Health Systems, Management and Policy Department, Colorado School of Public Health, Aurora, CO, United States.
Front Public Health. 2020 May 5;8:124. doi: 10.3389/fpubh.2020.00124. eCollection 2020.
We examined the community health needs assessments (CHNA) and implementation strategies of a national sample of 785 non-profit hospitals (NFPs) from the first round after the ACA. We found that the priorities targeted in the implementation strategies were well-aligned with the top community health priorities identified in CHNAs as reported in previous studies. The top five targeted priorities included obesity, access to care, diabetes, cancer, and mental health. We also found that 34% of sample NFPs collaborated with their local health department (LHD) to produce a single CHNA for their jurisdiction. Non-profit hospitals that collaborated with a LHD on the CHNA had higher odds of selecting behavioral health community issues (i.e., substance abuse, alcohol, and mental health), while hospitals located in counties with high uninsurance rates had lower odds of targeting these community issues. Our contribution was 3-fold; first, we examined a large sample of implementation strategies to extend on previous work that examined CHNAs only. This gives a more complete picture of which community issues identified in the CHNA are actually targeted for implementation. Second, this study was the first to present information on the status of NPF collaboration with LHDs to produce a single CHNA (from the NFP perspective). Third, we examined the association between targeted priorities with NFP and county-level characteristics. The community benefit requirement and Section 9007 of the ACA present an opportunity to nudge NFPs to improve the conditions for health in the communities they serve. The ACA has also challenged institutions in the health care sector to approach health through the social determinants of health framework. This framework moves beyond the provision of acute health services and emphasizes other inputs that improve population health. In this context, NFPs are particularly well-positioned to shift their contribution to improve population health beyond their four walls. Section 9007 is one mechanism to achieve such shift and has shown some promising changes among NFPs since its passage as reflected in the findings of this study. This study can inform future research related to NPF community benefit and local health planning.
我们考察了全国 785 家非营利性医院（NFPs）在《平价医疗法案》（ACA）实施首轮后的社区卫生需求评估（CHNA）和实施策略。我们发现，实施策略中针对的优先事项与之前研究中报告的 CHNA 中确定的首要社区卫生优先事项高度一致。排名前五的重点目标包括肥胖、获得医疗服务、糖尿病、癌症和精神健康。我们还发现，样本中的 34%的 NFPs 与当地卫生部门（LHD）合作，为其管辖范围制定了单一的 CHNA。与 LHD 合作进行 CHNA 的非营利性医院选择行为健康社区问题（即药物滥用、酒精和精神健康）的可能性更高，而位于保险覆盖率高的县的医院则不太可能针对这些社区问题进行重点关注。我们的贡献有三方面；首先，我们考察了大量的实施策略，以扩展之前仅考察 CHNA 的工作。这更全面地展示了 CHNA 中确定的哪些社区问题实际上是为实施而确定的。其次，本研究首次从非营利性医院的角度介绍了非营利性医院与 LHD 合作制定单一 CHNA 的情况。第三，我们考察了目标重点与非营利性医院和县级特征之间的关系。《平价医疗法案》中的社区福利要求和第 9007 条为非营利性医院提供了一个机会，可以推动它们改善所服务社区的健康状况。《平价医疗法案》还要求医疗保健部门的机构通过健康的社会决定因素框架来处理健康问题。这一框架超越了提供急性卫生服务的范畴，强调了改善人口健康的其他投入。在这种情况下，非营利性医院特别适合将改善人口健康的贡献从医院围墙内转移出来。第 9007 条是实现这一转变的一种机制，从本研究的结果可以看出，该法案通过后，非营利性医院已经发生了一些有希望的变化。本研究可为未来与非营利性医院社区福利和当地卫生规划相关的研究提供信息。
