Variation in Process and Priorities between Local Health Department Led Community Health...

Variation in Process and Priorities between Local Health Department Led Community Health 

Assessments/Improvement Plans and Hospital Led Community Health Needs Assessments, and Jointly 

Conducted AssessmentsAlexandria Drake, MPH

Program Manager, Ohio Research Association for Public Health Improvement

Sara Tillie, BAMPH Candidate, Case Western Reserve University Master of Public Health Program

Scott Frank, MD, MSDirector, Case Western Reserve University Master of Public Health Program

Director, Shaker Heights Health Department

2015 PHSSR Keeneland  Conference 

No financial disclosures

Acknowledgements Robert Wood Johnson Foundation Public Health 

Practice Based Research Network Quick Strike Health Policy Institute of Ohio (HPIO)

Purpose

To compare and contrast the community health assessment process and health priorities identified by LHD led Community Health Assessments (CHA) or Community Health Improvement Plans (CHIP); and by hospital led Community Health Needs Assessment (CHNA) and Community Health Needs Improvement Strategy (CHNIS)

Objectives 

1. Identify the variation in process  between LHD led CHA/ CHIP and hospital led CHNA/ CHNIS

2. Identify the variation in priorities between LHD led CHA/ CHIP and hospital led CHNA/ CHNIS

ImportanceLHD Led CHA/CHIP Documents

• Recent state and national movement to require LHD accreditation

• Significant efforts are underway to enhance the quality and consistency of CHA/CHIP documents

Hospital Led CHNA/ CHNIS Documents

• Under the Affordable Care Act IRS code section 501(r)(3), most nonprofit 501 (c)(3) hospitals are required to complete a CHNA/CHNIS document 

General• Little has been done to examine variations in priorities of these 

documents and how community characteristics may influence these differences

ImportanceLHD Led CHA/CHIP Documents

• Recent state and national movement to require LHD accreditation

• Significant efforts are underway to enhance the quality and consistency of CHA/CHIP documents

Hospital Led CHNA/ CHNIS Documents

• Under the Affordable Care Act IRS code section 501(r)(3), most nonprofit 501 (c)(3) hospitals are required to complete a CHNA/CHNIS document 

General• Little has been done to examine variations in priorities of these 

documents and how community characteristics may influence these differences

ImportanceLHD Led CHA/CHIP Documents

• Recent state and national movement to require LHD accreditation

• Significant efforts are underway to enhance the quality and consistency of CHA/CHIP documents

Hospital Led CHNA/ CHNIS Documents

• Under the Affordable Care Act IRS code section 501(r)(3), most nonprofit 501 (c)(3) hospitals are required to complete a CHNA/CHNIS document

General• Little has been done to examine variations in priorities of these 

documents and how community characteristics may influence these differences

ImportanceLHD Led CHA/CHIP Documents

• Recent state and national movement to require LHD accreditation

• Significant efforts are underway to enhance the quality and consistency of CHA/CHIP documents

Hospital Led CHNA/ CHNIS Documents

• Under the Affordable Care Act IRS code section 501(r)(3), most nonprofit 501 (c)(3) hospitals are required to complete a CHNA/CHNIS document 

General• Little has been done to examine variations in priorities of these

documents and how community characteristics may influence these differences

Methods

Comparative case study  Data abstracted from publicly available CHA/CHIP 

and CHNA/CHNIS documents  Ohio LHDs (n=110/124) Ohio hospital systems (n=170/189)

MethodsAdaptation of Wisconsin CHIPP (Community Health Improvement Plan and Process) Quality Measurement Tool Allow direct comparison between LHD and Hospital process General Working together Assessment Prioritization Implementation Evaluation

MethodsFurther adaptation to examine detailed priorities (35 items in 4 categories) Medical conditions (11 items) Health behaviors (9 items) Community conditions affecting health (5 items) Health systems factors (10 items)

Methods

Data abstraction logged in REDCap and exported to SPSS V22.0Analysis includes frequencies, Chi Square, and t-tests

LHD-Hospital Comparison of Process

Quality Measurement Tool Section LHDMean

Hospital Mean

General 2.52 1.96

Working Together 2.51 1.48

Assessment 2.79 3.10

Prioritization 2.65 3.43

Implementation 1.32 0.87

Total Quality Measurement Tool

2.37 1.97

LHD Led CHA CHIP Significantly Higher than Hospital Led CHNA CHNIS (≤ .05)

General The CHIP/CHNIS document(s) are electronically available to the public via a 

website. The document acknowledges state priorities.  A formal model is used to guide the process. Specific staff are designated to manage the process.

Working Together Sectors (stakeholders) participate in partnership to develop a comprehensive 

assessment (>4 sectors). The stakeholders define a purpose, mission, vision, and/or core values. Documentation of current collaborations that address specific public health 

issues or populations.

Assessment There is evidence of primary data collection. Trends in local data are reported.

LHD Led CHA CHIP Significantly Higher than Hospital Led CHNA CHNIS (≤ .05)

General The CHIP/CHNIS document(s) are electronically available to the public via a 

website. The document acknowledges state priorities. A formal model is used to guide the process. Specific staff are designated to manage the process.

Working Together Sectors (stakeholders) participate in partnership to develop a comprehensive 

assessment (>4 sectors). The stakeholders define a purpose, mission, vision, and/or core values. Documentation of current collaborations that address specific public health 

issues or populations.

Assessment There is evidence of primary data collection. Trends in local data are reported.

LHD Led CHA CHIP Significantly Higher than Hospital Led CHNA CHNIS (≤ .05)

General The CHIP/CHNIS document(s) are electronically available to the public via a 

website. The document acknowledges state priorities.  A formal model is used to guide the process. Specific staff are designated to manage the process.

Working Together Sectors (stakeholders) participate in partnership to develop a comprehensive

assessment (>4 sectors). The stakeholders define a purpose, mission, vision, and/or core values. Documentation of current collaborations that address specific public health 

issues or populations.

Assessment There is evidence of primary data collection. Trends in local data are reported.

LHD Led CHA CHIP Significantly Higher than Hospital Led CHNA CHNIS (≤ .05)

General The CHIP/CHNIS document(s) are electronically available to the public via a website. The document acknowledges state priorities.  A formal model is used to guide the process. Specific staff are designated to manage the process.

Working Together Sectors (stakeholders) participate in partnership to develop a comprehensive 

assessment of the population served by the health department (>4 sectors). The stakeholders define a purpose, mission, vision, and/or core values for the 

process. Documentation of current collaborations that address specific public health issues 

or populations.

Assessment There is evidence of primary data collection. Trends in local data are reported.

LHD Led CHA CHIP Significantly Higher than Hospital Led CHNA CHNIS (≤ .05)

Implement Data is used to inform public health policy, processes, programs,

and/or interventions. Identifies improvement strategies that are evidence-informed. Contains measurable objectives with time-framed targets. Activities that contribute to the development or modification of 

(public) health policy.  Detailed action plan exists or is under construction.  Identifies individuals and organizations that have accepted 

responsibility for implementing strategies. Includes priorities and action plans for entities beyond just the local 

health department/hospital. Seek resources to support implementation of the identified strategies.

LHD Led CHA CHIP Significantly Higher than Hospital Led CHNA CHNIS (≤ .05)

Implement Data is used to inform public health policy, processes, programs, 

and/or interventions. Identifies improvement strategies that are evidence-informed. Contains measurable objectives with time-framed targets. Activities that contribute to the development or modification of

(public) health policy.  Detailed action plan exists or is under construction.  Identifies individuals and organizations that have accepted 

responsibility for implementing strategies. Includes priorities and action plans for entities beyond just the local 

health department/hospital. Seek resources to support implementation of the identified strategies.

LHD Led CHA CHIP Significantly Higher than Hospital Led CHNA CHNIS (≤ .05)

Implement Data is used to inform public health policy, processes, programs, 

and/or interventions. Identifies improvement strategies that are evidence-informed. Contains measurable objectives with time-framed targets. Activities that contribute to the development or modification of 

(public) health policy.  Detailed action plan exists or is under construction.  Identifies individuals and organizations that have accepted

responsibility for implementing strategies. Includes priorities and action plans for entities beyond just the local

health department/hospital. Seek resources to support implementation of the identified strategies.

Hospital Led CHNA CHNIS Significantly Higher than LHD Led CHA CHIP (≤ .05)

General The CHA/CHNA document(s) are electronically available to the public 

via a website. The document acknowledges national priorities.

Assessment Health issues and specific descriptions of population groups with 

specific health issues are described. Health issues and specific descriptions of medically vulnerable 

population groups with specific health issues are described. Health disparities and/or health equity are discussed. A description of existing community assets and resources to address 

health issues is presented. Sources of data are cited.

Hospital Led CHNA CHNIS Significantly Higher than LHD Led CHA CHIP (≤ .05)

General The CHA/CHNA document(s) are electronically available to the public 

via a website. The document acknowledges national priorities.

Assessment Health issues and specific descriptions of population groups with 

specific health issues are described. Health issues and specific descriptions of medically vulnerable

population groups with specific health issues are described. Health disparities and/or health equity are discussed. A description of existing community assets and resources to address 

health issues is presented. Sources of data are cited.

Hospital Led CHNA CHNIS Significantly Higher than LHD Led CHA CHIP (≤ .05)

Prioritization Information from the community health assessment is

provided to the stakeholders who are setting priorities. Document(s) include issues and themes identified by

stakeholders in the community. Community health priorities were selected using criteria 

established and agreed upon by the stakeholder group. Priorities are easily located on a website and identifiable as 

priorities by the general public.

Hospital Led CHNA CHNIS Significantly Higher than LHD Led CHA CHIP (≤ .05)

Prioritization Information from the community health assessment is 

provided to the stakeholders who are setting priorities. Document(s) include issues and themes identified by 

stakeholders in the community. Community health priorities were selected using criteria

established and agreed upon by the stakeholder group. Priorities are easily located on a website and identifiable as

priorities by the general public.

Hospital Led CHNA CHNIS Significantly Higher than LHD Led CHA CHIP (≤ .05)

Implement Documentation of implemented health promotion

strategies. Documentation that health promotion strategies are 

communicated to the public in your community.

Top Priorities LHD CHA/ CHIP Hospital CHNA/CHNIS1. Physical Activity (69.6%)  1. Obesity (68.8%)

2. Obesity (69.1%) 2. Access to Medical Care (58.8%)

3. Nutrition (63.8%) 3. Mental Health (58.2%)

4. Substance Abuse Prevention (56.5%) 4. Addiction (54.7%)

5. Access to Medical Care (55.1%) 5. Heart Disease (52.4%)

6. Food Environment (49.3%) 6. Diabetes (50.0%)

7. Addiction (49.3%) 7. Cancer (47.1%)

8. Youth Development/ Schools (46.4%) 8. Infant Mortality (42.4%)

9. Access to Behavioral Health (44.9%) 9. Physical Activity (38.8%)

10. Mental Health (43.5%) 10. Nutrition (37.1%)

Top Priorities LHD CHA/ CHIP Hospital CHNA/CHNIS1. Physical Activity (69.6%) 1. Obesity (68.8%)

2. Obesity (69.1%) 2. Access to Medical Care (58.8%)

3. Nutrition (63.8%) 3. Mental Health (58.2%)

4. Substance Abuse Prevention (56.5%) 4. Addiction (54.7%)

5. Access to Medical Care (55.1%) 5. Heart Disease (52.4%)

6. Food Environment (49.3%) 6. Diabetes (50.0%)

7. Addiction (49.3%) 7. Cancer (47.1%)

8. Youth Development/ Schools (46.4%) 8. Infant Mortality (42.4%)

9. Access to Behavioral Health (44.9%) 9. Physical Activity (38.8%)

10. Mental Health (43.5%) 10. Nutrition (37.1%)

Top Priorities 

Combined Priorities (Weighted)1. Obesity (69.0%)2. Access to Medical Care (57.0%)3. Physical Activity (54.2%)4. Addiction (52.0%)5. Mental Health (50.9%)6. Nutrition (50.5%)7. Substance Abuse Prevention (40.3%)8. Access to Behavioral Health (36.6%)9. Diabetes (34.4%)10. Heart Disease (34.2%)

Comparison of LHD and Hospital Priority Category Emphasis

Hospital Local Health Department

Category Mean % Selected Mean % Selected

Medical Conditions

4.25 38.6% 2.62 23.8%

Health Behaviors

2.28 20.7% 3.80 34.5%

Community Conditions

0.54 1.1% 2.01 40.2%

Health Systems 1.56 15.6% 1.97 19.7%

Key Process FindingsLHD process more likely to:  Be grounded in theoretical and evidence based 

frameworks Define a mission or vision  Include implementation planning  Have broad stakeholder participation  Conduct health policy activity 

Key Process FindingsHospitals were more likely to:  Address community assets  Address health equity and vulnerable populations Choose health priorities using criteria Provide community health assessment 

information to the stakeholders who are setting priorities

Key Priority FindingsHospital based CHNA/ CHNIS priorities focused more on  Diagnostic conditions  Health system characteristics

LHD based CHA/ CHIP priorities focused more on  Behavioral health Community characteristics

Strengths

Large, whole sample (n=110 and n=170)Comprehensive approach crossing health systems boundariesMixed methodsUtilized standard abstraction protocols from adaptation of a previously successful model

Limitations

Based on information available in documents, not necessarily what was actually doneSome items were not effective across LHD-Hospital boundaries and were therefore excludedAnalysis based on current stage of assessment, therefore not final products 

Implications for Public Health

The variation between CHA/CHIP and CHNA/CHNIS identified priorities demonstrates important differences in perspective and experience. The differences appear complementary, implying the population needs would be more effectively served through a collaborative process.

Thank you!