Collaboration Among Missouri Nonprofit Hospitals and Local Health Departments: Content Analysis of Community Health Needs Assessments

摘要

Objectives. We identified the levels of joint action that led to collaboration between hospitals and local health departments (LHDs) using the hospital’s community health needs assessments (CHNAs). Methods. In 2014, we conducted a content analysis of Missouri nonprofit hospitals (n?=?34) CHNAs, and identified hospitals based on previously reported collaboration with LHDs. We coded the content according to the level of joint action. A comparison sample (n?=?50) of Missouri nonprofit hospitals provided the basic comparative information on hospital characteristics. Results. Among the hospitals identified by LHDs, 20.6% were “networking,” 20.6% were “coordinating,” 38.2% were “cooperating,” and 2.9% were “collaborating.” Almost 18% of study hospitals had no identifiable level of joint action with LHDs based on their CHNAs. In addition, comparison hospitals were more often part of a larger system (74%) compared with study hospitals (52.9%). Conclusions. The results of our study helped develop a better understanding of levels of joint action from a hospital perspective. Our results might assist hospitals and LHDs in making more informed decisions about efficient deployment of resources for assessment processes and implementation plans. The Patient Protection and Affordable Care Act (ACA) 1 and the launch of the voluntary national public health department accreditation program, 2 emphasize policies that encourage greater collaboration between health care and public health. Existing silos of communication and lack of cooperation between public health and other sectors of health are well documented. 3,4 Experts have recommended the removal of these barriers between health care and public health to create improved population health. 5 The process of identifying community needs, an essential part of the ACA and the voluntary national public health department accreditation program, has the potential to reduce barriers to communication and collaboration between hospitals and local health departments (LHDs). 6 A 2012 Institute of Medicine (IOM) report identified several advantages for LHDs and local health centers (e.g., hospitals) to share resources while fulfilling new government mandates, including cost-savings potential for communities, better coordination of care, and positive environmental changes. 5 Per the ACA, nonprofit hospitals must perform a community health needs assessment (CHNA) every 3 years. 1 The Internal Revenue Service published subsequent regulations in July 2011 that provided hospitals guidance on conducting the CHNAs. 7,8 According to the legislation, the CHNA is intended to be transparent, available to the community, 6,9 and includes individuals with expertise in public health to help during the CHNA process. 1,10 Any noncompliant hospital may incur a $50?000 excise tax liability as outlined in the legislation. 11 In addition to the CHNA, the ACA requires nonprofit hospitals to design an implementation plan, including strategies that address identified community needs from the CHNA. 1,7 LHDs may voluntarily seek accreditation through the Public Health Accreditation Board’s (PHAB) National Public Health Accreditation program. PHAB was incorporated in 2007, with the national public health accreditation program launched in September 2011. Many stakeholders were involved in creating, as well as in studying the desirability and feasibility of a national accreditation program. 2,12,13 In seeking accreditation, LHDs are required to conduct a community health assessment (CHA) and community health improvement plan (CHIP) every 5 years. 14 Collaborative community health efforts are cited as beneficial to those who participate. Although achieving a synergistic relationship relies on a number of factors, 15 the benefit to the community by combining knowledge, resources, and skills is greater than what can be achieved alone. 16–18 Furthermore, recent literature reflects that through collaborative efforts, there is a greater potential for improved community health. 3,19 For example, the Community Health Governance partnership allowed communities across the United States to use each other’s professional expertise and built upon existing resources to better solve their unique community’s health needs through an expanded resource network. 20 As previously mentioned, the CHNA process for nonprofit hospitals states that hospitals are to engage public health professionals and those with a broad stake in the community, emphasizing the importance of collaboration. 7 Likewise, in preparation for accreditation, LHDs are strongly encouraged to collaborate with community partners and stakeholders to accomplish the CHA and CHIP. The inherent assumption is that collaboration is better than working independently. The ability to describe, measure, and evaluate collaboration in a way that provides practical translation of the use of resources for both hospitals and LHDs is important for sustainability. The theory of change pro