Beyond CHNAS: Performance Measurement for Community Health Improvement
Authors: Stoto Michael A. , Davis Mary V. , Atkins Abby 
Published: August 2019

Research Objective: Non-profit hospitals are required to work with community
organizations to prepare Community Health Needs Assessment (CHNA) and implementation
strategy (IS). In concert with the health care delivery system’s transformation from
volume to value and efforts to enhance multi-sector collaboration, such community health
improvement (CHI) processes have the potential to bridge efforts of the health care
delivery sector, public health agencies, and community organizations to improve
population health. Having a shared measurement system is critical to achieving
collective impact, yet despite the availability of community-level data from a variety
of sources, many CHI processes lack clear, measurable objectives and evaluation plans.
Through an in-depth analysis of ten exemplary CHI processes, we sought to identify best
practices for population health measurement with a focus on monitoring collaborative
implementation strategies.Study Design: Based on a review of the scientific literature,
professional publications and presentations, and nominations from a national advisory
panel, we identified 10 exemplary CHI processes. Criteria of choice were whether (1) the
CHIs articulate a clear definition of intended outcomes; (2) clear, focused, measurable
objectives and expected outcomes, including health equity; (3) expected outcomes are
realistic and addressed with specific action plans; and (4) whether the plans and their
associated performance measures become fully integrated into agencies and become a way
of being for the agencies. We then conducted an in-depth analysis of CHNA, IS, and
related documents created by health departments and leading hospitals in each
process.Population Studied: U.S. hospitals.Principal Findings: Community health
improvement processes benefit from a shared measurement system that indicate
accountability for specific activities. Despite the importance of measurement and
evaluation, existing community health improvement efforts often fall short in these
areas. There is more variability in format and content of ISs than CHNAs; the most
developed models include population-level goals/objectives and strategies with clear
accountability and metrics. Other hospital IS’s are less developed.Although all U.S.
hospitals are familiar with performance measurement in their management, this
familiarity does not seem to carry over to Community Benefit and CHNA efforts. Indeed, 5
of the 10 CHI processes we examined have some Accountable Care Organization (ACO)
involvement, where population-health performance measures are commonplace. Yet this
involvement is not mentioned in the CHNAs and ISs, nor are ACO data cited.Conclusions:
Strengthening the CHNA regulations to require that hospitals report the evaluation
measures they intend to monitor based on an established community health improvement
model could help communities demonstrate impact. As in other areas of health care,
performance measures should be tailored to implementation strategy, with clear
indication of accountability, and move from outputs to process and outcome measures with
established validity and reliability.Implications for Policy or Practice: Although
performance measurement is now commonplace throughout the health care system, the
individuals who manage CHI processes may not be that familiar with this approach. This
suggests that it is important to develop practitioners’ knowledge and skills needed to
use it population health data effectively.