Comparison of Nonprofit Hospital Community Benefit Substance Abuse Identification and Practice Implementation in Appalachian and Non-Appalachian Counties.

CONTEXT: As substance use continues to be a public health crisis nationally, it disproportionately affects the Appalachian region. OBJECTIVES: Our research seeks to explore whether there is a greater substance use burden in Appalachia and whether that burden is being prioritized in local hospital systems' community health needs assessments (CHNAs) and implementation strategies (ISs). SETTING: The setting for this study is the 13 states that are represented within the Appalachian region. PARTICIPANTS: This study examines CHNAs and ISs of a stratified random sample (n = 140) representing 20% of the hospital population within the identified states (those with counties within the Appalachian region). Each sampled hospital is labeled as Appalachian or non-Appalachian based on its county designation. MAIN OUTCOME MEASURES: Our main outcome measures were the percentage of hospitals listing substance abuse in their CHNAs, with comparisons between Appalachian and non-Appalachian subgroups, and percent addressing substance use in their ISs in Appalachia and non-Appalachia. DESIGN: Community health needs assessments and ISs produced between the years 2018 and 2021 were gathered for each hospital within the sample; each document was then coded for the inclusion of substance use. Chi-square tests and logistic regression were employed to conduct the analysis and draw conclusions. RESULTS: Although all non-Appalachian Counties that had substance use listed as a need within a CHNA correspondingly addressed that need in their ISs, only 75% of Appalachian counties that listed substance use a need went on to prioritize substance use in an IS. In addition, logistic regression indicated no significant link between overdose rates and addressing substance use. CONCLUSIONS: These findings further support other literature that suggests that lack of resources is limiting Appalachian health care organizations' ability to address substance use issues.

Equity as a Guiding Theme in Hospitals' Community Health Needs Assessments.

INTRODUCTION: This study explores the relationship between nonprofit hospitals' use of equity as a guiding theme in the development of their community health needs assessments and the level of alignment between the health needs identified in the community health needs assessment and those addressed in hospitals' implementation strategy. METHODS: Using data from a nationally representative data set of 485 nonprofit hospital community health needs assessments for the years 2018-2021, this study employed a multivariate logistic regression model to examine the association between hospitals' use of equity as a guiding theme in the community health needs assessment and binary indicators of alignment for 6 common community health needs: access to care, chronic illness, obesity, mental health, substance use, and social determinants of health. RESULTS: Hospitals using equity as a guiding theme in their community health needs assessment reported significantly greater alignment for 3 needs: access to care (OR=3.40), substance use (OR=2.75), and social determinants of health (OR=3.60). CONCLUSIONS: Using equity as a guiding theme in the needs assessment process can help to align hospitals' community health initiatives with the most pressing health needs, thus contributing to public health improvement.