Evidence that collaborative action between local health departments and nonprofit hospitals helps foster healthy behaviors in communities: a multilevel study

Abstract

Background The Patient Protection and Affordable Care Act of 2010 (ACA) encouraged nonprofit hospitals to collaborate with local public health experts in the conduct of community health needs assessments (CHNAs) for the larger goal of improving community health. Yet, little is known about whether collaborations between local health departments and hospitals may be beneficial to community health. In this study, we investigated whether individuals residing in communities with stronger collaboration between nonprofit hospitals and local public health departments (LHDs) reported healthier behaviors. We further explored whether social capital acts as a moderating factor of these relationships. Methods We used multilevel cross-sectional models, controlling for both individual and community-level factors to explore LHD-hospital collaboration (measured in the National Association of County and City Health Officials (NACCHO) Forces of Change Survey), in relation to individual-level health behaviors in 56,826 adults living in 32 metropolitan and micropolitan statistical areas, captured through the 2015 Behavioral Risk Factor Surveillance System (BRFSS) SMART dataset. Nine health behaviors were examined including vigorous exercise, eating fruits and vegetables, smoking and binge drinking. Social capital, measured using an index developed by the Northeast Regional Center for Rural Development, was also explored as an effect modifier of these relationships. Results Stronger collaboration between nonprofit hospitals and LHDs was associated with not smoking (odds ratio, OR 1.32, 95% CI 1.11 to 1.58), eating vegetables daily (OR 1.29; 95% CI 1.06 to 1.57), and vigorous exercise (OR 1.17; 95% CI 1.05 to 1.30). The presence of higher social capital also strengthened the relationships between LHD-hospital collaborations and wearing a seatbelt (p for interaction = 0.01) and general exercise (p for interaction = 0.03). Conclusions Stronger collaboration between nonprofit hospitals and LHDs was positively associated with healthier individual-level behaviors. Social capital may also play a moderating role in improving individual and population health.

Effects of Body Mass Index and Pay-for-Performance Program on Risk of Death in Patients with Type 2 Diabetes: A Nationwide Cohort Study

“…The patients in the P4P group had an average of two more physician visits for diabetes than those in the comparison group. Wu et al [ 38 ] reported that participation in the P4P program might have reduced the risk of ER infection events and resulted in lower infection-related deaths in patients with type 2 diabetes. Despite the previous demonstration of the benefits of P4P participation for patients with diabetes in reducing the risk of death [ 14 , 37 ], there has been no report including BMI as a variable.…”

The Moderating Role of Caregiving on Fear of COVID-19 and Post-Traumatic Stress Symptoms

“…Informal caregiving, which is defined as the unpaid care provided to dependent relatives or family members [ 42 ], seems to increase even more the psychological consequences of the COVID-19 pandemic. Greater levels of anxiety, depression and even somatic symptoms have been found in this population [ 40 , 43 , 44 , 45 , 46 ], while its caregiving intensity and burden increased during this period [ 47 , 48 ]. Due to the complete closure of day-care centers, the loss of support services and the saturation of healthcare capacities, informal caregivers had played an even more important role during COVID-19 pandemic [ 43 , 49 , 50 ].…”

“…Greater levels of anxiety, depression and even somatic symptoms have been found in this population [ 40 , 43 , 44 , 45 , 46 ], while its caregiving intensity and burden increased during this period [ 47 , 48 ]. Due to the complete closure of day-care centers, the loss of support services and the saturation of healthcare capacities, informal caregivers had played an even more important role during COVID-19 pandemic [ 43 , 49 , 50 ]. For this reason, informal care has been considered an additional stressor that can negatively affect the physical and mental health of an already vulnerable population [ 43 , 51 , 52 , 53 ].…”

“…Due to the complete closure of day-care centers, the loss of support services and the saturation of healthcare capacities, informal caregivers had played an even more important role during COVID-19 pandemic [ 43 , 49 , 50 ]. For this reason, informal care has been considered an additional stressor that can negatively affect the physical and mental health of an already vulnerable population [ 43 , 51 , 52 , 53 ].…”

Network governance theory as basic pattern for promoting financial support system of the poor in Iranian health system

“…To efficiently serve the needy and achieve the mission of helping to improve their health, charitable organizations, for example, must coordinate and collaborate with counties, governorates, welfare organizations and relief councils, and medical universities. However, in the Iranian health system, such a partnership between these institutions has yet to be established [ 15 ].…”