Conducting Community Health Needs Assessments in Rural Communities: Lessons Learned. (original) (raw)
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Journal of the Georgia Public Health Association, 2016
Background: Under the Affordable Care Act, nonprofit hospitals are required to conduct a Community Health Needs Assessment (CHNA) every three years. Using recommendations proposed by Georgia Watch, students and faculty members from the University of Georgia (UGA) conducted a CHNA for a hospital in a rural county in Georgia. The purpose of the CHNA was to identify community health problems and needs, as well as community assets and resources. The aim of this report is to describe the process for conducting the CHNA, the findings, and the lessons learned. Methods: The CHNA team consisted of students and faculty members from UGA's College of Public Health and a Public Service and Outreach professional who worked in the community. In completing the CHNA, the team used the following fivestep process: define community, collect secondary data on community health, gather community input and collect primary data, prioritize community health needs, and implement strategies to address community health needs. Primary and secondary data were collected. Results: By triangulating findings across data sources, the CHNA team created a community health profile for the service area of the hospital. Based on these findings, the community identified four main areas for improvement, prioritized these health issues, and developed an implementation strategy for the hospital and community. Conclusions: The process used to conduct this CHNA can serve as a model for other rural communities undergoing similar assessments. Lessons learned from completing this CHNA can be applied to future CHNA efforts.
Journal of Rural Health, 2017
The purpose of this study is to understand the experiences of Appalachian hospitals in undertaking Community Health Needs Assessments (CHNAs). Of particular interest is whether new requirements to undertake regular evaluation and public health programming pose challenges for rural, Appalachian hospitals. Methods: Using a sample of nonprofit hospitals in Appalachian Ohio, we conducted in-depth qualitative interviews with hospital administrators overseeing community benefit activities and external consultants hired to complete assessments. Following a grounded theory approach, we coded interviews to ascertain major themes. Findings: Our findings suggest that there are several challenges faced by nonprofit hospitals that may relate to their status as rural hospitals. In particular, we found that these hospitals struggle to hire staff to oversee CHNAs, often lack the material resources to address needs identified in reports, and seek more concrete guidelines from the IRS on carrying out these new activities in their communities. Conclusions: The results from these interviews suggest that there is significant support for new CHNA activities in Appalachian Ohio, but challenges remain to translate these efforts into improved health outcomes in this region. Because rural Appalachia, in particular, faces significant health disparities and a relative lack of health care providers, there is a potential for hospitals to take on an important role in public and preventive health if initial challenges are addressed.
An Innovative Community-based Model for Improving Preventive Care in Rural Counties
The Journal of the American Board of Family Medicine
This quasi-experimental pilot study aimed to implement and evaluate a sustainable, rural community-based patient outreach model for preventive care provided through primary care practices (PCPs) located in a rural county in Oklahoma. A Wellness Coordinator (WC) working with PCPs, the county health department, the county hospital, and a health information exchange (HIE) organization helped county residents receive evidence-based preventive services. Methods: The WC used a community wellness registry connected to electronic medical records via HIE and called patients at the county level based on PCP-prioritized and tailored protocols. The registry flagged patient-level preventive care gaps, tracked outreach efforts, and documented the delivery of preventive services throughout the community. Return on investment (ROI) for prioritized preventive services was estimated in participating organizations. Results: Six of the 7 PCPs in the county expressed interest in the project. Three of these practices fully implemented the 1-year outreach program starting in mid 2015. The regional HIE supplied periodic data updates for 9138 county residents to help the coordinators address care gaps using the community registry. A total of 5034 outreach calls were made by the WC in the first year and 7776 prioritized recommendations were offered when care gaps were detected. Of the 5034 distinct patients who received a call, 1146 (22%) were up to date on all prioritized services, whereas 3888 (78%) were due for at least 1 of the selected services. Health care organizations in the county significantly improved the delivery of selected preventive services (mean increase, 35% across 10 services; P ؍ .004; range, 3% to 215%) and realized a mean ROI of 80% for these services (range, 32% to 122%). The health system that employed the WC earned an estimated revenue of $52,000 realizing a 40% ROI for the coordinator position. Conclusions: Although more research is needed, our pilot study suggests that it may be feasible and cost effective to implement an innovative, county-level patient outreach program for improving preventive care in rural settings.
Emerging Health Trends in North Dakota: Community Health Needs Assessment Aggregate Data Report
Needs assessments are commonly practiced and encouraged among health care providers to ensure they are meeting the needs of their patients. The Patient Protection and Affordable Care Act (PPACA) of 2010 mandates that all non-profit hospitals conduct a Community Health Needs Assessment (CHNA) once every three years. From 2011-2013 the Center for Rural Health (CRH) at the University of North Dakota School of Medicine and Health Sciences has conducted CHNAs on more than half of the Critical Access Hospitals (CAHs) in North Dakota. Specifically, of the 36 CAHS, the CRH has conducted 21 CHNAs for hospitals across the state representing 58 percent of all CAHs. Research designs vary on how best to conduct a CHNA but the overarching goal is to solicit community input from a broad sample, including input from a public health official. As part of the CHNA process, community participants are asked to prioritize the most pressing needs confronting their community from a compiled list of potential needs that were identified during the needs assessment process. Termed Tier 1 needs, these needs reflect the health concerns community participants selected and ranked as most prevalent, most persistent, and most substantial. With this prioritized list of Tier 1 needs, the hospital can attend to the needs of its constituents and address the health needs impacting the community. A systematic review of all the Tier 1 needs collected from 21 CHNAs was conducted to compose a macro understanding of community health needs in rural North Dakota. In this way, the Tier 1 needs were aggregated with an eye for overlapping and recurring significant needs. With a sample size of 21 rural hospitals, or more than half of the CAHs in North Dakota and including hospitals from all geographic corners, the results may be representable of the state’s health care needs. The Tier 1 needs occurring most frequently are: limited number of health care providers, higher costs of health care for consumers, financial viability of hospitals, mental health, and elevated rates of adult obesity. As a whole, these needs paint the current picture of health needs affecting the state. With the PPACA in its infancy, documenting the most significant needs at this juncture provides the baseline for which to measure change in the future. Additionally, an analysis of how the significant needs were determined is included. Findings show that primary data sources outweigh secondary data sources when participants are tasked with prioritizing health needs. Within primary data, focus group responses hold the most influence. This conclusion highlights the value of collaborative communication opportunities and may implicate that more CHNA research designs should include focus groups in the future.
Evaluation and Program Planning, 2019
This rubric can be used by providers, decision makers, policymakers, agencies, communities themselves, and other key stakeholders in rural areas to standardize and prioritize strategies to improve access to care in their communities. Use of the rubric can inform decision making processes by providing evidence-based, comparable results pertaining to the impact and feasibility of pertinent access to care improvement strategies. The rubric can be further modified to meet the specific population and/or health needs of each community. In the long-term, this rubric could facilitate discussions of strategy implementation successes and opportunities for improvement between rural communities.
The Power of Community Voices for Enhancing Community Health Needs Assessments
Health promotion practice, 2016
As required by the Affordable Care Act, Community Health Needs Assessments (CHNAs) are formalized processes nonprofit hospitals must perform at least every 3 years. CHNAs are designed to help hospitals better tailor health services to the needs of local residents. However, CHNAs most often use quantitative, population-level data, and rarely incorporate the actual voices of local community members. This is particularly a problem for meeting the needs of residents who are also racial or ethnic minorities. This article discusses one model for integrating residents' voices into the CHNA process. In this model, we videotaped interviews with community members and then coded and analyzed interview data to identify underlying themes. We created a short video aimed at starting conversations about community members' concerns. In addition to demonstrating how other nonprofit hospitals may use qualitative data in the CHNA process, this article illustrates how adding qualitative data may...
Journal of Community Medicine, 2016
According to public health literature, a Community Health Needs Assessment (CHNA) is the process of using quantitative and qualitative methods to systematically collect and analyze data in order to understand the health status and needs of a defined population/community [1]. The Affordable Care Act (ACA) requires that all 501(c) (3) hospitals conduct a CHNA and adopt an implementation strategy to meet identified community health needs at least once every three years [2]. Non-profit hospitals that fail to meet the CHNA requirement of the ACA can be penalized through an excise tax issued by the Internal Revenue Service (IRS). These fines can be as high as $50,000 [2, 3]. The Meadville Medical Center (MMC) is a 249-bed non-profit community hospital located in northwestern Pennsylvania (Figure 1). The MMC in collaboration with local health services organizations and agencies began a multi-year CHNA project to meet the ACA requirements in 2013. The population served by the MMC includes the majority of residents in Crawford County, PA (~58,000 individuals). Crawford County is a rural community located 90 miles north of Pittsburgh, PA and 40 miles south of Erie, PA. Approximately 17% of the population in Crawford County lives below the poverty line; less than 20% of adults have completed a Bachelor's degree in spite of the fact that 87% have completed high school; nearly 18% of adults are senior citizens [4]. The city of Meadville, the Crawford County Seat, is home to approximately 13,000 residents as well as the MMC, Allegheny College, and city, county, and state governmental offices [5]. However, nearly a quarter (24.2%) of the city residents lives in poverty [4]. Although the ACA provides specific instructions about what to include in the CHNA process and reported documents, it provides little guidance about how a CHNA should be conducted. Our research team at Allegheny College [6] has been collaborating with the MMC to conduct a comprehensive CHNA during 2013-15. The methodology we have developed for the CHNA includes three fundamental objectives: (1) Developing community partnerships (2) Developing a mixed methods research protocol and (3) Disseminating valid and reliable results [7].
Community health needs assessments: filling data gaps for population health research and management
EGEMS (Washington, DC), 2014
Community health needs assessments (CHNA) are completed to meet varied regulatory and statutory requirements for local public health departments, tax-exempt 501(c)(3) hospitals, and Federally Qualified Health Centers. Although compliance is a motivating factor, these entities are committed to understanding the communities they serve and to developing strategies to address health needs and inequities in health and health care. CHNAs have the potential to improve the health of communities and populations by giving crucial qualitative and quantitative context to hospital and patient data, thereby enhancing opportunities for health services and clinical outcomes researchers. Filling in these data gaps can help to improve population health by highlighting community-and social determinant-related dynamics relevant to the improved health of the community. Successful models exist that that have used CHNAs and the resulting data to improve population health management and reduce inequities, ...