Common and Critical Components Among Community Health Assessment and Community Health Improvement Planning Models.

Community health assessment and community health improvement planning are continuous, systematic processes for assessing and addressing health needs in a community. Since there are different models to guide assessment and planning, as well as a variety of organizations and agencies that carry out these activities, there may be confusion in choosing among approaches. By examining the various components of the different assessment and planning models, we are able to identify areas for coordination, ways to maximize collaboration, and strategies to further improve community health. We identified 11 common assessment and planning components across 18 models and requirements, with a particular focus on health department, health system, and hospital models and requirements. These common components included preplanning; developing partnerships; developing vision and scope; collecting, analyzing, and interpreting data; identifying community assets; identifying priorities; developing and implementing an intervention plan; developing and implementing an evaluation plan; communicating and receiving feedback on the assessment findings and/or the plan; planning for sustainability; and celebrating success. Within several of these components, we discuss characteristics that are critical to improving community health. Practice implications include better understanding of different models and requirements by health departments, hospitals, and others involved in assessment and planning to improve cross-sector collaboration, collective impact, and community health. In addition, federal and state policy and accreditation requirements may be revised or implemented to better facilitate assessment and planning collaboration between health departments, hospitals, and others for the purpose of improving community health.

A Mixed-Methods Approach to Understanding Community Participation in Community Health Needs Assessments.

CONTEXT: Nonprofit hospitals are exempt from paying taxes. To maintain this status, they must provide benefit to the community they serve. In an attempt to improve accountability to these communities and the federal government, the Patient Protection and Affordable Care Act of 2010 includes a provision that requires all nonprofit hospitals to conduct a community health needs assessment (CHNA) and implement strategies to address identified health priorities every 3 years. This Act's provision, operationalized by a regulation developed and enforced by the Internal Revenue Service, mandates the involvement of public health agencies and other community stakeholders in the completion of the CHNA. OBJECTIVE: To better understand community participation in nonprofit hospital-directed community health assessment and health improvement planning activities. DESIGN: Using a 2-phased, mixed-methods study design, we (1) conducted content analysis of 95 CHNA/implementation plan reports and (2) interviewed hospital and health system key informants, consultants, and community stakeholders involved in CHNA and planning processes. Community participation was assessed in terms of types of stakeholders involved and the depth of their involvement. RESULTS: Our findings suggest that many hospitals engaged and involved community stakeholders in certain aspects of the assessment process, but very few engaged a broad array of community stakeholder and community members in meaningful participation throughout the CHNA and health improvement planning process. Vast improvements in community participation and collaborative assessment and planning can be made in future CHNAs. CONCLUSIONS: On the basis of the findings, recommendations are made for further research. Practice implications include expanding community engagement and participation by stakeholder and activity type and using a common community health improvement model that better aligns hospital CHNA processes and implementation strategies with other organizations and agencies.

Emergency Medical Service-based Care Coordination for Three Rural Communities.

Providers in rural areas face challenges to increasing health care access, reducing costs, and improving health care quality and outcomes. One promising model is expanding paramedic roles to include non- emergency home visits to patients. Employing a comparative case study, this paper describes three Emergency Medical Services (EMS)- based care coordination programs that provide services to rural, underserved patients, who frequently use EMS/emergency departments. Across the three sites, four major themes emerged: (1) a shift in the paramedic and patient interactions from episodic, crisis- based to longer- term, ongoing relationships; (2) characteristics of rural context that both enabled and constrained paramedic care coordination programs; (3) impacts of care coordination including improvements in preventive care and disease self- management as well as peace of mind; and (4) concerns about programs' sustainability. Emergency Medical Service- based care coordination appears to be a promising model for addressing the health and social needs of rural residents who frequently use EMS.

Community Health Needs Assessment: Potential for Population Health Improvement.

Derived from various health care policies and initiatives, the concept of population health has been newly adopted by health care and medicine. In particular, it has been suggested that the Patient Protection and Affordable Care Act provision that requires nonprofit hospitals to conduct a community health needs assessment (CHNA) and implement strategies to address health priorities has the potential to improve population health. A mixed methods study design was used to examine the potential for population health improvements to occur through the Internal Revenue Service (IRS)-mandated nonprofit hospital CHNA and planning processes. Methods involved a 2-phased approach composed of (1) content analysis of 95 CHNA/implementation strategies reports and (2) interviews with key informants, consultants, and community stakeholders involved in CHNA and planning processes. Although this is a great opportunity for the nonprofit hospital assessment and planning processes to influence population health outcomes, the findings from the first 3-year assessment and planning cycle (2011-2013) suggest this is unlikely. As nonprofit hospitals begin the second 3-year assessment and planning cycle, this article offers recommendations to increase the potential for nonprofit hospitals to improve population health. These recommendations include clarifying the purpose of IRS CHNA regulations, engaging community stakeholders in collaborative assessment and planning, understanding disease etiology and identifying and addressing broader determinants of health, adopting a public health assessment and planning model, and emphasizing population health improvement. (Population Health Management 2016;19:178-186).

Nonprofit hospitals' approach to community health needs assessment.

OBJECTIVES: We sought a better understanding of how nonprofit hospitals are fulfilling the community health needs assessment (CHNA) provision of the 2010 Patient Protection and Affordable Care Act to conduct CHNAs and develop CHNA and implementation strategies reports. METHODS: Through an Internet search of an estimated 179 nonprofit hospitals in Texas conducted between December 1, 2013, and January 5, 2014, we identified and reviewed 95 CHNA and implementation strategies reports. We evaluated and scored reports with specific criteria. We analyzed hospital-related and other report characteristics to understand relationships with report quality. RESULTS: There was wide-ranging diversity in CHNA approaches and report quality. Consultant-led CHNA processes and collaboration with local health departments were associated with higher-quality reports. CONCLUSIONS: At the time of this study, the Internal Revenue Service had not yet issued the final regulations for the CHNA requirement. This provides an opportunity to strengthen the CHNA guidance for the final regulations, clarify the purpose of the assessment and planning process and reports, and better align assessment and planning activities through a public health framework.

Rural health roundtables: a strategy for collaborative engagement in and between rural communities.

INTRODUCTION: The lack of formal public health infrastructure and trained health professionals in rural areas has a deleterious impact on rural populations for various health issues. The purpose of this article is to: (1) suggest a strategy regularly used by the authors that encourages relationship building and serves as a catalyst for rural communities to work together to initiate and make changes based on the local assets and dynamics; (2) provide a descriptive overview of this strategy; and (3) provide an illustrative case, using the Rural Ready Communities project, in which this strategy has been used. METHODS: The Rural Health Roundtable strategy includes identifying relevant topics and stakeholders; using specific methods to ensure stakeholder attendance; creating an informal, social environment where participants feel comfortable sharing; utilizing targeted questions to engage participants and empower local ownership; and following up with the participants through communication and evaluation. RESULTS: The Rural Health Roundtable strategy can result in short-term, intermediate and long-term outcomes using various evaluation tools and methods. CONCLUSIONS: The Rural Health Roundtable strategy has demonstrated its value as an effective tool in working with rural communities. With fewer human and financial resources at their disposal, this strategy can aid rural communities in identifying and utilizing their unique strengths to overcome resource deficits when responding to public health emergencies and natural disasters. Initiated in 1999, the methodology has been refined and enhanced over the past 8 years to more effectively reach stakeholders, ensure attendance and participation, promote sharing and discussions, build stakeholder networks and encourage continued communication and collaboration. The Rural Health Roundtable strategy has significant potential for replication and application to all areas of rural public health.