Background: More than half of all local health departments (LHDs) in the U.S. are involved in collaborations with nonprofit hospitals on a community health needs assessment (CHNA), yet little is known about the role that LHDs play in hospitals’ implementation plans.
Purpose: This study aims to explore the current state of hospital–LHD collaborations around the implementation plan using data from a survey of LHDs across the country.
Methods: The study sample included 457 LHDs that completed both the 2015 Forces of Change survey and the 2013 Profile survey conducted by the National Association of County and City Health Officials. Univariate and bivariate analyses were used to compare LHDs involved in hospitals’ implementation plans to LHDs not involved in such activities. All analyses were conducted in 2016.
Results: Of the 457 sample LHDs, 62% were involved in at least one activity associated with hospitals’ implementation plans. These LHDs were larger, had greater budgets, and were more likely to be locally governed. In addition, almost all of these LHDs reported that they also collaborated with hospitals around the CHNA.
Implications: There is evidence of substantial involvement of LHDs in hospitals’ implementation plans. Importantly, joint CHNAs appear to pave the path for hospital–LHD collaboration in this area. Since LHDs that collaborate with hospitals on their implementation plans tended to be better resourced, policymakers may want to find ways to ensure that smaller LHDs have the necessary human and fiscal resources to be engaged in joint community health needs assessment and improvement planning activities

Carlton, Erik

Singh, Simone

English

University of Kentucky

Frontiers in Public Health Services and Systems Research Volume 5 Number 4 Article 6 September 2016 Local Health Departments’ Involvement in Hospitals’ Implementation Plans Simone Singh University of Michigan - Ann Arbor, singhsim@umich.edu Erik Carlton University of Memphis, erik.carlton@memphis.edu Follow this and additional works at: https://uknowledge.uky.edu/frontiersinphssr  Part of the Health Services Administration Commons, and the Health Services Research Commons Recommended Citation Singh S, Carlton E. Local health departments’ involvement in hospitals’ implementation plans. Front Public Health Serv Sys Res 2016; 5(4):34–9. DOI: 10.13023/FPHSSR.0504.06. This Article is brought to you for free and open access by the Center for Public Health Systems and Services Research at UKnowledge. It has been accepted for inclusion in Frontiers in Public Health Services and Systems Research by an authorized administrator of UKnowledge. For more information, please contact UKnowledge@lsv.uky.edu. Local Health Departments’ Involvement in Hospitals’ Implementation Plans Abstract Background: More than half of all local health departments (LHDs) in the U.S. are involved in collaborations with nonprofit hospitals on a community health needs assessment (CHNA), yet little is known about the role that LHDs play in hospitals’ implementation plans. Purpose: This study aims to explore the current state of hospital–LHD collaborations around the implementation plan using data from a survey of LHDs across the country. Methods: The study sample included 457 LHDs that completed both the 2015 Forces of Change survey and the 2013 Profile survey conducted by the National Association of County and City Health Officials. Univariate and bivariate analyses were used to compare LHDs involved in hospitals’ implementation plans to LHDs not involved in such activities. All analyses were conducted in 2016. Results: Of the 457 sample LHDs, 62% were involved in at least one activity associated with hospitals’ implementation plans. These LHDs were larger, had greater budgets, and were more likely to be locally governed. In addition, almost all of these LHDs reported that they also collaborated with hospitals around the CHNA. Implications: There is evidence of substantial involvement of LHDs in hospitals’ implementation plans. Importantly, joint CHNAs appear to pave the path for hospital–LHD collaboration in this area. Since LHDs that collaborate with hospitals on their implementation plans tended to be better resourced, policymakers may want to find ways to ensure that smaller LHDs have the necessary human and fiscal resources to be engaged in joint community health needs assessment and improvement planning activities. Keywords local health departments, nonprofit hospitals, community benefit, community health needs assessment, community health improvement planning Cover Page Footnote No competing financial or editorial interests were reported by the authors of this paper. This Article is available in Frontiers in Public Health Services and Systems Research: https://uknowledge.uky.edu/frontiersinphssr/vol5/iss4/6   INTRODUCTION nder the Affordable Care Act (ACA), nonprofit hospitals are required to conduct a community health needs assessment (CHNA) at least once every 3 years and adopt an implementation plan to address identified needs. Most hospitals completed their first round of CHNA and implementation plan activities in 2013 with the second round to occur during 2016. When conducting their CHNA, hospitals are asked to seek input from stakeholders who represent the broad interests of the community, including those with special knowledge of or expertise in public health, such as local health departments (LHDs).1–4 Prior research has shown that more than half of all LHDs in the U.S. are involved in CHNA-related collaborations with nonprofit hospitals, yet little is known about the role that LHDs play in the development and execution of hospitals’ implementation plans.5,6 Hospitals are currently not required to involve community stakeholders, such as the LHD, in their implementation plans. To achieve meaningful improvements in population health, however, broad collaboration with community stakeholders is needed beyond the assessment.7,8  This study aims to explore the current state of hospital–LHD collaborations around hospitals’ implementation plan using data from a survey of almost 700 LHDs across the U.S. Multi-sectoral collaboration on CHNA and improvement planning activities have the potential to ensure better coordination of population health activities conducted by various stakeholders in a community and thus a more efficient use of resources available to improve population health. METHODS Data for this study came from the 2015 Forces of Change survey and the 2013 Profile survey, both conducted by the National Association of County and City Health Officials (NACCHO).9,10 The study sample included 457 LHDs that participated in both surveys and indicated that they had at least one nonprofit hospital in their jurisdiction. The key measures of interest were LHDs’ responses to four questions regarding their involvement in hospitals’ implementation plan, including whether or not an LHD (1) participated in the development of a hospital’s implementation plan, (2) was listed as a partner in a hospital’s implementation plan, (3) conducted an activity listed in a hospital’s implementation plan, and (4) used the same implementation plan as a hospital. Each of these four activities was coded as a binary variable whereby missing answers were assumed to indicate that the LHD was not involved in the respective activity. Univariate and bivariate analyses were used to compare LHDs involved in hospitals’ implementation plans to LHDs not involved in such plans. All analyses were conducted in 2016. The study sample included 457 (66%) of the 690 LHDs that completed the 2015 NACCHO Forces of Change survey. Of the 233 excluded LHDs, 87 LHDs (37%) had not participated in the 2013 NACCHO Profile survey, and 146 LHDs (63%) indicated that they did not have a nonprofit hospital in their jurisdiction. When compared to all LHDs that completed the 2013 NACCHO Profile survey, sample LHDs were larger both in terms of the size of the population served and total expenditures incurred. Sample LHDs were also in somewhat better financial shape as indicated by larger rollover fund balances, yet there was no difference in the proportion of LHDs that reported budget cuts in recent years. Likewise, when comparing LHDs along other key demographic characteristics, such as type of jurisdiction served and type of governance, LHDs included in this study did not differ meaningfully from the LHDs that completed the 2013 NACCHO Profile survey. U 36Singh and Carlton: LHDs and Hospitals' Implementation PlansPublished by UKnowledge, 2016  RESULTS  Of the 457 sample LHDs, 42% (n=194) were involved in one activity associated with hospitals’ implementation plan, 9% (n=40) were involved in two activities, 7% (n=33) were involved in three activities, and 3% (n=15) were involved in all four activities. On the other hand, 38% (n=175) were not involved in any activity associated with hospitals’ implementation planning. As shown in Figure 1, being a partner in a hospital’s implementation plan was the most common activity in which LHDs listed as being involved, in the first round of nonprofit hospitals’ CHNA and implementation planning activities. Of the LHDs that were involved in only one activity, 45% were listed as a partner in a hospital’s implementation plan, and 42% participated in the development of a hospital’s implementation plan. Only 7% conducted an activity in a hospital’s implementation plan, and 6% used the same implementation plan as the hospital. Similarly, LHDs that were involved in more than one activity most frequently reported being a partner (98%) followed by participation in the development of the implementation plan (78%), conducting an activity in the implementation plan (70%), and using the same implementation plan as the hospital (29%).   Figure 1: Type and frequency of hospital implementation plan activities performed by sample local health departments  LHD, local health department Local health departments involved in the first round of hospitals’ implementation planning differed from LHDs not involved in such activities (Table 1): LHDs involved in implementation plans served larger populations and were more likely to be locally governed and have a local board of health, indicating that these LHDs may have stronger ties to their communities. LHDs involved in hospital implementation planning activities also had greater human and financial resources than those not involved in such activities. They employed a greater number of FTE staff and incurred larger total expenditures. Finally, LHDs that were involved in one or more 42%45%7% 6%77%98%69%27%0.2.4.6.81LHDs performing one activity LHDs performing more than one activityDevelopment of implementation strategyPartner in implementation strategyActivity in implementation strategyUse same implementation strategy37Frontiers in Public Health Services and Systems Research, Vol. 5, No. 4 [2016], Art. 6https://uknowledge.uky.edu/frontiersinphssr/vol5/iss4/6DOI: 10.13023/FPHSSR.0504.06  implementation plan activities were significantly more likely to report that they also collaborated with hospitals around the CHNA. Of all LHDs involved in hospitals’ implementation plans, 95% also engaged in CHNA-related collaboration with local hospitals. Of the LHDs not involved in hospitals’ implementation plans, only 51% were involved in such collaborations. Also of note is that almost half of LHD respondents involved in CHNAs were not engaged in implementation planning. Table 1: Characteristics of sample local health departments, by level of involvement in hospitals’ implementation plans Characteristics   comparison Number of plan activities in which an LHD is involved Total sample  None One Several  Sample size, n(%) 175 (38.3) 194 (42.5) 88 (19.3) 457 (100)      Demographic characteristics Total pop. served, mediana 54,512 63,749 69,893 62,778 Geographic jurisdiction served   City, n (%) 16 (9.1) 15 (7.7) 7 (7.7) 38 (8.3)   County, n (%) 119 (68.0) 146 (75.3) 69 (75.8) 331 (72.4) Governance of LHDb   Local, n (%) 109 (62.3) 138 (71.1) 77 (84.6) 321 (70.2)   State, n (%) 49 (28.0) 31 (16.0) 8 (8.8) 88 (19.3)   Shared, n (%) 17 (9.7) 25 (12.9) 6 (6.6) 48 (10.5) Has LBH, n (%)b 108 (62.1) 127 (65.5) 75 (85.2) 310 (68.0) Total expenditures, medianc $2,056,298 $3,613,306 $3,744,221 $2,956,822 Avg. per person exp., median $36.15 $37.98 $41.05 $37.33 Total FTE workforce, medianb 27.5 28.8 39.5 29.7  Engagement with hospitals on community health needs assessments Currently collaborating,  n (%)b 82 (46.9) 168 (86.6) 82 (90.1) 329 (72.0) Discussing collaboration,  n (%) 24 (13.7) 20 (10.3) 5 (5.5) 49 (10.7) Notes: aANOVA indicated that the difference in means across the three subgroups was significant at the 5% confidence level. bANOVA indicated that the difference in means across the three subgroups was significant at the 1% confidence level. cANOVA indicated that the difference in means across the three subgroups was significant at the 10% confidence level.  LHD, local health department; LBH, local board of health IMPLICATIONS There is evidence of substantial involvement of LHDs in nonprofit hospitals’ implementation plans. Not surprisingly, agency size and financial position play important roles in LHDs’ decision to collaborate with hospitals on their implementation plans. Moreover, joint CHNAs appears to pave the path for LHD involvement in the development and execution of hospitals’ implementation plans. These findings are encouraging given that the activities LHDs reported occurred primarily during the first round of nonprofit hospitals’ CHNA and implementation planning activities. As CHNA-related collaboration between hospitals and LHDs is becoming more established, the extent of LHD involvement in hospitals’ implementation plans will likely increase.  38Singh and Carlton: LHDs and Hospitals' Implementation PlansPublished by UKnowledge, 2016  To further encourage collaboration of LHDs with nonprofit hospitals and foster meaningful LHD involvement in implementation planning activities, policymakers may initiate a number of steps, including providing smaller LHDs with the necessary resources to be fully engaged in such activities. This study sheds some light on the state of LHD-hospital collaboration around implementation planning during round one of hospitals’ CHNA activities. Future research is needed to explore in more detail the quantity and quality of such collaborations, both from the perspective of the LHD and that of their hospital partners. How successful collaborations may lead to improved community health outcomes, as well as factors that prevent LHDs involved in CHNA-related collaborations with hospitals from taking on a more active role in implementation planning, are also important topics for future study.  SUMMARY BOX What is already known about this topic? While many LHDs are engaged in CHNA-related collaborations with nonprofit hospitals, little is known about LHDs’ involvement in hospitals’ efforts to develop and adopt an implementation plan to address the needs identified in the CHNA. What is added by this report? Using survey data for 457 LHDs across the United States, this report shows that over 60% of respondents were involved in one or more activities related to hospitals’ implementation plans. LHDs involved in such activities almost always also collaborated with hospitals around the CHNA. What are the implications for public health practice, policy, and research? Collaboration around the CHNA appears to pave the path for LHD involvement in the development and execution of hospitals’ implementation plans. Joint community health needs assessment and improvement planning has the potential to ensure better coordination of population health activities in a community and thus a more efficient use of resources available to improve population health.  REFERENCES 1. 78 Fed. Reg. at 20529 at https://www.gpo.gov/fdsys/granule/FR-2013-04-04/2013-07879. 2.  2013 proposed CHNA regulations: https://www.irs.gov/PUP/newsroom/REG-106499-12.pdf. 3.  9 Fed. Reg. at 78963 at https://www.irs.gov/irb/2015-5_IRB/ar08.html. 4.  Final CHNA regulations: https://www.gpo.gov/fdsys/pkg/FR-2014-12-31/pdf/2014-30525.pdf.  5.  Carlton E, Singh SR. Accreditation intent, community health assessments and local health department-hospital collaboration. Frontiers in PHSSR 2015;4(1):1–6; DOI: 10.13023/FPHSSR.0401.01.  6.  Singh SR, Carlton E. Exploring the link between completion of accreditation prerequisites and local health departments' decision to collaborate with tax-exempt hospitals around the community health assessment. In press. 7.  Association of State and Territorial Health Officials. Florida Department of Health encourages partnerships with hospitals to benefit communities. http://www.astho.org/Florida-CHNA-Case-Study/.  8.  Laymon B, Shah G, Leep C, Elligers J, Kumar V. The proof's in the partnerships: Are Affordable Care Act and local health department accreditation practices influencing collaborative partnerships in community health assessment and improvement planning? J Public Health Manag Pract 2015;21(1): 12–17; DOI: 10.1097/PHH.0000000000000087. 9.  2013 NACCHO Profile survey:  http://nacchoprofilestudy.org/wp-content/uploads/2014/02/2013_National_Profile021014.pdf;  10.  2015 NACCHO Forces of Change survey: http://nacchoprofilestudy.org/wp-content/uploads/2014/02/2013_National_Profile021014.pdf.  39Frontiers in Public Health Services and Systems Research, Vol. 5, No. 4 [2016], Art. 6https://uknowledge.uky.edu/frontiersinphssr/vol5/iss4/6DOI: 10.13023/FPHSSR.0504.06

Local Health Departments’ Involvement in Hospitals’ Implementation Plans

https://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1214&amp;context=frontiersinphssr

Local Health Departments’ Involvement in Hospitals’ Implementation Plans

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