Beyond CHNAS: Performance Measurement for Community Health Improvement

Abstract

Research Objective: Non-profit hospitals are required to work with community organizations to prepare Community Health Needs Assessment (CHNA) and implementation strategy (IS). In concert with the health care delivery system’s transformation from volume to value and efforts to enhance multi-sector collaboration, such community health improvement (CHI) processes have the potential to bridge efforts of the health care delivery sector, public health agencies, and community organizations to improve population health. Having a shared measurement system is critical to achieving collective impact, yet despite the availability of community-level data from a variety of sources, many CHI processes lack clear, measurable objectives and evaluation plans. Through an in-depth analysis of ten exemplary CHI processes, we sought to identify best practices for population health measurement with a focus on monitoring collaborative implementation strategies. Study Design: Based on a review of the scientific literature, professional publications and presentations, and nominations from a national advisory panel, we identified 10 exemplary CHI processes. Criteria of choice were whether (1) the CHIs articulate a clear definition of intended outcomes; (2) clear, focused, measurable objectives and expected outcomes, including health equity; (3) expected outcomes are realistic and addressed with specific action plans; and (4) whether the plans and their associated performance measures become fully integrated into agencies and become a way of being for the agencies. We then conducted an in-depth analysis of CHNA, IS, and related documents created by health departments and leading hospitals in each process. Population Studied: U.S. hospitals. Principal Findings: Community health improvement processes benefit from a shared measurement system that indicate accountability for specific activities. Despite the importance of measurement and evaluation, existing community health improvement efforts often fall short in these areas. There is more variability in format and content of ISs than CHNAs; the most developed models include population-level goals/objectives and strategies with clear accountability and metrics. Other hospital IS’s are less developed. Although all U.S. hospitals are familiar with performance measurement in their management, this familiarity does not seem to carry over to Community Benefit and CHNA efforts. Indeed, 5 of the 10 CHI processes we examined have some Accountable Care Organization (ACO) involvement, where population-health performance measures are commonplace. Yet this involvement is not mentioned in the CHNAs and ISs, nor are ACO data cited. Conclusions: Strengthening the CHNA regulations to require that hospitals report the evaluation measures they intend to monitor based on an established community health improvement model could help communities demonstrate impact. As in ...

Making Better Use of Population Health Data for Community Health Needs Assessments

“…As we describe in more detail in a companion paper [3], although the CHNA requirements offer an extraordinary promise for advancing population health through multi-sector collaboration to build health partnerships [4], evaluations of current efforts suggest that the new IRS regulations [5] do not yet seem to have not achieved their potential in most communities.…”

“…Second, implementation plans for hospitals and other entities should include pre-specified performance measures to align efforts and to ensure accountability for the organizations’ actions to address community health improvement [678]. A companion paper describes our methodology and addresses current practices in performance measurement [3]. This paper focuses on measures for community health needs assessments and priority setting.…”

Value-based focused global population health management

“…The increased attention to improving health in all communities across the United States utilizing the CHRR database is limited. Community Health Needs Assessment (CHNA) with an associated implementation strategy following CHRR allows the development of policies at the closest point of impact (12,(35)(36)(37)(38). The combinations of the county or countyequivalents with community-level reflect the healthcare boundaries of the decision-making approach in the United States.…”

The Power of Partnerships: State Public Health Department Multisector Collaborations in Major Chronic Disease Program Areas

“…Multisector cancer collaborations have shown increased use of evidence-based approaches to facilitate cancer screening [12,13] and increased cancer screening rates [14]. While hospitals are required to work with community-based organizations to inform their community health needs assessments and plans, such collaborations are often not sustained through implementation [15]. While evidence in local-level partnerships is promising, key differences exist in the roles and collaborative and partnership forming processes of state-level health departments versus local level health agencies.…”