The Generalizability of Community Health Needs Assessments a Decade After the Patient Protection and Affordable Care Act

Without better quality data collected, community health needs assessments could possibly further health disparities because the priorities identified may only target a small subset of the population.

In 2010, the Patient Protection and Affordable Care made new requirements for nonprofit hospitals on what was mandatory to maintain nonprofit status. These requirements stated that hospitals had to conduct a community health needs assessment every three years, identify priorities, and create an implementation plan to address those priorities. Further requirements were made to ensure that community voice was integrated, such as by soliciting input from at least one public health department and also including members of/ or entities representing medically underserved, low-income, and minority populations. However, there were no requirements as to how this assessment should be conducted in terms of data collection and data quality. With 105 billion spent by non-profit hospitals for community benefit in 2018, its vital to understand how well community health needs assessments actually represent the community that they serve.

We examined a random sample of 450 community health needs assessments from hospitals across the country. These reports were stratified by the USDA’s Rural-Urban Continuum Code to ensure that there was equal representation across various community sizes. Reports were first examined for how frequently primary and secondary data was collected from adults and youth. Then, reports were analyzed for the quality of survey data collected and the way it was collected (eg, online, languages offered). Finally, the reports were examined for other ways community voice could be incorporated such as through focus groups and community advisory committees.

Major Findings:

  • Hospitals rarely collected any data from youth directly.
  • Survey data collected came from significantly more female, college-educated, older, and English-speaking residents than the population it served.
  • Surveys were not often inclusive of populations that did not have internet access or could not speak English
  • Advisory committees had members that represented, on average, 10 different nonhospital organizations (eg, public health departments, schools), and nonhospital members comprised of about half of the total advisory committee.

Additional Considerations: Hospitals’ community health needs assessments could be improved by:

  • Promoting and offering surveys in ways that do not solely require Internet access
  • Standardizing and translating their assessment
  • Partnering with schools to include youth voice which can in turn serve as a partner to include in the implementation plan
  • Aligning with the same timeline as public health departments’ Community Health Assessment

Why this is important

  • Better inclusion of the most at-risk populations, such as refugees and immigrants, youth, and those from Internet dead zones (eg, rural and tribal communities) will ensure that data better represents the whole population.
  • Without better quality data collected, community health needs assessments could possibly further health disparities because the priorities identified may only target a small subset of the population.
  • Aligning with more partners, such as schools and public health departments, can promote data sharing, establish relationships to reduce the barriers to program implementation and be a more efficient way to distribute resources.

Read Our Paper in the Journal of Public Health Management and Practice:

Author Profile

Nicole Summers-Gabr
Dr. Nicole Summers-Gabr is the Director of Social Innovation and an Assistant Professor in the Department of Population Science and Policy at Southern Illinois School of Medicine. This year her work with Hillsboro Area Hospital was given the Outstanding Rural Health Program Award by the National Rural Health Association.

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