Nonprofit Hospitals’ Approach to Community Health Needs Assessment

摘要

Objectives. We sought a better understanding of how nonprofit hospitals are fulfilling the community health needs assessment (CHNA) provision of the 2010 Patient Protection and Affordable Care Act to conduct CHNAs and develop CHNA and implementation strategies reports. Methods. Through an Internet search of an estimated 179 nonprofit hospitals in Texas conducted between December 1, 2013, and January 5, 2014, we identified and reviewed 95 CHNA and implementation strategies reports. We evaluated and scored reports with specific criteria. We analyzed hospital-related and other report characteristics to understand relationships with report quality. Results. There was wide-ranging diversity in CHNA approaches and report quality. Consultant-led CHNA processes and collaboration with local health departments were associated with higher-quality reports. Conclusions. At the time of this study, the Internal Revenue Service had not yet issued the final regulations for the CHNA requirement. This provides an opportunity to strengthen the CHNA guidance for the final regulations, clarify the purpose of the assessment and planning process and reports, and better align assessment and planning activities through a public health framework. The Patient Protection and Affordable Care Act of 2010 includes a provision requiring all nonprofit hospitals to conduct a community health needs assessment (CHNA) and develop an implementation strategies plan. Nonprofit hospitals must conduct a CHNA at least every 3 years and implement strategies to address identified priority needs. 1 The Internal Revenue Service (IRS), the bureau responsible for the regulation and enforcement of Section 9007 of the Affordable Care Act, provides general guidelines to nonprofit hospitals regarding the CHNA requirement. 1 Included in this requirement are identifying and prioritizing community health needs, inventorying resources, developing an implementation strategies report to address health needs, and involving stakeholders with public health knowledge and expertise and leaders, representatives, or members of medically underserved, low-income, and minority populations in the community. 1 Very little research has been conducted on nonprofit hospitals’ approach to the CHNA requirement, perhaps because of its relative newness. Using CHNA and implementation strategies reports developed by nonprofit hospitals in Texas, we evaluated and analyzed various CHNA methods, report components, and influential factors. In addition, we assessed CHNA and implementation strategies report quality by using a public health framework.