The community of Springfield (population approximately 100,000) is made up of hardworking, mostly older, factory laborers who contributed to both the city and county growth from the late 1950s through early 2005. Since the plant closed, many of the former workers have little to look forward to. There are few jobs available and they are now aging; most are 60 years of age or older.

The Memorial Hospital has been in existence since the mid-1950s and has several primary care physicians and nurse practitioners, a couple of general surgeons, and one cardiologist, but no cardiac surgeons.

Many nurses are recruited from the nearby community college, and the hospital serves as the facility for clinical rounds in their education.

The community is pretty sedentary, with the exception of an occasional game of horseshoes. Cigarette smoking is prominent.

Serious concerns surround the continued existence of the hospital because many residents seek and obtain health care services elsewhere.

Comparethe population of this city to other problem areas using the Healthy People sources. The town's population is approximately 100,000, making the comparison fairly straightforward.

write a 2-page Letter to the Editor of the local paper that includes:

• An evaluation of the issues that would be the focus on need for quality improvement
• An analysis of existing problems/issues based on data/resources provided
• 2 or 3 recommended strategies to address each quality improvement issue