Tuesday, August 30, 2011

Community Health Needs Assessment

The Oklahoma Office of Rural Health (OORH) at the Oklahoma State University (OSU) Center for Health Sciences and the Oklahoma Cooperative Extension Service at OSU Stillwater have collaborated for more than seventeen years to provide a Community Health Engagement Process (CHEP) in rural towns.[1] The CHEP has been a popular program since its inception, with more than 60 communities across the state having completed the process (some more than once). The overall goal of the process was to create awareness of the local health sector, identify new services, and link local residents to local health services. Completing the CHEP took about four to six months with a total of five to seven meetings. The process resulted in the following deliverables:
  1. An analysis of the economic impact of the local health sector that quantifies the impact of the health sector; 
  2. A health services directory that lists current services and providers;
  3. A survey of local residents on their usage of health services and what additional services they would like to see offered; and 
  4. A county-specific data and information report that includes economic, health and behavioral, education, crime, and traffic data.
    While the Community Health Engagement Process has been very successful, recent legislation enacted as part of the Patient Protection and Affordable Care Act (PPACA) has prompted the OORH and the Cooperative Extension Service to modify the process.[2] The passing of PPACA in March 2010 included a new requirement for all 501(c)(3) hospitals (not-for-profit facilities) to conduct a community health needs assessment (CHNA) at least once every three years. The general idea behind the legislation is to require non-profit hospitals to gather community input that leads to recommendations of how the hospital and health sector as a whole can better serve residents. The existing CHEP was meeting most of this requirement, but the legislation compelled the OORH and the Cooperative Extension Service to make a few modifications. The primary differences are:
    1. A deeper examination of location-specific health indicators and outcomes; 
    2. An analysis of the demand for primary care physicians for the service area; 
    3. Replacing the telephone-based community wide survey with a participant-based hand-held survey (which shifts the responsibility for gathering survey responses on attendees); and 
    4. Constructing a prioritized list of community health needs and identifying potential remedies for their current health issues. 
    The recommendations derived from the process are then presented to the hospital board to determine if the facility can feasibly provide the new or additional services. The standard process is still envisioned to take approximately the same amount of time and number of meetings, but it can be shortened or lengthened depending on the community’s needs.

    At this time, only 501(c)(3) hospitals are required to conduct a Community Health Needs Assessment; however, there has been an overwhelming demand from hospitals that do not fit this criterion to develop their own set of health-related community recommendations. The OORH and the Cooperative Extension Service will offer to provide the CHNA to any rural community that has a hospital with less than fifty beds. This evolution reflects the desire of the OORH and the Cooperative Extension Service to advance the goals of the Flex Program while helping hospitals with their increasing regulatory burdens, and promoting a forward-looking attitude among all rural hospitals in the state.

    For more information about the Community Health Needs Assessment, contact Corie Kaiser (corie.kaiser@okstate.edu) or Lara Brooks (lara.brooks@okstate.edu).

    The aforementioned deliverables for communities that have completed the CHEP can be downloaded at the website of Oklahoma Rural Health Works.

    [1] The Oklahoma State University Center for Rural Health receives $650,000 through the Medicare Rural Hospital Flexibility Grant Program from the Federal Office of Rural Health Policy, Health Resources & Services Administration, United States Department of Health & Human Services. This grant funds 100% of the Community Health Needs Assessment and many other projects that benefit rural hospitals in Oklahoma.

    [2] The needs assessment is one out of a total of four new requirements for 501(c)(3) hospitals included in the Affordable Care Act. The other three refer directly to financial pieces. Schedule H of IRS form 990 has been updated to include questions pertaining to all four new requirements.

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