New York Public Health Practice-Based Research Network Organizational and Structural Characteristics of Local Health Department-Hospital Collaborations for Population Health New York Public Health Practice-Based Research Network

PRACTICE – RESEARCH TEAM New York State Department of Health Office of Public Health Practice Christopher Maylahn, MPH, DrPH candidate Sylvia Pirani, MPH, MS Priti Irani, MS SUNY at Albany School of Public Health Benjamin Shaw, PhD – HPMB Department Chair Caroline Bolarinwa, MPH candidate Temilayo Adeyeye, PhD candidate Eniola Dipe, MPH candidate Research was supported by Junior Investigator Award from the Robert Wood Johnson Foundation

BACKGROUND In 2008, New York State DOH required that local health departments and nonprofit hospitals collaborate in conducting CHAs and adopting an implementation strategy described in a community health improvement plan. In 2003, ACA requirements and PHAB standards for collaborative assessment and planning began nationally.

STUDY DESIGN A natural experiment to describe the variation in organizational and structural factors associated with effective partnerships and their capacity for sustainability. Retrospective cohort study of 58 LHDs and 137 nonprofit hospitals from 2008-2013. Completion of CHA and improvement plan. Plan for sustaining community engagement.

RESEARCH OBJECTIVES Describe variation in organizational and structural factors linked with conducting CHA and CHIP development. Identify associations between organizational and structural factors, and selected outputs.

COMMUNITY HEALTH PARTNERSHIPS Key Characteristics Collaborations between diverse organizations and members with wide range of resources Focus on problems that cannot be solved independently Variety of functions: Information exchange Public health service delivery System and policy level changes Centrality: Level of influence one organization has in partnership Breadth: Level of diversity in partnership Density: Level of interconnectedness between members

COMMUNITY HEALTH PARTNERSHIPS Determinants of Success Common vision/mission Shared goals/objectives Partner diversity Homogeneous vs. heterogeneous Strong leadership Frequent communication External funding Use of framework or logic model for planning Use of evidence-based strategies Adaptability Clear roles and guidelines for participation

DATA SOURCES NATIONAL PROFILE SERIES Survey conducted by NACCHO in 2008, 2010, 2013 NEW YORK STATE DEPARTMENT OF HEALTH REPORTS Narrative reports – required in 2008 and 2013 Summary data compiled by at least two reviewers / report

NACCHO PROFILE SERIES Topic 2008 2010 2013 CORE   Jurisdictional Information X Governance Funding Workforce - Top Executive Activities Community Health Assessment and Planning MODULE Partnership and Collaboration Community Health Assessment and Health Improvement Planning

Percent of LHDs Completing a Community Health Assessment 2008 NYS U.S. 2013 NYS U.S. 60.5 33.1 48.9 58.5

Percent of LHDs Completing a Community Health Assessment 2013 2008 New York State United States   New York State United States 49.0 58.5 60.5 33.1 Has a community health assessment been completed within the last three years?

PARTICIPATING IN DEVELOPMENT OF COMMUNITY HEALTH IMPROVEMENT PLAN 2013 2008 New York State United States   44.4 47.5 60.8 49.3 Did your LHD participate in developing a health improvement plan for your community within the last three years?

NACCHO DATA - NY Factors CHA COMPLETION NY-2013 p-value NY-2008 Yes No Top Executive Education Assoc/Bachelors Degree Masters/Doctoral Degree   15 39.47 6 85.71 23 60.53 1 14.29 0.0259 17 56.67 6 75.00 13 43.33 2 25.00 0.3523 Top Executive Gender Male Female 7 41.18 15 51.72 10 58.82 14 48.28 0.4942 10 66.67 13 56.52 5 33.33 10 43.48 0.5372 Top Executive First-time Unknown 17 44.74 5 71.43 0 0.00 21 55.26 2 28.57 1 100 0.2770 21 60.00 2 66.67 14 40.00 1 33.33 0.8230 In 2008, more than 60% of LHDs reported completing a CHA in the last three years. The percentage dropped to 48% in 2013. The State required LHD to conducted CHAs in 2005 and again in 2009, so this schedule probably influenced the responses. In 2013, CHA completion was significantly greater in LHDs when the top exectutive had a maters or doctoral degree.

NACCHO DATA - NY Factors CHA COMPLETION NY-2013 p-value NY-2008 Yes No Chronic Disease Program   16 47.06 5 45.45 18 52.94 6 54.55 0.9270 18 60.00 5 62.50 12 40.00 3 37.50 0.8991 Nutrition Program 14 41.18 7 63.64 20 58.82 4 36.36 0.1994 5 62.50 Physical Activity Program 14 42.42 7 58.33 19 57.58 5 41.67 0.3496 16 57.14 7 70.00 12 42.86 3 30.00 0.4811 Tobacco Program 18 43.90 3 75.00 23 56.10 1 25.00 0.2393 20 60.61 3 60.00 13 39.39 2 40.00 0.9797 The presence of a chronic disease program, as defined in the four options given here, was not associated with CHA completion in either survey year.

NACCHO DATA - NY Factors LHD PARTICIPATION IN DEVELOPING HEALTH IMPROVEMENT PLAN WITHIN LAST 3 YEARS NY-2013 p-value NY-2008 Yes N % No Top Executive Education Assoc/Bachelors Degree Masters/Doctoral Degree   15 39.47 4 57.14 23 60.53 3 42.86 0.3898 26 65.00 5 45.45 14 35.00 6 54.55 0.2443 Top Executive Gender Male Female 5 29.41 15 51.72 12 70.59 14 48.28 0.1450 11 55.00 19 63.33 9 45.00 11 36.67 0.5597 Top Executive First-time Unknown 17 44.74 2 28.57 1 100 21 55.26 5 71.43 0 0.00 0.3839 28 62.22 3 50.00 17 37.78 3 50.00 0.5685 Education level, gender or experience of the top executive made no difference in LHD participation in health improvement plan development.

NACCHO DATA - NY Factors LHD PARTICIPATION IN DEVELOPING HEALTH IMPROVEMENT PLAN WITHIN LAST 3 YEARS NY-2013 p-value NY-2008 Yes N % No Chronic Disease Program   16 47.06 3 27.27 18 52.94 8 72.73 0.2535 23 58.97 8 66.67 16 41.03 4 33.33 0.6365 Nutrition Program 15 44.12 4 36.36 19 55.88 7 63.64 0.6545 23 57.50 17 42.50 0.3644 Physical Activity Program 15 45.45 18 54.55 0.4716 22 59.46 9 64.29 15 40.54 5 35.71 0.7551 Tobacco Program 17 41.46 2 50.00 24 58.54 2 50.00 0.7442 28 62.22 3 50.00 17 37.78 0.5685 Our emphasis in this analysis was on how states are addressing chronic diseases, since that is the priority most communities in NYS selected. In 2008, 60% of the LHDs participated in CHIP development, falling to 42% in 2013. It is possible that the initiation of the Prevention Agenda that year may have influenced the responses. Our emphasis in this analysis was on how states are addressing chronic diseases, since that is the priority most communities in NYS selected. There were no significant differences in LHD participating in health improvement plan development by presence of chronic disease programs between the two years.

NACCHO DATA - US Factors CHA COMPLETION US-2013 p-value US-2008 Yes No Top Executive Education Assoc/Bachelors Degree Masters/Doctoral Degree   1007 58.75 80 62.02 707 41.25 49 37.98 0.4674 409 33.69 45 30.61 805 66.31 102 69.39 0.4549 Top Executive Gender Male Female 437 56.03 692 60.23 343 43.97 457 39.77 0.0662 189 30.93 290 34.86 422 69.07 542 65.14 0.1180 Top Executive First-time Unknown 888 59.72 242 55.13 6 37.50 599 40.28 197 44.87 10 62.50 0.0531 401 34.96 81 27.36 0 0.00 746 65.04 215 72.64 12 100.00 0.0023 In U.S, LHDs with a first time top executive were more likely to complete a CHA both years.

NACCHO DATA - US Factors CHA COMPLETION US-2013 p-value US-2008 Yes No N % N %   Chronic Disease Program 652 66.87 470 49.63 323 33.13 477 50.37 <0.0001 328 36.69 150 28.20 566 63.31 382 71.80 0.0010 Nutrition Program 832 61.40 297 50.86 523 38.60 287 49.14 384 35.10 96 28.49 710 64.90 241 71.51 0.0246 Physical Activity Program 660 64.90 457 50.61 357 35.10 446 49.39 323 36.41 154 28.73 564 63.59 382 71.27 0.0029 Tobacco Program 825 61.84 303 50.67 509 38.16 295 49.33 389 34.98 93 28.27 723 65.02 236 71.73 0.0234 Nationally, presence of chronic disease programs was significantly associated with CHA completion, especially in 2013.

NACCHO DATA - US Factors LHD participation in developing health improvement plan within last 3 years US-2013 p-value US-2008 Yes No N % N %   Top Executive Education Assoc/Bachelors Degree Masters/Doctoral Degree 808 47.22 68 52.31 903 52.78 62 47.69 0.2633 916 50.72 109 44.13 890 49.28 138 55.87 0.0521 Top Executive Gender Male Female 331 42.54 585 50.87 447 57.46 565 49.13 0.0003 432 44.63 650 53.28 536 55.37 570 46.72 <0.0001 Top Executive First-time Unknown 730 49.06 187 42.69 5 33.33 758 50.94 251 57.31 10 66.67 0.0349 849 49.85 232 49.89 8 20.51 854 50.15 233 50.11 31 79.49 0.0014 Nationally, with the exception of 2013, characteristics of the top executive were associated with LHD participation in a health improvement plan within last three years.

NACCHO DATA - US Factors LHD participation in developing health improvement plan within last 3 years US-2013 p-value US-2008 Yes No N % N % Chronic Disease Program   556 57.03 359 37.95 419 42.97 587 62.05 <0.0001 716 61.09 362 36.49 456 38.91 630 63.51 Nutrition Program 696 51.48 225 38.46 656 48.52 360 61.54 834 56.01 245 36.03 655 43.99 435 63.97 Physical Activity Program 556 54.72 355 39.36 460 45.28 547 60.64 697 59.88 377 37.89 467 40.12 618 62.11 Tobacco Program 677 50.90 239 39.83 653 49.10 361 60.17 856 55.58 230 35.71 684 44.42 414 64.29 Nationally, presence of chronic disease programs was associated with LHD participation in HIP development in 2008 and 2013.

CHA-CHIP DATA Now we move to data reported from our collaboratives: What is shown here is the number of hospitals (blue) and LHDs (red) reporting that they collaborated with various types of partners. Except for governmental organizations, local health departments were less likely to collaborate with other partners than hospitals.

CHA-CHIP DATA Hospitals identified more partners than LHDs across all three chronic disease focus areas (?)

CHA-CHIP DATA

CHA-CHIP DATA

CONCLUSIONS Literature review has identified many studies about organizational and structural factors associated with effective collaborations. NAACHO data include relevant variables at state and national levels for assessment and planning efforts .

IMPLICATIONS

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