Community Health
Room: Triple Crown I, II, & III
Wednesday, April 22, 2015, 2:00 to 3:30 PM
Moderator: Angela Carman, DrPH, MBA
Simone Singh, PhD, MA, BBA
The Role of Accreditation Intent in Local Health Departments’ Decision to Collaborate with Tax-exempt Hospitals Around the Community Health Assessment.
Co-Investigator(s): Erik Carlton, DrPH
Background: Community health assessments (CHA) are a core function of local health departments (LHDs) and many LHDs have been conducting CHAs on a regular basis for years. More recently, completing a CHA has also become a prerequisite for LHDs seeking accreditation by the Public Health Accreditation Board (PHAB). Similarly, under the Affordable Care Act, nonprofit hospitals are required to conduct periodic community health needs assessments. Opportunities thus exist for LHDs to partner with nonprofit hospitals in their communities, yet it remains unclear whether interest in PHAB accreditation indeed motivates LHDs to engage in collaborations around community health assessment and improvement planning. Research objective: We examined LHD-hospital collaborations around CHAs, including characteristics of LHDs involved in such collaborations and the relationship between LHDs’ level of engagement with accreditation activities and their involvement in collaborations with hospitals. Data sets and sources: Data for this study came from two sources, the 2013 National Association of County and City Health Officials (NACCHO) Profile Study and the Area Resource File. Study design: In its 2013 survey, NACCHO asked LHDs about their collaboration with nonprofit hospitals around CHAs. Specifically, respondents were asked to indicate whether they were “currently collaborating”, “discussing future collaboration”, or “not currently engaged in discussion or collaboration” with nonprofit hospitals on CHAs. The 2013 NACCHO Profile also surveyed LHDs about three PHAB accreditation prerequisites: completion of a CHA, completion of a community health improvement plan, and completion of an agency-wide strategic plan. Of the 2,000 LHDs that responded to the 2013 Profile survey, 1,958 provided information on the status of their collaboration with nonprofit hospitals. Of these, 1,492 LHDs provided complete information on all variables of interest, including PHAB accreditation prerequisites, and were thus included in the final sample. Analysis: Both descriptive and multivariate regression analyses were conducted. In our multivariate analysis, the dependent variable was a binary indicator of LHDs’ involvement in collaborations with nonprofit hospitals. The three PHAB accreditation prerequisites represented the primary independent variables. Regressions also controlled for a set of LHD, population, and community characteristics. Principal findings: LHDs that collaborated with hospitals on CHAs were larger, more likely to be locally governed and to have a local board of health. The three PHAB accreditation pre-requisites were all significantly correlated (p<.01) with LHD-hospital collaborations. Accreditation intent also was an important factor in LHDs’ decisions to collaborate with hospitals around the CHA when controlling for other LHD, population, and community characteristics. Conclusions: Study findings suggest that accreditation efforts may be a positive influence on LHD-hospital collaborations. LHDs need to conduct a CHA as a prerequisite for PHAB accreditation and these LHDs may thus be in a better position to engage in collaborations with hospitals than those that do not plan to pursue accreditation. Implications for public health practice and policy: Incentivizing voluntary accreditation among LHDs may help policy makers to encourage greater collaboration between LHDs and hospitals around CHAs. Public health practitioners who are discussing collaboration with local hospitals could focus on CHAs as a potentially mutually-beneficial collaborative activity.
Gulzar Shah, PhD, MS
Level and Predictors of LHDs' Engagement in Community Health Assessment, 2002-2013
Co-Investigator(s): Kay Lovelace, PhD, MPH, BA& Daniel Linder, PhD
Local health departments (LHDs) work to improve population health using key evidence-based decision-making practices, such as community health assessment (CHA). Yet, not all LHDs use these practices. Little is known about how community health assessments are used to adopt and implement evidence-based interventions, policies, and environmental and systems changes that ultimately translate into changes in community health. Our research objective for this study is to understand the level to which LHDs have used CHAs from 2002-2013 and the modifiable factors associated with LHDs’ engagement in these evidence-based decision-making processes over time. Our primary dataset was the longitudinal dataset constructed from NACCHO’s National Profile of LHDs surveys. Using each LHD’s unique NACCHO identifier, we have linked data from four waves of the Profile Study (2005, 2008, 2010, 2013). The linked data helped us isolate LHDs that have always been engaged in CHA/CHIP from those that have been intermittently or never involved. Our sample included approximately 1378 of the 2500 LHDs (55%) in the country. Study design and analyses: The study design is longitudinal and addresses the years of 2005-2013. Descriptive analyses were performed to identify the percentages of LHDs engaging in CHA over time (not completed, completed for some years, completed for all years). Second, using a time series vector of binary responses related to CHA and CHIP completion as the DV, we are employing a generalized linear mixed effects model to identify modifiable organizational and structural factors at the state and local levels that best predict the completion of CHA over time. Using the complete time series dependent structure will allow us to avoid the loss of information that results from collapsing repeated measures into a summary measure. Preliminary results: Descriptive: Descriptive analyses show that 32.3 percent of LHDs have completed new CHAs during each survey time period since 2002, as they indicated having completed CHA within past three years (in 2005 and 2008 Profiles) or within five years (2010 and 2013 Profiles). Slightly less than one-third (30%) reported having a current CHA in three out of four Profile study periods. Only 8.6 percent had not completed a CHA since 2002. We will also present the results of the generalized linear mixed effect model. Conclusion: This study provides a foundation for research on the effects of engaging in community health assessment processes on community health outcomes and partnerships. Public Health Implications: Our findings on predictors of completion of community health assessments over time should allow state and local public health officials to identify leverage points for increasing LHDs’ involvement in critical evidence-based planning processes and should aid efforts such as voluntary accreditation by the Public Health Accreditation Board.
Priscilla Barnes, PhD, MPH, CHES
Functions and Performance of Community Health Coalitions in Tennessee
Co-Investigator(s): Paul Erwin, MD, DrPH; Ashley Brooks, MPH; Ramal Moonesignhe, PhD, MS, MA; Erik Carlton, DrPH, MS; & Bruce Behringer, MPH
Background: County Health Councils (CHCs) were established across the state of Tennessee in the 1990s initially for the purpose of identifying health professional shortage areas, with their scope later expanded to include community-based health assessment and planning. In many ways CHCs are considered to be the locus for the local public health system. This present study builds upon a previous study of CHCs, which identified important functional characteristics that could enhance performance and (ultimately) impact community health. The present study focuses on the current functional characteristics of CHCs, measuring performance, and then exploring associations between function and performance. Research Objective: The primary research question is: What are the functional and performance characteristics of CHCs, and how does function predict performance? Data Sets and Sources: A survey instrument was developed, using previously validated surveys on community health coalitions, and underwent cognitive response testing with persons knowledgeable about CHCs. Chairs of CHCs were provided a link to the final survey through Qualtrics. Survey questions were grouped around eight functional characteristics and three major performance domains, including Internal and External Communication Strategies, Community Partnerships, and Public Health Systems Development. Study Design: Cross-sectional survey, with potential for linkages to a previous survey conducted in 2010 of the same CHCs. Analysis: This study is on going. Descriptive statistics will be provided for the presence of functional characteristics and the level of performance related to communications, partnerships, and health systems development. Inferential statistics – primarily utilizing linear regression – will identify associations between functional characteristics and performance. Time trends will be assessed for those CHCs, which responded to both the 2010, and current survey. Preliminary Findings: To-date there are 40 valid responses from the 90 CHCs which are active and have an identifiable chair (Response Rate=44.4%). Examples of functional characteristics include: 75% of these CHCs have written by-laws, 42% have a written strategic plan, 75% agree or strongly agree that the CHC is task-focused, and 40% have financial resources. Examples of performance: 10% have a communications plan; 68% have partnerships with other organizations or external groups; and 50% or more of CHCs are currently involved in the provision of essential public health services 1 (Monitor health status to identify community health problems), 3 (Inform, educate, and empower people about health issues), 4 (Mobilize community partnerships to identify and solve health problems), and 7 (Link people to needed personal health services and assure the provision of healthcare when otherwise available). Conclusions: With analyses on-going, final conclusions are not yet possible. We intend to show associations between functional characteristics and performance of the 10 essential services. Implications: Identifying the association between function and performance is critical to understanding how local public health systems can “move the needle” on population health outcomes.
Alexandria Drake, MPH, BA
Variation in Priorities between Local Health Department Led Community Health Assessments (CHAs) / Community Health Improvement Plans (CHIPs) and Hospital Led Community Health Needs Assessments (CHNAs) and Jointly Conducted Assessments
Co-Investigator(s): Sara Tillie, BA & Scott Frank, MD, MS, BA
Background: Conduct of Community Health Improvement Plans (CHIPs), Community Health Assessments (CHAs), and Community Health Needs Assessments (CHNAs) represent a changing and varied landscape, with different organizations informing varied approaches in Local Health Departments (LHDs) and hospital systems. Formal efforts are underway to merge these processes and provide avenues for systematic collaboration. These issues gain timely relevance as Ohio is requiring LHDs to enter the public health accreditation process by 2018. In parallel, Ohio hospitals have been confronted with a new requirement to conduct CHNAs to maintain tax-exempt status. Research Objective: To contrast and compare the health priorities in Ohio communities as identified by LHDs in CHAs/CHIPs; by hospital-lead CHNAs; and through joint LHD-Hospital conducted assessments. Data Set and Sources: The Ohio Research Association for Public Health Improvement collaborated with Health Policy Institute of Ohio to reframe the Wisconsin CHIPP Quality Measurement Tool to include items fitting the CHNA requirements for hospitals. The tools were then used to analyze CHAs/CHIPs led by LHDs (n=112 of 125 LHDs); and CHNAs led by associated hospitals (n= 98). Study Design: Comparative case study using mixed methods evaluated CHAs/CHIPs and CHNAs and recorded their identifiable priorities. The revised Quality Assessment Tools assessed 35 items in four categories of priority: health conditions (11 items); health behaviors (9 items); community conditions affecting health (5 items); and health systems factors affecting health (10 items). The LHDs with the highest quality process for both CHA (4) and CHIP (4) were then surveyed and interviewed along with their associated hospitals. Analysis: Quantitative and qualitative data were abstracted from publicly available CHA/CHIPs/CHNAs from Ohio LHDs and hospital systems utilizing a standardized protocol. Quantitative analysis includes descriptives, tests of association, and logistic regression utilizing SPSS v.22. A 3-group design compares LHD led; hospital led; and collaboratively led community assessments. Qualitative analysis includes open-ended data collected during the abstraction and the follow up survey/interviews using an inductive methodology. The description is not based on a predefined theoretical framework, but on the words of participants. Content analysis includes coding of data, identifying themes, and constructing generalizations based on these patterns. Preliminary Findings: The top five priorities for hospitals were: Obesity (69%); Medical care access (68%); Mental health (57%); Cancer (55%); Heart Disease (54%); Diabetes (54%). The top five priorities for LHDs were: Obesity (42%); Physical Activity (42%); Nutrition (40%); Substance abuse (35%); Medical care access (33%).The top 5 combined priorities were: Obesity (54%); Medical care access (50%); Physical activity (44%); Nutrition (42%); Mental Health (41%); Substance abuse (41%). Conclusions: Meaningful variations in health priorities exist between LHDs and hospitals. Hospital based CHNA priorities tended to focus on diagnostic conditions and health systems characteristics. LHD based CHIP priorities focused on behavioral and community based conditions that contribute to development or persistence of the medical and health systems conditions. Implications for Public Health Practice and Policy: The difference between CHA/CHIP and CHNA identified priorities demonstrates important differences in perspective and experience. Population health needs would be more effectively served through a collaborative process.