Leveraging Population Health Expertise to Enhance Community Benefit (original) (raw)
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The Contribution of Hospitals and Health Care Systems to Community Health
Annual Review of Public Health, 2009
This article reviews evidence on hospitals’ and health systems’ impacts on community health improvement. We begin with an overview of the history of community benefit and then discuss the lack of a widely accepted definition and measurement of community benefit activities as well as the expectations and accountability of tax-exempt not-for-profit hospitals and health systems in community initiatives. We highlight the approaches of two systems and identify strategic, cultural, technical, and structural challenges associated with increasing community benefit and health-improvement activities. We conclude by offering recommendations for policy and practice.
Journal of public health management and practice : JPHMP, 2017
Many hospitals in the United States are exploring greater investment in community health activities that address upstream causes of poor health. Develop and apply a measure to categorize and estimate the potential impact of hospitals' community health activities on population health and equity. We propose a scale of potential impact on population health and equity, based on the cliff analogy developed by Jones and colleagues. The scale is applied to the 317 activities reported in the community health needs assessment implementation plan reports of 23 health care organizations in the Minneapolis-St Paul, Minnesota metropolitan area in 2015. Using a 5-point ordinal scale, we assigned a score of potential impact on population health and equity to each community health activity. A majority (50.2%) of health care organizations' community health activities are classified as addressing social determinants of health (level 4 on the 5-point scale), though very few (5.4%) address stru...
HERD, 2015
To compare sociodemographic and motivational factors for healthcare use and identify desirable health-promoting resources among groups in a low socioeconomic status (SES) community in Chicago, IL. Disparities in health services and outcomes are well established in low SES urban neighborhoods in the United States and many factors beyond service availability and quality impact community health. Yet there is no clear process for engaging communities in building resources to improve population-level health in such locales. A hospital building project led to a partnership of public health researchers, architects, and planners who conducted community-engaged research. We collected resident data and compared factors for healthcare use and choice and likelihood of engaging new health-promoting services. Neighborhood areas were strongly associated with ethnic groupings, and there were differences between groups in healthcare choice and service needs, such as, proximity to home was more impor...
Journal of Urban Health, 2008
Improving community health "from the ground up" entails a comprehensive ecological approach, deep involvement of community-based entities, and addressing social determinants of population health status. Although the Centers for Disease Control and Prevention, the Office of the Surgeon General, and other authorities have called for public health to be an "inter-sector" enterprise, few models have surfaced that feature local health departments as a key part of the collaborative model for effecting community-level change. This paper presents evaluation findings and lessons learned from the Partnership for the Public's Health (PPH), a comprehensive community initiative that featured a central role for local health departments with their community partners. Funded by The California Endowment, PPH provided technical and financial resources to 39 community partnerships in 14 local health department jurisdictions in California to promote community and health department capacity building and community-level policy and systems change designed to produce long-term improvements in population health. The evaluation used multiple data sources to create progress ratings for each partnership in five goal areas related to capacity building, community health improvement programs, and policy and systems change. Overall results were generally positive; in particular, of the 37 partnerships funded continuously throughout the 5 years of the initiative, between 25% and 40% were able to make a high level of progress in each of the Initiative's five goal areas. Factors associated with partnership success were also identified by local evaluators. These results showed that health departments able to work effectively with community groups had strong, committed leaders who used creative financing mechanisms, inclusive planning processes, organizational changes, and open communication to promote collaboration with the communities they served. KEYWORDS Community health partnerships, Local public health departments, Communitybased health promotion, Resident involvement, Collaboration, Social determinants of health.
Preventing Chronic Disease, 2004
Regional health care systems have significant opportunities to adopt community-oriented approaches that impact the incidence and burden of chronic disease. In 1998, a vertically integrated, regional health care system established a community health institute to identify, understand, and respond to health needs from a community perspective. The project was implemented in four communities (two rural counties, a rural/urban transitional county, and an inner-city community) using five steps: 1) support or form a local community coalition; 2) hire and support a local coordinator; 3) prepare a formal community assessment; 4) fund locally designed interventions; and 5) evaluate each project.In four narrative case studies, we present the steps, challenges, and common principles faced at the local level by Carolinas Community Health Institute. The case studies were prepared using three data sources: reviews of written documents, interviews with the seven-member steering committee, and interviews with six key informants from each county. Data were coded and analyzed using standard qualitative software to identify common themes and sources of variance between cases.The project model was generally well accepted. Local autonomy and domain disputes were challenges in all four sites. Funding for local projects was the most frequently cited benefit. The project was successful in increasing local capacity and supporting well-designed interventions to prevent chronic disease. This approach can be used by large health care systems and by other organizations to better support local health initiatives.
2015
Lisa H. Ozaeta: Satisfying non-profit hospitals' community benefit obligations by targeting population health programs with distributed ambulatory practices: The Results of a Mixed Methods Study (Under direction of Mark Holmes) The findings of this study indicate that reimbursement reform will drive population health efforts by hospitals. Until there is a financial imperative to improve the health of communities, hospitals are more likely to focus on their historical business model. However, once the financial case can be made, hospitals are willing to move toward activities that seek to improve population health. Even as hospitals seek to develop population health programs, there remains many silos between hospitals and ambulatory physicians, which make effective partnerships challenging. The findings of this study include: 1) Health reform and new payment models have started discussions about population health, but have not affected reimbursement significantly enough to cause most hospitals to fully embrace population health programs. 2) Hospitals rely on community partnerships to address the community health needs that cannot be addressed in the hospital. 3) There is not an effective link between the community benefit office and community physicians that promotes cooperation in designing and implementing programs that affect population health.
AMA Journal of Ethics
In the past few decades, scholars have begun to establish ethical principles for public health engagement. A key tension has been how to reconcile public health improvement with local autonomy in decision making so as to express respect for community members' on-theground experience. This article describes the experience of one children's hospital in learning to ethically engage a surrounding community in conversations about housing development in partnership with a local faith-based development organization. Making Neighborhoods Better In 2008, amidst the throes of economic recession, a major crossroads confronted the Nationwide Children's Hospital (NCH) in Columbus, Ohio's South Side. The hospital had decided to remain in its location of 126 years and invest more deeply in the community. The collapse of the nation's housing markets had left hundreds of vacant properties in the area just beyond the hospital's campus, and it was clear that addressing housing was key to improving pediatric health outcomes for 3 reasons: (1) housing plays a documented role in the health of children, 1 and this neighborhood had severe housing shortage; (2) outreach efforts made clear that housing was a neighborhood priority; and (3) because of instability in housing, children were moving too frequently to make school-based or neighborhood-based programs effective. Accordingly, the new hospital administration was committed to effecting change in the neighborhood.