Institutional factors associated with hospital partnerships for population health: A pooled cross-sectional analysis

Abstract

BackgroundHospitals are increasingly engaging in partnerships to address population health in response to national policies, such as value-based payment models. However, little is known about how institutional factors influence hospital partnerships for population health.PurposeGuided by institutional theory, we examine the association between institutional pressures (coercive, normative, and mimetic isomorphism) and hospital partnerships for population health.MethodologyA pooled cross-sectional analysis used an unbalanced panel of 10,777 hospital-year observations representing respondents to a supplemental question of the American Hospital Association’s annual survey (2015–2017). The analysis included descriptive and bivariate statistics, and regression models that adjusted for repeated observations to examine the relationship between key independent variables and partnerships over time.FindingsIn regression analyses, we found the most support for measures of coercive (e.g., regulatory factors) isomorphism, with nonprofit status, participation in accountable care organizations, and acceptance of bundled payments, all being consistently and significantly associated with partnerships across all organization types. Modest increases were observed from 2015 to 2017 for hospital partnerships with public health organizations (+2.8% points, p < .001), governmental organizations (+2.0% points, p = .009), schools (+4.1% points, p < .001), and businesses (+2.2% points, p = .007).Practice ImplicationsOur results suggest that institutional factors, particularly those related to regulatory policies and programs, may influence hospital partnerships to support population health. Findings from this study can assist hospital leaders in assessing the factors that can support or impede the creation of partnerships to support their population health efforts.

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

“…Beyond social capital, several organizational characteristics also predicted hospital-community partnerships. Being a sole community hospital or critical access provider was associated with greater partnerships that may reflect fewer resources within these organizations and the need for expanding capacity and resources through community partnerships (Hilts et al, 2022). The fact that system members also had higher numbers of partnerships suggests that hospitals with greater resources may have better access to such partnerships in their communities.…”

“…A status as a safety net hospital has been one indicator of a greater likelihood to connect with other community organizations in collaborative efforts (Cheon et al, 2020). Another more commonly identified indicator has been hospital resources, with larger size in particular being a predictive factor among economically distressed areas (Hilts et al, 2022; Noh et al, 2022; Park et al, 2020). This has raised the question of how hospitals with fewer resources, such as smaller organizations or those in rural areas, could be better supported in building relationships to collaborate on population health improvement (Park et al, 2020).…”

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

“…3 Indeed, a new literature has developed, exploring the role of hospital and community factors associated with hospital partnerships in improving population health. 2,[4][5][6][7] A majority of these studies have looked at whether partnerships exist between hospitals and various organizations, and some have examined the breadth of those partnerships (e.g., the number and types of community partners). Studies that have assessed the breadth of hospital community partnerships, however, have failed to delineate hospital and community characteristics in explaining the variation in breadth of those partnerships.…”

“…1 In the era of values-based payment and an enhanced focus on community health needs assessments, hospitals are incentivized to proactively adopt strategies to improve the health of the populations they serve. 2 Given that hospitals' traditional expertise is in providing acute medical care services, cross-sector partnerships have developed alongside this growing openness to population health management and are being used to strengthen investments in the social determinants of health at a societal level. These cross-sector partnerships can be leveraged to improve care coordination for patients, building on the clinical expertise of health-care providers and referrals to community organizations to address patients' unmet social needs.…”

“…The idea of population health management has gained traction among policymakers and health‐care leaders in recent decades and was strengthened with the implementation of the Affordable Care Act in 2010 1 . In the era of values‐based payment and an enhanced focus on community health needs assessments, hospitals are incentivized to proactively adopt strategies to improve the health of the populations they serve 2 . Given that hospitals' traditional expertise is in providing acute medical care services, cross‐sector partnerships have developed alongside this growing openness to population health management and are being used to strengthen investments in the social determinants of health at a societal level.…”