1. Stabler, Henry S. MPH
  2. Begun, James W. PhD


Context: Nonprofit hospitals in the United States are required to conduct a community health needs assessment (CHNA) every 3 years to identify the most pressing health issues in their community and then develop an implementation strategy for addressing these health issues. CHNA reports must include "evaluation of the impact of any actions that were taken to address the significant health needs identified in the immediately preceding CHNA."


Objective: To determine whether and how nonprofit hospitals are responding to the requirement to evaluate their implementation strategies addressing their community's priority health needs.


Design: Using content analysis, we reviewed CHNA reports of all Minnesota nonprofit hospitals (n = 96) since regulations were finalized in December 2014.


Setting: Nonprofit hospitals in Minnesota.


Main Outcome Measure(s): Reports were coded to determine whether hospitals are responding to the evaluation requirement and the types of evaluation measures (process vs outcome indicators) used to assess hospitals' activities.


Results: Most of the reports (116 of 136 reports, or 85.3%) include narrative evaluating community benefit programs, showing widespread conformity with the IRS (Internal Revenue Service) mandate. All of the evaluations use process indicators, such as the number of individuals reached. More than half of the evaluations (64 of 116 reports, or 55.2%) also use outcome indicators, with many reporting short- and medium-term changes in health-related knowledge and behaviors. Use of outcome indicators increased substantially in CHNAs in the 2017-2020 period compared with 2015-2016.


Conclusions: In general, Minnesota hospitals are using program evaluation to assess their community benefit implementation strategies, although the extent to which they evaluate their strategies varies considerably between hospitals. While the use of outcome indicators of impact has increased over time, levels of use suggest the importance of incorporating public health expertise in CHNA work.