February HDRG Recap: Community Health Needs Assessment

At the February 17, 2017 meeting of the Health Disparities Research Group (HDRG) Dr. Thomas Shaw and Dr. Jaclyn Bunch of the Department of Political Science and Criminal Justice provided an overview of the 2015-2016 Community Health Needs Assessment (CHNA) they conducted for the USA Health System.  As director of the USA polling Group/Survey Research Center, Dr. Shaw was approached about conducting the assessment for the USA Medical System in March of 2016.

The CHNA is a requirement for not-for-profit hospitals under the Patient Protection and Affordable Care Act. The assessment, conducted every three years, “should define the community, solicit input regarding the health needs of the community, assess and prioritize those needs, identify relevant resources, and evaluate any actions taken since preceding CHNAs.” To this point, Dr. Shaw and Dr. Bunch explained the methodology for the 2015-2016 CHNA:

  • Specify the relevant community served by the USA Health System — USA Medical Center, USA Children’s and Women’s Hospital, and Mitchell Cancer Institute
  • Create a comprehensive demographic profile using secondary data sources that provides information on the makeup of the community and prevalent conditions.
  • Conduct a telephone survey of individuals living in the defined community (Mobile County)

In discussing the demographic profile, Dr. Bunch pointed out some concerning trends for Mobile county, including:

  • While the 20% of individuals living below the poverty line remained steady between 2010 and 2015, the percentage of individuals near poverty (100%-149% Federal Poverty Level) increased.
  • While the percentage of residents who have a high school diploma has increased in the county, it is still far behind the rest of the country in terms of those who obtain a bachelor’s degree.
  • Infant death rates rose from 7.5 in 2010 to 10.2 in 2014. Among African Americans, the increase was 11.5 in 2010 to 14.4 in 2014.

After the discussion of the demographic profile,  Dr. Shaw explained that the telephone survey was modeled on a similar survey that Mobile Infirmary conducted with healthcare providers. They then compared the responses from the provider survey with the community survey. They used two key sampling elements:

  • General community survey using a standard random digit dialled survey of residents of Mobile County (both landline and cell phones). This segment included 263 respondents from Mobile County.
  • Focused community survey included 257 respondents from zip codes within Mobile County where most USA Health System patients reside. To be included in this focused sample, the zip code area had to have at least 50 patients visiting either the USA Medical Center or the USA Children’s and Women’s hospital in fiscal year 2015.

The responses from the community survey were compared with those of the Mobile Infirmary provider survey. The responses showed striking differences between community members and healthcare providers on the “features of a healthy community”and “most important health issues;” however, there was considerable agreement between the community and providers over what healthcare services were difficult to obtain in Mobile County.


The final CNHA was presented to the Board of Trustees in August of 2016. Both the report and the recommendations for actions were approved by the board. The researchers commended the Board on its willingness to undertake a stringent assessment process and the development of more focused, quantifiable recommendations for meeting needs.

The 2015-2016 Community Health Needs Assessment is available online from the Health System.

Watch the presentation video.