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BACKGROUND: The Affordable Care Act requires that nonprofit hospitals collaborate with public health professionals to conduct community health needs assessments (CHNAs), develop implementation strategies on a regular basis, and establish performance measures to track progress. New guidance for local health departments (LHDs) from the Public Health Accreditation Board reinforces the need for LHDs to conduct or participate in a comprehensive assessment and planning process, and use a performance management system to monitor achievement of objectives. In 2008, New York State DOH initiated the same requirements and can serve as a natural experiment to examine hospital-LHD collaborations, quality of the assessment and planning efforts, and variation in contributing factors across communities.
METHODS: A qualitative study was conducted to describe variation in organizational and structural factors that influence collaborations, and investigate associations with the quality of the assessment and planning processes, and resulting products. The hypothesis is that the CHNAs and resulting improvement plans are better when organizational and structural factors favoring collaboration are in place. Data about the structure and organization of the county collaborations were summarized in 2010, 2011 and 2013 using ‘county’ as the unit of analysis. Information was obtained about the quality of the assessments and resulting improvement plans, and how they are being implemented using three sources: 1) A survey administered in 2011 and 2013 to 57 LHDs about the CHNAs; 2) community service plans were completed in 2010 and 2013 by 130 nonprofit hospitals describing the health profile of their catchment areas and progress in implementing strategies for health improvement; and 3) in 2010 and 2013, the NACCHO Profile Series reported data from all LHDs about community collaborations, and relevant organizational and structural characteristics. All of the initial reports and two-thirds of the reports providing current status were reviewed by January 9th. All reviews will be completed by at least two reviewers by end of February.
RESULTS: Preliminary data indicate that collaborations resulting in CHNAs and implementation strategies exist in all counties, but the composition and focus of the collaborations changed in many counties. The quality of CHNAs and health improvement plans also varied.
CONCLUSIONS: A collaborative process for soliciting community input and producing a community health assessment and health improvement plan has been widely employed in New York counties to address statewide priorities. Quality of these processes and products varies by county characteristics, LHD and hospital factors, composition of collaborations, and roles of partners.