By Benjamin Brady, MS
On March 23, 2012, the Federal Government began requiring rural and critical access hospitals to complete community health needs assessments (CHNAs). As a condition of their not-for-profit status, the Affordable Care Act mandates that these hospitals assess the health status of the communities they serve. By conducting regular CHNAs, it is believed that these hospitals can better align their healthcare services with identified community needs.
Six months ago, I met with Dr. Kevin Driesen, the rural hospital FLEX program director at the University of Arizona’s Center for Rural Health (CRH) to discuss how Arizona’s rural hospitals are completing and utilizing CHNAs. I was familiar with the concept of a community health assessment but unsure how health care organizations viewed and used them. In our discussion, Dr. Driesen pointed out that few of the hospitals had ever completed CHNAs. For this reason, it would be helpful for the CRH to have better information on the hospitals’ status in completing CHNAs and to be aware of any barriers they might be encountering.
A month later, I met with Joyce Hospodar, the CRH’s senior program coordinator to discuss enrolling in a one-credit practicum she oversees—Rural Health Policy and Management. During our visit, we saw the practicum as a perfect opportunity to respond to Dr. Driesen’s suggestion. With the support of Dr. Neil MacKinnon, Dr. Lynda Bergsma and Dr. Driesen, Ms. Hospodar and I developed and administered a questionnaire to each of Arizona’s rural and critical access hospitals. Excluding for-profit and tribal hospitals, and three not-for-profit hospitals that had already completed CHNAs, we telephone-interviewed executive administrators at the remaining 10 hospitals. We asked them about their progress, partnerships and strategy for completing CHNAs as well as what assistance they might be interested in receiving from the CRH.
The survey was a success. We achieved a 100% response rate and received feedback that will be used to inform how the CRH can assist these hospitals in serving Arizona’s rural communities.
Eight of the 13 hospitals in the study were almost done or had already completed their CHNAs. Two had not yet begun and three were just starting. About half of the hospitals conducted their assessments using in-house staff. The other half received assistance from contractors or hospital group managers. Only three of the 13 hospitals are planning to or have already completed CHNAs by themselves. Most hospitals either partnered with local health departments, other hospitals, or hospital management groups. Except for one hospital that expressed concern for its financial capacity to complete its assessment, most hospitals expressed little or no interest in receiving planning, data gathering, analysis, or community outreach assistance from the CRH.
Informing Future Service
We learned that the hospitals are most interested in the CRH’s assistance as an instructional and strategy partner, not as a service contractor. It seems that the CRH can best serve Arizona’s rural hospitals by mediating CHNA partnerships between hospitals and local health departments and by providing methodological guidance on key aspects of the CHNA process. For the few cases where hospitals lack financial resources to complete the assessment, the CRH might also assist by facilitating low cost options, including partnerships with MEZCOPH graduate interns.
For the CRH to provide relevant instruction, it will be necessary that CHNAs become a regular point of dialogue between the Center and Arizona’s rural hospitals. Through these discussions, the CRH can remain informed about the hospitals’ assessment status and use that information to suggest future hospital planning and implementation strategies. These recommendations can help the hospitals develop new services based on their assessment findings.
You can read the full report here.
Benjamin Brady, MS, is a MPH student at the University of Arizona. He plans to graduate in December 2013. His professional interests relate to community health, chronic disease management, and theories of social and behavioral change.