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Multnomah County Health Department Story from the Field Summary


What does the future hold for community health assessment?

A look at how one community in Portland, Oregon, is collaborating with four local health departments and 14 non-profit hospitals to conduct a regional community health needs assessment

Christine Sorvari and Beth Sanders of Multnomah County Health Department in Portland, Oregon are busy these days. They're in charge of facilitating a four county community health needs assessment (CHNA) involving four county health departments and 14 non-profit hospitals within the Portland metropolitan area.

"The four county CHNA aims to assess community health across this four county region and to identify strategies to address health issues," explained Sanders. "It makes sense to do a collaborative assessment because we are all part of the same metropolitan region around Portland."

In the last couple of years, the rationale behind hospital-health department collaborations has intensified. The launch of national public health department accreditation in September 2011 increased the visibility of community health assessment, requiring local health departments to submit a community health assessment and a community health improvement plan as prerequisites to applying. Provisions of the Patient Protection and Affordable Care Act of 2010 require each non-profit hospital facility in the United States to conduct a community health needs assessment and adopt an implementation strategy to meet identified community health needs.

"Hospital leaders and public health leaders [in the Portland area] began convening two years ago in anticipation of the accreditation requirements and the Affordable Care Act requirements," explained Sanders. "Everyone knew it would be a great effort to join all of these forces together."

"It was the Affordable Care Act that changed this from a polite conversation with our hospital colleagues to a more urgent and committed conversation," said Priscilla Lewis of Providence Health & Services, one of the hospital systems participating in the four county CHNA. "Hospitals have been doing CHNAs for over 12 years and the Catholic Health Association has pioneered those efforts along with and in collaboration with the Association for Community Health Improvement. This is [Providence Health's] fifth CHNA. That experience lead us to start the conversation about a single CHNA since we are all part of a single health ecosystem."

Sorvari and her team are using their past experience with Mobilizing for Action through Planning and Partnerships (MAPP) to help inform this project. MAPP is a community-driven strategic planning process for improving community health and is a framework that many communities use to conduct a community health assessment.

"We made a lot of mistakes [the last time we conducted MAPP]," said Sorvari. "It's been great to have that experience. Portland is a place where everyone and every organization, non-profit and government, really values community input and community engagement."

In addition to MAPP, Sorvari and her team are incorporating Healthy People 2020 into the assessment. Healthy People 2020 provides science-based, ten-year national objectives for improving the health of all Americans.

"We have an epidemiology workgroup that is conducting the community health status assessment of the MAPP process, and they created their own methodology on how to prioritize a lot of different health information," explained Sanders. "One of the criteria includes comparing regional data to Healthy People 2020 objectives."

The CHNA includes Multnomah County, Washington County, and Clackamas County of Oregon, and Clark County in Washington State.

"The four counties are very different and they cross over two states," Sorvari explained. "When I made the proposal to be a convener for this assessment, I asked myself how could I be neutral when I work for Multnomah County. We by far have the most people and the most resources. My response is that we can't be completely neutral, but I am very conscientious to try."

An unique aspect of this four county CHNA is how it works across state lines. Clark County, one of the four counties involved in the assessment, resides in Washington State. (Listen to the audio clip below)


Listen to Sorvari describe working across state lines.  audio clip


"It makes sense to include Clark County in this CHNA since Vancouver, Washington and Clark County are all part of the same metropolitan region around Portland,"said Sanders. "The system may be structured a little differently in Washington but it hasn't been a major challenge."

"Patients living in Washington State are right across the jurisdictional boundary but they get a lot of their services here in Oregon," explained Lewis. "[Clark County] is the natural service area of these hospitals and where patients live." (Listen to the audio clip below)


Listen to Lewis describe defining community. audio clip


Although state boundaries don't seem to be a problem, both sides agree that there are significant differences in perspective between public health and hospitals.

"We just live in a very different world," said Lewis. "Public health is a very deep expertise. In those areas [the hospitals] are really scrambling to catch up. There have been some really fun conversations where I can see the hospital people getting brain cramps from listening to the epidemiologists. On the public health side, it's really fascinating for me to realize how insulated they are from the amount of care, the patient volume, and the dollar volume of care that goes on within the four walls of our hospitals. That sounds sort of naïve but it's obvious that we just operate in two very different worlds." (Listen to the audio clip below)


Listen to Lewis describe how hospitals and health departments are two different worlds. audio clip


"As the convener, I found it challenging to negotiate between unknowns of what hospitals may think public health is about and what public health thinks hospitals are about," explained Sorvari. Another challenge is I don't think the partners fully understood the amount of work the epidemiologists would need to do. I just don't think anyone could have known since it is a new type of project. That has been another limitation in this first year."


Listen to Sorvari describe how hospitals and health departments often speak two different languages. audio clip



Despite some of the early challenges, all involved parties remain enthusiastic and positive about the collaboration.

"I've been really pleased with people's level of commitment," said Lewis. "All meetings are very well attended. People are putting in a lot of time outside of the meetings. Oftentimes this is additional work to their regular day jobs, so I think the level of commitment and enthusiasm has been somewhat surprising to me and really refreshing."

"We're learning as we go," said Sanders. "Everyone is really pleased and there is lots of enthusiasm on both sides. You never know what you're going to learn, or what your successes or challenges might be. But just come to the table and develop a relationship; that's always the first step."

The first iteration of the four county CHNA aims to be completed by June 2013. For more information, please refer to the Q&As with Sorvari, Sanders, and Lewis.