BACKGROUND: The Internal Revenue Service (IRS) regulations require non-profit hospitals to engage at least one state or local health department to conduct a community health needs assessment (CHNA) and develop an implementation strategy (IS). New epidemiological challenges in the final 2014 CHNA IRS regulations include:
- Soliciting Input: The hospital must identify, “solicit”, and “take into account” input from members of medically underserved (disparately impacted), low-income, and minority populations.
- Expanded “Health Needs” Definition: Includes “…social, behavior and environmental factors that influence health in the community.”
- Impact Evaluations: CHNAs must “include an impact evaluation of the actions taken by the hospital on significant health care needs it identified in its previous CHNA.”
METHODS: Analysis of more than 200 completed CHNAs and 100 Implementation Strategies identified the most common prioritized “health needs”, implementation strategies, and health department contributions. Identified resources for addressing community level “hot spots” of disparities were successfully piloted as part of the Sub-County Assessment of Life Expectancy (SCALE) Project. Literature reviews and environmental scans identified the upstream social determinants of health (SDOHs) most strongly linked to community health; available data sources and visualization tools; and successful case studies of multi-sector SDOH actions targeted with local data. CDC’s Health Impact in Five Years (HI-5) Project identified a list of the most impactful community health interventions, supported by the highest standard of scientific evidence and expected to improve health in as early as five years. The list was developed through a rigorous assessment of 148 candidate intervention against a set of objective criteria.
RESULTS: A compendium of resources and tools is available to assist epidemiologists engaged in CHNA or preparing for voluntary public health accreditation. This presentation demonstrates how these resources can be used to assess current health status; identify hot spots of disparities; catalyze multi-sector partnerships; and select, monitor, and evaluate the impact of proven strategies including interventions directly addressing SDOHs.
CONCLUSIONS: IRS requirements for over 3,000 hospitals create an unprecedented opportunity for health departments to leverage scarce resources towards collective community health impact. Newly available resources can inform data driven decision making and help ensure resource investments yield the most cost effective public health benefits.