1. Community Health Needs Assessments for Nonprofit Rural Hospitals: Next Steps Dave Palm College of Public Health Annual Conference of the Nebraska Rural Health Association Kearney, Nebraska September 17, 2015

2. Outline  Brief Review of the CHNA and Implementation Plan Requirements  Role of LHDs in the CHNA Process  Major Community Health Priorities Selected  Key Implementation Strategies Identified  Key Success Factors and Lessons Learned  Final Thoughts

3. Overview of the IRS Requirements  The CHNA and Implementation Plan must be completed every 3 years  The community must be defined and significant health needs identified using quantitative and qualitative methods  The state or LHD must be consulted and input received from persons who represent the broad interests of the community  The high priority health needs must be identified, including the criteria used (e.g., burden or urgency of need)

4. Overview Continued  The Implementation Plan is also a written document that describes how the priority needs will be met  It should include the actions the hospital intends to make, the anticipated impact of the actions, and a plan to evaluate the impact  It should also include the resources the hospital intends to commit and any planned collaborations with other hospitals or organizations (e.g., LHDs, FQHCs, or CMHCs)  It should also explain why the hospital does not intend to address some of the priority needs (e.g., resource constraints)

5. Study Design  The study focused on 31 nonprofit rural hospitals in Nebraska, including 30 CAHs  We reviewed all of the CHNAs and Implementation Plans  Most were easily retrieved from the websites, but some follow up telephone calls were made

6. The Role of LHDs in the Development of CHNAs  Nearly all of the hospitals developed their CHNA with their LHD (87%)  The LHD assumed a lead role in developing the CHNA for 65% of the hospitals  For 8 of the hospitals, the LHD prepared the CHNA  This was a natural partnership because all of the LHDs have experience in preparing community needs assessments and community plans

7. Data Collection Methods  A wide variety of data sources were used to identify the needs, including:  Mortality and morbidity data  Birth data  Behavior risk factor data  Hospital discharge data  Qualitative information was obtained through focus group and key informant interviews and town hall meetings

8. The Hospitals’ Top One or Two Priorities Priority Area  Access to care  Obesity  Mental health/Substance abuse  Cancer  Diabetes  Healthy living  Maternal and child health Number and % of Hospitals  15 (48%)  11 (35%)  9 (29%)  8 (26%)  5 (16%)  4 (13%)  2 (7%)

9. The Hospitals’ Overall Priorities Priority Area  Mental health/Substance abuse  Obesity  Access to care  Nutrition and Physical Activity  Cancer  Healthy living  Diabetes  Heart disease  Injury and violence prevention Number and % of Hospitals  25 (81%)  18 (58%)  17 (55%)  14 (45%)  13 (42%)  11 (35%)  6 (19%)  5 (16%)

10. The Intervention Strategies  The most common intervention strategies fell into the following categories:  Education programs  Increase or add new services  Develop/implement a program  Health events/screenings  Expand staff/providers  Expand telehealth services  Advocate for new policies

11. Some Examples of Interventions – Access to Care  Create a resource directory  Provide more eligibility information on the availability of Medicaid and Federal subsidies under the ACA  Open Lab days for blood screening at lower rates  Increase cancer screening (e.g., mammography)  Develop a volunteer transportation program  Use screening reminders as part of their EMR

12. Some Examples of Interventions - Obesity  Provide healthy cooking classes  Develop messages using a multi-media campaign  Promote employee and worksite wellness programs  Advocate for policies in schools supporting more time for physical activity  Educate local elected officials about the design of recreational programs

13. Some Examples of Interventions – Mental Health/Substance Abuse  Educate local students on potential career opportunities  Develop school-based educational programs  Expand counseling services  Expand telehealth services  Add psychiatric capacity as part of a remote EAP  Create a uniform screening tool to detect problems such as depression and potential suicides  Implement a drug take-back plan

14. Some Examples of Interventions - Cancer  Expand cancer screening programs  Provide education on sun safety and skin cancer  Promote screening guidelines through a multi-media campaign  Work with LHDs to reach other organizations (e.g., worksite wellness programs)

15. Key Success Factors and Lessons Learned  It is advantageous to work closely with the LHD  As expected, there is a learning curve in developing a CHNA  Local data are not always available, but regional data can often pinpoint problems  It is important to obtain input directly from the community through focus group interview and/or town hall meetings  It would be helpful if all hospitals used a core data set to determine needs

16. Key Success factors and Lessons Learned Continued  Most of the significant gaps were in the implementation plans  The strategies were not always clear  The role of the hospital and their partners  The resources committed by the hospital  The indicators that would measure success  These obstacles could be overcome with measureable objectives and a detailed work plan  Some hospitals align their priorities and strategies with the LHD – could lead to interventions that are broader in scope and more targeted to the needs of the region

17. Conclusion  Small rural hospitals can develop comprehensive CHNAs and Implementation Plans  It is important to wok with the LHD and if possible align priorities and strategies  The major priorities identified are complex and not easily resolved  Nevertheless, these initiatives are creating collaborative partnerships that have the potential to address critical population health issues in rural communities

18. Dave Palm College of Public Health University of Nebraska Medical Center E-mail: david.palm@unmc.edu Telephone: 402.559.8441