SESSION 2D: System Structure & Performance-Hospitals & Community Health
Room: Thoroughbred 4
Wednesday, April 9, 2014, 9-10:15 am
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KC14 Session 2D on System Structure & Performance: Hospitals & Community Health by NCC for PHSSR
MODERATOR
Angela Carman, Dr.P.H., M.B.A.
PRESENTERS
Kate Beatty, Ph.D., M.P.H.
Missed Opportunities – describing collaboration between LHDs and hospitals around a community health assessment
Co-Investigators: Kristin Wilson, Ph.D., Amanda Ciecior, B.S.
Background: Hospitals and local health departments (LHDs) are under policy requirements from the Affordable Care Act and accreditation standards through PHAB. These have led to a renewed interest in hospitals and LHDs working together to achieve common goals.
Research Objective: to gain an understanding of the collaboration occurring between LHDs and hospitals around a community health assessment (CHA).
Data Sets and Sources: In 2012, the Missouri Department of Health and Senior Services conducted a survey of LHDs. From the LHDs, a subset were (was?) selected based on self-reported collaboration (n=26) or unsureness about collaboration (n=29) with a local hospitals around their CHA. LHDs were surveyed regarding their relationship with local hospitals.
Study Design: Our study design was observational, performing analysis on primary and secondary data from multiple sources.
Analysis: For LHDs currently collaborating with a hospital, a collaboration continuum scale was calculated. Appropriate non-parametric tests, chi-squares, and Spearman’s rank correlations were conducted to determine differences between groups.
Principal Findings: A total of 44 LHDs responded to the survey (80.0%). LHDs currently collaborating positively correlated with aspects of the CHA and CHA process including having a CHA, how often the CHA is used during the year, and satisfaction with the hospital relationship. How often the health department uses the CHA was positively correlated with having current state-level accreditation and interest in PHAB accreditation.
Conclusions: Quantifying the collaboration between LHDs and local hospital(s) provides an opportunity to begin evaluating the extent of collaboration necessary for each LHD to achieve further accreditation. For LHDs seeking accreditation, there is also a positive correlation with using the CHA, not just obtaining one. Of the LHDs unsure about collaboration, many report being unsure about their local hospital’s desire for collaboration or lacked any communication with the hospital on this subject, perhaps missing their opportunity for collaboration.
Implications for Public Health Practice and Policy: Understanding of the levels of joint action required may assist LHDs in making informed decisions regarding deployment of resources for accreditation. Additionally, best practices in collaboration could start the collaboration process for those LHDs not currently utilizing their local hospital(s).
Simone Singh, Ph.D., M.A., B.B.A.
Hospital community benefit: Are hospitals' charitable activities aligned with community health needs?
Co-Investigators: None Listed
Background: A key provision of the Affordable Care Act (ACA) requires tax-exempt hospitals, which comprises most not-for-profit hospitals in the US, to conduct community health needs assessments (CHNA) once every three years. However, little is known about whether these hospitals take into account community health needs when making decisions about how much and what types of community benefits to provide.
Research Objective: While previous research has found no relationship between community need and hospitals’ provision of community benefit, this study extends prior work by using a more comprehensive set of variables to characterize the health needs of a community.
Data: Tis study used data from hospital tax filings to the Internal Revenue Service, the American Hospital Association’s Annual Survey, the Area Resource File, and the County Health Rankings. The study population comprised 1,525 hospitals that reported their community benefits at the individual hospital level in 2009.
Study Design: Univariate and multivariate analyses were conducted to examine the relationship between the health needs of communities and the provision of community benefits by tax-exempt hospitals controlling for select hospital and community characteristics.
Principal Findings: Consistent with prior empirical evidence, we found almost no relationships between the health needs of a community and the amount and types of community benefit provided by not-for-profit hospitals in these communities. Neither the level nor pattern of hospital community benefits was associated with community need. Conclusions: Given the lack of a relationship between community need and community benefit, our findings indicate important opportunities for tax-exempt hospitals to improve the alignment between their community benefit activities and the health needs of the communities they serve.
Implications for Public Health Practice & Policy: The ACA requirement that tax-exempt hospitals conduct periodic CNHAs may be a first step in improving the alignment between community need and hospital-based community benefits. A detailed assessment of the health needs of their communities can enable hospitals to refocus their charitable activities to address the most pressing health needs. The IRS should closely monitor the implementation of th CNHA requirement and evaluate its impact on aligning hospital community benefits with community need.
Christopher Maylahn, M.P.H., B.A.
Organizational and Structural Characteristics of Local Health Department-Hospital Collaborations for Population Health
Co-Investigators: Sylvia Pirani, M.S.P.H., B.A., Priti Irani, M.S.P.H.
Background: In 2008, New York State DOH required that local health departments (LHDs) and nonprofit hospitals collaborate in conducting community health assessments and adopting an implementation strategy described in a community health improvement plan. These actions mirror the ACA requirements and PHAB standards now in place nationally. Hence, New York can serve as a natural experiment to examine these collaborations, how they vary across communities and their potential for sustainability.
Research Objective: Describe the variation in organizational and structural factors shown to be important in such collaborations. The project addresses questions 10 and 11 of the National PHSSR Research Agenda under Public Health System Structure and Performance.
Data Sets & Sources: Three sources were used: 1) A survey administered in 2011 to all LHDs and nonprofit hospitals to assess their progress in implementing strategies for health improvement after three years; 2) in 2013, both groups submitted reports updating their individual and collaborative efforts; and 3) in 2010 and 2013, the NACCHO Profile Series reported data from all LHDs about community collaborations, and relevant organizational and structural characteristics.
Study Design: Descriptive study to document relevant structural and organizational attributes of collaborations over time.
Analysis: Using ‘county’ as the unit of analysis, data about the structure and organization of the community collaborations were summarized in 2010, 2011 and 2013. Information was also obtained about the quality of their community health assessments and improvement plans; and how the plans are being implemented. County-specific changes over time will be documented. New York’s LHDs will be compared with all other states represented in the NACCHO Profile.
Principal Findings: After three years, collaborations were occurring in most counties with interventions underway in many of them. Updated information for 2013 including their plans for the next four years will be available in February.
Conclusions: Preliminary analyses indicate considerable variation in organizational and structural characteristics of collaborations.
Implications for Public Health Practice & Policy: Results may shed light on how LHD-hospital collaborations will fare when implemented across the U.S. Insights gained from this knowledge can lead to recommended policies and practices that support sustainability of these required collaborations.