Abstract
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.
Highlights
Health services researchers have increasingly focused on the role that health care institutions play in providing health care services and engaging entire communities to improve population health and reduce disparities
Substance misuse was identified in the Community Health Needs Assessments (CHNAs) of 34% of children’s hospitals and 27% of general hospitals
Our findings provide important insight into the decisions that hospitals make to include health needs as top priorities in their CHNAs
Summary
Health services researchers have increasingly focused on the role that health care institutions play in providing health care services and engaging entire communities to improve population health and reduce disparities. There is an opportunity to better understand how general and children’s hospitals are assessing needs in their surrounding communities, which likely impacts the development of new population health activities. Hospitals may tailor their community benefit activities to specific populations based on their organizational mission or other local factors. We explore the extent to which children’s hospitals are unique in the community health needs they identify as compared with hospitals serving primarily adults. We have an opportunity to assess the content of newly required community benefit reports and how the process of identifying and prioritizing health needs varies across between general and children’s hospitals
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