The data for assessing the level of collaboration between LHDs and nonprofit hospitals came from the 2015 Forces of Change Survey administered by the National Association of County and City Health Officials (NACCHO). This survey was developed to measure the impacts of economic forces on the budget, staff, and programs of LHDs. The survey was administered to a subset of the nearly 3000 LHDs across the country using stratified random sampling (on state and size of population in the LHD jurisdiction) [21 ]. Nine hundred and forty-eight (948) LHDs were randomly selected, of which 690 LHDs participated (73% response rate). Approximately 77% of the included LHDs reported having at least one nonprofit hospital in their jurisdiction (n = 519).
We used each LHD’s response to a single question as a proxy for whether it had a long-standing collaboration with nonprofit hospitals in the community for which the LHD was responsible [22 , 23 (link)]. The survey question asks “Is your LHD included in any nonprofit hospital’s implementation plan for the community health needs assessment (CHNA)?” Response options included: no collaboration, participating in the development of a hospital implementation plan, listed as a partner in a hospital implementation plan, conducting an activity together in a hospital implementation plan, and using the same implementation plan as the hospital. Because we were interested in identifying established collaborations between LHDs and hospitals within local communities, we created a binary variable indicating “long-standing collaboration” for those LHDs that reported conducting an activity together or using the same implementation plan as the nonprofit hospital in their community. Although the survey question did not specify a defined time period for reported LHD-hospital collaboration, such CHNA implementation efforts typically entail multiple years of activity. Accordingly, we interpreted LHD responses indicating a joint effort for implementing community health needs assessments to be reflective of relatively long-standing relationships (or lack thereof) between an LHD and one or more nonprofit hospitals in a community. While this variable lacked granularity in terms of the nature, strength, and scale of LHD-hospital collaboration (e.g., the content of implementation plans was not known), previous research suggests that any level of meaningful, ongoing collaboration between these two sectors within the same community is uncommon [24 (link)]. Thus, we constructed this variable to measure if such collaboration is associated with positive individual-level health outcomes.
We used each LHD’s response to a single question as a proxy for whether it had a long-standing collaboration with nonprofit hospitals in the community for which the LHD was responsible [22 , 23 (link)]. The survey question asks “Is your LHD included in any nonprofit hospital’s implementation plan for the community health needs assessment (CHNA)?” Response options included: no collaboration, participating in the development of a hospital implementation plan, listed as a partner in a hospital implementation plan, conducting an activity together in a hospital implementation plan, and using the same implementation plan as the hospital. Because we were interested in identifying established collaborations between LHDs and hospitals within local communities, we created a binary variable indicating “long-standing collaboration” for those LHDs that reported conducting an activity together or using the same implementation plan as the nonprofit hospital in their community. Although the survey question did not specify a defined time period for reported LHD-hospital collaboration, such CHNA implementation efforts typically entail multiple years of activity. Accordingly, we interpreted LHD responses indicating a joint effort for implementing community health needs assessments to be reflective of relatively long-standing relationships (or lack thereof) between an LHD and one or more nonprofit hospitals in a community. While this variable lacked granularity in terms of the nature, strength, and scale of LHD-hospital collaboration (e.g., the content of implementation plans was not known), previous research suggests that any level of meaningful, ongoing collaboration between these two sectors within the same community is uncommon [24 (link)]. Thus, we constructed this variable to measure if such collaboration is associated with positive individual-level health outcomes.
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