other treatment-related resources; and end-of-life or palliative care issues. * The cancer key informant interview recommended the following strategies to address barriers of care for those with cancer: the provision of lay navigators, including integration of navigators into the care process; community coordinators with knowledge of hospital needs and community resources; greater hospital and community partnerships; resources to educate providers on end-of-life and palliative care issues; personnel within the health care system to identify resources and answer questions; financial assistance for co-pays, prescriptions, child care and other bills; and survivorship clinics. * As part of the SMH 2016 CHNA process, cancer support group patients participating in the Health Access and Navigation Survey suggested the following areas for improvement in cancer care: more time with doctors; more comprehensive educational groups; a navigator staff member or case manager for all oncology patients, not just newly diagnosed; help navigating health insurance options to identify the best coverage for individual needs; and tours specifically for patients who have a serious illness requiring multiple treatments. * In 2015, cancer was the leading cause of death for SDC residents and was responsible for 24.3 percent of all deaths. * There were 5,025 deaths due to cancer (all types) in SDC in 2015. The age-adjusted death rate due to cancer was 148.3 deaths per 100,000 population in SDC. * In 2015, 20 percent of all cancer deaths in SDC were due to lung cancer, 9 percent to colorectal cancer, 7 percent to female breast cancer, 7 percent to pancreatic cancer, 6 percent to prostate cancer, 5 percent to liver cancer, 4 percent to Leukemia and 4 percent to female reproductive cancer (LWSD, 2015). * A”

“Free cancer support groups provided a safe environment for more than 300 individuals to discuss their experience with cancer and tools for coping. Monthly groups were offered for friends and family members of cancer patients, individuals living with a brain tumor or brain cancer, and young cancer patients (ages 20 through early 40), while bimonthly groups were available for individuals living with breast cancer and those with advanced cancer. In addition, the Laurel Amtower Cancer Institute offered emotional support during the 2016 holiday season through its Coping With Cancer Through the Holidays community seminar. Additional emotional support was offered to those with cancer through free classes focused on healing through art, movement and relaxation exercises. This included the monthly Cancer and the Arts class, which served as an outlet to cope through creativity, as well as the weekly Relaxation Skills and Chair Yoga workshop, which taught physical and mental exercises to help participants release stress brought on by their cancer diagnosis. Together, these classes reached more than 230 individuals in FY 2017. In addition, approximately 25 people were served through free Lunch and Learn workshops designed to address the emotional aspects of cancer. This included a monthly workshop for those who were newly diagnosed with cancer, and a monthly workshop for individuals undergoing or nearing the completion of treatment. Throughout the year, approximately 50 individuals were reached through classes designed to support the nutritional needs of those with cancer. This included a free monthly nutrition class for those who were currently receiving or just finished treatment for breast cancer. The class utilizes resources and guidelines from the National Cancer Institute, American Institute for Cancer Research, ACS and the Environmental Working Group, a nonprofit organization that educates consumers on making safe and informed product purchases. The classes provided education on healthy eating and nutrition before and during breast cancer treatment; addressed common diet and nutrition-related questions and concerns; and shared the most current breast cancer diet and physical activity guidelines. In addition, a free class on maintaining optimal nutrition for the cancer patient was offered in January, May and September. Further, the Laurel Amtower Cancer Institute offered the Cancer Prevention and Survival Series in March and September, which focused on the power of food for preventing and fighting cancer. Led by instructors from Veg-Appeal - a San Diego-based vegan cooking and nutrition class provider - each four-session series provided cancer-related nutrition education, recipes, a cooking demonstration and a plant-based dinner to approximately 40 attendees. The Laurel Amtower Cancer Institute offered two free educational classes on lymphedema - a condition where part of the body swells due to fluid accumulation resulting from obstructed, impaired or absent lymphatic vessels. Led by a certified lymphedema therapist, the classes were open to anyone in the community with or at risk of developing lymphedema, as well as their caregivers and partners. Approximately 20 people attended the classes in FY 2017, which provided an overview of lymphedema and information on risk reduction and treatment options. Participants also received educational resources, including a guide to local medical vendors for the purchase of a compression garment to help manage their condition. In addition, approximately 90 individuals were reached through free weekly Healthy Steps classes. Utilizing the Lebed Method - an effective therapeutic program of exercise and movement - Healthy Steps classes help increase range of motion and prevent lymphedema among breast cancer survivors, seniors and individuals battling other chronic health conditions. The Laurel Amtower Cancer Institute provided specialized breast cancer education for both individuals with an existing”

“FY 2018 Plan The Laurel Amtower Cancer Institute at SMH will do the following: * Continue to provide classes on topics including nutrition, exercise, art and relaxation for patients and community members impacted by cancer * Offer one new class on nutrition for prostate cancer * Provide a new monthly lymphedema class for patients and community members * Increase frequency of nutrition class for individuals with breast cancer from once a month to twice a month * Continue to provide support groups for community members, patients and their loved ones, including groups for breast cancer, brain tumors and brain cancer, advanced cancer, young cancer patients, and friends and family of cancer patients * Continue to provide meeting space for four ACS Look Good Feel Better classes * Continue to participate in community walks, health fairs and events * Provide a free community event to educate community members about breast health and lifestyle choices for reducing breast cancer risk * Participate in oncology-related continuing education opportunities for community physicians and other health care professionals * Through philanthropic support, expand transportation services for cancer patients in need of assistance to and from treatment appointments * Continue to seek funding to support the Laurel Amtower Cancer Institute Identified Community Need: Prevention of Unintentional Injuries Rationale references the findings of the 2016 SMH 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 unintentional injury as one of the top 15 priority health conditions among SDC hospitals. * In 2015, accidents (unintentional injuries) were the fourth leading cause of death for SDC overall. Unintentional injuries - due to motor vehicle accidents, falls, pedestrian-related incidents, 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 SDC residents of all ages, regardless of gender, race or region. * Between 2011 and 2015, over 5,200 San Diegans died as a result of unintentional injuries. * In 2015, there were 1,190 deaths due to unintentional injury in SDC. The county's age-adjusted death rate due to unintentional injury was 34.3 deaths per 100,000 population. In 2015, unintentional injury accounted for 5.8 percent of total deaths in SDC. * In 2015, there were 19,812 hospitalizations related to unintentional injury in SDC. The age-adjusted rate of hospitalizations due to unintentional injury was 586 per 100,000 population. * In 2015, there were 162,945 unintentional injury-related ED discharges in SDC. The age-adjusted rate of discharges due to unintentional injury was 5,017.7 per 100,000 population. * Unintentional injury was the leading cause of death for children ages zero to 14 years in 2015. The effects of safety campaigns, educational strategies, and change in parenting practices have all had a positive impact on the safety and well-being of children in the San Diego community (HHSA, 2012). * 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 spinal cord injury, injury prevention measures, and the use of safety habits at an early age (www.thinkfirst.org/kids, 2015). * According to HP2020, most events resulting in injury, disability or death are predictable and preventable. There”

“* Grow partnership with HASPI through participation in conferences and roundtable events * As appropriate and with funding, explore opportunities to incorporate concussion education into school and community-based presentations * As grant funding allows, continue to build HASPI partnerships and expand educational presentations to schools in North County, South Bay, Coronado and Imperial Valley * Explore further opportunities to provide education to health care professionals and college students interested in health care careers, including public health students at SDSU * As appropriate and with funding, continue to explore opportunities to utilize ThinkFirst/Sharp on Survival curricula to serve varied populations throughout SDC Identified Community Need: Health Professions Education and Training, and Collaboration with Local Schools to Promote Interest in Health Care Careers Rationale references the findings of the SMH 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). * The same report indicated that the six fastest-growing health care occupations in SDC between 2013 and 2016 were physician's assistants (22 percent), medical assistants (18 percent), health care social workers (15 percent), home health aides (13 percent), licensed vocational nurses (12 percent), and medical and clinical lab technicians (11 percent). Registered nurses (RNs) accounted for 1,366 added jobs during this period, which was the largest increase in total jobs among all health care occupations (SDWP, 2017). * The Health Care Priority Sector report also found that health care employers identified RNs, physicians and surgeons, and health technicians as the most difficult positions to fill. The most frequently cited reason for hiring difficulties were lack of experience, small applicant pools and insufficient non-technical skills (SDWP, 2017). * A 2014 SDWP labor market analysis indicated an increase in the number of health care training providers in SDC, but a shortage of clinical training facilities where applicants can gain necessary experience. The scarcity of clinical facilities offering prerequisite training has made it increasingly difficult for employers to find qualified workers. * The 2017 SDWP Nonprofit Sector Employment Trends and Career Opportunities report recommends that nonprofit sector health care training and education programs in SDC emphasize soft skills such as being a team player, interpersonal and communication skills, big-picture thinking with the ability to plan and forecast, problem solving, and the ability to adapt to a variety of situations. It also recommends incorporating more training on data management and technology into curriculums in order for graduates to meet the needs of this increasingly data-driven sector. * 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. There are several factors leading to the increased demand for these professions, including: projected population growth in the next decade; aging of the U.S. population; greater numbers of 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, or 9.8 million, from 2014 to 2024. The health care and social”

“Through affiliations with EMSTA College, Palomar Community College, SWC and the San Diego Fire-Rescue Department's paramedic training program, SMH provided both clinical training and observation hours for 34 emergency paramedic interns in FY 2017. Each student completed 144 hours of clinical training primarily in the ED, with scheduled rotations in the trauma center, catheterization lab, operating rooms, labor and delivery, and pulmonary services. ED staff contributed nearly 4,900 hours of clinical training and supervision to these specialized community programs in FY 2017. SMH and SGH 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 emergency nurses. Participants received certification through EMS upon successful completion of a 48-hour classroom component, a passing score of 85 percent or higher on the County 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 EMS personnel and MICN trained RNs in SDC. SMH continued to participate in the HSHMC program to provide early professional development for high school students. During the school year, 128 students in 9th through 12th grade were supervised for approximately 30,700 hours between SMH and the OPP. Students shadowed staff in a variety of hospital departments, including nursing, ED, post-anesthesia care unit, laboratory, pathology, radiology, imaging, endoscopy, catheterization lab, and pulmonary and cardiac rehabilitation. Students were also oriented to hospital operations, including the cafeteria, supply chain, security and patient transporter services. Further, SMH has incorporated education on patient- and family-centered care and the culture of a professional work environment into the HSHMC experience. In addition to placement at SMH, 20 HSHMC students devoted nearly 7,700 hours to shadowing pediatric, orthopedic and electrocardiogram services at the SRSMG facility located adjacent to SMMC. Sharp Rehab provided professional development opportunities for community and Sharp professionals in FY 2017, including free Compassion Cultivation Training (CCT) and Mindful Self-Compassion (MSC) courses. Developed by the Center for Compassion and Altruism Research and Education at the Stanford University School of Medicine, CCT is a nine-week course designed to help professionals develop compassion for themselves and others. Through lectures, guided compassion cultivation exercises and group discussions, CCT can improve communication, increase resilience to stress and enhance participants' feelings of well-being. Designed by professionals at the University of Texas and Harvard Medical School - Cambridge Health Alliance, MSC is an eight-week course that teaches mindfulness, self-kindness and self-compassion skills to help health professionals recognize difficult situations and respond with greater stress resilience. The CCT and MSC courses trained approximately 50 health professionals in FY 2017. SMH is a Planetree Patient-Centered Hospital Designated with Distinction, representing the highest level of patient-centered care. The Planetree philosophy upholds that care should be organized first and foremost around the needs of the patient. With this recognition, SMH provides hospital tours to share its experience in patient- and family-centered care upon request from various local, national and international hospitals, nonprofit organizations and universities. In FY 2017, guests toured various hospital units as well as the Cushman Wellness Center Community Health Library to learn about SMH's unique programs and design properties that promote patient- and family-centered care, a healing environment, workforce efficiency and effective use of t”

“* The Regional Task Force for the Homeless' January 2017 WeAllCount campaign counted 9,116 homeless individuals in SDC, roughly 62 percent of whom were unsheltered. The most commonly cited cause of homelessness was loss of a job (26 percent), followed by "other" (21 percent), money issues (15 percent), and kicked out/ran away (10 percent). * The Kaiser Family Foundation's 2016 Employer Health Benefits Survey indicated that the average health insurance premium for a single adult in 2016 is $536 per month, or $6,435 annually. The average health insurance premium for a family in 2016 is $1,512 per month, or $18,142 annually. The average family premium in 2016 is now 20 percent higher than the average family premium in 2010 and 58 percent higher than the average family premium in 2006. Objectives * Collaborate with community organizations to provide follow-up medical care, financial assistance, and psychiatric and social services to chronically homeless individuals * Assist economically disadvantaged individuals through transportation and pharmaceutical assistance FY 2017 Report of Activities SMH provides post-acute care facilitation for high-risk patients, including those who are homeless or lack a safe home environment. Advocacy for safe discharge from the hospital is a top priority, regardless of funding. SMH continued to collaborate with the SDRM to provide services to chronically homeless patients. Through the partnership, in FY 2017, SMH discharged 34 homeless patients to the SDRM's Recuperative Care Unit (RCU), which is a temporary shelter program that addresses the needs of homeless men and women who are newly released from the hospital yet still in need of supervision. Through the RCU, these patients can 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. Funded completely by SMH, the program provides a safe discharge plan for homeless individuals who require a stable living environment for their continued recovery. SMH also assists high-risk, underserved patients with transportation and placement; connections to community resources; and financial support for medical equipment, medications, outpatient dialysis and nursing home stays. In addition, clinical social work services for the homeless population include assessment for individuals at risk for psychiatric disorders, developmental disorders and substance abuse issues. Referrals are provided as needed for housing, medication management and supportive community services. Further, in FY 2017 the SMH Auxiliary provided approximately 200 items of clothing to homeless individuals upon discharge. The Auxiliary also continued to fund an initiative to provide clothing to other patients who lack clothing when they leave the hospital. Finally, in FY 2017 SMMC assisted economically disadvantaged individuals through the provision of approximately $140,700 in free medications and transportation through its Project HELP program. FY 2018 Plan SMH will do the following: * Continue to collaborate with community organizations to provide medical care, financial assistance, clinical social work services and community resources for chronically homeless patients * Explore collaborations with Society of St. Vincent de Paul and Connections Housing to provide post-discharge housing and services to chronically homeless patients * Continue to administer Project HELP funds to those in need; evaluate program to ensure it meets the needs of the population served * With funding from the SMH Auxiliary, provide clothing for patients who lack usable clothing at discharge * Continue to provide financial assistance for prescription copayments and other personal items * Explore the provision of temporary caregivers to support vulnerable elderly patients with the transition from hospital to home SMH Program and Service Highlights Sharp Memorial Hospital: * 24-hour Em”

“Shortfall in Medicare - $5,998,706 Note: 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. Shortfall in San Diego County Indigent Medical Services - $7,819,380 Note: 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. Shortfall in CHAMPVA/TRICARE - $721,983 Note: 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. Charity Care - $708,670 Note: 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. Bad Debt - $58,934 Note: 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. Other Benefits for Vulnerable Populations, Broader Community, and Health Research, Education and Training Programs: Patient transportation and other assistance for the needy - $522,956 Note: 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. Health education and information, support groups, health fairs, meeting room space, donations of time to community organizations and cost of fundraising for community events - $278,986 Note: 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. Education and training programs for students, interns and health care professionals - $350,815 Note: 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 unreimbursed costs of public programs such as Medi-Cal, Medicare, San Diego County Indigent Medical Services and CHAMPVA/TRICARE. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; free psychiatric assessments and referrals; programs to address barriers to mental health services for disadvantaged, culturally diverse urban seniors; contribution of time to Stand Down for Homeless Veterans, Feeding San Diego, Habitat for Humanity, Ssubi is Hope and the San Diego Food Bank; the Sharp Humanitarian Service Program; and other assistance for community members facing inequities. * Other Benefits for the Broader Community included h”

“Not Currently Insured: Adults 18 to 64 Years: Rate - 9.2%, Year 2020 Target - N/A Source: 2016 California Health Interview Survey (CHIS) Table 41: Medi-Cal (Medicaid) Eligibility Among Uninsured in SDC (Adults Ages 18 to 64 Years), 2015 Medi-Cal Eligible - 13.9% Not Eligible - 86.1% Source: 2016 CHIS Among SDC adults ages 18 to 64 surveyed in 2015, 38.9 percent reported an episode of binge drinking in the past year. In 2016, five percent of SDC teens reported an episode of binge drinking during the previous month. Also in 2016, 14.8 percent of SDC adults ages 18 to 64 reported seeing a health care provider for mental-emotional or drug-alcohol issues, while 44.7 percent reported that they needed help but did not receive treatment of any kind. Among SDC seniors, 9.2 percent of those surveyed in 2016 reported needing help for mental-emotional or alcohol-drug issues in the past year. In 2015, the age-adjusted rate of discharges from the emergency department (ED) for self-inflicted injury in SDC overall was 78.3 per 100,000 population, although this rate was lower among seniors ages 65 and older (17.6 per 100,000 population). The rate of hospitalization for self-inflicted injury among seniors was 21 per 100,000 population. During the same year, the age-adjusted death rate due to suicide in SDC was 10.16 deaths per 100,000 population, slightly lower than the HP2020 target of 10.2 deaths per 100,000 population, however the suicide rate among seniors was much higher (18.6 per 100,000 population). An analysis of 2015 mortality data for SDC revealed Alzheimer's disease (and related dementias) and suicide as the third and 10th leading causes of death for SDC, respectively. See Table 42 for a summary of leading causes of death in SDC. For additional demographic and health data for communities served by SMV and SMC, please refer to the 2016 CHNAs for these entities, available at http://www.sharp.com/about/community/community-health-needs-assessments.cfm. Table 42: Leading Causes of Death in SDC, 2015 Overall Cancer: Number of Deaths - 5,025, Percent of Total Deaths - 24.3% Coronary Heart Disease: Number of Deaths - 2,898, Percent of Total Deaths - 14.0% Alzheimer's Disease and Related Dementias: Number of Deaths - 2,482, Percent of Total Deaths - 12.0% Unintentional Injuries: Number of Deaths - 1,190, Percent of Total Deaths - 5.8% Stroke: Number of Deaths - 1,162, Percent of Total Deaths - 5.6% Chronic Obstructive Pulmonary Disease/Chronic Lower Respiratory Diseases: Number of Deaths - 973, Percent of Total Deaths - 4.7% Overall Hypertensive Diseases: Number of Deaths - 733, Percent of Total Deaths - 3.5% Diabetes: Number of Deaths - 708, Percent of Total Deaths - 3.4% Overdose/Poisoning: Number of Deaths - 360, Percent of Total Deaths - 1.7% Suicide: Number of Deaths - 342, Percent of Total Deaths - 1.7% All Other Causes: Number of Deaths - 4,795, Percent of Total Deaths - 23.2% Total Deaths: Number of Deaths - 20,668, Percent of Total Deaths - 100.0% Source: County of San Diego Health and Human Services Agency (HHSA), Public Health Services, Epidemiology & Immunization Services Branch Community Benefit Planning Process In addition to the steps outlined in Section 3: Community Benefit Planning Process regarding community benefit planning, SMV and SMC: * Incorporate community priorities and community relations into their strategic plans and develop specific programmatic goals * Estimate an annual budget for community programs and services based on community needs, the prior year's experience and current funding levels * Host a bimonthly committee to discuss, plan and implement community activities Priority Community Needs Addressed in Community Benefit Report - SMV 2016 CHNA and SMC 2016 CHNA Both SMV and SMC completed their most recent CHNAs in September 2016. These CHNAs were significantly influenced by the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2016 CHNA process and findings, and details on thos”

“* In 2015, there were 1,067 hospitalizations due to overdose/poisoning in SDC. The age-adjusted rate of hospitalizations due to overdose/poisoning was 31.4 per 100,000 population. * In 2015, the age-adjusted rate of overdose/poisoning-related ED discharges in SDC was 116.6 per 100,000 population. Age-adjusted rates for overdose/poisoning-related ED discharges were higher among males, Blacks and individuals ages 15 to 24 years in comparison among groups. * Approximately 10.2 million adults have co-occurring mental health and addiction disorders in the U.S. (NAMI, 2016). * According to HP2020, the effects of substance abuse contribute to costly social, physical, mental and public health problems, including teenage pregnancy, sexually transmitted diseases, motor vehicle accidents, physical fights, suicide and crime, including domestic violence, child abuse and homicide. * Approximately eight percent of the population will develop post-traumatic stress disorder (PTSD) during their lifetime; however, these figures are higher among veterans and active duty servicem embers. According to the VA, in a given year, approximately 11 to 20 percent of veterans of Operations Iraqi Freedom and Enduring Freedom and 12 percent of Gulf War veterans have PTSD, while it is estimated that 30 percent of Vietnam veterans have had PTSD in their lifetime. * Both active duty service members and veterans face barriers to treatment for behavioral health issues, including long wait times to receive treatment; embarrassment, shame or stigma around service-related disabilities; a lack of understanding or awareness about behavioral health problems and treatment options; logistical issues, such as travel difficulties; concerns over the VA's care offerings; and demographic barriers such as age or gender (National Veterans Foundation, 2016). * In 2014-2015, 12.3 percent of California adolescents ages 12 to 17 experienced a Major Depressive Episode (MDE). This rate has increased 3.1 percent since 2011-2012 (Substance Abuse and Mental Health Services Administration (SAMHSA), Behavioral Health Barometer - California Volume 4, 2015). * From 2011 to 2015, an average of only 32.1 percent of California adolescents ages 12 to 17 with a MDE in the past year received treatment (SAMHSA, Behavioral Health Barometer - California Volume 4, 2015). Objectives * Provide behavioral health and substance use education for patients, their loved ones and the community * Support the behavioral health community through sponsorship of and participation in community events FY 2017 Report of Activities During FY 2017, SMV and SMC hosted numerous on-site community speaking engagements and workshops to increase awareness of behavioral health and substance use issues. Education addressed a variety of topics, including cognitive therapy, chemical dependency, life transitions, domestic violence and child and geriatric psychiatry. This included SMV's monthly cognitive therapy lecture series designed to educate participants about cognitive behavioral therapy - a research-based treatment approach to mood disturbances and behavior problems that is used to treat anxiety, anger, depression, panic disorder, bipolar disorder, phobias, relationship problems, grief and loss, and other difficulties that bring people to therapy. Further, in response to the need for information and support for caregivers of individuals with mental illness, SMV provided educational materials, local behavioral health resources and information on behavioral health support to family and friends in the hospital lobby through NAMI San Diego's Friends in the Lobby program. Throughout the year, SMV provided specialized services to active duty servicemembers, veterans and their families. These programs provide a safe environment for veterans to learn effective methods for managing symptoms of PTSD, acute stress disorder and mood-related disruptions. SMV's military-specific programs also decrease the use of maladaptive coping skills”

“Throughout the year, SMV and SMC provided behavioral health education to the community through interviews with local news outlets, including CW6 San Diego, KUSI News, CBS News 8 - San Diego, FOX 5 San Diego, 10News - ABC San Diego, Newsradio 600 KOGO, and Televisa Tijuana Oficial. Interview topics included helping children cope with negative media imagery; navigating post-election feelings; veterans and PTSD; drinking in moderation and approaching a loved one about concerning habits; positively progressing into the new year; risks surrounding the increasing trend of binge drinking among older women; the connection between substance use and behavioral health disorders; the impact of new marijuana legislation on behavioral health providers; new guidelines for alcohol use; the health effects of long-term drug usage; the increasing prevalence of alcoholism and how to seek help; and bullying. Professionals with expertise in a variety of disciplines, including clinical psychology, chemical dependency, marriage and family therapy (MFT) and clinical child psychology shared information through these news outlets. In FY 2017, SMV and SMC provided behavioral health education, resources and presentations to approximately 1,400 community members through participation in health and wellness fairs, conferences and events. This included the Community Resource Fair at Balboa Park, which was sponsored by the San Diego Commission on Gang Prevention and Intervention, and the San Diego Unified School District's Counseling and Guidance Department and Office of Secondary Schools; a health fair sponsored by the Philippine Nursing Association as part of the Lunar New Year Tet Festival at San Diego County Credit Union Stadium; the Jewish Family Service of San Diego (JFS) Behavioral Health Committee's annual Behavioral Health Panel and Luncheon; NAMI North Coastal San Diego County Chapter's annual resource fair at St. Michael's by the Sea Episcopal Church in Carlsbad; the Recovery Awareness Resource Fair at La Maestra Community Health Center; the second annual Critical Issues in Child and Adolescent Mental Health Conference at the Crowne Plaza San Diego hotel in Mission Valley; the International Bullying Prevention Association's summit in support of lesbian, gay, bisexual, transgender and queer youth titled "Inclusion Through Kindness and Compassion" at the Marina Village Conference Center; and the 2017 SDC Wellness and Recovery Summit at the Joe & Vi Jacobs Center. Additionally, SMV provided behavioral health resources as well as an educational presentation about self-care, mindfulness and stress reduction at the Caregiver Coalition of San Diego and NAMI's A Day for Caregivers: Caring for a Loved One with Mental Health Challenges conference held at the First United Methodist Church in Mission Valley. Lastly, SMV collaborated with CHIP for the Suicide Prevention Council Mental Health Month event that featured local behavioral health organizations and their work in prevention, intervention and aftercare at United Way of San Diego County. The event highlighted the continuum of behavioral health care in the community and the connection between behavioral health and suicide prevention. In FY 2017, SMV sponsored and participated in several events benefitting behavioral health organizations across SDC. Events included NAMI's 13th annual Color Ball and Inspiration Awards at the San Diego Air & Space Museum; the International Bipolar Foundation's Starry Night fundraising event at Liberty Station and luncheon at the Hyatt Regency; San Diego Psychological Association's 2016 Fall Conference at the Handlery Hotel; the Healthy Lives Safe Communities: Justice Connected event at the Crowne Plaza San Diego hotel in Mission Valley; the Behavioral Health Recognition Dinner, which recognizes individuals who work to help community members achieve recovery without stigma; and the Strut for Sobriety event benefitting A New PATH, a nonprofit organization focused on reducing s”

“FY 2018 Plan SMV or SMC will do the following: * Continue to explore opportunities for outreach to multicultural and at-risk groups through increased community involvement and education * Continue serving as the media's go-to experts for information on behavioral health conditions and treatment * Host and provide a variety of educational events and programs for community members * Participate in community events to raise awareness and funds for behavioral health services * Participate in key behavioral health events and activities alongside patients * Explore and expand collaborations with law enforcement and housing planning committees to provide better outcomes for community members living with mental illness and substance use issues * Continue to collaborate with community providers and provide education to ILFs to improve living conditions for individuals with mental illness * Participate in Sharp's partnership with the City of San Diego to provide behavioral health education and resources to employees and residents in the city's nine districts Identified Community Need: Behavioral Health and Substance Use Screenings and Support for the Community Rationale references the findings of the SMV and SMC 2016 CHNAs, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMV and SMC 2016 CHNAs identified behavioral health as the priority health issue for community members served by SMV and SMC. * The HASD&IC 2016 CHNA identified behavioral health as the top priority health issue for community members in SDC. * The following conditions were identified in the SMV and SMC 2016 CHNAs as priority behavioral health issues in SDC: Alzheimer's disease, anxiety, drug and alcohol issues, and mood disorders. * Discussions with Alpine Special Treatment Center as part of the HASD&IC 2016 CHNA identified the following challenges to the behavioral health of vulnerable populations: lack of available placements for patients ready to leave facilities; overburdened case managers; difficulty with the disability application process; and difficulty managing patients' physical health problems. * Respondents of the Health Access and Navigation Survey administered during the SMV and SMC 2016 CHNA processes identified the following barriers to accessing behavioral health care: getting, using and understanding health insurance; knowing where to go for care, especially understanding when to use the ED, urgent care and primary care; and making appointments, specifically availability of appointments and wait time issues. * Key informant interviews conducted as part of the SMV and SMC 2016 CHNA processes identified the following resources that should be developed to address substance use and related issues: early prevention programs that emphasize the dangers of alcohol; increased accessibility of treatment programs; presence of psychologists in the ED to provide screening, brief intervention, and referrals; available beds for those who cannot pay; and long-term aftercare. * According to OSHPD data presented in the SMV and SMC 2016 CHNAs, anxiety disorders were the top primary diagnosis for behavioral health-related ED discharges among those ages 5 to 44 and ages 65 and older. For those ages 45 to 64, the top ED discharge for behavioral health was alcohol-related disorders, followed by anxiety and mood disorders. * In general, data analysis in the SMV and SMC 2016 CHNAs revealed a higher rate of behavioral health hospital discharges in SDC's more vulnerable communities (Dignity Health, SanGIS, OSHPD & SpeedTrack Inc., 2015). * According to 2016 CHIS data, 9.5 percent of adults in SDC have ever seriously thought about committing suicide. * In 2015, there were 1,067 hospitalizations due to overdose/poisoning in SDC. The age-adjusted rate of hospitalizations due to overdose/poisoning was 31.4 per 100,000 population. * In 2015, the age-adjusted rate of overdose/poisoning-related ED discharges in SDC was 116”

“the year, SMV offered a variety of support groups for community members with behavioral health challenges. A weekly Mood Disorders support group was available for individuals, family and friends impacted by depression, bipolar disorder, PTSD or anxiety. A National Association of Anorexia Nervosa and Associated Disorders support group was also offered weekly for individuals and families affected by an eating disorder. Further, a biweekly Dialectical Behavioral Therapy (DBT) support group utilized DBT ideas and skills to help attendees manage severe emotional reactions, intense anxiety, impulsivity, self-harm, suicidal thoughts and high-conflict relationships. SMV also offered a free support group to provide psychoeducation and support for veterans and their families. More than 1,800 community members attended these support groups in FY 2017. SMV further supported the community by providing free space for a variety of self-help groups to meet each week. The hospital's meeting spaces were booked for more than 1,800 hours in FY 2017 for groups including: Narcotics Anonymous; the Narcotics Anonymous Family group; Alcoholics Anonymous; Al-Anon; Cocaine Anonymous; Pills Anonymous; Project SMILE 12 Step Recovery Workshop; SMART Recovery San Diego; Co-Dependents Anonymous; Obsessive Compulsive Disorder support group; Hoarders Working support group; Shyness and Social Anxiety group; San Diego Phobia Foundation; Concerned United Birthparents; the California Board of Registered Nursing's Nursing support group; A New PATH; and the SMV and SMC Aftercare and Lifetime Support meetings. For more than 50 years, the San Diego Rescue Mission (SDRM) has helped San Diego's homeless and poor population create better lives for themselves through comprehensive programs, including services that address housing, hunger, behavioral health and other education and awareness programs. SMV continued to support the SDRM by donating food three times weekly to help support approximately 400 men, women and children living in the shelter. Each week during FY 2017, SMV collected and donated more than 300 pounds of food for the SDRM. FY 2018 Plan SMV or SMC will do the following: * Provide free psychiatric assessments, substance use screenings and referrals for the community * Continue to participate in psychiatric rehabilitation programs and activities * Explore further collaborations and partnerships with community partners * Host and facilitate various support groups and provide free meeting space for use by a variety of community self-help groups Identified Community Need: Improving Behavioral Health Outcomes for Seniors at Risk Rationale references the findings of the SMV and SMC 2016 CHNAs, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMV, SMC and HASD&IC 2016 CHNA processes continued to identify behavioral health as a priority health concern for SDC, including Alzheimer's disease and dementia. * According to HHSA's 2015 Alzheimer's Disease and Other Dementias in San Diego County report, Alzheimer's disease is the third leading cause of death in SDC, the fifth leading cause of death in California, and the sixth leading cause of death in the U.S. * The same report projects that the number of SDC residents living with Alzheimer's disease and other dementias will increase from 60,000 to approximately 94,000 people between 2012 and 2030, representing a 55.9 percent increase. * In SDC, rates of anxiety disorder, mood disorders, schizophrenia and other psychotic disorders as well as self-inflicted injury were consistently highest among those ages 55 to 64 compared to those age 65 and older in both ED and inpatient settings in 2012. * According to HHSA's 2015 Senior Health Report, suicide is the leading cause of non-natural death for SDC residents ages 55 to 64, and the second leading non-natural cause of death among adults ages 75 and older. * According to 2016 CHIS data, 5.2 percent of SDC adults”

“SMV's Senior Intensive Outpatient Program (SIOP) is designed for older adults experiencing depression, anxiety, addiction or other behavioral health disorders. Using an educational approach, SIOP clinicians help seniors develop healthy coping strategies, maximize communication and conflict resolution skills, understand and change unhealthy thoughts, and use relaxation techniques to manage anxiety and improve sleep. Throughout the year, SMV's SIOP staff provided education and outreach to community members in an effort to debunk the myths associated with older adulthood, such as 'depression is a normal part of aging' and 'growing old is characterized by loss and pain.' Seven educational sessions were offered in FY 2017 addressing the following topics: Coping with Grief and Loss; Coping with Life Transitions; Mindfulness; and Coping Tools for Managing Anxiety. Lectures were delivered to more than 150 community members at JFS College Avenue Senior Center, the George Stevens Senior Center, Tierrasanta Village of San Diego's Villa Monterey Clubhouse, Toby Wells YMCA and Rancho Penasquitos Branch Library. Throughout the year, SMV's SIOP provided behavioral health resources, memory screenings, and information about the hospital's senior services at numerous senior health fairs and community events in SDC, including: San Diego County Council on Aging's Head, Shoulders, Knees & Toes Senior Health and Resource Fair; the Point Loma Senior Health Fair; the JFS Health Fair and Flu Shot Event; the East County Senior Services Providers 18th annual Senior Health Fair; the San Diego LGBT Community Center's 11th annual Senior Resource Fair; and a health fair at La Vida Real, a senior living community in Rancho San Diego. In FY 2017, nearly 900 seniors and their family members were reached through the SIOP's participation in these community events. SMV's SIOP both provided behavioral health resources and presented at senior health-focused conferences throughout SDC, serving more than 1,500 community members in FY 2017. Events included: Sharp HospiceCare and the Sharp Senior Resource Centers' Annual Aging Conference: Planning for Physical, Mental and Financial Health events at the La Mesa Community Center and All Souls Episcopal Church; Sharp Women's Health Conference at the Sheraton San Diego Hotel & Marina; Sharp HospiceCare's Advanced Illness Management conference at Paradise Point Resort & Spa; and the County of San Diego Aging and Independence Services Vital Aging 2017: Steps for Success Conference at Liberty Station. At these conferences, SIOP clinicians presented on a variety of topics, including attitudes and aging, reducing emotional suffering and brain health. In FY 2017, SMV partnered with Alzheimer's San Diego to provide a variety of screenings, behavioral health education and resources to community members. In October, approximately 120 community members learned about the latest research on reducing the risk of dementia at the Keeping Your Brain Healthy Conference held at Sharp's corporate office location in Kearny Mesa. In January, March and April, SMV educated 60 seniors about the latest in Alzheimer's disease research, including prevention and treatment, through three lectures at Alzheimer's San Diego. In September, SMV provided 400 community members with behavioral health resources and information about participation in clinical trials at Alzheimer's San Diego's Date with a Cure event at the University of San Diego's (USD) Shiley Theatre. In November, February, May and August, SMV and Alzheimer's San Diego offered free memory screenings - a wellness tool that helps identify possible changes in memory and cognition - to community members who were concerned about memory loss or interested in establishing a baseline to detect future changes. Further, SMV clinicians, including a psychiatrist, provided education and research on the early signs of Alzheimer's disease as part of Alzheimer's San Diego's Take Charge! Early Memory Loss Prog”

“* According to the University of Washington's Center for Health Workforce Studies, challenges contributing to the nation's behavioral health workforce crisis include the aging of certain occupations, low compensation and perceptions of low status for jobs requiring less formal education, and high burnout and stress due to the nature of the work (Center for Health Workforce Studies, 2016). * In 2016, there were 453 designated Mental Health Care Health Professional Shortage Areas (HPSAs) in California, representing approximately 6.5 million residents. The Kaiser Family Foundation estimates that 252 new practitioners would need to be added to the behavioral health workforce to remove HPSA designation from all areas. Objectives * Collaborate with local schools to provide opportunities for students to explore health care professions * Collaborate with the behavioral health community - including other behavioral health educational institutions - to provide education and training for health care professionals FY 2017 Report of Activities Throughout the year, SMV participated in internship and clinical training programs for trainees and students in various health care disciplines, including clinical dietary/nutrition, psychology, clinical social work, social work administration, MFT, pharmacy, health information technology (HIT), music therapy, clinical chaplains, medicine and nursing. SMV provided clinical supervision and training for 26 psychology trainees, including 16 graduate students, 7 doctoral interns, and 3 postdoctoral fellows, as well as 8 MFT and 8 Master of Social Work (MSW) student interns. In FY 2017, SMV continued to provide a nine-month internship for a student completing a dual master's degree in Music Therapy and Professional Counseling. In total, all ancillary (non-nursing) students served 29,870 hours on the SMV campus. In addition, nearly 400 nursing students worked clinical rotations of 6 to 8 hour shifts and spent more than 27,600 hours at SMV. Nursing students were placed in all inpatient units and several of the outpatient programs at SMV and SMC. SMV offers two clinical rotations in one day, including morning and evening shifts, and nursing students are on campus seven days a week. Including time spent with groups and individual preceptors, nursing students served nearly 29,800 hours at SMV in FY 2017. Academic institution partners included, but were not limited to, Alliant University, Argosy University, Azusa Pacific University (APU), Catholic University of America, California State University San Marcos (CSUSM), National University, Point Loma Nazarene University (PLNU), San Diego City College, San Diego State University (SDSU), Southwestern College, Touro University, University of Cincinnati, USD, University of Southern California (USC) and University of the Pacific. Nursing students from various universities and colleges were also provided free meeting space as needed. In FY 2017, SMV received nearly 160 applications for seven doctoral intern positions available through Sharp's year-long American Psychological Association-accredited doctoral internship in clinical psychology. Selected interns rotated through three four-month rotations that included experience in SMV's adult inpatient and outpatient programs, as well as inpatient and outpatient senior behavioral health and child and adolescent programs. Interns also rotated through SMC. The hospitals offered these interns a unique opportunity to receive intensive training in psychological assessment and neuropsychological screening. With this training, psychology doctoral students provided approximately 75 detailed psycho-diagnostic assessments throughout the year. In addition, psychology trainees provided more than 5,300 hours of group therapy and more than 2,400 hours of individual therapy. Psychology trainees were also integrally involved in clinical staff training as well as program development and evaluation efforts throughout the hospital. At SMV an”

“SMV continued its collaboration with PERT through participation in PERT roundtables, monthly meetings and community-oriented trainings. SMV staff also supported approximately 600 SDC police officers at the quarterly PERT Academy Resource Fair. During these events, SMV team members provided officers with educational resources on understanding psychiatric emergencies and community psychiatric services. The police officers were subsequently paired with licensed mental health clinicians to help them evaluate and assess an individual's behavioral health condition and needs, and, if appropriate, transport the individual to a hospital or refer the individual to a community resource or treatment facility. Throughout FY 2017, staff at SMV and SMC regularly led or attended various community and professional health boards, committees, and advisory and work groups, including A New PATH, Alzheimer's San Diego Client Advisory Board, Alzheimer's Project Safety Workgroup, American Academy of Nursing, American Nurses Association, American Psychiatric Nurses Association, Association for Ambulatory Behavioral Healthcare, Association of California Nurse Leaders, California Association of Marriage and Family Therapists San Diego Chapter, LWSD Check Your Mood Committee, CHIP Behavioral Health Work Team, CHIP ILA Advisory Board and Peer Review Advisory Team, CHIP Suicide Prevention Council, City of San Diego Park & Recreation - Therapeutic Recreation Services Disabled Services Advisory Council, EAPA forums, Hidden Heroes Campaign Committee, HASD&IC, Inner City Action Network, JFS Behavioral Health Committee, JFS Public Affairs Committee, MHA Board, NAMI, PERT, PLNU, Residential Care Committee, San Diego Community College District, San Diego County Older Adult Council, San Diego County Falls Prevention Task Force, San Diego Health Information Association, San Diego Mental Health Coalition, San Diego Mental Health History Planning Team, SDMFC, San Diego Psych-Law Society, SDWP, SDWP Work Well Committee, Sigma Theta Tau International Honor Society of Nursing - Gamma Gamma Chapter, Special Needs Trust Foundation and VA San Diego Mental Health Council. FY 2018 Plan SMV or SMC will do the following: * Offer internship and clinical training programs and/or placement for clinical dietary/nutrition, psychology, clinical social work, social work administration, MFT, medicine, music therapy, HIT, clinical chaplains and pharmacy students * Provide lectures on behavioral health issues to the local academic community * Continue the behavioral health careers curriculum within the HSHMC program and provide students with experience in a broad range of programs including therapeutic activities services, environmental services and health information services * Provide educational offerings for behavioral health care professionals, community groups and community members SMV and SMC Program and Service Highlights Sharp Mesa Vista Hospital: * Child, adolescent, adult and older adult inpatient, partial hospitalization, and outpatient psychiatric and chemical dependency services * On- and off-campus specialty outpatient programs treating seniors, eating disorders, trauma, chronic pain, opiate and prescription drug dependence and dual diagnosis * Cognitive behavioral therapy, electroconvulsive therapy, and dialectical behavioral therapy programs * Outreach to active duty military, veterans and their families through programs geared specifically toward servicemembers, including the VA-supported Veterans Choice Program * Transportation services and complimentary lunches * Practicum programs for graduate MSW and MFT interns * Clinical supervision site for graduate psychology doctoral interns * Medication research studies and clinical trials Sharp McDonald Center at Sharp HealthCare: * Chemical dependency and substance abuse inpatient and outpatient treatment services for children, teens, adults and seniors * Residential treatment services for adults and seniors * Inpatient det”

“* 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 * 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 * Greater San Diego East County Advisory Board * Grossmont College * 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 Care Communicators Board * Health Industry Collaboration Effort, Inc. * Health Insurance Counseling and Advocacy Program * Health Sciences High and Middle College (HSHMC) * Helix Charter High School * Hidden Heroes Campaign Committee * 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 * 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 * John A. Davis Family YMCA Board of Management * Kitchens for Good * 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 Foundation * Live Well San Diego Check Your Mood Committee * Mama's Kitchen * March of Dimes * Meals on Wheels San Diego County * Meals on Wheels San Diego County 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 Neonatal Nurses * National Association of Orthopedic Nurses * National Hospice and Palliative Care Organization * National Institute for Children's Health Quality * National Kidney Foundation * National University * Neighborhood Healthcare * Neighborhood House Association * North County Community Action Network * North San Diego Business Chamber * Pacific Arts Movement * Palomar Community College * Partnership for Smoke-Free Families * Peninsula Shepherd Senior Center * Perinatal Safety Collaborative * Perinatal Social Work Cluster * Planetree Board of Directors * Point Loma Nazarene University * Practice Greenhealth * Promises2Kids * Psychiatric Emergency Response Team * Regional Perinatal System * Residential Care Committee * Ronald McDonald House Operations Committee * Rotary Club of Chula Vista * Rotary Club of Coronado * San Diego Association of Diabetes Educators * San Diego Association of Directors of Volunteer Services * San Diego Association of Governments * San Diego Black Nurses Association * San Diego Blood Bank * San Diego Community Action Network * San Diego Community College District * San Diego County Breastfeeding Coalition * San Diego County Breastfeeding Coalition Advisory Board * San Diego County Civilian/Military Liaison Work Group * San Diego County Coalition for Improving End-of-Life Care * San Diego County Council on Aging * San Diego County Emergency Medical Care Committee * San Diego County Falls Prevention Taskforce * San Diego County Health and Human Services Agency * San Diego County Hospice-Veteran Partnership * San Diego County Medical Society Bioethics Commission * San Diego”

“Tax Exempt Bonds are issued for the Sharp HealthCare Obligated Group. As a result, the tax exempt bond balances are reported on the Sharp HealthCare return (EIN 95-6077327). This organization's allocated portion is included in Part X, Line 25.”

“Sharp Memorial Hospital employees' salaries and wages are paid under Sharp HealthCare's tax ID number (EIN 95-6077327), and as such are also reported on Sharp HealthCare's Form 990.”

“Tax Exempt Bonds are issued for the Sharp HealthCare Obligated Group. As a result, the tax exempt bond balances are reported on the Sharp HealthCare return (EIN 95-6077327) and this organization has reported zero on Form 990, Part X, Line 20 and has reported the allocated balance on Line 25.”

“Change in minimum pension liability - 4303131;”