Barriers and Facilitators to Establishing Partnerships for Substance Use Disorder Care Transitions Between Safety-Net Hospitals and Community-Based Organizations.

BACKGROUND: The effectiveness of hospital-based transitional opioid programs (TOPs), which aim to connect patients with substance use disorders (SUD) to ongoing treatment in the community following initiation of medication for opioid use disorder (MOUD) treatment in the hospital, hinges on successful patient transitions. These transitions are enabled by strong partnerships between hospitals and community-based organizations (CBOs). However, no prior study has specifically examined barriers and facilitators to establishing SUD care transition partnerships between hospitals and CBOs. OBJECTIVE: To identify barriers and facilitators to developing partnerships between hospitals and CBOs to facilitate care transitions for patients with SUDs. DESIGN: Qualitative study using semi structured interviews conducted between November 2022-August 2023. PARTICIPANTS: Staff and providers from hospitals affiliated with four safety-net health systems (n=21), and leaders and staff from the CBOs with which they had established partnerships (n=5). APPROACH: Interview questions focused on barriers and facilitators to implementing TOPs, developing partnerships with CBOs, and successfully transitioning SUD patients from hospital settings to CBOs. KEY RESULTS: We identified four key barriers to establishing transition partnerships: policy and philosophical differences between organizations, ineffective communication, limited trust, and a lack of connectivity between data systems. We also identified three facilitators to partnership development: strategies focused on building partnership quality, strategic staffing, and organizing partnership processes. CONCLUSIONS: Our findings demonstrate that while multiple barriers to developing hospital-CBO partnerships exist, stakeholders can adopt implementation strategies that mitigate these challenges such as using mediators, cross-hiring, and focusing on mutually beneficial services, even within resource-limited safety-net settings. Policymakers and health system leaders who wish to optimize TOPs in their facilities should focus on adopting implementation strategies to support transition partnerships such as inadequate data collection and sharing systems.

New insights about community benefit evaluation: Using the Community Health Implementation Evaluation Framework to assess what hospitals are measuring.

BACKGROUND: Nonprofit hospitals are required to conduct community health needs assessments (CHNA) every 3 years and develop corresponding implementation plans. Implemented strategies must address the identified community needs and be evaluated for impact. PURPOSE: Using the Community Health Implementation Evaluation Framework (CHIEF), we assessed whether and how nonprofit hospitals are evaluating the impact of their CHNA-informed community benefit initiatives. METHODOLOGY: We conducted a content analysis of 83 hospital CHNAs that reported evaluation outcomes drawn from a previously identified 20% random sample ( n = 613) of nonprofit hospitals in the United States. Through qualitative review guided by the CHIEF, we identified and categorized the most common evaluation outcomes reported. RESULTS: A total of 485 strategies were identified from the 83 hospitals' CHNAs. Evaluated strategies most frequently targeted behavioral health ( n = 124, 26%), access ( n = 83, 17%), and obesity/nutrition/inactivity ( n = 68, 14%). The most common type of evaluation outcomes reported by CHIEF category included system utilization ( n = 342, 71%), system implementation ( n = 170, 35%), project management ( n = 164, 34%), and social outcomes ( n = 163, 34%). PRACTICE IMPLICATIONS: CHNA evaluation strategies focus on utilization (the number of individuals served), with few focusing on social or health outcomes. This represents a missed opportunity to (a) assess the social and health impacts across individual strategies and (b) provide insight that can be used to inform the allocation of limited resources to maximize the impact of community benefit strategies.

Association of Medicaid expansion and 1115 waivers for substance use disorders with hospital provision of opioid use disorder services: a cross sectional study.

INTRODUCTION: Opioid-related hospitalizations have risen dramatically, placing hospitals at the frontlines of the opioid epidemic. Medicaid expansion and 1115 waivers for substance use disorders (SUDs) are two key policies aimed at expanding access to care, including opioid use disorder (OUD) services. Yet, little is known about the relationship between these policies and the availability of hospital based OUD programs. The aim of this study is to determine whether state Medicaid expansion and adoption of 1115 waivers for SUDs are associated with hospital provision of OUD programs. METHODS: We conducted a cross-sectional study of a random sample of hospitals (n = 457) from the American Hospital Association's 2015 American Hospital Directory, compiled with the most recent publicly available community health needs assessment (2015-2018). RESULTS: Controlling for hospital characteristics, overdose burden, and socio-demographic characteristics, both Medicaid policies were associated with hospital adoption of several OUD programs. Hospitals in Medicaid expansion states had significantly higher odds of implementing any program related to SUDs (OR: 1.740; 95% CI: 1.032-2.934) as well as some specific activities such as programs for OUD treatment (OR: 1.955; 95% CI: 1.245-3.070) and efforts to address social determinants of health (OR: 6.787; 95% CI: 1.308-35.20). State 1115 waivers for SUDs were not significantly associated with any hospital-based SUD activities. CONCLUSIONS: Medicaid expansion was associated with several hospital programs for addressing OUD. The differential availability of hospital-based OUD programs may indicate an added layer of disadvantage for low-income patients with SUD living in non-expansion states.

For-Profit Hospital Reflections on Community Relationships in the Time of COVID-19.

GOALS: Throughout the COVID-19 pandemic, hospitals and their staffs have been pushed to their limits. Hospitals have had to rethink how they support community health while also providing critical acute care services to combat the morbidity and mortality associated with COVID-19. As anchor institutions, hospitals have a significant effect on not only community health and well-being but also on local economies as primary employers and contractors. This study aimed to understand how the pandemic reshaped interactions with community members, staff, and other community organizations and changed the nature of hospital-community engagement among for-profit hospitals. METHODS: We recruited leaders of for-profit hospitals, systems, and a business association that represents for-profit hospitals. We interviewed 28 participants in various leadership roles via telephone or videoconferencing and then thematically coded interview transcriptions. The themes identified in early interviews guided the structure of forthcoming interviews. PRINCIPAL FINDINGS: For-profit hospitals appear motivated to address community health needs as anchor institutions in their communities, and these efforts have strengthened and changed in important ways as a result of the COVID-19 pandemic. In this study, three themes emerged regarding the influence of COVID-19 on hospital-community relationships: Hospitals refocused outreach and engagement efforts to support employees, found essential new ways to safely engage with the community through partnerships and collaborations, and were reminded of the critical roles of social and cultural factors in the health and well-being of individuals and communities. PRACTICAL APPLICATIONS: Hospitals may be able to use lessons learned during the pandemic to support the growing need for community engagement and attention to social determinants of health. The themes that emerged from this study present valuable opportunities for hospitals to carry forward the lessons learned over the course of the pandemic, as they have the potential to improve the delivery of healthcare and community engagement in day-to-day operations as well as in crises.

Evaluation of Community Benefit Activities Among Nonprofit Hospitals, 2018-2021.

OBJECTIVE: This study examined approaches that nonprofit hospitals use to evaluate community benefit activities in the Community Health Needs Assessment/Implementation Plan (CHNA/IP) process. DESIGN: Content analysis of CHNAs/IPs completed between 2018 and 2021 from a 20% stratified random sample (n = 503) of US nonprofit hospitals. MAIN OUTCOME MEASURES: A coding sheet was used to record details about the evaluation content reported by hospitals in their CHNAs/IPs. Evaluation was coded into 4 categories: (1) no mention of evaluation; (2) description of evaluation without reporting any measures; (3) reporting reach (number of people served) only; and (4) reporting social/health outcomes. For logistic regression analyses, categories 1 and 2 were grouped together into "no evaluation measures" and categories 3 and 4 were grouped into "evaluation measures" for binary comparison. Multinomial logistic regression was also used to individually examine categories 3 and 4 compared with no evaluation measures. RESULTS: While a majority of nonprofit hospitals (71.4%, n = 359) mentioned evaluation in their CHNAs, almost half (49.7%, n = 250) did not report any evaluation measures. Among the 50.3% (n = 253) of hospitals that reported evaluation measures, 67.2% (n = 170) only reported reach. Fewer than 1 in 5 hospitals (16.5%, n = 83) reported social/health outcomes. Hospitals that hired a consultant (adjusted odds ratio [AOR] = 1.61; 95% confidence interval [CI], 1.08-2.43) and system members (AOR = 1.76; 95% CI, 1.12-2.75) had higher odds of reporting evaluation measures. Using hospitals that reported no measures as the base category, system members (AOR = 7.71; 95% CI, 2.97-20.00) also had significantly higher odds of reporting social/health outcomes, while rural locations had lower odds (AOR = 0.43; 95% CI, 0.20-0.94). CONCLUSIONS: Although hospitals are required to evaluate the impact of actions taken to address the health needs identified in their CHNAs, few hospitals are reporting social/health outcomes of such activities. This represents a missed opportunity, as health/social outcomes could be used to inform the allocation of resources to maximize community benefits and the expansion of successful community initiatives.

Community Engagement in Nonprofit Hospital Community Health Needs Assessments and Implementation Plans.

CONTEXT: Nonprofit hospitals are required to provide community benefits in exchange for their tax-exempt status. This includes a community health needs assessment (CHNA) to identify community needs and an implementation plan (IP) with strategies to address top needs every 3 years. In addition, hospitals are required to engage community members in these assessments. OBJECTIVE: The objective of this study was to explore community engagement and representation in CHNAs and IPs. DESIGN: The researchers conducted a content analysis of CHNAs and IPs from a nationally representative sample of 503 nonprofit hospitals between 2018 and 2021. MAIN OUTCOME MEASURES: For CHNAs, a coding sheet was used to record the types of community members engaged by hospitals. For IPs, the team coded whether community engagement was reported at all and then performed an in-depth analysis to identify categories of community members, engagement methods used, and roles of community input. Finally, frequencies of categories across IPs were quantified. RESULTS: Eighty-nine percent of hospitals (n = 449) engaged community members in their CHNA, but only 14% (n = 71) engaged community members in their IP. An in-depth look at these IPs found that hospitals engaged underserved/minority populations, low-income populations, high school students, public health experts, and stakeholder organizations. Community members were involved in multiple steps, including brainstorming ideas, narrowing down needs, developing strategies, and reacting to proposed strategies. CONCLUSIONS: Although IPs are intended to benefit the community, there is a lack of community involvement reported in IPs. Hospitals may need incentives, resources, and personnel support to ensure representation of community members throughout the entire CHNA and IP process.

Hospital Community Benefit Reporting: How Group Reporting Practices Limit Accountability.

OBJECTIVE: To identify the prevalence of group reporting of hospital community benefit efforts to the Internal Revenue Service (IRS) and understand hospital and community characteristics associated with this practice. DESIGN: The study was based on data collected from publicly available community benefit reports from 2010 to 2019, as well as secondary data from the 2020 American Hospital Association (AHA) Annual Survey. The sample was drawn from the entire nonprofit US hospital population reporting community benefit activities. The analytic plan employed descriptive statistics and bivariate analysis. SETTING: The United States. PARTICIPANTS: All data are self-reported by US hospitals, either through the publication of community benefit reports (IRS Form 990 Schedule H) or a response to the AHA Annual Survey. MAIN OUTCOME MEASURES: Analyzed variables include whether a hospital reported its community benefit expenditures individually or as a group member; community benefit spending as a percentage of hospital operating expenses; and whether the hospital was part of a multihospital system, with consideration of hospital and community characteristics. RESULTS: Between 2010 and 2019, more than 40% of hospitals participated in group reporting, with most doing so consistently. System membership and hospital size were significantly and positively tied to group reporting, with state community benefit policy tied to the lower prevalence of group reporting. CONCLUSIONS: The high prevalence of group reporting limits accountability to communities and restricts an accurate assessment of community benefit expenditures, counter to policy intentions. Stakeholders should consider what modifications to reporting rules could be made to promote transparency and to ensure that the effects of community benefit policies align with intentions.

Comparison of Nonprofit Hospital Community Benefit Substance Abuse Identification and Practice Implementation in Appalachian and Non-Appalachian Counties.

CONTEXT: As substance use continues to be a public health crisis nationally, it disproportionately affects the Appalachian region. OBJECTIVES: Our research seeks to explore whether there is a greater substance use burden in Appalachia and whether that burden is being prioritized in local hospital systems' community health needs assessments (CHNAs) and implementation strategies (ISs). SETTING: The setting for this study is the 13 states that are represented within the Appalachian region. PARTICIPANTS: This study examines CHNAs and ISs of a stratified random sample (n = 140) representing 20% of the hospital population within the identified states (those with counties within the Appalachian region). Each sampled hospital is labeled as Appalachian or non-Appalachian based on its county designation. MAIN OUTCOME MEASURES: Our main outcome measures were the percentage of hospitals listing substance abuse in their CHNAs, with comparisons between Appalachian and non-Appalachian subgroups, and percent addressing substance use in their ISs in Appalachia and non-Appalachia. DESIGN: Community health needs assessments and ISs produced between the years 2018 and 2021 were gathered for each hospital within the sample; each document was then coded for the inclusion of substance use. Chi-square tests and logistic regression were employed to conduct the analysis and draw conclusions. RESULTS: Although all non-Appalachian Counties that had substance use listed as a need within a CHNA correspondingly addressed that need in their ISs, only 75% of Appalachian counties that listed substance use a need went on to prioritize substance use in an IS. In addition, logistic regression indicated no significant link between overdose rates and addressing substance use. CONCLUSIONS: These findings further support other literature that suggests that lack of resources is limiting Appalachian health care organizations' ability to address substance use issues.

The impact of Maryland's payment reforms on hospital community benefit efforts.

BACKGROUND: In 2014, Maryland established a global budget policy for all hospitals in the state. Under this policy, hospitals are incentivized to not only provide clinical care services to individual patients but also address the health needs of their broader patient population through prevention efforts and investment in the upstream social and economic factors that determine health. PURPOSE: To better understand the incentives created for hospitals under this policy, our study assessed whether the implementation of global budgets changed the levels and patterns of Maryland hospitals' investments in community benefits. APPROACH: Data on hospital community benefit spending from the Internal Revenue Service Form 990 Schedule H for the years 2010-2016 were utilized for this study. RESULTS: We found that Maryland hospitals' total spending on community benefits decreased under the global budget policy. Unlike hospitals in similar states without a global budget policy, Maryland hospitals did not experience any increases in Medicaid shortfalls between 2014 and 2016. Although Maryland hospitals provided more subsidized health services, their investment in broader community health improvement activities remained unchanged. CONCLUSION: Our analysis suggests that Maryland hospitals have shifted strategies because of the implementation of the global budget policy. The ability to report community benefit in a way that accurately considers the context and constraints of a state's policies would provide hospitals better means of communicating these efforts to stakeholders. PRACTICE IMPLICATIONS: Our results suggest that global budgets impact the levels and patterns of hospitals' community benefit investments.

Assessing the Strategies That Children's Hospitals Adopt to Engage the Social Determinants of Health in US Cities.

CONTEXT: There is growing evidence that social factors contribute disproportionately to health outcomes in the United States as compared with health care services. As a result, nonprofit hospitals are incorporating strategies to address social needs into their Internal Revenue Service (IRS)-mandated community benefit work. Much of the research base on this subject, however, has focused on the efforts of adult-serving hospitals. OBJECTIVE: The aim of this study was to determine whether communities surrounding children's hospitals are unique with regard to social needs and categorize how children's hospitals are addressing social needs in their IRS-mandated community benefit work. METHODS: Using county-level health and economic data, we compared community characteristics of children's hospital counties with the national average. We then coded and analyzed the community benefit reports of all nonprofit children's hospitals in the United States to categorize the different strategies that hospitals adopt to address social needs. RESULTS: Children's hospitals (N = 168) serve communities with greater social needs than the national average. In terms of community benefit investments, children's hospitals were more likely to identify social needs in their community health needs assessment than adult-serving hospitals, but still less than half identified or addressed 1 or more social needs. Children's hospitals were more likely to adopt interventions that address broader population health rather than strategies that focus on clinical services or children and adolescents in particular. CONCLUSIONS: Pediatric health care institutions have a profound opportunity to reduce health disparities by altering the social environments in which children develop. Policy makers and scholars should provide support and resources to increase community benefit investments in this area.

The Role of Local Health Departments in Strengthening the Alignment Between Nonprofit Hospitals' Community Health Needs Assessments and Their Implementation Strategies.

Nonprofit hospitals frequently partner with their local health department on developing community health needs assessments (CHNAs); yet, little is known about the role that such partnerships play in strengthening the alignment between needs identified in hospitals' assessments and the strategies adopted by hospitals to address identified needs. Using data for 486 hospitals from the third round of CHNAs (spanning the years 2018-2021), this study showed strong alignment between the health needs identified in the CHNAs and those addressed in hospitals' implementation strategies, independent of collaboration with the local health department. One noteworthy exception to this finding was that hospital-public health collaboration remained important for improved alignment of needs related to substance use. Involvement of the local health department may strengthen hospitals' capacity to address needs outside their traditional areas of expertise, such as substance use.

For-profit hospitals as anchor institutions in the United States: a study of organizational stability.

BACKGROUND: Anchor institutions, by definition, have a long-term presence within their local communities, but it is uncertain as to whether for-profit hospitals meet this definition; most research on anchor institutions to date has been limited to nonprofit organizations such as hospitals and universities. Accordingly, this study aims to determine whether for-profit hospitals are stable enough to fulfill the role of anchor institutions through a long-term presence in communities which may help to stabilize local economies. METHODS: This longitudinal study analyzes national, secondary data between 2008 and 2017 compiled from the Dartmouth Atlas of Health Care, the American Hospital Association Annual Survey, and County Health Rankings. We use descriptive statistics to calculate the number of closures and mergers of hospitals of different ownership type, as well as staffing levels. Using logistic regression, we also assessed whether for-profit hospitals had higher odds of closing and merging, controlling for both organization and community factors. RESULTS: We found for-profit hospitals to be less stable than their public and nonprofit hospital counterparts, experiencing disproportionately more closures and mergers over time, with a multivariable analysis indicating a statistically significant difference. Furthermore, for-profit hospitals have fewer full-time employees relative to their size than hospitals of other ownership types, as well as lower total payroll expenditures. CONCLUSIONS: Study findings suggest that for-profit hospitals operate more efficiently in terms of expenses, but this also may translate into a lower level of economic contributions to the surrounding community through employment and purchasing initiatives. For-profit hospitals may also not have the stability required to serve as long-standing anchor institutions. Future studies should consider whether for-profit hospitals make other types of community investments to offset these deficits and whether policy changes can be employed to encourage anchor activities from local businesses such as hospitals.

Are Nonprofit Hospitals Addressing the Most Critical Community Health Needs That They Identify in Their Community Health Needs Assessments?

CONTEXT: Virtually all nonprofit hospitals are in compliance with the Affordable Care Act's new Community Health Needs Assessments requirements. OBJECTIVE: To assess what needs have emerged in the Community Health Needs Assessments hospitals complete nationally, the degree to which identified needs reflect the most pressing community health issues, and the extent to which hospitals address identified needs. DESIGN: Using both bivariate and logistic regressions, we analyzed the Community Health Needs Assessments and implementation strategies of nonprofit hospitals to determine whether identified needs overlapped with county health-ranking indicators of need and whether institutional or community-level factors predicted hospital willingness to address identified needs. PARTICIPANTS: We included a 20% random sample of US nonprofit hospitals (n = 496). MAIN OUTCOME MEASURES: Our main outcome measures were whether nonprofit hospitals addressed each of the most common needs. RESULTS: Mental health, access to care, obesity, substance abuse, diabetes, cancer, and the social determinants of health were the most commonly identified needs across the sample. The rate at which hospitals chose to address each of these needs in their implementation strategies, however, varied considerably, ranging from 56% (cancer) to 85% (obesity). We found that several institutional and community characteristics predicted hospital willingness to address each need; whether the community ranked a need as number 1 was a better predictor of hospital investment than the severity of the need, as measured by county health-rankings data. CONCLUSIONS: These findings may help inform local, state, and federal policy makers as they consider interventions aimed at encouraging hospitals to invest in improving the health of their communities.

Patient Characteristics Affect Discharge Status for Opioid-related Infective Endocarditis.

BACKGROUND: Opioid overdoses have increased dramatically in the last 20 years, but secondary complications, such as infective endocarditis (IE) are also on the rise. OBJECTIVE: The objective of this study was to understand the effect that opioid-related IE has on hospitals across the US and to understand the disposition of patients after treatment for IE, particularly in regard to insurance status and type. RESEARCH DESIGN: Secondary data analysis of the publicly-available 2015 Nationwide Inpatient Sample (NIS) was used to assess opioid-related IE based on patient and hospital characteristics. Bivariate and logistic regression was calculated to determine significance between the outcome variable (IE) and other covariates. SUBJECTS: The 2015 NIS data contained 7,153,989 weighted observations with 5760 (0.02%) incidences of opioid-related IE. MEASURES: The NIS dataset represents a 20% stratified sample of all US hospitalizations across all payors in a given year. Opioid-related IE was the outcome variable measured through ICD-9 and ICD-10 codes, and the independent variables included the patient's age, sex, primary payer, household income, discharge status, length of stay, and transfer status, and the hospital's size, ownership, region, and location with teaching status. RESULTS: Routine discharge was the top discharge status across all payors, except Medicare. Nearly 26% of self-pay patients were discharged against medical advice. Logistic regression results indicate that patients who are younger, uninsured, have increased condition severity, have longer lengths of stay, and are discharged against medical advice or transferred to a short-term hospital or other health facility experienced significantly higher odds of opioid-related IE admissions as compared with all other admissions. The only significant hospital characteristic was region. CONCLUSIONS: The fact that patient disposition varied across different payors suggests that hospitals are missing opportunities to engage the most vulnerable patients with IE. Given the long-term care required by this condition, hospitals are well-positioned to participate in interventions to initiate substance abuse treatment and help patients navigate outpatient substance abuse treatment options.

Differential impact of hospital and community factors on breadth and depth of hospital population health partnerships.

OBJECTIVE: The aim was to identify hospital and county characteristics associated with variation in breadth and depth of hospital partnerships with a broad range of organizations to improve population health. DATA SOURCES: The American Hospital Association Annual Survey provided data on hospital partnerships to improve population health for the years 2017-2019. DESIGN: The study adopts the dimensional publicness theory and social capital framework to examine hospital and county characteristics that facilitate hospital population health partnerships. The two dependent variables were number of local community organizations that hospitals partner with (breadth) and level of engagement with the partners (depth) to improve population health. The independent variables include three dimensions of publicness: Regulative, Normative and Cultural-cognitive measured by various hospital factors and presence of social capital present at county level. Covariates in the multivariate analysis included hospital factors such as bed-size and system membership. METHODS: We used hierarchical linear regression models to assess various hospital and county factors associated with breadth and depth of hospital-community partnerships, adjusting for covariates. PRINCIPAL FINDINGS: Nonprofit and public hospitals provided a greater breadth (coefficient, 1.61; SE, 0.11; p < 0.001 and coefficient, 0.95; SE, 0.14; p < 0.001) and depth (coefficient, 0.26, SE, 0.04; p < 0.001 & coefficient, 0.13; SE, 0.05; p < 0.05) of partnerships than their for-profit counterparts, partially supporting regulative dimension of publicness. At a county level, we found community social capital positively associated with breadth of partnerships (coefficient, 0.13; SE, 0.08; p < 0.001). CONCLUSIONS: An environment that promotes collaboration between hospitals and organizations to improve population health may impact the health of the community by identifying health needs of the community, targeting social determinants of health, or by addressing patient social needs. However, findings suggest that publicness dimensions at an organizational level, which involves a culture of public value, maybe more important than county factors to achieve community building through partnerships.

Alignment of substance use community benefit prioritization and service lines in US hospitals: a cross-sectional study.

BACKGROUND: Non-profit hospitals in the U.S. are required by the 2010 Patient Protection and Affordable Care Act (ACA) to conduct a community health needs assessment (CHNA) every three years and to formulate an implementation strategy in response to those needs. Hospitals often identify substance use as a need relevant to their communities in their CHNAs and then must determine whether to create strategies to address such a need within their implementation strategies. The aim of this study is to assess the relationship between a hospital's prioritization of substance use within its community benefit documents and its substance use service offerings, while considering other hospital and community characteristics. METHODS: This study of a national sample of U.S. hospitals utilizes data collected from publicly available CHNAs and implementation strategies produced by hospitals from 2018 to 2021. This cross-sectional study employs descriptive statistics and multivariable analysis to assess relationships between prioritization of substance use on hospital implementation strategies and the services offered by hospitals, with consideration of community and hospital characteristics. Hospital CHNA and strategy documents were collected and then coded to identify whether the substance use needs were prioritized by the hospital. The collected data were incorporated into a data set with secondary data sourced from the 2021 AHA Annual Survey. RESULTS: Multivariable analysis found a significant and positive relationship between the prioritization of substance use as a community need on a hospital's implementation strategy and the number of the services included in this analysis offered by the hospital. Significant and positive relationships were also identified for five service categories and for hospital size. CONCLUSIONS: The availability of service offerings is related both to a hospital's prioritization of substance use and to its size, indicating that these factors are likely inter-related regarding a hospital's sense of its ability to address substance use as a community need. Policymakers should consider why a hospital may not prioritize a need that is prevalent within their community; e.g., whether the organization believes it lacks resources to take such steps. This study also highlights the value of the assessment and implementation strategy process as a way for hospitals to engage with community needs.

Ohio Presents Opportunities For Understanding Hospital Alignment With Public Health Agencies On Community Health Assessments.

Multisector collaboration is critical for improving population health. Improving alignment between nonprofit hospitals and local health departments is one promising approach to achieving health improvement, and a number of states are exploring policies to facilitate such collaboration. Using public documents, we evaluated the alignment between Ohio nonprofit hospitals and local health departments in the community health needs they identify and those they prioritize. The top three needs identified by hospitals and health departments were mental health, substance use, and obesity. Alignment across organizations was high among the top needs, but it varied more among less commonly identified needs. Alignment related to social determinants of health was low, with health departments being more responsive to social determinants than hospitals. Given the different strengths and capacities of hospitals and health departments, this divergence may be in the best interests of the communities they serve. Community benefit policies should consider how to promote collaboration between hospitals and health departments while also encouraging organizations to use their own expertise to meet community needs.

Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services.

INTRODUCTION: Hospitals are an ideal setting to stage opioid-related interventions with patients who are hospitalized due to overdose or other substance use-related complications. Transitional opioid programs-which initiate care and provide linkages upon discharge, such as screening, initiation of medications for opioid use disorder, and addiction consult services-have become the gold standard, but implementation has been uneven. The purpose of this study was to assess disparities in the availability of hospital-based transitional opioid programs, across rural and urban hospital settings in the United States. METHODS: Using hospital administrative data paired with county-level demographic data, we conducted bivariate and regression analyses to assess rural-urban differences in the availability of transitional opioid services including screening, addiction consult services, and MOUD in U.S general medical centers, controlling for hospital- and community-level factors. Our sample included 2846 general medical hospitals that completed the 2021 American Hospital Association (AHA) Annual Survey of Hospitals. Our primary outcomes were five self-reported measures: whether the hospital provided screening in the ED; provided screening in the inpatient setting; whether the hospital provided addiction consult services in the ED; provided addiction consult services in the inpatient setting; and whether the hospital provided medications for opioid use disorder. RESULTS: Rural hospitals did not have lower odds of screening for OUD or other SUDs than urban hospitals, but both micropolitan rural counties and noncore rural counties had significantly lower odds of having addiction consult services in either the ED (OR: 0.74, 95 % CI: 0.58, 0.95; OR: 0.68, 95 % CI: 0.50, 0.91) or inpatient setting (OR: 0.76, 95 % CI: 0.59, 0.97; OR: 0.68, 95 % CI: 0.50, 0.93), respectively, or of offering MOUD (OR: 0.69, 95 % CI: 0.52, 0.90; OR: 0.52, 95 % CI: 0.37, 0.74). CONCLUSIONS: Our study suggests that evidence-based interventions, such as medications for opioid use disorder and addiction consult services, are less often available in rural hospitals, which may contribute to rural-urban disparities in health outcomes secondary to OUD. A priority for population health improvement should be developing implementation strategies to support rural hospital adoption of transitional opioid programs.

From microbe to metaphor: virus-like problems in organizations.

Despite the important role of problem-solving in organizations, our understanding of the fundamental nature of problems is limited. To generate insights and discussion on this topic, we introduce the metaphor of a "virus-like" problem, which is a special kind of problem that often escapes the awareness of organizational leaders. Virus-like problems differ from other problems in organizations because, just like actual viruses, they are hidden, their source is difficult to identify, and they can quickly spread to others. Integrating the public health and organizational psychology fields, we draw lessons from the COVID-19 pandemic and how it was (mis) managed by public officials to offer a new perspective on problems in organizations and offer practical ideas for how leaders can address virus-like problems of their own.

The public availability of hospital CHNA reports: limitations and potential to study hospital investments in the next phase of public health.

Nonprofit hospitals have been required to complete and make publicly available their community benefit reports for more than a decade, a sign of changing expectations for private health care organizations to explicitly collaborate with public health departments to improve community health. Despite these important changes to practice and policy, no governmental agency provides statistics regarding compliance with this process. To better understand the nature and usefulness of the data provided through these processes, we led a research team that collected and coded Community Health Needs Assessment (CHNA) and Implementation Strategy (IS) Reports for a nationally representative sample of hospitals between 2018 and 2022. We utilized descriptive statistics to understand the frequency of noncompliance; t-tests and chi-square tests were employed to identify characteristics associated with incomplete documents. Approximately 95% of hospitals provided a public CHNA, and approximately 86% made their IS available. The extent of compliance with the CHNA/IS mandate indicates that these documents, paired with existing public health and policy data, offer considerable potential for understanding the investments nonprofit hospitals make to improve health outcomes and health equity in the communities they serve.