Focus on What’s Important
The key concepts below underscore the importance of addressing factors that impact health in order to focus CHI efforts and prioritize community health needs.
Your assessment of needs and resources will yield a wealth of information including opportunities to improve community health. The challenge will be how to prioritize those opportunities to maximize impact while making the best use of your resources. Remember to consider in advance how the availability of effective policies and programs will affect the prioritization of opportunities identified.
- Processes and criteria that are open, transparent, and objective are used to set priorities
- Development of goals based on an analytic framework or logic model that conveys known or hypothesized causal pathways, upstream social and environmental determinants, and insights about what it takes to improve population health
Tools for Getting Started
Tools are listed below in an order roughly aligned with the order of the key concept(s) they support above.
- Developing and Using Criteria and Processes to Set Priorities
- Go to the Main Section, Checklist, and Tools tabs for guidance on how to decide which issues are the most important to address and the best strategies to address them.
- Guide to Prioritization Techniques
- This overview of widely used prioritization criteria and techniques includes guidance on which technique best fits your needs, step-by-step instructions for carrying out your effort(s), practical examples, and customizable templates.
- Developing a Framework or Model of Change
- Go to the Outline and Examples tabs for a step-by-step guide to developing a picture of the pathway from activities to intended outcomes, with additional related resources at each step. These sections also contain example frameworks and models for reference.
Relevant Excerpts from the Internal Revenue Service (IRS) Final Rule
The IRS Final Rule on Community Health Needs Assessments (CHNA) for Charitable Hospitals contains language related to select key concepts above. An excerpt of this language is provided below. To see the full regulation, click on the hyperlinked references below this paragraph.18
“[T]o ensure transparency with respect to a hospital facility’s prioritization, the final regulations, like the 2013 proposed regulations, require a hospital facility’s CHNA report to describe the process and criteria used in prioritizing the significant health needs identified. In addition, the final regulations require a hospital facility to take into account community input not only in identifying significant health needs but also in prioritizing them.”19
“These needs may include, for example, the need to address financial and other barriers to accessing care, to prevent illness, to ensure adequate nutrition, or to address social, behavioral, and environmental factors that influence health in the community.”20
Note: The above statements do not constitute legal advice or regulatory guidance from CDC. Questions regarding the application of law to a specific circumstance or circumstances should be submitted to an attorney or other qualified legal professional.
18Additional Requirements for Charitable Hospitals; Community Health Needs Assessments for Charitable Hospitals; Requirement of a Section 4959 Excise Tax Return and Time for Filing the Return, 79 Fed. Reg. 78,953 (December 31, 2014) (to be codified at 26 C.F.R. pts. 1, 53, and 602), available at IRS Final Rule on Community Health Needs Assessments (CHNA) for Charitable Hospitals .
19Id. at 78,963.
20Id. at 79,002.
CHI Guiding Principles
The following resources contain additional information about the underlying principles of collaborative CHI. The key concepts found in this section were derived from a review of these guiding principles.
- County Health Rankings and Roadmaps
- Georgia Health Policy Center Sustainability Framework
- Improving Community Health through Hospital–Public Health Partnerships
- Primary Care and Public Health: Exploring Integration to Improve Population Health (Institute of Medicine 2012)
- Principles to Consider for the Implementation of a Community Health Needs Assessment Process (Rosenbaum 2013)
- Robert Wood Johnson Foundation Culture of Health Prize Criteria
- Assessing and Addressing Community Health Needs: Go to Step 5: Define and Validate Priorities (pages 71–76) for an overview of how to set priorities, from establishing criteria to validation.
- Priority Setting Process Checklist: Go to pages 6-8 for assistance in using one of four priority-setting methods: dotmocracy, paired comparisons, decision boxes, and grid analysis.