One Decade Later: The Generalizability, Diversity, and Inclusion of Community Health Needs Assessments

Context:The 2010 Patient Protection and Affordable Care Act aimed to reduce health disparities and change medicine to be more community-driven. To maintain tax-exempt status, hospitals must complete a Community Health Needs Assessment (CHNA) every 3 years. This assessment must (a) integrate input from individuals the community serves, (b) make the report publicly assessable, and (c) adopt an implementation strategy based on community health needs identified in the assessment. However, there is little information on how representative CHNAs are of the community. Design:A content analysis was performed on a random sample of CHNA reports. Setting:This investigation examined nonprofit hospitals across the United States. Objectives:This investigation analyzed the quality of CHNAs and described existing CHNA practices through 4 means: (1) identified the type of data included; (2) examined the frequency in the methods of data collection; (3) understood how representative those data are of the hospital's service region; and (4) explored to what extent the hospital addressed diversity and inclusion such as through recruitment. Methods:A stratified random sample was drawn of CHNAs published in the past 3 years (n = 450 reports). The sample was stratified by the US Department of Agriculture's Rural-Urban Continuum codes to balance hospital representation from metro and nonmetro areas. Results:A series of dependent t tests revealed that these hospitals' reports represented a significantly more female, White, college-educated, and older population than the service area. In addition, only 3.12% of hospitals collected primary youth data. Finally, results also found that survey recruitment was not inclusive of individuals who did not have Internet access, could not read, or did not speak English fluently.