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Most Hospitals Receive Failing Score in at Least 1 Quality Dimension of Their Community Health Needs Assessment
November 21, 2018

Most Hospitals Receive Failing Score in at Least 1 Quality Dimension of Their Community Health Needs Assessment

Neeraj Sood, PhD, is director of research at the Leonard D. Schaeffer Center for Health Policy and Economics, vice dean for research at the Price School for Public Policy, and associate professor at the Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics and Pharmaceutical Economics & Policy at the University of Southern California. His prior work has focused on the economics of innovation, HIV/AIDS, health care financing, and global health. His research has been published in several peer-reviewed journals and books, including leading journals in economics, medicine, and health policy. Dr Sood is on the editorial boards of Health Services Research and Forum for Health Economics and Policy. He is a research associate at the National Bureau of Economic Research and standing member of the Health Services Organization and Delivery study section at the National Institutes of Health. Prior to joining USC, Dr Sood was a senior economist at RAND and Professor at the Pardee RAND Graduate School.
What Grade Did Hospitals Receive for Their CHNAs?
Exhibit 2 shows the grades for each dimension. More than 1 in 5 hospitals received a failing grade for input depth, three-fourths received a failing grade for input breadth, and two-thirds received a failing grade on implementation plans for addressing patient needs. Some hospitals performed very well, however: nearly half of all hospitals received an A for input depth and roughly 1 in 5 hospitals received an A for input breadth of implementation plans.

Overall, we found that 84% of hospitals were failing in at least 1 dimension, an observation that is echoed by another study which evaluated hospitals in Texas in 2013.

We find that 16% of hospitals received a passing grade (an A or B) across all dimensions and 5% received an A across all dimensions, suggesting that hospitals can produce high-quality CHNAs. We also find that while a hospital may perform poorly along 1 dimension, it will often succeed in another, suggesting that while most hospitals need help in improving their CHNAs, the help needs to be tailored to the strengths and weaknesses of each hospital and community.

More Specific Guidelines Would Improve Hospitals’ Assessments
These findings lead us to argue that more specific guidelines are needed so that CHNAs could be improved across all dimensions. The importance of these guidelines is 2-fold. First and foremost, non-profit hospitals receive the highly-coveted benefit of tax-exemption because they provide “community benefit.” To produce meaningful community benefit, hospitals must understand the needs of their community and a quality CHNA is a step towards that goal.

In addition, CHNAs can serve as a tool for measuring the extent to which hospitals are adopting a population health outlook. Engaging with a representative and diverse sample of the community they serve can help hospitals understand and address needs that extend beyond the traditional medical paradigm of disease treatment.

We must develop clearer guidelines for measuring a hospital’s orientation toward population health, such as with a CHNA. This would be a big step towards fundamentally improving population health and changing the relationship between a hospital and its community.

Vivek Shah is a medical student at the UCLA David Geffen School of Medicine. He graduated with bachelors' degrees in Biochemistry and Philosophy from the University of Southern California in 2018.

Rebecca Li is an undergraduate student at the USC Keck School of Medicine. She is majoring in Global Health, minoring in Business Finance, and pursuing a progressive degree in Healthcare Decision Analysis. She is expecting to complete her bachelor's and master's degrees in 2020.


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