Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States.
Ohio University, Athens, OH, United States.
Front Public Health. 2020 Feb 27;8:47. doi: 10.3389/fpubh.2020.00047. eCollection 2020.
The Affordable Care Act expanded community benefit requirements for nonprofit hospitals, which now must demonstrate that they take into account the needs of their surrounding community in deciding where to make community benefit investments. No study to date has assessed the Community Health Needs Assessments (CHNAs) of a large sample of nonprofit hospitals to understand how hospitals determine the priority health needs that they include for their community or how prioritized health needs differ between general and children's hospitals. We analyzed the CHNAs of a 20% random sample of general hospitals in the United States as well as all children's hospitals. After identifying the five most common needs across all hospitals-mental health, substance misuse, social needs, chronic illness, and access to care-we used descriptive statistics and multivariate logistic regression to determine which hospitals were most likely to prioritize each of these five needs in their CHNA and the organizational, county, and regional factors associated with prioritizing a need. We found that children's hospitals were more likely than general hospitals to prioritize each of these five needs in their CHNA and that related county-level health indicators were significantly associated with hospitals prioritizing social needs and substance misuse as top needs in their CHNAs. County-level demographic variation, such as the percentage of white residents, and regional location were significantly related to whether hospitals prioritized a need in their CHNA. Our results suggest that children's hospitals are more likely to include a similar list of health issues on their CHNAs and that factors beyond county-level health indicators (e.g., organizational mission, regional health indicators, etc.) are operative in hospital decisions to include needs on their CHNAs.
平价医疗法案扩大了非营利性医院的社区福利要求，现在必须证明在决定在哪里进行社区福利投资时，他们考虑到了周围社区的需求。迄今为止，尚无研究评估大量非营利性医院的社区健康需求评估（CHNA），以了解医院如何确定其社区纳入的优先健康需求，以及综合医院和儿童医院之间的优先健康需求有何不同。我们分析了美国 20%的综合医院和所有儿童医院的 CHNA。在确定了所有医院中最常见的五种需求（心理健康、药物滥用、社会需求、慢性疾病和获得医疗服务的机会）之后，我们使用描述性统计和多变量逻辑回归来确定哪些医院最有可能在其 CHNA 中优先考虑这五种需求中的每一种，以及与优先考虑某种需求相关的组织、县和区域因素。我们发现，儿童医院比综合医院更有可能在其 CHNA 中优先考虑这五种需求中的每一种，并且相关的县级健康指标与医院在 CHNA 中优先考虑社会需求和药物滥用作为首要需求显著相关。县级人口统计数据的差异，如白人居民的百分比，以及区域位置，与医院是否在 CHNA 中优先考虑某种需求有显著关系。我们的结果表明，儿童医院更有可能在其 CHNA 中纳入类似的健康问题清单，并且除了县级健康指标之外的因素（例如，组织使命、区域健康指标等）也在医院决定将需求纳入 CHNA 方面发挥作用。
