Assessing the Outcomes, Successes of Community Health Programs

Community health program leaders need to develop better measures to assess the success and efficacy of projects that address the social determinants of health, according to a study recently published in Health Affairs.

Community health has been put in the healthcare spotlight as of late, especially as it relates to value-based care. In theory, community health programs that address the social determinants of health should lower overall healthcare costs because they keep patients healthier and out of the doctor’s office or hospital.

However, there is little research related to how effective community health programs actually are.

“Many of these investments have been made in multisector coalitions that seek to improve specific communitywide health outcomes, such as reductions in obesity or smoking,” the researchers explained.

“Through their programs, these coalitions develop consensus on targeted health outcomes, potential metrics, and programs for implementation; align existing resources in community-based organizations; and implement evidence-based interventions to fill programmatic gaps,” the team continued.

There are also limited resources for communities to measure the outcomes of their programs. Traditionally, community health organizations would use pre- and post-implementation data collection to assess improvements in public health. Data sources would be limited and would not include a comparison or control community, much to the detriment of program leaders.

The researchers investigated the way in which community health programs truly improve public health and the ways in which organizers can improve data analysis for these programs. An assessment of county-wide community health programs and their public health data helped show the efficacy of community health projects.

Over the course of the 5-year study period, the researchers found that the prevalence of community health programs increased from 14 in 2007 to 52 in 2012. The number of counties included in community health programs increased from 319 to 396 during that same time period.

Although community health programs grew in popularity during that five-year timeframe, the researchers found that programs did not have a statistically significant impact on public health outcomes. During that time, patients reporting poor or fair health decreased by 0.06 percentage points, and obesity decreased by 0.15 percentage points.

Smoking rates decreased by a more significant amount, a point the researchers said indicates that targeted programs are more successful.

However, target programs may also have a negative impact on the public health outcomes they are not necessarily addressing.

“It is important to note that programs that focused on obesity saw increases in tobacco use and programs that focused on tobacco control saw increases in obesity rates, which suggests that these programs may focus on one health outcome to the detriment of others,” the research team said.

Counties that implemented community health programs tended to have more young adults, higher rates of poverty, and lower employment rates, the data revealed. These factors combined may have motivated certain communities to implement strategies to support public health and welfare.

However, the lack of success in these programs might indicate that programs need to address other social determinants of health.

“If this is the case, such programs may improve overall health status, but not to a degree that overcomes other potential measures of social or economic disadvantage—such as educational attainment rates, the predominant industry, or median household income,” the team explained.

The amount of elapsed time used to measure progress also may have undercut the potential for community health outcomes, the research team pointed out.

“Improving population-level health outcomes is difficult, and it takes time to ‘move the needle’ on health outcomes,” the researchers wrote. “Thus, five years of post-implementation data (the maximum in our data set) might not provide enough time for changes in health outcomes to be realized, depending on the intensity and specificity of programming.”

That limitation notwithstanding, the researchers concluded that organizations need a better plan to evaluate before, during, and after data for community health program implementation.

“Retrospective evaluation of collaborative, multisector health improvement initiatives, including the health improvement programs evaluated here, is difficult,” the researchers explained. “Thus, an evaluation team should be employed to provide guidance and expertise in measurement, data collection, and analytic strategies at the beginning of program implementation.”

Due to limited resources, policymakers and overarching community health program grant-makers need to restructure their operations to assist in data collection.

“Grant-making organizations and private-sector entities that invest in the implementation of programs could consider also providing resources to perform a thorough summative evaluation to adequately evaluate their return on investment,” the researchers concluded. “In addition, they may want to invest in more-robust data collection, not only for evaluation but also to target needs and guide implementation of population health improvement programs more broadly.”