Nonprofit Hospitals' Response to the Opioid Epidemic in Urban Communities: A Content Analysis of Hospitals' Community Health Needs Assessments and Implementation Strategies.

Abstract

Addressing the opioid epidemic requires a coordinated community response; yet, the role that nonprofit hospitals play in these efforts has not been systematically examined. To explore hospital-initiated strategies to address opioid use in urban communities most affected by the opioid epidemic. We conducted content analysis of publicly available community health needs assessments (CHNAs) and accompanying implementation strategies of 140 nonprofit hospitals. We employed a qualitative approach using open coding methods to explore the extent to which hospitals identified opioid use as a community health need and engaged in interventions to address opioid use in their communities. We also conducted bivariate analysis to compare organizational and community characteristics of hospitals that did and did not engage in strategies to address opioid use. One hundred forty nonprofit hospitals in urban areas with high opioid death rates across 25 states. Almost 70% of CHNAs identified opioid use as a community health need, and 63% of implementation strategies included at least 1 hospital-initiated activity to address this need. More than 90% of these implementation strategies involved providing additional capacity for and access to treatment. Bivariate analysis showed that hospitals that engaged in activities to address opioid use did not differ meaningfully from hospitals that did not engage in such activities, with 2 exceptions. Hospitals that relied on consultants to prepare the CHNA were more likely to engage in activities to address opioid use as were hospitals located in Medicaid expansion states. Nonprofit hospitals are taking action to address the opioid epidemic in their communities, most commonly by providing additional treatment capacity for patients with opioid use. While an important contribution, hospitals need incentives to develop a more comprehensive response to the opioid epidemic that extends beyond medical care to include the social and economic determinants of this crisis.