Studies have shown that community health workers (CHWs) can improve the effectiveness of health care systems; however, little has been reported about CHW program costs. We examined the costs of a program staffed by three CHWs associated with a small, rural hospital in Vermont. We used a standardized data collection tool to compile cost information from administrative data and personal interviews. We analyzed personnel and operational costs from October 2010 to September 2011. The estimated total program cost was $420,348, a figure comprised of $281,063 (67 %) for personnel and $139,285 (33 %) for operations. CHW salaries and office space were the major cost components. Our cost analysis approach may be adapted by others to conduct cost analyses of their CHW program. Our cost estimates can help inform future economic studies of CHW programs and resource allocation decisions.

Although process elements that define community-based participatory research (CBPR) are well articulated and provide guidance for bringing together researchers and communities, additional models to implement CBPR are needed. One potential model for implementing and monitoring CBPR is Action Learning Collaboratives (ALCs); short term, team-based learning processes that are grounded in quality improvement. Since 2010, the Prevention Research Center at Dartmouth (PRCD) has used ALCs with three communities as a platform to design, implement and evaluate CBPR. The first ALC provided an opportunity for academia and community leadership to strengthen their relationships and knowledge of respective assets through design and evaluation of community-based QI projects. Building on this work, we jointly designed and are implementing a second ALC, a cross-community research project focused on obesity prevention in vulnerable populations. An enhanced community capacity now exists to support CBPR activities with a high degree of sophistication and decreased reliance on external facilitation.

EXECUTIVE SUMMARYRecent changes in U.S. national policies and regulations have created an opportunity for meaningful collaborations to take place between health systems, public health departments, and social service organizations. For medical systems, and particularly tax-exempt hospitals, new requirements include community health assessments (CHAs) and implementation strategies to address identified health needs. Individuals and groups responsible for meeting the new CHA and implementation strategy requirements may be unsure about the best ways to achieve specific aspects of the CHA process. In this report, we provide an in-depth review and rating of tools developed by public health and community experts that cover the steps necessary to meet the new requirements. A team of three community and public health experts and the authors developed a rating sheet based on a well-known community health improvement process model and on the steps in the new requirements to identify and systematically rate nine comprehensive tools. The ratings and recommendations provide a guide for hospitals in choosing tools that will best assist them in meeting the new requirements.For more information about the concepts in this article, contact Dr. Schiffer-decker at Karen.E.Schifferdecker@dartmouth.edu. IOM, 2012) and Kania and Kramer (2011). Unfortunately, these efforts have yielded mixed results because of challenges associated with incentives, finances, regulations, and time, as well as a lack of shared knowledge, skills, purpose, and goals (Gale, Coburn, & Newton, 2014;Jones & Wells, 2007; Porterfield et al., 2012). HHS Public AccessRecent changes in U.S. national policies and regulations have created an opportunity for meaningful collaborations to take place between health systems, public health departments, and social service organizations that result in shared goals and interventions for population health improvement (Chok-shi, Singh, & Stine, 2014; Stoto, 2013). For medical systems, and particularly tax-exempt hospitals, these changes include the 2010 Affordable Care Act's (ACA) requirement that "tax-exempt hospitals conduct triennial community health needs assessments (CHNAs) with input from public health experts and other community stakeholders" (Gale et al., 2014), as well as adopt an implementation strategy to address identified population health needs (Berkery, 2013). These requirements are not trivial; hospitals failing to meet the CHA requirements can incur a $50,000 excise tax (Berkery, 2013).Although many U.S. hospitals conduct community needs assessments and develop implementation plans and have partnered with community stake-holders (Gale et al., 2014), a recent review of the community benefits provided by tax-exempt U.S. hospitals revealed that little is being spent on community health improvement (Young, Chou, Alexander, Lee, & Raver, 2013). This finding suggests that many hospitals will need to make significant investments of time and resources to meet the new requirements and provide evidence of meaningful pa...