APPENDIX E – IMPACT EVALUATION

ChristianaCare abides by the ChristianaCare Way:

We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value. ChristianaCare is guided by its commitment to partnering with our neighbors to better understand their needs and goals for health.

Impacts of COVID-19

In March 2020, the COVID-19 pandemic was declared and our focus, across the system, was an all-out response to support testing and expert-informed care to ensure all aspects of patient safety were addressed. ChristianaCare was a regional leader with our pandemic response, especially with the introduction of COVID-19 vaccinations. Between January 16 and June 11, 2021, ChristianaCare held 28 vaccination events at its Newark Campus and administrative location in Wilmington, Avenue North. A total of 22,362 first and second doses were provided to community members. ChristianaCare’s Office of Health Equity also organized eight first and second dose vaccination events in community locations throughout New Castle County between February and June 2021. At these events, 2,810 1st doses and 2,616 2nd doses were provided. Individuals who received a 1st dose were invited back to the same location to receive their second dose. These individuals received reminders to get their second dose as well. In December 2020, ChristianaCare was also able to begin providing monoclonal antibody treatments to individuals to ensure they do not face severe illness or hospitalization due to COVID-19. To date, 2,395 individuals have received this treatment since it was first offered at ChristianaCare. To ensure that transportation barriers would not prevent someone from receiving this life-saving treatment, ChristianaCare’s Center for Virtual Health and Community Health Department worked together to create a pipeline to provide transportation for those receiving these treatments. Before the vaccines and treatments were available, ChristianaCare also worked to ensure it served the community with COVID-19 testing. Between March 13th and June 3rd , 2020, ChristianaCare organized and carried out 16 mobile testing events throughout New Castle County and one testing event was also held in neighboring Cecil County, Maryland. At a time when testing was difficult to obtain, 3,526 individuals were able to be tested at these events. ChristianaCare ended its mobile testing initiative once the state and county were able to provide routine testing within our communities. ChristianaCare also collaborated with the Latin American Community Center (LACC) and Kingswood Community Center (KCC) to offer COVID-19 testing centrally located in Wilmington in historically underserved minority communities. Testing began in April 2020 at both LACC and KCC and it continued at LACC until April 2021, at which time the LACC resumed its own programming in that space. During the period from July 2020 to April 2021, ChristianaCare saw 497 patients at the LACC testing site. COVID-19 testing continues to be offered at the Kingswood Community Center, but within a newly developed primary care practice that began operating in April 2021.

ChristianaCare is proud of its quick response to the pandemic to keep our patients safe and bring COVID-19 testing, vaccination, and treatment to the community. Within the new landscape of the pandemic, it became apparent how much we relied upon being community-based to provide education, screenings, and other resources to our communities when these avenues for providing community benefit were no longer an option. Simply put: the specter of COVID-19 on almost all aspects of life are impossible to ignore; and many areas of work which were community-based were the first to shut down. Nevertheless, the community benefit we continued to undertake to address our prioritized areas of need continued to be significant.

CHNA Activities

In the most recent CHNA, finalized June 2019, ChristianaCare identified the community’s most significant needs as:

• Social Determinants of Health including poverty, food insecurity, housing, affordability of care, education, and employment/job security • Mental Health and Substance Use Disorder • Violence and Public Safety • Maternal and Child Health especially Infant Mortality • Access to Dental and Primary Care

All but access to dental and primary care were also identified as significant health needs in the 2016 CHNA. In the 2016 CHNA, ChristianaCare also identified transportation, housing, and employment as significant needs, but determined that it was not able to address these needs at that time given a lack of expertise and infrastructure. Addressing social determinants of health is essential to improving the health of our community and we have advanced our organizational capacity to support a social care framework to integrate internal and external resources as we work to address these issues.

Social Determinants of Health

In fiscal year 2019, ChristianaCare’s Office of Health Equity designed the Community Investment Fund in partnership with ChristianaCare’s Finance Department. In fiscal year 2020, ChristianaCare gave nearly $2,000,000 in community investment funding to 32 community organizations across the state. Due to the disruption and financial uncertainty caused by the pandemic, the Office of Health Equity was unable to provide Community Investment funding in fiscal year 2021, but in fiscal year 2022, 13 organizations addressing substance use disorder and housing were selected by ChristianaCare to receive just over $1,000,000 in Community Investment funding.

ChristianaCare has supported the Purpose Built Communities’ REACH Riverside Community Development Initiative. In March 2019, ChristianaCare gave a gift of $1,000,000 to the initiative in support of community health and youth development

programs in Riverside, one of Wilmington’s oldest and most underserved communities. ChristianaCare leadership serves on the REACH Riverside Board and the Health, Wellness, and Safety Committee and as mentioned previously, ChristianaCare now has a Virtual Health Primary Care Practice located at Kingswood Community Center which is located within the Riverside community. Bringing easily accessible healthcare into the community was one of the goals of the initiative that we were eager to help the community meet. The Office of Health Equity launched Unite Delaware in November 2019. Unite Delaware is a coordinated care network of health and social service providers connected through a shared technology platform, Unite Us, which enables all organizations on the platform to send and receive referrals to address individuals’ social and health needs. There are nearly 200 participating organizations from throughout the state of Delaware on the platform that can address a variety of social and health needs. In fiscal year 2021, ChristianaCare partnered with Delaware 211 to bring them onboard the Unite Us platform to address any need that may not be met by the current participating partner. The Delaware 211 partnership ensures that no Delawarean who seeks help through Unite Delaware will leave empty handed. ChristianaCare also began working with Unite Us to integrate the platform into the Electronic Health Record to ensure easier access to address patients’ needs in clinical settings. Another comprehensive way in which ChristianaCare addresses social determinants of health is the Delaware Medical Legal Partnership (MLP) created in partnership with Delaware’s Community Legal Aid Society, Inc. (“CLASI”). The MLP provides free, civil legal services to low-income patients, adults, and children who are facing legal matters or needs that may negatively impact their health or legal matters or needs which may have been created or aggravated by a person’s health issues. Some of the matters addressed through this program are safe housing, prevention of subsidized and public housing evictions, assistance obtaining or preserving income maintenance and government benefits, access to social services, appropriate educational services, health insurance, and access to health care.

In anticipation that the pandemic would exacerbate existing legal needs in the areas of housing, unemployment, domestic violence, and other areas for already vulnerable populations, ChristianaCare expanded its contract with CLASI. This was prescient as we quickly realized this increased demand and served more than double the number of individuals in the MLP program in fiscal year 2021, 274, than were served in the prior fiscal year. ChristianaCare also addressed social determinants of health through its commitment to a Community Health Workers (CHW) program. As recently as 2017, ChristianaCare did not employ any CHWs, but like many states, Delaware is transitioning from volume to value which presents an exciting opportunity to develop a standardized, scalable, sustainable CHW program. ChristianaCare partnered with University of Pennsylvania’s Center for Community Health Workers’ IMPaCT team to develop an effective, optimized CHW program. As of this writing, ChristianaCare has employed nearly 40 CHWs. CHWs are embedded within:

• The Wilmington Hospital Emergency Department (ED) to provide support to patients who are high ED utilizers

• 6 Primary Care Practices • 9 School Based Health Centers • Women’s Health • Delaware Food Farmacy

These CHWs work with patients to address their social determinants of health and craft and meet personal goals, health related or not, so that the patient can successfully improve their health. Food Insecurity ChristianaCare’s Community Health Department launched the Delaware Food Farmacy (DFF) in in collaboration with Primary Care, Nutrition Services, Behavioral Health, and iREACH (ChristianaCare Institute for Research on Equity and Community Health). ChristianaCare partnered with Lutheran Community Services to develop and launch the DFF, a program that addresses healthcare inequities by providing holistic care with radical convenience. DFF is designed to help Medicaid at-risk patients with uncontrolled diabetes, hypertension and/or heart failure self-manage their chronic condition through a nutritionbased comprehensive care model - treating the “whole person.” ChristianaCare is also continuing its long-standing partnership with Urban Acres to support Produce Delivery. Through this partnership, from July 2020 through June 2021,190 at-risk, food insecure, patients were provided with fresh, local produce on a weekly basis for a minimum of 6 months.

Housing ChristianaCare made significant investments (nearly $600,000) in housing and housing improvement initiatives in fiscal year 2020. • Funding provided to The Friendship House, a community-based organization which houses and provides community for homeless individuals as they assist in transitioning to permanent housing, allowed for additional housing for women who have recently left a substance use treatment disorder facility, along with case management and administrative support. • Funding provided to Attack Addiction, a statewide non-profit organization committed to addressing and preventing substance use disorder, to build a continuum of housing for women in New Castle County. There will be three houses with the capability of serving 26 women at one time. These houses will provide women with a safe and affordable place to live while initiating and continuing with substance use disorder treatment. • Funding provided to Housing Alliance Delaware, a statewide non-profit organization that addresses affordable housing needs and homelessness, to undertake a program that will serve chronically homeless individuals at risk of poor health outcomes by offering financial assistance to reduce economic barriers to exiting homelessness, engineer a more efficient and comprehensive process to ensure hospitalized homeless individuals are connected to the health and housing services

they need, and finally, conduct a qualitative assessment to allow those experiencing chronic homelessness share their barriers to receiving behavioral, medical, and social needs.

Importantly, we have also offered our partnership along with funding. We are collaborating with these community organizations to ensure individuals are not only housed but having their health needs met as well.

In fiscal year 2021, ChristianaCare provided $50,000 in funding to Housing Alliance Delaware, a statewide non-profit organization that addresses affordable housing needs and homelessness, to continue its program that will serve chronically homeless individuals at risk of poor health outcomes by offering financial assistance to reduce economic barriers to exiting homelessness and engineering a more efficient and comprehensive process to ensure hospitalized homeless individuals are connected to the health and housing services they need. A qualitative assessment to allow those experiencing chronic homelessness to share their barriers to receiving behavioral, medical, and social needs is also conducted through this program. This is the second year of funding this program. In December 2020, New Castle County government purchased a hotel along I-95 and rapidly transformed it into an emergency homeless shelter, The Hope Center. ChristianaCare served as a partner to the County during this process and is now on-site providing medical care to the residents. The uncertainty of the pandemic did not allow ChristianaCare to provide as much community funding for housing in fiscal year 2021, but as affordable housing becomes increasingly difficult to obtain nationally and locally, we expect to respond to our community need in this area. Education

ChristianaCare’s Workforce Development aims to expose high school scholars to careers in health care. Typically, scholars mistakenly think that the health system is primarily made up of professionals wearing white coats and/or scrubs. The programming provided by Work Force Development sets out to confirm that those wearing white coats and scrubs are not the only professionals in healthcare. The Work Force Development programming explores careers in health care, aims to build successful partnerships and reduce achievement gaps. Participants in this programming are high school students, specifically the systemically overlooked members of our community, to ensure we develop a pipeline for a workforce of caregivers that reflect the communities we serve. Transportation In the 2016 CHNA, ChristianaCare decided not to address transportation as a community need as we did not have the ability to do so. In 2020, we began to address transportation needs by partnering with Roundtrip Health to provide, to those patients with transportation barriers, convenient and free transportation to get them to and from medical services. During fiscal year 2021, the use of Roundtrip was so successful for the patients and caregivers that we decided to expand it to other areas. In May 2022, other departments, and programs such as Discharge, Heart Failure Bridge Clinic, Outpatient Behavioral Health,

Metabolic Health, and Cancer Care Management, among others, will also have access to Roundtrip to provide patients with transportation barriers rides to their medical appointments. Between July 1, 2020, and June 30, 2021, 1,493 rides were given to 206 unique patients. We also recognize that to improve patient health there is a need to identify and address individual patients’ SDOH. Addressing patients’ social needs in addition to providing clinical care has become a major public health initiative and is a key component of our work at ChristianaCare to create an integrated clinical and social care framework. Since the 2019 CHNA, ChristianaCare has developed its systemwide standardized SDOH screening tool that is being universally implemented throughout ChristianaCare. As use of the screening tool is expanding, ChristianaCare internal access to Unite Delaware is also increasing through integration in the electronic health record. These are two vitally connected initiatives because we feel strongly that if a patient discloses a need, we must be prepared to help them address it. Unite Delaware allows us to do exactly that through social service referrals to a platform of community-based organizations.

Mental Health and Substance Use Disorder

ChristianaCare strives to provide personalized and effective treatment for mental health illnesses and substance use disorders. Access to behavioral health services has been a long-standing concern of our communities, and the pandemic certainly exacerbated the issues of access. Through programming introduced in the last three years, ChristianaCare hopes to make behavioral health services more accessible. ChristianaCare’s Center for Hope and Healing, which began operating in fiscal year 2020, offers support to people in our communities who are struggling with mental, medical, and social health problems. The goal of the Center is to give patients access to providers who can help stabilize their health and their lives. Specialists work together to quickly stabilize patients’ health and then put long-term support in place with other providers and programs. The Center offers flexible, responsive care in a respectful, caring, and supportive setting. In fiscal year 2021, the Center for Hope and Healing opened a second location in Wilmington. This new location incorporates a primary care practice for this patient population. ChristianaCare’s Community Substance Overdose Support (Community SOS), which was created in partnership with New Castle County in 2019, employs peer engagement specialists who are in recovery to engage with individuals in their homes or communities after they have been brought to the hospital following a suspected overdose. The primary goal is to help the individual enter treatment. Community SOS also offers harm reduction education to those who are not yet ready to enter treatment and provides naloxone and training on its use to those with substance use disorder and their friends and family. In fiscal year 2021, Community SOS gave out 325 naloxone kits to individuals. In November 2021, ChristianaCare launched a partnership with New Castle County, to embed six caregivers within the New Castle County Police Department’s Behavioral Health Unit. Four of these caregivers engage in the community with individuals who suffered a non-fatal overdose and provide them with a treatment plan and ongoing case management. The other two caregivers accompany county police when responding to 911

calls when mental health is thought to be an issue. The caregivers will ensure the individual’s mental health needs are addressed as well as provide them with connection to care.

Violence and Public Safety

ChristianaCare recognizes that violence is a public health issue and determined that as a health system, it was necessary to address violence head on by implementing a Hospital Based Violence Intervention Program (HVIP), Empowering Victims of Lived Violence (EVOLV). EVOLV launched on February 15, 2021. EVOLV works with patients who have suffered a gunshot wound, stab wound, or violent blunt assault, are residents of New Castle County, and aged 13 years or older. EVOLV’s initial focus included patients admitted in the Trauma Department for a complex injury. The EVOLV social worker approached patients at the hospital to introduce the program goals and explain the support the program provides. The Social Worker enrolls hospitalized patients and provides a warm hand-off to the EVOLV community health worker (CHW) to start the rapport building process and prepare for the community engagement prior to discharge. The CHW actively follows patients and supports them by providing them with access to care, addressing any social determinants, and identifying and achieving patient centered goals and outcomes. The length of engagement is three months.

Importantly, in FY21, ChristianaCare collaborated with the State of Delaware’s Office of the Governor around the issue of violence and as part of this collaborative, EVOLV began engaging with community organizations that focus on violence, including Social Contract, Community Intervention Team (CIT), and Group Violence Intervention (GVI) which each have their own unique approach to addressing the gun violence issue in Delaware. CIT and GVI are both Wilmington based organizations with a mix of community and governmental support.

ChristianaCare continued to provide education to youth throughout Delaware about violence prevention with the Choice Road Program which urges students to consider the choices they make and a new program which introduces students to the concept of gun violence as a public health issue.

In addition to violence prevention, ChristianaCare also educates adolescents and adults about safe choices to prevent injuries. The Trauma team adapted to hold many of these sessions virtually and continued to be a presence in schools and senior centers despite the pandemic.

Maternal and Child Health especially Infant Mortality

ChristianaCare is working to improve the infant mortality rate through programs aimed at pregnant women like the embedded CHWs in Women’s Health mentioned previously, but also by addressing social determinants of health. While it will not be immediately apparent, our expectation is that improving communities will improve maternal and child health and decrease infant mortality.

Since 2012, the State of Delaware has awarded ChristianaCare a grant to support the Health Ambassadors Program since 2012. The program is designed to improve maternal and child morbidity and mortality through the promotion of health before, during, and after pregnancy. In fiscal year 2021, the Health Ambassadors assisted and were able to successfully meet the needs of 3,212 individuals. Since 2018, ChristianaCare’s Community Health Department in the Office of Health Equity has also provided Boot Camp for New Dads (BCND) and Boot Camp for New Moms (BCNM). BCND provides community-based workshops to help new and soon to be dads become confident in their ability to care for their infants, support their partner, and successfully become capable dads. These workshops are for dads of all ages, cultures, and economic levels. The workshops are co-facilitated by local dads who were recruited and trained by ChristianaCare. BCNM seeks to provide information about what happens after pregnancy, labor, and delivery. BCNM is focused on helping new moms handle the changes in her life and the relationship with her partner once her baby has been born. In partnership with the Delaware Division of Public Health, ChristianaCare’s Healthy Beginnings Program brings together preconception care which identifies and addresses potential risks to future pregnancies, pregnancy planning which guides the woman through the first steps that lay the groundwork for a healthy pregnancy, and prenatal care that ensures the good health of mother and baby from conception to birth. This holistic approach is undertaken by a team that includes doctors, nurse practitioners, social workers, case workers, resource mothers, and dieticians, working with the mother to assist her in having a healthy pregnancy and infant. The ChristianaCare Healthy Beginnings Program is also utilizing Roundtrip transportation services to ensure patients can attend their medical appointments.

Access to Dental and Primary Care

ChristianaCare successfully expanded dental services at Wilmington Hospital with the completion of a two-year renovation project in fiscal year 2020 that increased the clinical capacity of our dentistry and oral-maxillofacial surgery practices. This increase enables more than 5,000 additional visits per year at one of the few access points in the community for dental care. ChristianaCare is expanding primary care services to support improved access to the preventive care and chronic disease management that helps patients to be healthy and avoid costly unnecessary emergency room visits and hospital admissions. ChristianaCare will continue to seek opportunities to place providers and staff in community settings to meet patient needs at convenient access points. This is necessary because there are barriers to accessing care caused by transportation and work schedules. We aim to meet the needs of our neighbors in the community where they live, work, and play as demonstrated by our previously described newly established practice at Kingswood Community Center and the new Center for Hope and Healing practice. In fiscal year 2021, ChristianaCare also launched a primary care practice embedded in the Helen F. Graham Cancer Center and Research Institute. ChristianaCare is one of the first cancer programs in the nation to offer patients undergoing cancer treatments the opportunity to see a primary care provider on-site. In fiscal year 2021, ChristianaCare also acquired a

practice, Su Centro de Salud with Primary Care at Kirkwood, which serves patients with Spanish speaking and culturally competent providers and staff to ensure the health needs of Hispanic community can be met.

Planning for 2023, and Beyond

Over the past several years, even amidst the COVID-19 pandemic, ChristianaCare has worked to address our community’s needs through significant investment and carefully considered programming. We have worked hard to ensure that our programs address our neighbors’ needs in a way that is convenient for them, and if not, then we have adapted to pivot quickly to what will serve our neighbors. With this new CHNA, we are eager to continue and create new community partnerships and programs to address the needs in ways that our communities find helpful and value.