Exploring the Role of Community Social Capital in Not-for-profit Hospitals' Decision to Engage Community Partners in the Community Health Needs Assessment Process.

Not-for-profit hospitals (NFPs) frequently partner with community organizations to conduct internal revenue service-mandated community health needs assessment (CHNA), yet little is known about the number of partnerships that hospitals enter into for this purpose. This article uses "American Hospital Associations' 2020 Annual Survey" data to examine hospital-community partnerships around the CHNA and the role that community social capital defined as, "the networks that cross various professional, political and social boundaries to reflect community level trust needed to pursue shared objectives" plays in hospitals' choices to partner with community organizations for the CHNA. After controlling for a set of hospital, community, and state characteristics, we found that hospitals present in communities with higher social capital were likely to partner with more community organizations to conduct CHNA. Greater social capital may thus promote community health by facilitating the partnerships NFPs develop with community organizations to conduct the CHNA.

A national overview of nonprofit hospital community benefit programs to address the social determinants of health.

Decades of research have solidified the crucial role that social determinants of health (SDOH) play in shaping health outcomes, yet strategies to address these upstream factors remain elusive. The aim of this study was to understand the extent to which US nonprofit hospitals invest in SDOH at either the community or individual patient level and to provide examples of programs in each area. We analyzed data from a national dataset of 613 hospital community health needs assessments and corresponding implementation strategies. Among sample hospitals, 69.3% (n = 373) identified SDOH as a top-5 health need in their community and 60.6% (n = 326) reported investments in SDOH. Of hospitals with investments in SDOH, 44% of programs addressed health-related social needs of individual patients, while the remaining 56% of programs addressed SDOH at the community level. Hospitals that were major teaching organizations, those in the Western region of the United States, and hospitals in counties with more severe housing problems had greater odds of investing in SDOH at the community level. Although many nonprofit hospitals have integrated SDOH-related activities into their community benefit work, stronger policies are necessary to encourage greater investments at the community-level that move beyond the needs of individual patients.

Social determinants of health (SDOH) refer to the "conditions in which people are born, grow, live, work, and age." SDOH have an outsized effect on the health outcomes of individuals and communities, above and beyond formal medical care. For this reason, health care organizations such as hospitals are facing new requirements to screen patients for their individual health-related social needs and invest in improving SDOH in the communities where they are located. In this study, we investigated what approaches nonprofit hospitals use to address both patients' health-related social needs and community-level SDOH, and present data from a national sample of 613 hospitals. We found that 44% of hospital programs addressed patients' health-related social needs, while 56% addressed community-level SDOH, such as improving economic conditions or investing in local schools. The most common programs to address community-level SDOH were aimed at increasing social support and improving local infrastructure such as housing, parks, and transportation. Stronger policies and regulation may be necessary to encourage hospitals to invest in improving community-level SDOH above and beyond addressing individual patients' health-related social needs.

Nonprofit Hospital Community Benefit in the U.S.: A Scoping Review From 2010 to 2019.

Background: U.S. nonprofit hospital community benefit recently underwent significant regulatory revisions. Starting in 2009, the Internal Revenue Service (IRS) required hospitals to submit a new Schedule H that provided greater detail on community benefit activities. In addition, the Affordable Care Act (ACA), which became law in 2010, requires hospitals to conduct community health needs assessments (CHNA) and develop community health implementation plans (CHIP) as a response to priority needs every 3 years. These new requirements have led to greater transparency and accountability and this scoping review considers what has been learned about community benefit from 2010 to 2019. Methods: This review identified peer-reviewed literature published from 2010 to 2019 using three methods. First, an OvidSP MEDLINE search using terms suggested previously by community benefit researchers. Second, a PubMed search using keywords frequently found in community benefit literature. Third, a SCOPUS search of the most frequently cited articles in this topic area. Articles were then selected based on their relevance to the research question. Articles were organized into topic areas using a qualitative strategy similar to axial coding. Results: Literature appeared around several topic areas: governance; CHNA and CHIP process, content, and impact; community programs and their evaluation; spending patterns and spending influences; population health; and policy recommendations. The plurality of literature centered on spending and needs assessments, likely because they can draw upon publicly available data. The vast majority of articles in these areas use spending data from 2009 to 2012 and the first cycle of CHNAs in 2013. Policy recommendations focus on accountability for impact, enhancing collaboration, and incentivizing action in areas other than clinical care. Discussion: There are several areas of community benefit in need of further study. Longitudinal studies on needs assessments and spending patterns would help inform whether organizations have changed and improved operations over time. Governance, program evaluation, and collaboration are some of the consequential areas about which relatively little is known. Gaps in knowledge also exist related to the operational realities that drive community benefit activities. Shaping organizational action and public policy would benefit from additional research in these and other areas.

Utilizing Community Health Needs Assessments (CHNAs) in Nonprofit Hospitals to Guide Population-Centered Outcomes Research for Pediatric Patients: New Recommendations for CHNA Reporting.

Currently, Community Health Needs Assessment (CHNA) reports lack a standard structure, making it difficult to derive meaningful information. However, they have the potential to be a useful tool for analyzing pediatric outcomes, guiding resource allocation, and linking to Patient-Centered Outcomes Research Institute priorities. The objective was to evaluate the utility of CHNA for informing future pediatric, patient-centered outcomes research. The authors analyzed CHNA documents, published before July 1, 2016 by 61 nonprofit hospitals, focusing on 4 metropolitan areas in Florida: Miami, Orlando, Tampa, and Jacksonville. Out of 18 health priorities identified, access to care and obesity were universally recognized as the most urgent pediatric health needs across all hospital types and metropolitan regions. This analysis also yielded insights into key regional differences. The authors advocate that a major change in the CHNA format be implemented using a common set of domains to produce meaningful, interpretable, and comparable results that inform and guide patient-centered health outcomes research.

Beyond CHNAS: Performance Measurement for Community Health Improvement.

RESEARCH OBJECTIVE: Non-profit hospitals are required to work with community organizations to prepare Community Health Needs Assessment (CHNA) and implementation strategy (IS). In concert with the health care delivery system's transformation from volume to value and efforts to enhance multi-sector collaboration, such community health improvement (CHI) processes have the potential to bridge efforts of the health care delivery sector, public health agencies, and community organizations to improve population health. Having a shared measurement system is critical to achieving collective impact, yet despite the availability of community-level data from a variety of sources, many CHI processes lack clear, measurable objectives and evaluation plans. Through an in-depth analysis of ten exemplary CHI processes, we sought to identify best practices for population health measurement with a focus on monitoring collaborative implementation strategies. STUDY DESIGN: Based on a review of the scientific literature, professional publications and presentations, and nominations from a national advisory panel, we identified 10 exemplary CHI processes. Criteria of choice were whether (1) the CHIs articulate a clear definition of intended outcomes; (2) clear, focused, measurable objectives and expected outcomes, including health equity; (3) expected outcomes are realistic and addressed with specific action plans; and (4) whether the plans and their associated performance measures become fully integrated into agencies and become a way of being for the agencies. We then conducted an in-depth analysis of CHNA, IS, and related documents created by health departments and leading hospitals in each process. POPULATION STUDIED: U.S. hospitals. PRINCIPAL FINDINGS: Community health improvement processes benefit from a shared measurement system that indicate accountability for specific activities. Despite the importance of measurement and evaluation, existing community health improvement efforts often fall short in these areas. There is more variability in format and content of ISs than CHNAs; the most developed models include population-level goals/objectives and strategies with clear accountability and metrics. Other hospital IS's are less developed.Although all U.S. hospitals are familiar with performance measurement in their management, this familiarity does not seem to carry over to Community Benefit and CHNA efforts. Indeed, 5 of the 10 CHI processes we examined have some Accountable Care Organization (ACO) involvement, where population-health performance measures are commonplace. Yet this involvement is not mentioned in the CHNAs and ISs, nor are ACO data cited. CONCLUSIONS: Strengthening the CHNA regulations to require that hospitals report the evaluation measures they intend to monitor based on an established community health improvement model could help communities demonstrate impact. As in other areas of health care, performance measures should be tailored to implementation strategy, with clear indication of accountability, and move from outputs to process and outcome measures with established validity and reliability. IMPLICATIONS FOR POLICY OR PRACTICE: Although performance measurement is now commonplace throughout the health care system, the individuals who manage CHI processes may not be that familiar with this approach. This suggests that it is important to develop practitioners' knowledge and skills needed to use it population health data effectively.

Making Better Use of Population Health Data for Community Health Needs Assessments.

RESEARCH OBJECTIVE: Non-profit hospitals are required to work with community organizations to prepare a Community Health Needs Assessment (CHNA) and implementation strategy (IS). In concert with the health care delivery system's transformation from volume to value and efforts to enhance multi-sector collaboration, such community health improvement (CHI) processes have the potential to bridge efforts of the health care delivery sector, public health agencies, and community organizations to improve population health. Having a shared measurement system is critical to achieving collective impact, yet despite the availability of community-level data from a variety of sources, many CHI processes lack clear, measurable objectives and evaluation plans. Through an in-depth analysis of ten exemplary CHI processes, we sought to identify best practices for population health measurement with a focus on measures for needs assessments and priority setting. STUDY DESIGN: Based on a review of the scientific literature, professional publications and presentations, and nominations from a national advisory panel, we identified 10 exemplary CHI processes. Criteria of choice were whether (1) the CHIs articulate a clear definition of intended outcomes; (2) clear, focused, measurable objectives and expected outcomes, including health equity; (3) expected outcomes are realistic and addressed with specific action plans; and (4) whether the plans and their associated performance measures become fully integrated into agencies and become a way of being for the agencies. We then conducted an in-depth analysis of CHNA, IS, and related documents created by health departments and leading hospitals in each process. POPULATION STUDIED: U.S. hospitals. PRINCIPAL FINDINGS: Census, American Community Survey, and similar data are available for smaller areas are used to describe the populations covered, and, to a lesser extent, to identify health issues where there are disparities and inequities.Common data sources for population health profiles, including risk factors and population health outcomes, are vital statistics, survey data including BRFSS, infectious disease surveillance data, hospital & ED data, and registries. These data are typically available only at the county level, and only occasionally are broken down by race, ethnicity, age, poverty.There is more variability in format and content of ISs than CHNAs; the most developed models include population-level goals/objectives and strategies with clear accountability and metrics. Other hospital IS's are less developed. CONCLUSIONS: The county is the unit of choice because most population health profile data are not available for sub-county areas, but when a hospital serves a population more broadly or narrowly defined, appropriate data are not available to set priorities or monitor progress.Measure definitions are taken from the original data sources, so comparisons across measures is difficult. Thus, although CHNAs cover many of the same topics, the measures used vary markedly. Using the same community health profile, e.g. County Health Rankings, would simplify benchmarking and trend analysis.Implications for Policy or Practice: It is important to develop population health data that can be disaggregated to the appropriate geographical level and to groups defined by race and ethnicity, socioeconomic status, and other factors associated with health outcomes.