Guidance on hospital community benefit programs

A new analysis led by the University of Pittsburgh Graduate School of Public Health offers insights for nonprofit hospitals in implementing community health improvement programs. In a special issue of the Journal of Health Care for the Poor and Underserved that focuses on the Affordable Care Act (ACA), a multidisciplinary team of Pitt researchers explore published research on existing community benefit programs at U.S. hospitals and explain how rigorous implementation of such programs could help hospitals both meet federal requirements and improve the health of the populations they serve.

"Hospitals have long provided uncompensated care to people who could not otherwise afford it, and this in part has justified their nonprofit status. One goal of the ACA is to provide health insurance to more individuals, thereby potentially reducing uncompensated care," said lead author Jessica Burke, Ph.D., M.H.S., associate professor of community and behavioral health sciences at Pitt Public Health. "By working with public health professionals, hospitals can design and implement effective community benefit programs, such as preventative care outreach, that will improve the health of people in their service area and ultimately support continued nonprofit status."

Dr. Burke and her colleagues note that "community health needs assessments," which are required by the ACA and rely on large surveys and input from community stakeholders, including minorities and underserved populations, can provide information to help guide the development of community benefit programs, as well as provide data needed to assess their impact.

By evaluating 106 scientific articles detailing hospital-based community benefit programs, Dr. Burke and her colleagues were able to categorize the programs into those based in the hospital and those administered at a community facility, finding that the programs were split almost evenly.

Hospital-based programs typically included preventative screenings or health education. Outside the hospitals, the programs included hospital after-care and benefits and coverage counseling, but were largely community-based programs, either with or without a community partner organization, such as a local school or community center.

"More than 80 percent of the community-based programs included a community partner, which can facilitate greater reach into a community," said Dr. Burke. "The more you can engage the community in the benefit programs you are trying to provide, the greater the likelihood of a positive outcome."

The analysis reinforces the value hospitals and health systems can derive from partnering with public health professionals to design their community health needs assessments and determine the best community benefit programs to address those needs, said senior author Everette James, J.D., M.B.A., professor of health policy and management in Pitt Public Health and director of Pitt's Health Policy Institute.

"Public health researchers add methodological rigor and experience with a range of evidence-based interventions to hospital community health implementation strategies," said Mr. James, who recently served as the 25th Pennsylvania Secretary of Health. "Our study is intended to strengthen this link between hospital programs and population health, and to provide useful information for hospitals and their public health partners as they comply with new ACA requirements."

UPMC worked with Dr. Burke and her colleagues at Pitt Public Health and Pitt's Health Policy Institute to conduct community health needs assessments for 13 of its hospitals, which the health system then used to guide its community benefit programs and set community health improvement goals.

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Vaccine education programs may not work as hoped

NEW YORK (Reuters Health) - Education campaigns that aim to inform people about the benefits of vaccines do little to increase the intent of parents to vaccinate their future children, according to a new study.

Furthermore, researchers found that among a group of parents who were least likely to vaccinate their future children, some education campaigns actually added to their reservations.

The study's lead author told Reuters Health that the research is an extension of his work in political science that found it is difficult to correct people's misinformation.

"We found political misinformation is often very difficult to correct and giving people the correct information can backfire," said Brendan Nyhan, a political scientist at Dartmouth College in Hanover, New Hampshire.

"We were interested in seeing if the messages public health agencies were putting out were effective," he said.

Specifically, Nyhan and his colleagues examined public health campaigns about the measles-mumps-rubella (MMR) vaccine.

Although national U.S. MMR vaccination rates are high, the researchers write in Pediatrics that there are states where the rate dips below 90 percent, which is a commonly used threshold for so-call herd immunity. Herd immunity is the point where high vaccination rates within a population may also offer protection to the unvaccinated.

They also write that maintaining high levels of MMR vaccination is important because of the increasing number of measles cases reported in the U.S. and recent outbreaks in the UK. Measles is a highly contagious respiratory disease that can lead to death.

Another study published by Centers for Disease Control and Prevention (CDC) researchers in the same journal found that vaccinating U.S. kids born in 2009 according to the routine immunization schedule will save about $70 billion and prevent over 40,000 early deaths and over 20 million cases of disease.

For their new study, Nyhan and his colleagues used data from nationally representative surveys conducted in June and July 2011 of 1,759 parents who were at least 18 years old.

During one survey, parents were asked for general information about the health of their children and about their attitudes toward vaccination.

The parents were then randomly assigned to receive one of five messages an average of 12 days later and surveyed again after that.

The first message or campaign used information from the CDC to correct misinformation that the MMR vaccine causes autism, a belief that has been disproven.

The second and third campaigns also used materials from the CDC to present information on the risk of the preventable diseases or a story about one woman's experience with her son being hospitalized with measles.

The fourth campaign consisted of pictures of children who had each disease.

Another group of parents was asked to read information about the cost and benefits of bird feeding to act as a comparison group.

During the second survey, there was no significant increase in parents' intents to vaccinate their future children, but those who received the CDC information debunking the link between the MMR vaccine and autism had fewer misperceptions about that topic.

However, among the one third of people who were least likely to vaccinate any future children they may have, getting those same materials was linked to an even lower likelihood that they would vaccinate.

That strengthening of convictions among the least likely to vaccinate may be due to those people coming up with other arguments to support their beliefs, the researchers write.

"We can't look inside their head," Nyhan said, adding that it's a theoretical interpretation but consistent with other research.

The researchers also found the campaigns aimed at stressing the dangers of the preventable diseases only increased parents' misperceptions.

"We need to test public health messages of all sorts to see if they're effective - especially with some sub-populations that may be resistant to some public health messages," Nyhan said.

Dr. Mary Healy said it's also important that there not be just one mass-market public health campaign addressing vaccines.

"This is very important research, because any public health campaign we release we have to make sure they're effective," said Healy, from the Center for Vaccine Awareness and Research at Texas Children's Hospital in Houston. She was not involved with the new research.

Healy said the study also emphasizes the role of the relationship between the parent and healthcare provider in clearing up misinformation.

"If I had any message, you need to talk to your healthcare provider and bring your worries to your healthcare provider," she said.

SOURCES: bit.ly/1n2APr0 and bit.ly/1n2AS6l Pediatrics, online March 3, 2014.

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