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Non-profit hospitals are required to collaborate with local health departments and engage communities on the development of CHNAs and improvement plans, although the level of collaboration and engagement varies. In contrast, nothing requires HCOs to collaborate with or engage communities, once the needs assessment is complete, on prioritizing community health needs or interventions, although some do so nonetheless. Providing data on how communities served by the organization would themselves set priorities could influence decisions made by HCOs and other entities, activate groups and organizations to work on prioritized needs (with or without support or collaboration with the HCO) and encourage HCOs to be more inclusive and transparent. In addition, identifying community health needs for which there are no or few evidence-based interventions will generate high priority research questions related to community health improvement. With funding from the Michigan Institute for Clinical and Health Research (MICHR), the team will create partnerships in three focal areas across Michigan (n=4 groups in NW MI, n=4 groups in the Thumb region of MI, n=4 groups in Detroit/Wayne County in MI) in informed deliberations about setting priorities about community health benefit.
Rationale:
Low-income and minority communities have poorer health outcomes than higher income communities. The U.S. health system, long focused on treatment of diseases at an individual level, is evolving to include more attention to population and community health. Community hospitals and health systems are beginning to recognize and even act on social determinants of health, in part due to the Affordable Care Act (ACA). For decades, non-profit health care organizations have had to provide evidence of benefit to their communities to maintain their non-profit status. The ACA strengthened this requirement by mandating community engagement in the development of a community health needs assessment and improvement plan. However, once these requirements are met, nothing requires ongoing collaboration with communities to prioritize and address their needs, nor to improve health equity. While one study found that 65% of CHNAs referenced health disparities or health equity, only 9% of implementation strategies included activities explicitly designed to improve health equity (Cramer, Singh, Flaherty and Young, 2017; Carroll-Scott, Henson, Kolker and Purtle, 2017). Engaging underserved and minority communities in setting priorities for community health benefits could influence decisions made by healthcare organizations and other entities, activate work on prioritized needs, and encourage healthcare organizations to be more inclusive and transparent.
Plan:
Create and/or build on existing academic-community partnerships with health care organizations and community leaders in Northern Michigan, Detroit/Wayne County, and the tri-county Thumb area.
Use existing community Health Needs Assessments (CHNAs) from these regions to develop an exercise to engage community members in informed deliberations about setting priorities for community health benefit.
Engage community members, particularly minority and medically underserved populations, in informed deliberations about priorities for community health benefit.
Provide information about community priorities to community based organizations, healthcare organizations, research institutions and other influential stakeholders and decision makers.
Assess the impact of community engagement on participants, on decisions about community health benefit priorities, and on activation of community members and organizations for community health.
Status:
Three deliberative CHAT sessions occurred in 2017 in Northern Michigan. In late 2017, the software malfunctioned, leading to some loss of data from those groups, and the need to rebuild the software, which was completed in 2019. Nine deliberative CHAT sessions occurred in 2019. Four were in the metro Detroit area (at or with Friends of Parkside in Detroit, ACCESS in Dearborn, Latino Family Services in Detroit, community members active in public health in Washtenaw County), three in Sanilac and Huron counties, a “test” session with two Detroit Community Needs Assessment facilitators for their advice and feedback on the exercise, and a group of stroke survivors in Flint done at the request of that community-academic partnership. The eight groups varied in age, race, gender, health status (presence or lack of chronic conditions), and ethnicities. Of the eight focus groups, 62.50% (5 out of 8) of the groups prioritized Mental Wellness at the highest level of investment. Mother, Baby and Kid was the second most highly invested category, with 50% (4 out of 8) groups prioritizing it at the highest level of investment. Long-term Illness was selected by all groups, 3 at the highest level. Two categories were the next highly prioritized: Affording Care, and Air, Water, Land. The least prioritized categories were Getting Together (social capital), and Work, Learn, Play. The table below compares group choices in 2019, in Detroit and the Thumb area, with choices in 2017 in NW Michigan. Categories and levels of resources are available upon request.
With support from M-LEEaD (the Michigan Lifestage Environmental Exposures and Disease Center), a virtual town hall dissemination event was held for Northern Michigan communities in March 2021 to describe the project and discuss results related to Air, Water, Land (environmental risks to health).
DECIDERS role: Leaders
Collaborators:
Support for various aspects of the project provided by:
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