Findings from the 2021 Greater Cincinnati Collaborative CHNA

The Health Collaborative (THC) is a nonprofit membership organization headquartered in Cincinnati, Ohio. The organization serves as the health information exchange (HIE) and regional health improvement collaborative (RHIC) for its 14-county region, and its members (30+ hospitals/health systems and 120+ post-acute/long-term care providers) benefit from THC’s services, which include clinical data exchange, the development of reports to help members improve the delivery of health care services to the communities they serve, and convening competitive stakeholders to solve complex problems. In 2021, THC, in partnership with the Greater Dayton Area Hospital Association (GDAHA), selected Measurement Resources Company and subcontractor Scale Strategic Solutions to conduct its regional Community Health Needs Assessment (CHNA).

“Our cross-sectional team facilitates community health improvement projects, in conjunction with THC members,” said Lauren Bartoszek, PhD, MCHES, assistant director, Population Health, THC. “This work includes the regional community health needs assessment (CHNA) every three years. But as we began preparing for the 2021 assessment cycle, we had been serving as the primary convener for Ohio’s Region 6, coordinating all response to the COVID-19 pandemic. From June 2020 on, our staff had produced a number of COVID-related reports so that our members and other stakeholder groups could better understand and address emerging community needs.”

While the COVID-19 response efforts continued to be a priority, THC still needed to help members and stakeholders fulfill their IRS and PHAB requirements of completing a CHNA to remain in alignment with non-profit hospital and local health department standards. Additionally, the feedback THC had received from prior CHNAs pointed to the region’s desire to see deeper community engagement; the inclusion of voices of marginalized populations; and the collection of additional social science data.

“The IRS and PHAB provide guidelines for conducting CHNAs — to measure the community’s health needs in a defined population,” said Lauren. “We knew we needed to understand the top concerns in health behaviors and conditions in our community. But we wanted to dig deeper to try to understand why people in different populations in different parts of the region are experiencing these at different rates. We framed the assessment around the five social determinants of health (SDOH) categories (economic stability; education access and quality; health care access and quality; neighborhood and built environment; and social and community context), as identified in Healthy People 2030.”

Leading up to the 2021 CHNA, dialogue was also elevated around racial inequities and systemic barriers as a result of the COVID-19 pandemic. The CHNA devoted research questions to help THC better understand these inequities and barriers specific to the region. THC also wanted providers’ perspectives related to how they experience their work, as they try to help meet individuals’ needs and address their health challenges.

The Research and the Results
In addition to an extensive review of current literature and existing community resources, Measurement Resources and Scale Strategic Solutions collected, analyzed, and synthesized feedback from 8,321 community survey respondents; 850 health and social work provider survey respondents; 38 interviews with system leaders; and 51 targeted focus groups. The final deliverables included an executive summary, full report, and 26 county-level reports. Visit THC’s website to read these reports.

“Over the years, we’ve heard anecdotally about individuals’ experiences navigating the health care system,” said Lauren. “But the data from this CHNA confirmed and quantified the countless stories that we knew to be true from providers, community members, and community organizations. Now, we have a really rich set of quantitative and qualitative data to support these real-life human stories.”

Another finding from the CHNA was that, while THC and its stakeholders have long understood that Ohio, as a state, doesn’t typically rank well in general health indices, the region actually is incredibly dense in terms of the number of providers and the variety of health services that are offered.

“Even with six or seven major hospital systems — statistically highly accessibility to resources — the region continues to rank poorly in many metrics, such as behavioral health, heart disease, access to preventive care for dental and vision, food security, and safe and stable housing — really basic needs,” said Lauren “It’s clear that, as a region, we really need to step up our support to meet our community’s basic needs.”

According to the findings, the three most prevalent health conditions in the region included cardiovascular-related conditions (such as hypertension), mental health-related conditions (such as depression and anxiety), and arthritis/osteoporosis. The three most untreated health conditions were vision, dental, and allergy.

“One thing that felt surprising to people was that dental was a top condition,” said Lauren “This finding has been a good reminder that when people don’t have access to care, they forego annual check-ups, like seeing their primary care physician to get their blood pressure taken, or seeing a dentist for their six-month cleaning. And it’s part of the larger story about lack of access to these services.”

The Community’s Response to the CHNA
The stakeholders’ initial responses to the CHNA results have compelled them to do more. And the breadth, depth, and scope of the CHNA has set the tone for collective action throughout the region.

“We now have this rich set of data that is stronger than any version of a CHNA that we have produced before,” said Lauren “Over 10,000 community members responded to at least one question on the survey with a total of 8,321 valid surveys included in the analysis, so there’s an underlying sense of urgency — our community has told us what’s wrong, and now we need to act.”

Since the completion of the CHNA, THC has continued to serve as the convener for its members and stakeholders, including a broad scope of community-based organizations. Together, these organizations have committed time, energy, and resources toward a collective effort to make an impact on a select number of issues that they will tackle and measure progress over the next three-to-five years.

“Throughout the process, the THC, GDAHA, Measurement Resources and Scale Strategic Solutions teams, and then also the community team represented by our Advisory Committee, which was a diverse committee of hospitals, health departments, and community-based organizations — we all met every single month and came to those meetings with the mindset of, ‘I have a role to play,” said Lauren. “It is not to do it all, but it is to do my role really well.’ I was so thankful for Measurement Resources and Scale, because we needed that additional capacity due to COVID, and while we didn’t have the capacity for survey creation, data collection, and analysis, we were able to ensure that we were that bridge to the region’s stakeholders and their networks.”