1. 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

2. 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

3. 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.

4. 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
Completion of CHA and improvement plan.
Plan for sustaining community engagement.

5. 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.

6. 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

7. 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

8. 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

9. 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

10. Percent of LHDs Completing a Community Health Assessment
2008
NYS U.S.
2013
NYS U.S.

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

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

13. NACCHO DATA - NY Factors CHA COMPLETION NY-2013 p-value NY-2008 YesNo
Top Executive Education
Assoc/Bachelors Degree
Masters/Doctoral Degree
0.0259
0.3523
Top Executive Gender
Male
Female
0.4942
0.5372
Top Executive First-time
Unknown
0.2770
0.8230
In 2008, more than 60% of LHDs reported completing a CHA in the last three years. The percentage dropped to 48% in 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.

14. NACCHO DATA - NY Factors CHA COMPLETION NY-2013 p-value NY-2008 YesNo
Chronic Disease Program
0.9270
0.8991
Nutrition Program
0.1994
Physical Activity Program
0.3496
0.4811
Tobacco Program
0.2393
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.

15. 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
0.3898
0.2443
Top Executive Gender
Male
Female
0.1450
0.5597
Top Executive First-time
Unknown
0.3839
0.5685
Education level, gender or experience of the top executive made no difference in LHD participation in health improvement plan development.

16. 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
0.2535
0.6365
Nutrition Program
0.6545
0.3644
Physical Activity Program
0.4716
0.7551
Tobacco Program
0.7442
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 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.

17. NACCHO DATA - US Factors CHA COMPLETION US-2013 p-value US-2008 Yes No
Top Executive Education
Assoc/Bachelors Degree
Masters/Doctoral Degree
0.4674
0.4549
Top Executive Gender
Male
Female
0.0662
0.1180
Top Executive First-time
Unknown
0.0531
0.0023
In U.S, LHDs with a first time top executive were more likely to complete a CHA both years.

18. NACCHO DATA - US
Factors
CHA COMPLETION
US-2013
p-value
US-2008
Yes No
N %
N %
Chronic Disease Program
<0.0001
0.0010
Nutrition Program
0.0246
Physical Activity Program
0.0029
Tobacco Program
0.0234
Nationally, presence of chronic disease programs was significantly associated with CHA completion, especially in 2013.

19. 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
0.2633
0.0521
Top Executive Gender
Male
Female
0.0003
<0.0001
Top Executive First-time
Unknown
0.0349
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.

20. 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
<0.0001
Nutrition Program
Physical Activity Program
Tobacco Program
Nationally, presence of chronic disease programs was associated with LHD participation in HIP development in 2008 and 2013.

22. 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.

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

24. CHA-CHIP DATA

25. CHA-CHIP DATA

26. 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 .

27. IMPLICATIONS

28. References
Herman E. J., Keller A., Davis A., Ehrensberger R., Telleen S., Kurz R., Nesvold J. H., Findley, S., Bryant-Stephens T., Benson M., & Fierro L. (2011). A Model-Driven Approach to Qualitatively Assessing the Added Value of Community Coalitions. Journal of Urban Health: Bulletin of the New York Academy of Medicine; 88(Suppl. 1), S130-S143.
Mays G.P. & Scutchfield F. D. (2010). Improving public health system performance through multiorganizational partnerships. Prev Chronic Dis;7(6):A
Mitchell S. M. & Shortell S. M. (2000). The Governance and Management of Effective Community Health Partnerships: A Typology for Research, Policy, and Practice. The Milbank Quarterly;78(2),
Palsbo S. E., Kroll T., & McNeil M. (2004). Addressing Chronic Conditions through Community Partnerships: A Formative Evaluation of Taking on Diabetes. National Rehabilitation Hospital Center for Health & Disability Research.
Shortell S.M., Zukoski A. P., Alexander J. A., Bazzoli G. J., Conrad D. A., Hasnain-Wynia R., Sofaer S., Chan B. Y., Casey E., & Margolin F. S. (2002). Evaluating Partnerships for Community Health Improvement: Tracking the Footprints. Journal of Health Politics, Policy and Law;27(1),49-91.
Woulfe J., Oliver T. R., Zahner S. J., Siemering K. Q. (2010). Multisector partnerships in population health improvement. Prev Chronic Dis;7(6):A
Butterfoss F. D. (2009). Evaluating partnerships to prevent and manage chronic disease. Prev Chronic Dis;6(2).