BY: MICHAEL BILTON, M.A.
Community health needs assessment is a pressing topic these days, due in part to the Affordable Care Act's new requirements of nonprofit hospitals. Whether a given hospital is relatively new to community health needs assessments or has years of experience conducting and using them, there is an emerging, wider context that suggests both potential partners for and strategic uses of these assessments. Identifying where to obtain assistance and even collaborators, as well as valuable ways to put a community health needs assessment's information to work, can help eliminate any worry associated with the activity.
First, it is helpful to note that assessing community health needs is not new to hospitals or health systems, thus there is a strong base of practical knowledge from which to draw and learn. A number of national and state hospital associations and metropolitan hospital councils have offered resources, tools and even services to support community health needs assessment activity well before the advent of the requirement, and the prevalence of these is growing. Hospital associations are an excellent first place to inquire when looking for resources and guidance.
Hospitals are not the only health organizations with a requirement or a strong incentive to conduct these assessments, opening up the possibility of potentially labor- or cost-saving voluntary local collaboration. Federally qualified health centers serving medically underserved populations in many communities and public health departments are two of these that frequently work with hospitals on other programs and services. Because hospitals' community health needs assessments can be based on information collected by other organizations and can be done collaboratively (including with other hospitals), it can be valuable to learn who in your community may be planning one.
Federally qualified health centers must periodically conduct an assessment that "demonstrates and documents the needs of its target population" as a key program requirement.1 And, public health departments' new voluntary accreditation program requires a community health assessment and a community health improvement plan. Local health departments seeking accreditation must "participate in or conduct a collaborative process resulting in a comprehensive community health assessment" and "conduct a comprehensive planning process resulting in a … health improvement plan."2 Reaching out to these and potentially other community organizations when conducting a community health needs assessment often can yield valuable data for a hospital's assessment, as well as the possibility of collaboration on parts or all of the assessment process.
Regardless of a hospital's decisions about how to conduct its assessment, wider factors in the transformation of health care delivery are making community health needs assessment findings potentially more relevant and useful than ever. A growing emphasis on prevention, health promotion, health care quality and population health improvement all speak to possible uses of assessment data.
The U.S. Department of Health and Human Services' National Strategy for Quality Improvement in Health Care, submitted to Congress in March 2011, adapted the Institute for Healthcare Improvement's work for its "Triple Aim" initiative focused on improving population health, enhancing patient care experience and reducing or controlling per-capita cost.
Notably relevant to community health needs assessment and community health programs, one of the strategy's three principal aims is to "improve the health of the U.S. population by supporting proven interventions to address behavioral, social and environmental determinants of health in addition to delivering higher-quality care." Among the strategy's six priorities are "promoting the most effective prevention and treatment practices" and "working with communities to promote wide use of best practices to enable healthy living."3
The inclusion of determinants of health, prevention and enabling healthy living points to one potential application of community assessment findings. Often, information that will be helpful in understanding and impacting these factors resides outside of the hospital and even outside of health care. By examining the health status, behaviors and knowledge, access to care and other resources, and social and living conditions of people in the community, one can develop an understanding of health needs and opportunities in a way that supports the national strategy's "healthy people/healthy communities" aim.
This perspective complements that of the federal government's National Prevention Strategy released in June 2011. Just as the health care quality strategy references prevention and working with communities, the prevention strategy discusses the role of medical care and working across care delivery and community settings. One of the report's recommendations is to "support implementation of community-based preventive services and enhance linkages with clinical care." Another speaks of "reducing barriers to accessing clinical … preventive services."4 These recommendations, and many of the document's suggestions for actions that health care, employer, civic and other organizations can take to achieve them, frequently rely on the availability and use of information about conditions at the community level. Here again, there is potential for community health needs assessments to provide insight and evidence to help prevent illness and improve health.
For hospitals, the growing focus on population health may best represent the convergence of many factors in the health care environment (i.e. patient-centered care, medical home demonstrations), the regulatory environment (i.e. value-based reimbursement) and broader societal conditions (i.e. health disparities, rising chronic disease rates). According to a recent Health Research & Educational Trust paper, "improving population health requires effective initiatives to (1) increase the prevalence of evidence-based preventive health services and preventive health behaviors, (2) improve care quality and patient safety, and (3) advance care coordination across the health care continuum."5
As hospitals build population health management capacity, findings from community health needs assessments can be considered alongside clinical, utilization, financial and other data to help craft health improvement solutions that take into account both the individual's health and the community context in which they live.
MICHAEL BILTON is executive director of the Association for Community Health Improvement, a personal membership group of the American Hospital Association, Chicago.
- U.S. Department of Health and Human Services, Bureau of Primary Health Care, Health Center Program Requirements. Accessed online May 13, 2012, at http://bphc.hrsa.gov/about/requirements/index.html.
- Public Health Accreditation Board, PHAB Standards and Measures 1.1 (Standards 1.1 and 5.2). Accessed online May 13, 2012, at www.phaboard.org/accreditation-process/public-health-department-standards-and-measures.
- U.S. Department of Health and Human Services, National Strategy for Quality Improvement in Health Care (March 2011): 1-2. Accessed online May 13, 2012, at www.healthcare.gov/center/reports/nationalqualitystrategy032011.pdf.
- National Prevention, Health Promotion and Public Health Council, Office of the Surgeon General, U.S. Department of Health and Human Services, National Prevention Strategy, 19-20. Accessed online May 13, 2012 at www.healthcare.gov/prevention/nphpphc/strategy/report.pdf.
- Health Research & Educational Trust, Managing Population Health: The Role of the Hospital (Chicago: April 2012): 4. Accessed online May 13, 2012 at www.hpoe.org/population-health.
Copyright © 2012 by the Catholic Health Association of the United States
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