Not-For-Profit Hospital Community Benefit: Multi-Sectoral Collaboration in Local Health Planning to Improve Population Health, Equity, and Hospital Investment in the Social Determinants of Health

项目摘要 联邦和州级社区福利(CB)对非营利性医院(NFP)的要求 已经有几十年了。从历史上看，医院CB的大部分支出都用于未报销的患者护理，尽管 期望NFP将其CB支出与更广泛的社区需求相匹配，这些需求通常需要投资于 非临床领域。抛开联邦法规不谈，有几个州已经试验了CB法规，以增加 国家合作伙伴应加强对社区卫生的投资，并将社区卫生活动集中在具体的社区卫生优先事项上。 纽约州、俄亥俄州和俄勒冈州是首批要求NFP与当地卫生部门合作的州之一 各部门(LHD)和其他社区合作伙伴评估和确定社区需求的优先顺序。另外， 俄勒冈州使用一个公式设置最低CB支出下限，该公式基于财务状况计算门槛 医院的健康。虽然这些NFP法规和实施它们的决定早在大流行之前， 这些规定有可能利用CB投资来缓解长期存在的不平等和 应对健康的社会决定因素(SDOH)因大流行而恶化。研究的目的是 评估NY、OH和OR法规对非临床类别CB、SUD-NFP支出的影响 重点关注健康结果和健康公平。为了实现这一点，这项研究将使用不同的因果推理 方法和纵向CB支出数据，关于急诊科利用和护理过渡的数据， 以及来自国家方案执行战略的信息。深入的案例研究将阐明这些机制。 通过它，协作需求发挥作用，完善理论框架，告知 改进现有政策和在其他司法管辖区的执行情况，并产生新的假设。 K01的支持将帮助我获得开发严格理论框架所需的经验 通过将组织和管理科学与经济理论相结合。此外，这款K01将支持 我在健康公平创新概念化和社区参与的定性研究方面的发展。 该项目将导致申请R01资金，以审查多部门合作对以下方面的影响 更广泛的一套人口健康结果和健康公平。R01提案将扩大 多部门合作，包括更多的社区合作伙伴。这款K01对齐得很好 AHRQ的首要目标。第一，重点是“社区与卫生之间伙伴关系的作用” 影响SDOH和改善健康结果的系统“将成为AHRQ实现”高价值“的目标 医疗保健系统“。第二，重点放在NFP-LHD合作解决SUD的有效性上 流行病与AHRQ的目标有关，该目标是了解“SUD危机并提供解决方案”。最后， 这项研究考察了NFP-LHD合作对种族、民族和地理环境的影响 与该机构的目标一致，即在重点关注特定优先人群的同时促进卫生公平。

Project Summary Federal and State-level community benefit (CB) requirements for not-for-profit hospitals (NFP) have been around for decades. Historically, most of hospital CB spending is on unreimbursed patient care despite the expectation that NFPs align their CB spending with broader community needs that often require investments in non-clinical areas. Federal regulations aside, a few states have experimented with CB regulations to increase NFPs’ investment in community health and to focus their CB activities on specific community health priorities. New York, Ohio, and Oregon are among the first states to require NFPs to collaborate with local health departments (LHD) and other community partners in assessing and prioritizing community needs. Additionally, Oregon set a minimum CB spending floor using a formula that calculates the threshold based on the financial health of hospitals. While these NFP regulations and the decision to implement them predated the pandemic, the regulations have the potential to leverage CB investments in alleviating long-standing inequities and addressing social determinants of health (SDOH) worsened by the pandemic. The purpose of the study is to estimate the effect of NY, OH, and OR regulations on NFP spending in non-clinical categories of CB, SUD- focused health outcomes, and health equity. To accomplish this, the study will use different causal inference methods and longitudinal CB spending data, data on emergency department utilization and transitions of care, and information from NFPs’ implementation strategies. The in-depth case studies will elucidate the mechanisms through which the requirement for collaboration works, refine the theoretical framework, inform the improvement of existing policies and implementation in other jurisdictions, and to generate new hypotheses. This K01 support will help me acquire the necessary experience to develop rigorous theoretical frameworks by integrating organizational and management science with economic theory. Additionally, this K01 will support my development in innovative conceptualization of health equity and community-engaged qualitative research. This project will lead to an application for R01 funding to examine the impact of multi-sectoral collaboration on a broader set of population health outcomes and health equity. The R01 proposal will expand the multi-sectoral collaboration to include additional community partners. This K01 is well-aligned with AHRQ’s overarching goals. First, the focus on “the role of partnerships between the community and health systems in impacting SDOH and improving health outcomes” will inform AHRQ’s goal of “achieving a high value healthcare system”. Second, the focus on the effectiveness of NFP-LHD collaboration to address the SUD epidemic is linked to AHRQ’s goal to understand “the SUD crisis and provide solutions for addressing it”. Finally, the study examines the impact of NFP-LHD collaboration on outcomes by race, ethnicity, and geography which aligns with the agency’s goal to advance health equity while focusing on specific priority populations.