Community health assessments (CHA) and community health improvement plans (CHIP) are the foundation of effective public health practice. Yet, in the recent study “Applying an Evaluation Framework of Hospital CHA/CHIP Quality and Heterogeneity to Accredited Local Health Departments in Kentucky, 2015-2022,” published in the Journal of Public Health Management and Practice, we found significant variation in the quality of CHA/CHIP documents among Kentucky’s Public Health Accreditation Board (PHAB)-accredited local health departments (LHDs). Our findings point to clear areas where targeted improvements could enhance public health outcomes—not only in Kentucky, but potentially nationwide.
When we first set out to analyze Kentucky’s CHA/CHIP reports, our goal was simple: to better understand how local health departments are identifying and addressing public health needs in their communities. Kentucky’s diverse geography, rural-urban divide, and persistent health disparities make it a unique lens through which to study the CHA process. We adapted an evaluation framework originally designed for hospital community health needs assessments, scoring 17 LHD CHA/CHIP documents based on criteria like stakeholder involvement, use of evidence-based strategies, and collaboration with hospitals.
What we found was both promising and revealing. The majority of LHDs scored well in areas such as partner engagement, data examination, and plan feasibility—key components of solid public health planning. But consistently, we saw lower scores in areas that are arguably more complex: collaboration between hospitals and LHDs, the use of evidence-based strategies, and clear evaluation plans.
Why does this matter? The implications are more than academic. Hospital-LHD collaboration, for example, can result in better-coordinated care, reduced duplication of services, and more efficient resource use. In Kentucky, hospitals must complete their own community health needs assessments every three years, while LHDs must produce assessments every five years. Aligning these processes could streamline efforts and maximize impact, yet we saw little evidence of strong collaboration between these entities.
Similarly, the lower scores for incorporating evidence-based strategies highlight the need for clearer technical guidance and resources for LHDs. Evidence-based approaches are crucial for ensuring that interventions are not only well-intentioned but effective. And evaluation—another lower-scoring area—is the linchpin of continuous improvement. Without it, there’s no feedback loop to measure whether strategies are working or how they can be refined.
One of the most encouraging findings in our study was the strong positive correlation between overall quality scores and attention to social determinants of health. LHDs that addressed social determinants more thoroughly also tended to score higher across other evaluation areas. This reinforces what many of us in public health already know: equity-centered assessments lead to better-informed, more impactful plans.
Read Our Article in the May Issue of JPHMP
So, what can be done to address the gaps we identified? First, more robust guidance—whether from PHAB, state governments, or public health associations—could help LHDs incorporate evaluation processes and evidence-based strategies more effectively. Second, aligning reporting timelines and expectations between hospitals and LHDs could foster stronger partnerships and reduce redundancy. Finally, providing technical assistance and targeted funding for lower-resourced departments may help bridge the gap between well-resourced and under-resourced LHDs.
For other public health professionals and students working on or learning about community assessments, we hope our findings offer both practical insights and a call to action. Standardizing high-quality CHA/CHIP processes not only benefits individual communities but also allows for stronger data aggregation, informing state and regional public health priorities. Our study, though focused on Kentucky, underscores broader lessons for improving the infrastructure supporting population health efforts nationwide.
If you’d like to dive deeper into our findings, we encourage you to read our full article, “Applying an Evaluation Framework of Hospital CHA/CHIP Quality and Heterogeneity to Accredited Local Health Departments in Kentucky, 2015-2022,” available in the May 2025 issue of JPHMP.
