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Desired State: A Unified Community Health Improvement Framework Supporting Multiple Stakeholders

This model illustrates the operation of a desired state of a unified community health improvement framework that supports multiple stakeholders, including tax-exempt hospitals, health departments, federally qualified health centers, and other community organizations. The four phases of this framework are assessment, planning, implementation, and monitoring and evaluation. The final output is improved health outcomes.

In this framework, assessment, planning, implementation, and monitoring and evaluation are supported by data and analytic decision tools. Transparency, a central principle present in all phases of the community health improvement framework, is realized through several reporting requirements, including section 501(r) of the Internal Revenue Code, IRS Form 990 Schedule H, Public health Accreditation, and nonprofit hospital community benefit reporting as outlined in 26 USC § 501(c)(3) and IRS Revenue Ruling 69-545.

The following key issues promote alignment between public health accreditation, nonprofit hospital community benefit, and other community-oriented processes, ordered by phase:

  • Community engagement and assuring shared ownership are overarching issues that must be addressed across all phases of this framework.
  • These are the key issues to address in the assessment phase:
    • Arranging assessments that span jurisdictions.
    • Using small area analysis to identify communities with health disparities.
    • Collecting and using information on social determinants of health.
    • Collecting information on community assets.
  • These are the key issues to address in the planning phase:
    • Using explicit criteria and processes to set priorities (use of evidence to guide decision-making.
    • Assuring shared investment and commitments of diverse stakeholders.
  • The key issue to address in the implementation phase is collaborating across sectors to implement comprehensive strategies.
  • The key issue to address in the monitoring and evaluation phase is participatory monitoring and evaluation of community health improvement efforts.
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