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Purpose: Buprenorphine is a highly effective medication for opioid use disorder (OUD) that remains substantially underutilized by primary care professionals (PCPs). This is particularly true in rural communities, which have fewer prescribers and significant access disparities. The Drug Enforcement Administration removed the X‐waiver requirement in December 2022, yet many rural clinicians still report barriers to prescribing buprenorphine. In this study, we examined rural PCPs' experiences with buprenorphine to identify tailored training strategies for rural practice. Methods: Physicians, nurse practitioners, and physician associates practicing in rural Ohio counties were recruited through contacts at statewide health associations and health professions training programs. Twenty‐three PCPs were interviewed about their perspectives on prescribing buprenorphine, including their training history. Findings: PCPs self‐reported being motivated to respond to OUD. However, they also reported that current training efforts failed to equip them with the knowledge and resources needed to prescribe effectively, and that urban‐focused training often alienated rural clinicians. Participants suggested tailoring training content to rural settings, using rural trainers, and bolstering confidence in navigating rural‐specific barriers, such as resource deficits and acute opioid fatigue. Conclusion: Our study found that current training on buprenorphine prescribing is inadequate for meeting the needs of rural PCPs. Tailored buprenorphine training is needed to improve accessibility and acceptability, and to better support the clinical workforce in communities disproportionately impacted by the opioid epidemic. [ABSTRACT FROM AUTHOR]

A significant challenge in the United States' response to COVID-19 continues to be wide variation in the extent to which individuals believe the virus is a credible health threat and are willing to undertake measures to protect personal and public health. In this study, data were collected from a national sample of 1141 participants from the United States to examine how beliefs and behavioral responses to COVID-19 have been shaped by sociopolitical characteristics. The relationships between social predictors; perceived severity, knowledge, and fear of the virus; and health behaviors were tested using path analysis. Social characteristics significantly predicted perceived severity, knowledge, and fear, as well as health behaviors, even after controlling for an objective indicator of the risk of contracting the virus. Our findings suggest that perceptions and knowledge of the virus, especially believing that the virus poses a serious threat to one's individual health, are important determinants of behavior, but also that perceptions and knowledge are strongly driven by social and cultural factors above and beyond political affiliation., Author(s): Berkeley Franz [sup.1] , Lindsay Y. Dhanani [sup.2] Author Affiliations: (1) grid.20627.31, 0000 0001 0668 7841, Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, , Grosvenor [...]

Objectives: To investigate the availability of Alzheimer's Centers (ACs) in US hospitals. Methods: Utilizing the American Hospital Association Annual Survey, Area Health Resource File, and US Census (n = 3251), we employed multivariable logistic regression to examine hospital, county, and regional predictors of AC availability. Results: Large hospitals (>399 beds) had approximately 14 times higher odds of having an AC than small hospitals (<50 beds; OR = 14.0; 95% CI = 6.44 – 30.46). Counties with a higher proportion of Latino residents, relative to non-Latino Whites, had lower odds of having an AC (OR =.05; 95% CI =.01 –.41). Northeastern (OR = 1.92; 95% CI = 1.15 – 3.22) and Midwestern (OR = 2.12; 95% CI = 1.34 – 3.37) hospitals had higher odds of having an AC than Southern hospitals. Discussion: To address dementia needs and disparities, investment in a national infrastructure is critical. [ABSTRACT FROM AUTHOR]

Background: Nonprofit hospitals are required to conduct community health needs assessments (CHNA) every 3 years and develop corresponding implementation plans. Implemented strategies must address the identified community needs and be evaluated for impact. Purpose: Using the Community Health Implementation Evaluation Framework (CHIEF), we assessed whether and how nonprofit hospitals are evaluating the impact of their CHNA-informed community benefit initiatives. Methodology: We conducted a content analysis of 83 hospital CHNAsthat reported evaluation outcomes drawn from a previously identified 20% random sample (n = 613) of nonprofit hospitals in the United States. Through qualitative review guided by the CHIEF, we identified and categorized the most common evaluation outcomes reported. Results: A total of 485 strategies were identified from the 83 hospitals' CHNAs. Evaluated strategies most frequently targeted behavioral health (n = 124, 26%), access (n = 83, 17%), and obesity/nutrition/inactivity (n = 68, 14%). The most common type of evaluation outcomes reported by CHIEF category included system utilization (n = 342, 71%), system implementation (n = 170, 35%), project management (n = 164, 34%), and social outcomes (n = 163, 34%). Practice Implications: CHNA evaluation strategies focus on utilization (the number of individuals served), with few focusing on social or health outcomes. This represents a missed opportunity to (a) assess the social and health impacts across individual strategies and (b) provide insight that can be used to inform the allocation of limited resources to maximize the impact of community benefit strategies. [ABSTRACT FROM AUTHOR]

This article examines the theoretical basis of the community as it is evoked in health evaluation. In particular, we examine how hospitals carrying out Community Health Needs Assessments (CHNAs) define communities as well as the implications for these definitions for how to study and engage community problems. We present qualitative findings from a sample of Appalachian nonprofit hospitals, who we asked to describe their approach to defining the community in their most recent Internal Revenue Service-mandated CHNA. Drawing upon a theoretical debate in the history of evaluation research, the authors argue that the contemporary community cannot be circumscribed merely by geographic boundaries, nor can it be identified easily with a bounded group of clearly demarcated individuals. Instead, following the tenets of community-based health research, the authors argue for a richer, more dynamic conceptualization of the community in evaluation research in which definitions arise from community bodies themselves.

Objective: The aim was to identify hospital and county characteristics associated with variation in breadth and depth of hospital partnerships with a broad range of organizations to improve population health. Data Sources: The American Hospital Association Annual Survey provided data on hospital partnerships to improve population health for the years 2017–2019. Design: The study adopts the dimensional publicness theory and social capital framework to examine hospital and county characteristics that facilitate hospital population health partnerships. The two dependent variables were number of local community organizations that hospitals partner with (breadth) and level of engagement with the partners (depth) to improve population health. The independent variables include three dimensions of publicness: Regulative, Normative and Cultural‐cognitive measured by various hospital factors and presence of social capital present at county level. Covariates in the multivariate analysis included hospital factors such as bed‐size and system membership. Methods: We used hierarchical linear regression models to assess various hospital and county factors associated with breadth and depth of hospital‐community partnerships, adjusting for covariates. Principal Findings: Nonprofit and public hospitals provided a greater breadth (coefficient, 1.61; SE, 0.11; p < 0.001 and coefficient, 0.95; SE, 0.14; p < 0.001) and depth (coefficient, 0.26, SE, 0.04; p < 0.001 & coefficient, 0.13; SE, 0.05; p < 0.05) of partnerships than their for‐profit counterparts, partially supporting regulative dimension of publicness. At a county level, we found community social capital positively associated with breadth of partnerships (coefficient, 0.13; SE, 0.08; p < 0.001). Conclusions: An environment that promotes collaboration between hospitals and organizations to improve population health may impact the health of the community by identifying health needs of the community, targeting social determinants of health, or by addressing patient social needs. However, findings suggest that publicness dimensions at an organizational level, which involves a culture of public value, maybe more important than county factors to achieve community building through partnerships. [ABSTRACT FROM AUTHOR]

Vaccination is an effective public health initiative to reduce severe illness and death due to COVID-19. Vaccine uptake in the United States has been uneven, however. One proposed mechanism to improve vaccine uptake is to engage religious groups to provide health information and encourage vaccination. It remains unclear though if Americans with differing racial/ethnic identities and religious affiliations are equally likely to receive health-related information in religious settings and endorse COVID-19 vaccination. We assessed data from the 2020–2021 National Politics Study, which utilized a national research panel of U.S. adults. Using logistic regression and a treatment effects approach, we found that having heard health-related messages in religious settings and endorsing progressive religious ideology were associated with increased COVID-19 and flu vaccine acceptance. This relationship was stronger among White American worship-goers. These findings suggest that partnerships with religious organizations may be important if additional barriers to vaccination are also addressed. [ABSTRACT FROM AUTHOR]

Purpose: Greater health care engagement with social determinants of health (SDOH) is critical to improving health equity. However, no national studies have compared programs to address patient social needs among critical access hospitals (CAHs), which are lifelines for rural communities. CAHs generally have fewer resources and receive governmental support to maintain operations. This study considers the extent to which CAHs engage in community health improvement, particularly upstream SDOH, and whether organizational or community factors predict involvement. Methods: Using descriptive statistics and Poisson regression, we compared 3 types of programs (screening, in‐house strategies, and external partnerships) to address the patient social needs between CAHs and non‐CAHs, independent of key organizational, county, and state factors. Findings: CAHs were less likely than non‐CAHs to have programs to screen patients for social needs, address unmet social needs of patients, and enact community partnerships to address SDOH. When we stratified hospitals according to whether they endorsed an equity‐focused approach as an organization, CAHs matched their non‐CAH counterparts on all 3 types of programs. Conclusions: CAHs lag relative to their urban and non‐CAH counterparts in their ability to address nonmedical needs of their patients and broader communities. While the Flex Program has shown success in offering technical assistance to rural hospitals, this program has mainly focused on traditional hospital services to address patients' acute health care needs. Our findings suggest that organizational and policy efforts surrounding health equity could bring CAHs in line with other hospitals in terms of their ability to support rural population health. [ABSTRACT FROM AUTHOR]

Diabetes affects Americans across the lifespan requiring individual and community-level interventions for prevention and management. Nonprofit hospitals are required to address community health needs under current tax law. The study objective was to assess what strategies children's hospitals implemented in prevention and care of diabetes and determine how many hospitals used evidence-based strategies. We identified the most recent Children's Hospital Needs Assessments and implementation strategies for each hospital. Data were thematically coded. Twenty-nine of the 233 U.S. children's hospitals addressed diabetes in their community benefit investments. Of the 130 hospital programs, 48 (37%) aligned with the DSMES framework. Programs focused on prevention (32%), healthy eating (18%), education (15%), physical activity (12%), quality improvement (11%), and self-management (5%). Most children's hospital interventions (85%) did not state a focus on reducing health disparities and none addressed problem solving or diabetes technology. Minimal hospitals are using evidence-based programming for diabetes management and are not targeting health disparities which undercuts their efforts. Hospitals are not adopting structural evidence-based approaches, missing key opportunities to implement strategies shown to reduce diabetes prevalence and lower A1c. This study suggests that children's hospitals need improvement in their diabetes programming to better serve their communities. [ABSTRACT FROM AUTHOR]

Objectives: Hospitalizations are an important opportunity to address substance use through inpatient services, outpatient care, and community partnerships, yet the extent to which nonprofit hospitals prioritize such services across time remains unknown. The objective of this study is to examine trends in nonprofit hospitals' prioritization and implementation of substance use disorder (SUD) programs. Methods: We assessed trends in hospital prioritization of substance use as a top five community need and hospital implementation of SUD programing at nonprofit hospitals between 2015 and 2021 using twowaves (wave 1: 2015-2018; wave 2: 2019-2021) by examining hospital community benefit reports. We utilized t or x2 tests to understand whether there were significant differences in the prioritization and implementation of SUD programs acrosswaves. We usedmultilevel logistic regression to evaluate the relation between prioritization and implementation of SUD programs, hospital and community characteristics, and wave. Results: Hospitals were less likely to have prioritized SUD but more likely to have implemented SUD programs in the most recent 3 years compared, even after adjusting for the local overdose rate and hospitaland community-level variables. Although most hospitals consistently prioritized and implemented SUD programs during the 2015-2021 period, a 11% removed and 15% never adopted SUD programs at all, despite an overall increase in overdose rates. Conclusions: Our study identified gaps in hospital SUD infrastructure during a time of elevated need. Failing to address this gap reflects missed opportunities to engage vulnerable populations, provide linkages to treatment, and prevent complications of substance use. [ABSTRACT FROM AUTHOR]

Nonprofit hospitals have been required to conduct Community Health Needs Assessments and develop implementation strategies for almost a decade, yet little is known about this process on the national level. Using a nationally representative dataset of 2019 to 2021 nonprofit hospital community benefit reports, we assessed patterns in hospital identification of community health needs and investments in corresponding programs. The five most common needs identified by hospitals were mental health (identified by 87% of hospitals), substance use (76%), access (73%), social determinants of health (69%), and chronic disease (67%). The five most common needs addressed were: mental health (87%), access (81%), substance use (77%), chronic disease (72%), and obesity (71%). Institutional and community-level factors were associated with whether hospitals identified and addressed health needs. Hospitals often addressed needs that they did not identify, particularly related to the provision of medical services—which has important implications for population health improvement. [ABSTRACT FROM AUTHOR]

Not-for-profit hospitals (NFPs) frequently partner with community organizations to conduct internal revenue service-mandated community health needs assessment (CHNA), yet little is known about the number of partnerships that hospitals enter into for this purpose. This article uses "American Hospital Associations' 2020 Annual Survey" data to examine hospital-community partnerships around the CHNA and the role that community social capital defined as, "the networks that cross various professional, political and social boundaries to reflect community level trust needed to pursue shared objectives" plays in hospitals' choices to partner with community organizations for the CHNA. After controlling for a set of hospital, community, and state characteristics, we found that hospitals present in communities with higher social capital were likely to partner with more community organizations to conduct CHNA. Greater social capital may thus promote community health by facilitating the partnerships NFPs develop with community organizations to conduct the CHNA. [ABSTRACT FROM AUTHOR]