Hospital-community Partnership Research Articles

Community partnership approaches to safe sleep (CPASS) program evaluation

BackgroundSudden unexpected infant death (SUID) continues to be a leading cause of death in infants in the United States (US), with significant disparities by race and socio-economic status. Infant safe sleep behaviors are associated with decreasing SUID risk, but challenges remain for families to practice these routinely. The objective of this program was to implement and evaluate a novel approach for an infant safe sleep pilot program built upon partnerships between hospitals and community-based organizations (CBOs) serving pregnant and parenting families in at-risk communities.MethodsCommunity Partnership Approaches to Safe Sleep (CPASS) was a prospectively implemented infant safe sleep program. CPASS included children’s hospitals partnered with CBOs across five US cities: Portland, OR, Little Rock AR, Chicago, IL, Birmingham, AL, and Rochester, NY. The program consisted of (1) monthly learning community calls; (2) distribution of Safe Sleep Survival Kits; and (3) surveys of sites and families regarding program outcomes. Survey measures included (1) site participation in CPASS activities; (2) recipients’ use of Safe Sleep Kits; and (3) recipients’ safe sleep knowledge and behaviors.ResultsCPASS learning community activities were consistently attended by at least two representatives (1 hospital-based, 1 CBO-based) from each site. Across the five sites, 1002 safe kits were distributed over 9 months, the majority (> 85%) to families with infants ≤ 1 month old. Among participating families, 45% reported no safe sleep location before receipt of the kit. Family adherence to nighttime safe sleep recommendations included: (1) no bedsharing (M 6.0, SD 1.8, range 0–7); (2) sleep on back (M 6.3, SD 1.7, range 0–7); and (3) sleep in a crib with no blankets/toys (M 6.0, SD 2.0, range 0–7). Site interviews described how participation in CPASS influenced safe sleep conversations and incorporated local data into counseling. Hospital-CBO relationships were strengthened with program participation.ConclusionsThe CPASS pilot program provides a new, innovative model built on hospital-community partnerships for infant safe sleep promotion in SUID-impacted communities. CPASS reached families before their infant’s peak age risk for SUID and empowered families with knowledge and resources to practice infant safe sleep. Important lessons learned included improved ways to center and communicate with families.

Exploring Health Disparities in the Effectiveness of Hospital-Community Partnerships in Preventive Healthcare Interventions

Exploring Health Disparities in the Effectiveness of Hospital-Community Partnerships in Preventive Healthcare Interventions

COVID-19 Community Response Team for Toronto Homeless Services and Congregate Living Settings: an evaluation of Hospital-Community partnership through COVID-19 vaccine provision

Individuals experiencing homelessness face unique physical and mental health challenges, increased morbidity and premature mortality. In Canada, it is estimated that 235,000 individuals experience homelessness annually, and 180,000 use emergency shelters each night. (1) COVID -19 creates a significant heightened risk for those living in congregate sheltering spaces. Individuals with a recent history of homelessness and diagnosed with COVID-19, are at significantly higher risk of hospitalization and death than those housed in Ontario communities (2). 
 Women’s College Hospital (WCH) is an ambulatory hospital situated in downtown Toronto. In March 2020, WCH set up one of Toronto’s 14 COVID-19 assessment centres to facilitate free testing for SARS-CoV-2. Formed by a group of health care providers at WCH, the goal of the COVID-19 Community Response Team (CRT) was to support Toronto shelters and congregate living sites to manage and prevent outbreaks of SARS-CoV-2 using a collaborative model through onsite mobile testing; supporting the management and prevention of outbreaks; and providing infection prevention and control training and guidance. (3) In total, CRT leveraged this model of care with 49 shelter and congregate living sites from April 2020 to April 2021. From this, the WCH COVID-19 vaccine program emerged, where 14 shelters were regionally identified to co-design and support the administration of vaccine clinics within each sheltering site. This research seeks to evaluate the impact and importance of this partnership model and its future potential in community-centered integrated care. In this study, three areas of inquiry are addressed: (1) Vaccine program evaluation and lessons learned (e.g., What were barriers, facilitators, and lessons throughout the process? How were shelter staff and clients impacted?); (2) Perceptions on hospital/community partnership (e.g., What were overall perceptions of this partnership and strategy?); (3) Opportunities forward (e.g., How can this partnership between hospitals and shelters be sustained in the future to fulfill needs beyond COVID-19). 
 Constructivist grounded theory (CGT) is used in this project to explore perceptions and experiences of this partnership. (4) CGT data analysis revealed five main categories, 16 subcategories, and one core category. The core category is “access to healthcare is a human right; understand our communities”. The main categories are COVID-19 response capacity, outbreak identification and management, barriers to the vaccine program, community-centred immediate shelter needs, and avenues for intersectoral relationship strengthening. In conclusion, three key takeaways emerged for health(care) policy and practice:
 1.‘Health as a human right’ framework is an organizing principle in shelters but not necessarily in hospitals. How can hospitals adopt and integrate this framework at the policy level to operationalize an equity-based approach to care? 
 2.For hospitals, there are gaps in knowledge about community and shelter realities. Ongoing formal partnering between hospitals and communities is one way to bridge this gap. 
 3.Empowering shelter staff is crucial to the success of hospital-partnered programs and clinical interventions. 
 Finally, this project calls attention to the urgent context-specific exploration needed to advance official hospital-community partnerships, where there is an everlasting commitment and accountability. 

Differential impact of hospital and community factors on breadth and depth of hospital population health partnerships.

The aim was to identify hospital and county characteristics associated with variation in breadth and depth of hospital partnerships with a broad range of organizations to improve population health. The American Hospital Association Annual Survey provided data on hospital partnerships to improve population health for the years 2017-2019. The study adopts the dimensional publicness theory and social capital framework to examine hospital and county characteristics that facilitate hospital population health partnerships. The two dependent variables were number of local community organizations that hospitals partner with (breadth) and level of engagement with the partners (depth) to improve population health. The independent variables include three dimensions of publicness: Regulative, Normative and Cultural-cognitive measured by various hospital factors and presence of social capital present at county level. Covariates in the multivariate analysis included hospital factors such as bed-size and system membership. We used hierarchical linear regression models to assess various hospital and county factors associated with breadth and depth of hospital-community partnerships, adjusting for covariates. Nonprofit and public hospitals provided a greater breadth (coefficient, 1.61; SE, 0.11; p < 0.001 and coefficient, 0.95; SE, 0.14; p < 0.001) and depth (coefficient, 0.26, SE, 0.04; p < 0.001 & coefficient, 0.13; SE, 0.05; p < 0.05) of partnerships than their for-profit counterparts, partially supporting regulative dimension of publicness. At a county level, we found community social capital positively associated with breadth of partnerships (coefficient, 0.13; SE, 0.08; p < 0.001). An environment that promotes collaboration between hospitals and organizations to improve population health may impact the health of the community by identifying health needs of the community, targeting social determinants of health, or by addressing patient social needs. However, findings suggest that publicness dimensions at an organizational level, which involves a culture of public value, maybe more important than county factors to achieve community building through partnerships.

"Boiling Water but There's No Pop-Off Valve": Health Care Provider Perceptions of the Effects of COVID-19 on Intimate Partner Violence.

This study sought to understand the effects of COVID-19, including movement-related restrictions such as shelter-in-place, quarantine, and isolation orders, on intimate partner violence (IPV) from the perspective of health care providers (HCPs) working at a public hospital in Atlanta, Georgia. From November 2020 to May 2021, we conducted 12 interviews. Three themes emerged: (1) HCPs perceived that COVID-19 movement-related restrictions likely exacerbated IPV; (2) HCPs encountered many practice-oriented and community barriers in IPV care provision during COVID-19; and (3) HCPs suggested process and partnership improvements for IPV response. These findings can inform future pandemic preparedness including improved communication, improved IPV screening and follow-up, and strengthened hospital-community partnerships.

Addressing health disparities of individuals experiencing homelessness in the U.S. with community institutional partnerships: An integrative review.

To examine existing community-institutional partnerships providing health care services to people experiencing homelessness by addressing social determinants of health (SDOH) at multiple socioecological levels. Integrative review. PubMed (Public/Publisher MEDLINE), CINAHL (The Cumulative Index of Nursing and Allied Health Literature database), and EMBASE (Excerpta Medica database) were searched to identify articles on health care services, partnerships, and transitional housing. Database search used the following keywords: Public-private sector partnerships, community-institutional relation, community-academic, academic community, community university, university community, housing, emergency shelter, homeless persons, shelter, and transitional housing. Articles published until November 2021 were eligible for inclusion. The Johns Hopkins Nursing Evidence-Based Practice Quality Guide was used to appraise the quality of articles included in the review by two researchers. Seventeen total articles were included in the review. The types of partnerships discussed in the articles included academic-community partnerships (n= 12) and hospital-community partnerships (n= 5). Health services were also provided by different kinds of health care providers, including nursing and medical students, nurses, physicians, social workers, psychiatrists, nutritionists, and pharmacists. Health care services spanning from preventative care services to acute and specialized care services and health education were also made possible through community-institutional partnerships. There is a need for more studies on partnerships that aim to improve the health of homeless populations by addressing social determinants of health at multiple socioecological levels of individuals who experience homelessness. Existing studies do not utilize elaborate evaluation methods to determine partnership efficacy. Findings from this review highlight gaps in the current understanding of partnerships that seek to increase access to care services for people who experience homelessness. The results of the systematic review were solely from the articles reviewed and do not include information from patients, service users, caregivers, or members of the public.

Descriptive Analysis of Current Burn Care for Plain Communities in Ohio and Pennsylvania: A Qualitative Study of Strengths and Needs in a Hospital-Community Partnership.

Plain communities present with a higher risk of sustaining burn injuries. Yet, little is known about the hospital-community partnerships with Plain caretakers to facilitate culturally competent burn care. The current study provides a qualitative analysis of Plain caretakers' perspectives on an existing hospital-community partnership for facilitating culturally sensitive burn care and their perspectives on the ongoing physical, structural, and behavioral health needs of this population. Twelve Plain community caregivers who serve on a burn wound treatment team or an oil therapy team within their community took part in a focus group interview. Caretakers identified as White, were majority male (83%), and resided in Plain communities. Retrospective thematic analysis was used to analyze the data. Five major themes (ie, informational needs, strengths of Plain community burn care, behavioral health concerns, behavioral health resources, and preferred teaching methods) evolved. Results revealed that Plain caregivers displayed an openness to learning about recommended burn care from the medical providers. Caretakers also cited their traditional (homeopathic) burn care procedures as perceived strengths, while simultaneously maintaining that their relationship with the hospital is a valuable part of life-saving burn care. Regarding their behavioral health needs, caretakers highlighted difficulties in helping their children cope with burn injuries and pain during rehabilitation and treatment. Other topics discussed included social support and cultural factors that impact the delivery of burn care to Plain communities from non-Plain providers. These results provide important considerations that other burn centers may consider when establishing similar partnerships to deliver of culturally competent medicine for Plain burn survivors.

Exploring the Role of Community Social Capital in Not-for-profit Hospitals' Decision to Engage Community Partners in the Community Health Needs Assessment Process.

Not-for-profit hospitals (NFPs) frequently partner with community organizations to conduct internal revenue service-mandated community health needs assessment (CHNA), yet little is known about the number of partnerships that hospitals enter into for this purpose. This article uses "American Hospital Associations' 2020 Annual Survey" data to examine hospital-community partnerships around the CHNA and the role that community social capital defined as, "the networks that cross various professional, political and social boundaries to reflect community level trust needed to pursue shared objectives" plays in hospitals' choices to partner with community organizations for the CHNA. After controlling for a set of hospital, community, and state characteristics, we found that hospitals present in communities with higher social capital were likely to partner with more community organizations to conduct CHNA. Greater social capital may thus promote community health by facilitating the partnerships NFPs develop with community organizations to conduct the CHNA.

What is Driving Hospital-Community Partnerships to Address Social Determinants of Health?

Social determinants of health (SDOH) are strongly linked to individual and population health outcomes. Hospitals and health systems are in a unique position to initiate or partner on community-wide efforts address SDOH. However, such efforts typically require collaboration with other healthcare and local community organizations since SDOH affect more than just medical care. Despite studies that have identified specific organizational and environmental factors associated with hospital-community partnerships, the role of social capital and community health needs as drivers of such partnerships remains unexplored. This study examines whether hospital partnerships with community organizations in the United States are driven predominantly by community social capital or the prevailing health needs of the community, and whether these drivers are similar for overall partnerships as well as for partnerships with individual organizations. We use 2020 data from the American Hospital Association, US County Health Rankings, and Social Capital Project and employ feasible generalized least-squares (FGLS) regression and logit models to assess the relationship between social capital, community health needs and hospital-community partnerships to address SDOH. Our results indicate that for community social capital was significantly and positively associated with total hospital partnerships (ß=0.05, p=0.01). We also found that community social capital was significantly more likely to be associated with hospitals’ partnerships with local/state public health agencies, schools, local service agencies, other healthcare providers, and organizations that assist with food insecurity. On the other hand, community health needs were not associated with total partnerships and had limited associations with hospital partnerships with individual organizations. Overall, this research suggests that social capital is a critical determinant of hospital partnerships with community organizations, and hospitals may seek partnerships with organizations that allow them to address community health issues outside of their own expertise since such partnerships and collaborative efforts can help address SDOH and manage population health.

Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China.

Quality measurements in primary healthcare (PHC) have become an essential component for improving diabetes outcomes in many high-income countries. However, little is known about their implementation within the Chinese health-system context and how they are perceived by patients, physicians, and policy-makers. We examined stakeholders' perceptions of quality and performance measurements for primary diabetes care in Shanghai, China, and analyzed facilitators and barriers to implementation. In-depth interviews with 26 key stakeholders were conducted from 2018 to 2019. Participants were sampled from two hospitals, four community healthcare centers (CHCs), and four institutes involved in regulating CHCs. The Consolidated Framework for Implementation Research (CFIR) guided data analysis. Existing quality measurements were uniformly implemented via a top-down process, with daily monitoring of family doctors' work and pay-for-performance incentives. Barriers included excluding frontline clinicians from indicator planning, a lack of transparent reporting, and a rigid organizational culture with limited bottom-up feedback. Findings under the CFIR construct "organizational incentives" suggested that current pay-for-performance incentives function as a "double-edged sword," increasing family doctors' motivation to excel while creating pressures to "game the system" among some physicians. When considering the CFIR construct "reflecting and evaluating," policy-makers perceived the online evaluation application - which provides daily reports on family doctors' work - to be an essential tool for improving quality; however, this information was not visible to patients. Findings included under the "network and communication" construct showed that specialists support the work of family doctors by providing training and patient consultations in CHCs. The quality of healthcare could be considerably enhanced by involving patients and physicians in decisions on quality measurement. Strengthening hospital-community partnerships can improve the quality of primary care in hospital-centric systems. The case of Shanghai provides compelling policy lessons for other health systems faced with the challenge of improving PHC.

Community social capital or health needs: What is driving hospital-community partnerships to address social determinants of health?

Social determinants of health (SDOH) are strongly linked to individual and population health outcomes. Hospitals and health systems are in a unique position to initiate or partner on community-wide efforts address SDOH. However, such efforts typically require collaboration with other healthcare and local community organizations since SDOH affect more than just medical care. Despite studies that have identified specific organizational and environmental factors associated with hospital-community partnerships, the role of social capital and community health needs as drivers of such partnerships remains unexplored. This study examines whether hospital partnerships with community organizations in the United States are driven predominantly by community social capital or the prevailing health needs of the community, and whether these drivers are similar for overall partnerships as well as for partnerships with individual organizations. We use 2020 data from the American Hospital Association, US County Health Rankings, and Social Capital Project and employ ordinary least-squares (OLS) regression and logit models to assess the relationship between social capital, community health needs and hospital-community partnerships to address SDOH. Our results indicate that for community social capital was significantly and positively associated with total hospital partnerships (β = 0.05, p = 0.01). We also found that community social capital was significantly more likely to be associated with hospitals’ partnerships with local/state public health agencies, schools, law enforcement agencies, other healthcare providers, and organizations that assist with food insecurity. On the other hand, community health needs were not associated with total partnerships and had limited associations with hospital partnerships with individual organizations. Overall, this research suggests that social capital is a critical determinant of hospital partnerships with community organizations, and hospitals may seek partnerships with organizations that allow them to address community health issues outside of their own expertise since such partnerships and collaborative efforts can help address SDOH and manage population health.

771 Improving Burn Care in the Amish Community: A Qualitative Study of Strengths and Needs

IntroductionAmish communities present with a higher risk for sustaining traumatic burn injuries; thus, these communities have a high need for culturally competent burn care. Although homeopathic remedies for mild to moderate burn injuries have been studied in Amish communities, little is known about hospital-community partnerships to facilitate culturally competent burn care, particularly with more severe injuries. The current study aimed to 1) understand the successful aspects of an existing hospital-community partnership for facilitating culturally sensitive burn care for Amish communities, and (2) identify the ongoing physical, structural, and behavioral health needs of this population as the partnership continues to develop.MethodsQualitative data from 12 Amish caregivers who participate on a burn/wound team or an oil therapy team, were collected on through a focus group interview. Caregivers identified as White, were majority male (83%), and resided in Amish communities. Retrospective thematic analysis was used to analyze the qualitative data. Five major themes (i.e., informational needs, strengths of Amish burn care, behavioral health concerns, behavioral health resources, and preferred teaching methods) evolved.ResultsResults indicated that Amish caregivers displayed a great curiosity and openness to learning about all aspects of recommended burn care from the medical providers. Caregivers also cited their traditional (homeopathic) burn care procedures (e.g., oil therapy) as strengths, while simultaneously maintaining that their relationship to the hospital is a valuable part of their burn care. Relating to behavioral health, caregivers highlighted difficulties in helping their children cope with burn injuries and pain during rehabilitation and treatment. Caregivers emphasized the role of strong social support that the Amish community provides to burn survivors. Additionally, caregivers stressed the significance of delivering burn care information in a form that is culturally appropriate for their community.ConclusionsResults of this study provide important considerations that other accredited burn centers may consider when establishing similar partnerships to enhance their delivery of culturally competent medicine for Amish burn survivors.

Clinically Screening Hospital Patients for Social Risk Factors Across Multiple Hospitals: Results and Implications for Intervention Development.

Hospitals are increasingly screening patients for social risk factors to help improve patient and population health. Intelligence gained from such screening can be used to inform social need interventions, the development of hospital-community collaborations, and community investment decisions. We evaluated the frequency of admitted patients' social risk factors and examined whether these factors differed between hospitals within a health system. A central goal was to determine if community-level social need interventions can be similar across hospitals. We described the development, implementation, and results from Northwell Health's social risk factor screening module. The statistical sample included patients admitted to 12 New York City/Long Island hospitals (except for maternity/pediatrics) who were clinically screened for social risk factors at admission from June 25, 2019, to January 24, 2020. We calculated frequencies of patients' social needs across all hospitals and for each hospital. We used chi-square and Friedman tests to evaluate whether the hospital-level frequency and rank order of social risk factors differed across hospitals. Patients who screened positive for any social need (n = 5196; 6.6% of unique patients) had, on average, 2.3 of 13 evaluated social risk factors. Among these patients, the most documented social risk factor was challenges paying bills (29.4%). The frequency of 12 of the 13 social risk factors statistically differed across hospitals. Furthermore, a statistically significant variance in rank orders between the hospitals was identified (Friedman test statistic 30.8 > 19.6: χ2 critical, p = 0.05). However, the hospitals' social need rank orders within their respective New York City/Long Island regions were similar in two of the three regions. Hospital patients' social needs differed between hospitals within a metropolitan area. Patients at different hospitals have different needs. Local considerations are essential in formulating social need interventions and in developing hospital-community partnerships to address these needs.

Experiences and challenges faced by community mental health workers when providing care topeople with mental health conditions: Aqualitative descriptive study.

The global prevalence of mental health conditions and the associated wide treatment gaps have led to increased demand for quality mental healthcare services. In Singapore, despite a shift towards a joint provision of mental healthcare in hospitals and the community, experiences of mental healthcare teams in such hospital-community partnerships have remained unclear. Through a qualitative descriptive approach, this study explored community mental health workers' experiences and perceptions of working with partners from tertiary hospitals and other community organisations. Eighteen participants were individually interviewed with a semi-structured question guide through video conferencing. This study was guided by the 32-item checklist from the Consolidated Criteria for Reporting Qualitative Research. Data were subjected to Braun and Clark's six-step thematic analysis. Three themes emerged: (i) the need for supportive partners, due to institutional and legal challenges faced in the participants' liaison with hospital partners and other community organisations; (ii) the need for a supportive organisation, whose presence and importance were revealed by the interviews; and (iii) the necessity of advanced training, identified by the participants as a contributor to their professional growth. The findings highlighted the importance of inter-sectoral communication and positive effects of a robust organisational support system. Accordingly, hospitals and community mental healthcare organisations should consider strengthening networking and boosting case discussions through regular inter-sectoral meetings that would prioritise the clients' continuity of care. Furthermore, opportunities for advanced trainings should be created for community-based mental healthcare workers.

Assessing readiness to implement patient navigator programs in Toronto, Canada.

To explore factors influencing the implementation of patient navigator programs within a hospital for seniors with complex care needs. A qualitative descriptive design using in-depth interviews was conducted. Participant interviews were conducted in Toronto, Ontario between September 2020 and February 2021. Data were analysed using thematic analysis. Thirty-five semi-structured interviews were conducted with 38 participants from a large urban hospital (n = 21) and community healthcare organizations (n = 17), including organizational leaders, and acute care and rehabilitation providers. Follow-up interviews occurred with 16 participants (7 from the community and nine from the hospital). This study identified five key factors influencing organizational readiness for successful implementation of a patient navigator program for seniors with complex conditions, which included: (a) vision from senior leadership, (b) technological infrastructure, (c) existing hospital-community partnerships, (d) well-established process for referrals, and (e) staff capacity. The overarching theme of communication was also identified. The findings of this study provide a better understanding of hospital and community professionals' needs and challenges when implementing patient navigator programs for seniors with complex care conditions. There are a number of factors that influence an organization's readiness for program uptake and delivery, with the need for clear communication being paramount. Further research to test the effects of readiness on successful implementation outcomes is warranted.

Examining the Relationship Between Hospital-Community Partnerships and COVID-19 Case-Fatality Rates.

Abtract During the COVID-19 pandemic, hospitals across the United States were tasked to develop partnerships with other hospitals and community organizations to overcome the unexpected challenges. The aim of this study is to examine COVID-19 case-fatality rates and explore their relationship with hospital-community partnerships. This study employed a cross-sectional design using a multilevel generalized linear model with a Poisson regression distribution and publicly available COVID-19 mortality data from February to October 2020 across 2526 hospital service areas (HSAs). HSAs with a greater number of partnerships were found to have a reduced risk of higher case-fatality rates than those with fewer health system partnerships. The findings indicated the need for greater cooperation between individual health care systems, state and local governments, and community programs for better outcomes in the ongoing and evolving COVID-19 pandemic, and to be better prepared for future pandemics or large-scale public health crises. This study provides the necessary insights for policy makers, hospital administrators, and public health leaders to understand the critical importance of community partnerships and their influence on reducing the COVID-19 case-fatality rate, as well as their potential effects on improving the health of vulnerable populations as a means to achieve the Centers for Disease Control and Prevention's goal of achieving health equity. This research illustrates the need for further inquiries into the importance of these health care partnerships for positive health care outcomes.

Examining supports and barriers to breastfeeding through a socio-ecological lens: a qualitative study

BackgroundEarly breastfeeding cessation is a societal concern given its importance to the health of mother and child. More effective interventions are needed to increase breastfeeding duration. Prior to developing such interventions more research is needed to examine breastfeeding supports and barriers from the perspective of breastfeeding stakeholders. One such framework that can be utilized is the Socio-Ecological Model which stems from Urie Broffenbrenner’s early theoretical frameworks (1973–1979). The purpose of this study was to examine supports and barriers to breastfeeding across environmental systems.MethodsA total of 49 representatives participated in a telephone interview in Nebraska, USA in 2019. Interviewees represented various levels of the model, based on their current breastfeeding experience (i.e., mother or significant other) or occupation. A direct content analysis was performed as well as a constant comparative analysis to determine differences between level representatives.ResultsAt the Individual level, breastfeeding is a valued behavior, however, women are hindered by exhaustion, isolation, and the time commitment of breastfeeding. At the Interpersonal level, social media, peer-to-peer, and family were identified as supports for breastfeeding, however lack of familial support was also identified as a barrier. At the community level, participants were split between identifying cultural acceptance of breastfeeding as support or barrier. At the organizational level, hospitals had supportive breastfeeding friendly policies in place however lacked enough personnel with breastfeeding expertise. At the policy level, breastfeeding legislation is supportive, however, more specific breastfeeding legislation is needed to ensure workplace breastfeeding protections.ConclusionFuture efforts should target hospital-community partnerships, family-centered education, evidence-based social media strategies and improved breastfeeding legislation to ensure breastfeeding women receive effective support throughout their breastfeeding journey.

Hospital Partnerships for Population Health: A Systematic Review of the Literature.

The U.S. healthcare system continues to experience high costs and suboptimal health outcomes that are largely influenced by social determinants of health. National policies such as the Affordable Care Act and value-based payment reforms incentivize healthcare systems to engage in strategies to improve population health. Healthcare systems are increasingly expanding or developing new partnerships with community-based organizations to support these efforts. We conducted a systematic review of peer-reviewed literature in the United States to identify examples of hospital-community partnerships; the main purposes or goals of partnerships; study designs used to assess partnerships; and potential outcomes (e.g., process- or health-related) associated with partnerships. Using robust keyword searches and a thorough reference review, we identified 37 articles published between January 2008 and December 2019 for inclusion. Most studies employed descriptive study designs (n = 21); health needs assessments were the most common partnership focus (n = 15); and community/social service (n = 21) and public health organizations (n = 15) were the most common partner types. Qualitative findings suggest hospital-community partnerships hold promise for breaking down silos, improving communication across sectors, and ensuring appropriate interventions for specific populations. Few studies in this review reported quantitative findings. In those that did, results were mixed, with the strongest support for improvements in measures of hospitalizations. This review provides an initial synthesis of hospital partnerships to address population health and presents valuable insights to hospital administrators, particularly those leading population health efforts.

Population health partnerships and social capital: Facilitating hospital-community partnerships.

Social capital refers to the social norms and networks that build trust and enable individuals to pursue shared objectives; it can vary considerably between communities and across time. Considerable evidence suggests that the presence of social capital at the local or state level is associated with improved individual health and lower community-level mortality, chronic illness, and diseases of despair such as substance abuse. Social capital may influence health outcomes because community-engaged institutions are more common in communities with strong social bonds and cross-sector partnerships are more easily leveraged. This study examines the impact of social capital on the effectiveness of health care organizations, specifically hospitals, in establishing population health partnerships which are critical for addressing health disparities and reducing preventable deaths. In a national sample of hospitals, we find that in communities with high social capital, hospitals are more likely to hold partnerships with public health and social service agencies. Social capital within communities may create the conditions in which hospitals are able to easily identify possible partnerships and engage in collaborative efforts to improve population health.

Exploring the Gap: Food Insecurity and Resource Engagement.

Pediatric health care institutions are increasingly implementing food insecurity (FI) screens, but there is limited information about participant interest in referral and engagement with resources provided. In this descriptive cross-sectional study, we recruited participants from a consecutive sample of adult caregivers arriving with pediatric patients in the emergency department at an urban, freestanding children's hospital. Caregivers completed a validated, 2-question screen for FI. All participants received a list of food access resources. Direct referral to a partnered community food resource agency was offered to those who screened positive for FI; that agency completed a phone call to the participant for resource provision within 2 weeks. Among the 1818 participants recruited, 20.6% (375) screened positive for FI, consistent with the area's reported child FI rate. Of those who screened positive, 54.9% (206) opted to receive a direct-referral via phone call to a food resource agency, and 35.9% (74) of these were reached by phone. About 31.1% (23) of those contacted were no longer interested in food resource referrals, 10.8% (8) were signed up for the Supplemental Nutrition Assistance Program, and 59.5% (44) were referred to local food pantries. Through hospital-community partnership in an initial attempt to screen and offer direct-referral for FI, we elicited considerable interest among families for connection to resource agencies. However, there was a substantial gap between referral acceptance and ultimate connection with the resource agency stemming from 2 major sources: inability to re-contact and loss of interest after contact.