THE AFFORDABLE CARE ACT, PUBLIC HEALTH ACCREDITATION, AND COMMUNITY HEALTH ASSESSMENT IN NORTH CAROLINA: 2007-2017

ECU Author/Contributor (non-ECU co-authors, if there are any, appear on document)

Kathryn Garner Dail (Creator)

Institution

East Carolina University (ECU )

Web Site: http://www.ecu.edu/lib/

Abstract: This study explored the reporting of health equity issues in public health-led community health assessments (CHAs) and the reporting of measurable outcomes in the public health-led community health assessments (CHIPs). Research design: The study used a cross-sectional descriptive-correlational approach to perform a secondary data analysis of CHA, CHIP, and SOTCH archived documents submitted to the N.C. Division of Public Health from North Carolina local health departments (LHDs). Sample: The sample included all CHAs (N = 200) from LHDs submitted between 2011 and 2017. The CHAs were used to investigate health equities. In addition to the CHAs, the most recent CHIP submitted by public health departments (N = 100) between the years 2011 and 2015 was selected to identify measurable outcomes. All 100 counties in N.C. are included in the analysis. For each CHIP, the interim SOTCH reports were selected to evaluate the success of the outcomes identified in the CHIPs. Research questions: The four research questions were: RQ1. What is the prevalence of health equity issues reported in the community health assessment? RQ2. Which characteristics or combination of characteristics are associated with the reporting of health equity issues? RQ3. What are the characteristics (interventions, outputs, and outcomes) of the most recent community health improvement plans submitted by the 100 counties and what level of progress on the health outcomes have been reported in the county health SOTCH documents? RQ4. Which characteristics or combination of characteristics are associated with successful outcomes? Findings: The health equity issues reported most frequently included race/ethnicity, gender, education, unemployment, and poverty. Health equity issues reported least often include incarceration, military (active duty, dependents, and veterans), visual, hearing, and mobility impaired, homelessness, and soil quality. Six predictor variables explained 37 percent of the variance in the number of health equities reported in the CHAs. The strongest predictor was using a vendor in the development of a CHA, with a beta value of .429. The analysis of 471 measurable outcomes in the sample showed that 59% were never reported as required by LHD accreditation. The results that were reported found that 24% could not be interpreted as presented in the SOTCH, and 12% were not achieved, 4% were partially achieved, and 2% were achieved. Practice implications were discussed including support for public health infrastructure, promotion of public-private partnerships, use of population health model with equity lens and disparity focus, and incorporation of results-based accountability for Healthy People 2030/Healthy NC 2030.

Additional Information

Publication

Dissertation

Language: English

Date: 2023

Subjects

Community Health Assessment

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