HOSPITAL CROSS-SECTOR PARTNERSHIPS TO PROMOTE POPULATION HEALTH

Abstract

Health reform efforts continue to hold hospitals accountable for the care they provide by connecting hospital payments to hospital quality. With an understanding that there is no one size fits all solution and a long history of operating within the silo of the medical sector, hospitals have slowly begun to look beyond health care and invest in population health strategies. These upstream strategies usually promote health and wellbeing by addressing the social needs of patients and the social determinants of health: the conditions in which we live, work, and play. The central research question asks if hospital investments in population health strategies improve hospital quality of care. As cross-sector partnerships have long been at the center of solving large population health concerns, this dissertation seeks to assess how hospitals are engaging partners across-sectors, establish a taxonomy of hospital partnership engagement, and examine variation in hospital and community characteristics across the taxonomy in Chapter Two. This taxonomy will then be used to assess the provision of community-oriented health services in Chapter Three and readmission rates in Chapter Four. Data sources include the 2018 American Hospital Association Annual Survey Database, Area Health Resource Files, Minority Health Social Vulnerability Index, Care Compare data for unplanned readmission rates, and the Centers for Medicare and Medicaid Services’ Impact File. The analysis resulted in a four-cluster taxonomy of hospital partnership engagement (HPE) that ranged from little to no partnerships to many partnerships and often at formal levels of engagement. In general, partnership engagement increased with hospital size, teaching status, nonprofit ownership, multihospital systems, greater proportions of Medicaid discharges, urbanicity, hospital competition, median home value, household income, educational attainment, and non-white population. Partnership engagement declined with the proportion of Medicare discharges, critical access hospitals, and sole community providers shortage area designation, poverty, and elderly populations. HPE was also found to be a significant predictor of the total sum of community health services provided by hospitals, as well as each of those services, even after accounting for state-level effects. Lastly, high levels of HPE were associated with lower 30-day unplanned readmission rates. Results demonstrate an association between HPE and hospital quality, indicating that hospital investments in population health strategies can improve hospital quality.