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Evidence that collaborative action between local health departments and nonprofit hospitals helps foster healthy behaviors in communities: a multilevel study

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Cramer, Geri Rosen, Young, Gary J., Singh, Simone, McGuire, Jean, Kim, Daniel·2021·BMC Health Services Research
DOI 10.1186/s12913-020-05996-8PMC PMC7777410
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Abstract

Background: The Patient Protection and Affordable Care Act of 2010 (ACA) encouraged nonprofit hospitals to collaborate with local public health experts in the conduct of community health needs assessments (CHNAs) for the larger goal of improving community health. Yet, little is known about whether collaborations between local health departments and hospitals may be beneficial to community health. In this study, we investigated whether individuals residing in communities with stronger collaboration between nonprofit hospitals and local public health departments (LHDs) reported healthier behaviors. We further explored whether social capital acts as a moderating factor of these relationships. Methods: We used multilevel cross-sectional models, controlling for both individual and community-level factors to explore LHD-hospital collaboration (measured in the National Association of County and City Health Officials (NACCHO) Forces of Change Survey), in relation to individual-level health behaviors in 56,826 adults living in 32 metropolitan and micropolitan statistical areas, captured through the 2015 Behavioral Risk Factor Surveillance System (BRFSS) SMART dataset. Nine health behaviors were examined including vigorous exercise, eating fruits and vegetables, smoking and binge drinking. Social capital, measured using an index developed by the Northeast Regional Center for Rural Development, was also explored as an effect modifier of these relationships. Results: Stronger collaboration between nonprofit hospitals and LHDs was associated with not smoking (odds ratio, OR 1.32, 95% CI 1.11 to 1.58), eating vegetables daily (OR 1.29; 95% CI 1.06 to 1.57), and vigorous exercise (OR 1.17; 95% CI 1.05 to 1.30). The presence of higher social capital also strengthened the relationships between LHD-hospital collaborations and wearing a seatbelt (p for interaction = 0.01) and general exercise (p for interaction = 0.03). Conclusions: Stronger collaboration between nonprofit hospitals and LHDs was positively associated with healthier individual-level behaviors. Social capital may also play a moderating role in improving individual and population health.

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  • A patient's health information may be distributed among multiple healthcare facilities and is not interchangeable or accessible to another health institution.

    “The health information of a patient may be distributed among an unspecified number of healthcare facilities. A hospital's medical information are not interchangeable and accessible to another health institution.”

    From Interoperability of heterogeneous health information systems: a systematic literature review (2023) · cites this paper as [7]

  • In a given situation, a health professional does not have access to the whole of a patient's medical information unless the patient is conscious and can provide the required information.

    “In a given situation, the health professional does not have access to the whole of the patient's medical information unless the patient is conscious and can provide the information that the health professional requires to make an informed and individualized decision on the best course of action at the time [7].”

    From Interoperability of heterogeneous health information systems: a systematic literature review (2023) · cites this paper as [7]

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  1. [30]Chaudhary KR, Schreiber-Gregory DN. Multiple Imputation for Arbitrary Missing Data: SAS® and R. Available at: https://www.mwsug.org/proceedings/2015/TT/MWSUG-2015-TT-04.pdf. Published: 2015.

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Authors
Cramer, G. R., Young, G. J., Singh, S., McGuire, J., & Kim, D.
Affiliations
  • Northeastern University (US)
  • University of Michigan (US)
Corresponding author
Kim, Daniel
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2021-01-02
Volume
21
Issue
1
Pages
1-1
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/s12913-020-05996-8
PMC
PMC7777410
OpenAlex
W3119111511
Cited by
179
References
21
Citations by year
2026: 5 · 2025: 52 · 2024: 38 · 2023: 28 · 2022: 44 · 2021: 12
FWCI
34.54
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • University of Michigan Library
Topics
  • Health Sciences › Health Professions › General Health Professions › Community Health and Development
  • Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
local health departments, nonprofit hospitals, community health needs assessment, social capital, health behavior, smoking, fruit and vegetable intake, physical activity, seat belt use, binge drinking, Affordable Care Act, community health
MeSH terms
Adult, Cross-Sectional Studies, Hospitals, Humans, Organizations, Nonprofit, Public Health, United States, Health Behavior, Patient Protection and Affordable Care Act

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