Conducting Community Health Needs Assessments in Rural Communities

Abstract

The Affordable Care Act of 2010 requires all nonprofit hospitals in the United States to conduct a Community Health Needs Assessment (CHNA) at least every 3 years. With this law in its infancy, the best practice to conduct an assessment that complies with the law is unknown. Research designs vary across states and agencies, and little is known about the reliability or representativeness of results. The rural community group model (RCGM) is a newly developed model designed for conducting assessments in rural communities. Key components of the model are disseminating surveys, conducting key informant interviews, facilitating focus groups, and integrating secondary data of county-level health behaviors and outcomes. It has been used to conduct CHNAs on more than half the critical access hospitals in North Dakota (58%). Given this large sample size, which used the same methodology, this article provides an evaluation of the model focusing on lessons learned and challenges encountered in the conduct of CHNAs. Particular strategies for assessment planners are warding off group think, monitoring against bias creep in data collection, and integrating multiple data sources to inform decision making. The model is recommended for replication in rural settings to provide meaningful feedback that allows a hospital to match long-term planning with community needs.

Nonprofit Hospital Community Benefit in the U.S.: A Scoping Review From 2010 to 2019

“…• There is high variation in community-engagement during needs assessments • Vulnerable populations and communities often receive less attention during needs assessments • The process for needs assessments must be context-specific: rural/urban, local health department/not, level of community capacity Spending and finance: basics • There is high variation in whether individual hospitals provide more community benefit than they receive in tax exemption, but overall community benefit exceeds hospital tax benefit • ∼7.5% of operating expenses go to community benefit, with ∼0.4% devoted to community health improvement • Non-profit hospitals generally provide more community assistance than for-profit peers challenges and opportunities for community engagement in rural settings (23). The author found group think to be particularly strong in rural communities where people know each other well (23), which may signal an important risk to be aware of in those instances where strong community health networks exist. Skinner et al found through interviews representing 21 hospitals in Appalachia that rural hospitals struggle to hire staff for their CHNA process and often lack the resources to address the needs once they are identified (60).…”

What Challenges Do Nonprofit Hospitals Face in Taking on Community Health Needs Assessments? A Qualitative Study From Appalachian Ohio

“…Although some templates and best practices have been made available for rural hospitals conducting CHNAs, some aspects of these models may be difficult considering the conditions described by our Appalachian participants. For example, one model provides information about how to study populations spread out over large geographic areas, but requires 3‐6 months for data collection . Given the lack of staffing and resources available in our sample, this model may not be realistic for many Appalachian hospitals.…”

“…Case studies on rural CHNAs in North Dakota and Indiana advance recommendations for addressing challenges associated with CHNAs in rural settings, particularly with regard to achieving buy‐in from rural community members and developing partnerships to help share the resource‐intensive task of engaging the community to understand local needs and compiling the official report . Another study in rural Wisconsin found that ACA requirements encouraged collaboration between a hospital and its local health department and also shifted the focus from traditional health promotion to the social determinants of health …”

“…13 Case studies on rural CHNAs in North Dakota and Indiana advance recommendations for addressing challenges associated with CHNAs in rural settings, particularly with regard to achieving buy-in from rural community members and developing partnerships to help share the resource-intensive task of engaging the community to understand local needs and compiling the official report. 14,15 Another study in rural Wisconsin found that ACA requirements encouraged collaboration between a hospital and its local health department and also shifted the focus from traditional health promotion to the social determinants of health. 16 The Journal of Rural Health 34 (2018) 182-192 c 2017 National Rural Health Association A small amount of evidence related to general challenges that might affect rural hospitals' ability to take on new CHNA requirements is thus available, although this link has not yet been explored with regard to the nature of rural hospitals as unique organizations.…”

The impact of the Affordable Care Act on hospital‐led community health evaluation in the U.S. Appalachian Ohio region

“…Although case studies on rural CHNAs provide some helpful recommendations for conducting CHNAs in low resource settings, scholars have yet to study CHNA processes in the Appalachian region of the United States specifically. This gap in the literature is significant because Appalachia possesses unique cultural and economic characteristics that result in significant health challenges.…”