Dr. Gray is a young, bright emergency medicine physician who recently relocated to Austin, Texas, to start his first job as an attending. Nervous and excited, Dr. Gray is eager to explore the lively city of Austin and start practicing emergency medicine on his own. After a few months in the city, he noticed higher rates of obesity, homelessness, and uncontrolled diabetes among his patients compared to his prior practice setting. Curious and well-informed, Dr. Gray reaches for Austin’s Community Health Needs Assessment (CHNA) to further investigate the city’s health needs. As he reads through the CHNA document, he begins to see how local housing insecurity, food deserts, and gentrification are contributing to higher rates of obesity, and uncontrolled diabetes in the city.
The next morning, a 40-year-old woman presents to the emergency department (ED) with complaints of cough and nasal congestion. History reveals the patient has type two diabetes mellitus and is on insulin but with no other comorbidities. Investigations reveal a random blood glucose of 400mg/dl, but the patient is asymptomatic despite the elevated blood sugar. While counseling the patient regarding her blood sugar and the importance of compliance with insulin administration, Dr. Gray decides to go one step further by asking the patient about her housing and food needs. He delicately probes into the patient’s social needs and recognizes that the patient lives in a food desert and struggles to afford healthy options. Dr. Gray quickly connects her to a compassionate social worker who helps the patient identify food pantries with healthy foods in her zip code. The above example highlights the significance of the CHNA as a resource for emergency providers (EP) to deliver improved patient-centered care.
A Community Health Needs Assessment (CHNA), also called Community Health Assessment (CHA), is a thorough evaluation conducted at the state, tribal, local, or territorial level to identify significant health needs and concerns. This assessment is carried out through a systematic and comprehensive process of collecting and analyzing large community-related data with a focus on gaining insights into the various health issues within a community. CHNAs provide comprehensive information on the social determinants of health (SDOH), such as education, environment, housing, socioeconomic status, health insurance access, health care access, and morbidity and mortality statistics.
According to the World Health Organization (WHO), SDOHs are “non-medical factors that influence health outcomes.” These factors include circumstances in which people are born and raised, their employment, place of residence, age, and other broad range of systems that influence their daily living conditions. Research has shown that SDOH accounts for 30 to 55 percent of health outcomes, contributing to increased morbidity and mortality. For example, a lack of health insurance can cause limited access to primary, preventive, and specialty health care services, which could in turn result in delayed diagnoses, inadequate treatment, and suboptimal management of chronic conditions. Individuals of low socioeconomic status often face challenges in accessing healthy food and safe housing, leaving them to consume “junk food,” which can increase their risk of obesity, cardiovascular disease, mental health issues, and lead to overall poorer health outcomes.
Considering the above, EPs can leverage information from the CHNA to create SDOH screening tools that can be used to routinely ask patients about their social circumstances, like housing stability, access to healthy food, employment, and social support. Based on the information gathered, EPs can refer patients to appropriate community resources such as social workers, community health centers, housing assistance programs, food banks, mental health services, and other support services. By facilitating these connections, EPs help address the underlying social factors that affect patient health outcomes, ensure comprehensive patient care beyond the ED visit, and, most importantly, prevent unnecessary ED visits.
Information provided in the CHNA is easily accessible. Because the Affordable Care Act mandates nonprofit hospitals to complete a CHNA as a condition for their federal tax-exempt status, CHNAs must be done once every three years and must be made publicly available. Thus, this invaluable ready-to-go resource can equip EPs with base information that makes “big” issues seem less daunting. CHNA provides an excellent evidence-based framework and starting point for EPs to decide how and where they would like to make an impact in the communities they serve. EPs can leverage partnerships with community health organizations listed in the CHNA to make meaningful health differences in their communities. For example, they can collaborate with social workers, case managers, community organizations, and governmental agencies listed in the CHNA to hold various community outreach health programs like health education seminars on diabetes and hypertension and health counseling and screenings. This collaboration will ensure that patients receive the appropriate social assistance they need.
Although the importance of the CHNA is widely recognized in public health and policymaking, its significance to EPs is still very much untapped. In today’s dynamic health care landscape, the role of EPs should extend beyond the immediate treatment of acute illnesses and injuries. As the health care landscape continues to evolve, it is crucial for EPs to be aware of and responsive to the unique health needs of the populations and communities they serve. The CHNA is a vital tool that can aid in this process. The CHNA is an easily accessible, comprehensive document that can provide any EP with information necessary to deliver well-informed, patient-centered care and serve as a stepping stone for effective upstream and downstream health care interventions. EPs can leverage the invaluable insights that CHNAs provide to address specific health challenges a community faces. Recognizing the significance and benefits of the CHNA, as well as incorporating this tool into their daily practice, EPs can enhance their ability to address specific health challenges in their community, improving patient outcomes and promoting overall community well-being.
Benjamin O. Aiwonodagbon and Mary O. Peter are physician scientists. Peter S. Yun is an emergency medicine resident. Emmanuel C. Ohuabunwa is an emergency physician.
