Community Health Needs Assessment Toolkit
Part II: Completing the CHNA Report
Kaiser Permanente
National Community Benefit
Updated August 2015
1
Copyright 2015 Kaiser Foundation Hospitals
This toolkit was developed by Kaiser Permanente, for use by Kaiser Foundation Hospitals for conducting their 2016
Community Health Needs Assessment (CHNA).
Kaiser Permanente Community Benefit is the owner of the content within and must be acknowledged as such. The content
may not be modified or used in other formats without prior permission from Kaiser Permanente Community Benefit. This toolkit
may not be sold for revenue generation by those who have been granted permission to use or adapt it.
For questions, please contact:
Brittany Giles, MPH
National Community Benefit
Kaiser Permanente
Brittany. N. [email protected]
(510) 271-4685
2
CHNA Toolkit Part 2 Table of Contents
Table of Contents
CHNA Toolkit Part 2: Completing the CHNA Report
I.
Overview
Introduction .......................................................................... 1
Overview of Identification and Prioritization
of Health Needs.................................................................... 2
II.
Identifying Community Health Needs and Related Assets
Overview of Identification Process........................................ 4
Defining Health Need ........................................................... 5
Criteria for Identifying Health Needs .................................... 6
III.
Using Data to Identify Health Needs
Process for Identifying Health Needs ................................... 7
Using Quantitative Data ........................................................ 8
Using Qualitative Data ....................................................... 12
Combining Data to Identify Health Needs .......................... 13
IV.
Prioritizing Community Health Needs
Criteria for Prioritizing Health Needs ................................. 14
Process for Prioritizing Health Needs ................................. 15
V.
CHNA Report
Overview ............................................................................ 17
Identifying Community Assets ............................................ 18
Health Needs Profiles ......................................................... 18
Evaluation of Impact ........................................................... 18
Updated August 2015
Kaiser Permanente National Community Benefit
GLOSSARY ...................................... i
APPENDICES
A: Identification Toolbox .......... iii
B: Prioritization Toolbox ........... v
C: CHNA Report Outline .......... x
D: Sample Health Profiles ...... xv
CHNA Toolkit Part 2 Introduction and Purpose
I. OVERVIEW
Introduction
Once you’ve collected the primary and secondary data that you plan to use
for your CHNA, the next step is to analyze and combine the data in order
to first identify and then prioritize community health needs.
In this section:


Introduction
Overview of Identification and
Prioritization of Health Needs
This toolkit outlines decision-making criteria and process guidelines for the
identification and prioritization of health needs, preparing KFH hospital
facilities to complete their CHNA Reports in early 2016. After completing
the identification and prioritization process and completing the CHNA
Report, hospitals will be ready to select the health needs that they will
address through Implementation Strategies.
The process of selecting the needs that the hospital will address is
introduced in this section of the toolkit but will be covered in greater detail,
along with guidelines for the development of implementation strategies, in
CHNA Toolkit Part 3 (to be released in early 2016).
Including Community and
Expert Input
While it is likely that you have already
conducted focus groups with community
members and key informant interviews with
public health experts, there are other
opportunities for including both experts and
community members in the CHNA process.
For example, it may be helpful to have key
individuals from the community involved in the
process of identifying and prioritizing needs,
such as residents; small business owners;
faith leaders; and/or representatives from key
organizations, such as schools, social service
agencies, or other public agencies.
Updated August 2015
Kaiser Permanente National Community Benefit
1
CHNA Toolkit Part 2 Introduction and Purpose
Overview of Identification and Prioritization of Health Needs
Following data collection, the federal CHNA guidelines require three distinct stages
in order to complete the CHNA and Implementation Strategy processes:
1. Identification of significant health needs facing the community served
2. Prioritization of the identified health needs facing the community served
3. Selection of health needs that the hospital plans to address
KEY TERMS
Community Served—Kaiser
Permanente defines community served
as those individuals residing within its
hospital service area. A hospital service
area includes all residents in a defined
geographic area surrounding the hospital
and does not exclude low-income or
underserved populations.
Updated August 2015
Kaiser Permanente National Community Benefit
2
CHNA Toolkit Part 2 Introduction and Purpose
Overview of Identification and Prioritization of Health Needs (cont.)
For the identification and prioritization stages, each hospital must describe the
criteria and methodology used in their decision-making process. This toolkit
includes guidelines for both components.
The checklist below includes the Federal CHNA Guidelines related to the
content of this toolkit. Making note of these requirements now and
documenting the information as you go will make it easier to populate the
CHNA Report at the end.
 Description of the process and criteria used to identify the
community health needs
 Prioritized description of all of the significant community health
needs identified through the CHNA
 Description of the process and criteria used in prioritizing the
identified community health needs
 Description of the existing facilities and resources within the
community available to meet the identified community health needs
 Each facility has documented its CHNA and made it widely available
to the public
Updated August 2015
Kaiser Permanente National Community Benefit
3
Introduction
Community
and Purpose
Needs
CHNA Toolkit Part 2 Identifying
II. IDENTIFYING COMMUNITY HEALTH NEEDS AND RELATED ASSETS
Federal CHNA Guidelines require non-profit hospitals to:
 Describe the process and methods used to conduct the assessment
 Provide a prioritized description of the significant community health needs identified
through the CHNA
 Describe existing facilities and resources within the community to meet the identified
health needs
In this section:




Overview of Identification Process
Defining a Health Need
Criteria for Identifying Health Needs
Identifying assets
Overview of Identification Process
The purpose of identifying community health needs and related assets is to broadly
and comprehensively assess a community’s health in order to determine all of the
significant health needs facing the community. This essential step ensures that
future efforts are aligned with substantiated need and have the greatest impact.
The end product of this stage is a complete list of significant community health
needs as determined by a set of pre-identified criteria. This stage builds on the
data collected during the first phase of the process, including secondary data from
the CHNA Data Platform and other local sources, as well as primary data collected
from community members, stakeholders and public health experts. It is important
to collect a comprehensive set of data to inform this process in order to establish a
solid foundation from which to develop the list of community health needs. There
are three key steps to consider:
1. Defining the term “health need”
2. Developing a process for consolidating findings from multiple data sources and
identifying the criteria that will be used to determine whether an issue is a health
need
3. Applying and documenting the process used to determine the list of health
needs
Updated August 2015
Kaiser Permanente National Community Benefit
How does the IRS define
health needs?
The final Federal CHNA guidelines expand
the examples of health needs that a hospital
facility may consider in its CHNA to include
not only the need to address financial and
other barriers to care but also the need to
prevent illness, to ensure adequate nutrition,
or to address social, behavioral, and
environmental factors that influence health in
the community.
4
Introduction
Community
and Purpose
Needs
CHNA Toolkit Part 2 Identifying
Defining Health Need
Before developing a list of community “health needs” it is important to define the
term. To ensure some level of comparability and consistency across Kaiser
Permanente, for the purposes of CHNA a health need is defined as any of the
following that arise from a comprehensive review and interpretation of a robust set
of data (e.g. using the KP CHNA Data Platform):



A health outcome and/or the related conditions that contribute to a defined
health need
What a health need is not:

Health needs are identified by the comprehensive identification, interpretation, and
analysis of a robust set of primary and secondary data.
In addition to identifying the health needs in your community, you should be
prepared to provide the context for the health need as part of a Health Need Profile
(see page 18). This Profile may include, for example, what data supports the
health need, what health drivers are likely contributing to the health need, and what
populations and/or neighborhoods are disproportionately impacted by the health
need.

Broad categories that encompass multiple
health outcomes (e.g., chronic conditions,
infectious diseases, health disparities,
etc.)
Health defined by populations (e.g., teen
health, senior health, women’s health,
etc.)
A specific indicator (e.g., asthma
hospitalizations, pap screening rates,
alcohol expenditures, etc.)
A specific strategy to address a health
need (e.g., parenting classes, insurance
outreach and enrollment, etc.)
KEY TERMS
Health Outcome—Snapshots of diseases in
a community that can be described in terms
of both morbidity and mortality. (Ex: breast
cancer)
Health Driver—behavioral, environmental,
and clinical care factors as well as more
upstream social and economic factors that
impact health
Updated August 2015
Kaiser Permanente National Community Benefit
5
Introduction
Community
and Purpose
Needs
CHNA Toolkit Part 2 Identifying
Criteria for Identifying Health Needs
The criteria that you use to identify your list of health needs should be clearly
defined before you begin to review and interpret your data. Having a pre-identified
set of criteria is important for two reasons:
1. It helps eliminate bias
2. You will be required to document the process used, including criteria,
in your CHNA Report
KP Required Criteria
Each KP hospital or collaborative is expected to identify a list of criteria that works
for them. However, to ensure both compliance with the legislative mandates as
well as rigor and consistency across KP hospitals, Kaiser Permanente has
identified a set of required criteria. Additional criteria have been provided for your
consideration. Kaiser Permanente requires you to include, at a minimum, the
following criteria in your process:



The issue must fit the KP definition of a “health need” (see pg. 5)
The health need is confirmed by multiple data sources
Indicator(s) related to the health need perform(s) poorly against a defined
benchmark (e.g. state average)
Additional Optional Criteria
In addition to the criteria outlined above, the KP hospital or collaborative may
choose additional criteria to include in their process. Some options you may
consider include:



The issue is getting worse and/or not improving over time
There are clear disparities/inequities across different sub-populations
The community perceives the issue as important
Updated August 2015
Kaiser Permanente National Community Benefit
Determining the Strength of
a Data Source:

Is the sample size large enough?

Does it represent the broader population?

How recent is the data?

How granular is the data?

Does the data allow you to examine
health needs by subgroups?

Is the data complete enough to allow an
examination of all health needs?

Are the data sources reliable?
KEY TERMS
Indicator—A characteristic of an individual,
population, or environment which is subject
to measurement (directly or indirectly) and
can be used to describe one or more
aspects of the health of an individual or
population.
Benchmark—Something that serves as a
standard by which others may be measured
or judged. (Ex: Healthy People 2020)
6
CHNA Toolkit Part 2
Using Data to Identify Community Health Needs
III. USING DATA TO IDENTIFY COMMUNITY HEALTH NEEDS
In this section:
Process for Identifying Needs
Once you have identified your criteria, there are multiple ways to move through the
process of going from the data to a list of identified community health needs.
The diagram below is intended to demonstrate the high level steps involved.
Updated August 2015
Kaiser Permanente National Community Benefit




Process for Identifying Needs
Using Quantitative Data
Using Qualitative Data
Combining Data to Identify Health
Needs
7
CHNA Toolkit Part 2
Using Data to Identify Community Health Needs
Using Quantitative Data
Using the KP CHNA Data Platform to Identify Health Needs
Each KP hospital is expected to utilize the KP CHNA Data Platform
(www.CHNA.org/KP) in their CHNA process. The platform can be used to prepare
secondary data reports for KFH hospital facility service areas that allow for the
identification of indicators that perform poorly against prescribed benchmarks.
There are two options for viewing secondary data reports within the KP CHNA Data
Platform:
1. On-line (downloadable to a Word or PDF document). This option allows
viewing indicator data along with narrative, graphs, interactive maps, and other
visual formats.
2. Excel Report Download. The KP CHNA Data Platform includes an option to
download data to an Excel spreadsheet. The Preliminary Health Needs
Identification Tool download option creates a special Excel spreadsheet
with built in formulas and analysis that facilitates the identification of health
needs. This report format is only available for the In-Depth Report option.
There are several types of reports that can be viewed using the KP CHNA Data
Platform. The type of report that is designed to help hospitals and other partners
identify community health needs is the In-Depth Report. This report offers a
robust analysis of potential health needs for the selected report area. The Excel
format of this report, the Preliminary Health Needs Identification Tool, provides
additional analysis and is described on the following pages.
For a complete list of the reports available in the platform, please visit
www.chna.org/kp.
Accessing and Using the
CHNA Data Platform
Visit www.CHNA.org/KP for information and
tutorials on how to access and use secondary
data reports found on the platform
Updated August 2015
Kaiser Permanente National Community Benefit
8
CHNA Toolkit Part 2
Using Quantitative Data (cont.)
Preliminary Health Needs Identification Tool
Within the In-Depth Report option users can select to download the Preliminary
Health Needs Identification Tool as a Microsoft Excel spreadsheet. The
purpose of this tool is to provide quantitative analysis of secondary data to identify
potential health needs in the community. The goal of this tool is to make the
secondary data analysis process more efficient for consultants, to provide a
defensible scoring method for identifying and prioritizing potential health needs,
and to provide a benchmarking option for your KFH hospital facility service areas.
The Preliminary Health Needs Identification Tool includes the following five tabs:





Tab 1—In-Depth: Indicators are mapped to a potential health need and
designated as core or related. Selected report area values are benchmarked to
the state to calculate Potential Health Need Scores. National benchmark
values are also included in this tab.
Tab 2—Racial and Ethnic Disparities: If available, data are reported by
various racial and ethnic population categories. Conditional formatting is used
to highlight disparities between the racial or ethnic group and the report area
overall.
Tab 3—Demographics: Provides demographics, including report area and
state counts and rates by age and race and ethnicity. [Note: if your report area
crosses state boundaries, state data is not reported in this tab.]
Tab 4—About Data Dictionary: The Data Dictionary describes the
methodology for each of the other previous tabs in the spreadsheet, including
Excel calculations performed and assumptions made.
Tab 5—Indicator Details: The Indicator Details is a list that includes
detailed information about each indicator reported from the platform.
Updated August 2015
Kaiser Permanente National Community Benefit
Using Data to Identify Community Health Needs
Using the Preliminary Health
Needs Identification Tool
 Explore Potential Health Need Scores in
service areas as benchmarked to the
State
 Explore racial and ethnic disparities in
indicators as benchmarked to service
areas
 Consider the demographic profile of
service areas and unique features as
compared to the State
 Customize benchmarking options if
desired
KEY TERMS
Core Indicators - Core indicators are
indicators that directly relate to a health
outcome of the potential health need
Related Indicators - Related indicators
are indicators that are upstream "drivers"
to the potential health need.
Potential Health Need Score - This
score is a number used to identify how
well or poorly a Potential Health Need
category of indicators perform against
benchmarks.
9
CHNA Toolkit Part 2
Using Data to Identify Community Health Needs
Using Quantitative Data (cont.)
Understanding the
Preliminary Health Needs
Identification Tool
Preliminary Health Needs Identification Tool (cont.)
Functionalities and Components of Tab1_InDepth: Potential Health Needs Scoring
Tab 1 of the spreadsheet assigns indicator specific points based on differences
between report area and benchmark indicator values. Within a potential health
need category, point values are averaged to create a core indicators score, a
related indicators score, and an overall score for each of the 14 potential health
needs.
Potential Health Needs Scores are one potential data analysis input and
should be used in combination with other data sources to identify and
prioritize health needs. Components of calculating a health need score
include:

The Excel report establishes desired
directionality of each Potential Health
Need indicator, and then calculates points
based on the magnitude of the difference
from benchmark.

Point values can be customized if you
decide to benchmark to other magnitudes
of difference. Default point values are:


In-Depth Indicator Mapping: Indicators are mapped to at least one potential
health need as a core or related indicator.

Benchmarking: Points are calculated based on how the selected report area
benchmarks to the state. In instances where a report area crosses state
boundaries, the better state benchmark is used for scoring.

Assigning Point Values: Point values are assigned to each indicator based on
the magnitude of the difference from the state benchmark and the desired
directionality of that difference (see text box at right).

Potential Health Need Scores: Potential Health Needs Scores are generated for
core indicators, related indicators, and all indicators combined within each
potential health need. Within a potential health need, scores are calculated by
averaging assigned point values across indicators. The scores range from 0-2,
with a higher score indicating a greater potential health need according to
secondary data.
Updated August 2015
Kaiser Permanente National Community Benefit



0 points for values with a
difference less than 1%
1 point for values with a difference
of 1%-2%
2 points for values with a
difference greater than 2%
Cells are conditionally formatted so that
values and points are green, yellow, and
red (0, 1, and 2 points respectively).
10
CHNA Toolkit Part 2
Using Data to Identify Community Health Needs
Using Quantitative Data (cont.)
Preliminary Health Needs Identification Tool
Functionalities and Components of Tab2_RaceEthnicDisparities: Identifying Need
by Assessing Disparity
Some potential health needs may not receive a “high” score in Tab 1, but might be
considered a potential health need for your report area due to significant disparity.
Tab 2 provides additional disparity data critical to identifying such health needs.
When available, values for racial and ethnic groups are benchmarked to the report
area. The Excel cells are conditionally formatted to draw your attention to
indicators and groups that show significant disparity by not benchmarking well.
Keep in mind, an indicator that is not listed in Tab 2 of the Preliminary Health
Needs Identification Tool does not necessarily mean that disparities do not exist. It
simply means the data is not available by race-ethnicity groups.
Updated August 2015
Kaiser Permanente National Community Benefit
11
CHNA Toolkit Part 2
Using Data to Identify Community Health Needs
Using Qualitative Data
Each KFH hospital is expected to collect qualitative data. This can include written
comments received on the previous CHNA report, key informant interviews, focus
groups, or other methods to engage with the community. Qualitative primary data will be
used to either reinforce health needs highlighted by the Preliminary Health Needs
Identification Tool or to raise health concerns in the community that are ranked lower or
not ranked in the Tool.
Themes raised within and across qualitative data sources should be used to help identify
community health needs. Standardizing interview write ups can help to quicken the
process of identifying community health needs. For large amounts of qualitative data, it is
recommended to use a Computer Assisted Qualitative Data Analysis Software
(CAQDAS) to more quickly and efficiently pull out interview themes. Once themes are
selected, the health need can be assessed based on how often the need was brought up
and how important the health need is to key stakeholders and community members. If
importance of the potential health need is not readily available from a CAQDAS, writeups should be referred to and reviewed. This qualitative information will be combined with
Potential Health Need Scores from the Preliminary Health Needs Identification Tool to
identify and prioritize health needs and select health needs that the hospital will address.
Templates to combine and prioritize data can be found on the CHNA resources section of
www.CHNA.org/KP.
Required Community Input
The final Federal CHNA Guidelines
require hospitals to gather community
input on the following questions:
 What are the health needs?
 What are the health need priorities?
 What assets are available to address
the identified health needs?
Given the criteria for identifying health needs (see page 6), please consider the following
when incorporating primary data into the process:



The issue must fit the KP definition of a “health need”. (see page 5)
The health need is confirmed by multiple data sources. It is important to not
value a need that one person strongly advocates for over the needs that a majority of
people agree are important. To meet this criteria, either many people within a focus
group must agree that the need is a priority or the need must be discussed across
multiple qualitative data sources (e.g., discussed in 2 or more focus groups).
Indicator(s) related to the health need perform(s) poorly against defined
benchmark. Where available, find secondary data to confirm that any new
health needs do not benchmark well.
Updated August 2015
Kaiser Permanente National Community Benefit
12
CHNA Toolkit Part 2
Using Data to Identify Community Health Needs
Combining Data to Identify Health Needs
To develop a list of potential health needs, a combination of quantitative and
qualitative data should be used. Together these will provide a full picture of the
health needs in the report area by lifting up health needs that are reinforced by both
secondary data and community input. The following factors should be considered
when reviewing data:








What themes were pulled out of primary data?
How often was a health need brought up in primary data?
How important is the health need to the community?
Does the health need benchmark poorly?
How does the Potential Health Need Score rank against other health needs in
the report area?
Are there racial or ethnic disparities within the report area?
If necessary, do other secondary data sources support the health need?
Does the health need meet the KP Required Criteria on page 6?
Examples of templates that can be used to identify health needs are available in
Appendix A and in the CHNA Resources section of the CHNA Data Platform
(www.CHNA.org/KP).
Updated August 2015
Kaiser Permanente National Community Benefit
13
Introduction
Process
Pre-Assessment
Secondary
Web-based
Map
Data
Community
Data
andGuidelines
Platform
Purpose
Needs
CHNA Toolkit Part 2 Prioritizing
IV. Prioritizing the Community’s Needs
Federal CHNA Guidelines require non-profit hospitals to:
 Include a prioritized description of all of the community health needs identified through
the CHNA
 Describe the process and criteria used in prioritizing the identified community health
needs
In this section:


Criteria for Prioritizing Health Needs
Process for Prioritizing Health Needs
Once all of the health needs of the community are identified, they all need to be
prioritized. This is a prioritization of community needs and not the time to select
the needs that the hospital will address. The end product of this stage is still the
complete list of health needs categorized by a chosen method of prioritization.
You may determine the prioritization method that makes the most sense for your
process (e.g., high priority and low priority; high, medium, low priority; ranking in
order, etc.), however you must be able to document the method used in the
CHNA Report.
Criteria for Prioritizing Health Needs
Each hospital or collaborative is expected to develop a set of criteria before
beginning the prioritization process. While KP is not requiring you to use a specific
list of criteria for this stage, the following list was designed to provide guidance as
you work to determine which criteria best fit your group’s process.








Severity of issue/degree of poor performance against the benchmark
Clear disparities/inequities
Issue is getting worse over time/not improving
Community prioritizes the issue over other issues
Existing attention/resources dedicated to the issue
Effective and feasible interventions exist
A successful solution has the potential to solve multiple problems
Opportunity to intervene at the prevention level
Updated August 2015
Kaiser Permanente National Community Benefit
Keep in mind
If you are working in a collaborative, it is
possible that issues may get prioritized as
high need that KP is not equipped to
address (e.g. poverty). At this stage, you
are prioritizing all of the identified community
needs and are not selecting the needs KP
will address.
14
Introduction
Process
Pre-Assessment
Secondary
Web-based
Map
Data
Community
Data
andGuidelines
Platform
Purpose
Needs
CHNA Toolkit Part 2 Prioritizing
Process for Prioritizing Health Needs
There are multiple methods and tools available for prioritizing needs (see Appendix
B for examples or visit the CHNA Resources section of www.CHNA.org/KP).
You should use the method that best suits your group, as long as that process
aligns with the criteria you selected, is transparent, and is well documented. For
some groups, community members and/or experts may also participate in the
prioritization discussion. Including these individuals in your process can allow for
immediate validation of the priorities. If community members and experts are not
included in this step, you may find it helpful to ask one or both of these groups to
review and validate your results prior to finalizing the prioritization process.
The following is an example using the Prioritization Matrix ranking system. There is
a template for this tool as well as other tools provided in the Prioritization Toolbox
(see Appendix B and the CHNA Data Platform.)
CHNA Prioritization Matrix: Example (Capital City Service Area)
Step 1: Create a matrix, using the first column to list your health needs and the
following columns to list the criteria you will be using to prioritize your needs. Include an
additional column for the priority score (see table below).
Step 2: Either as individuals or as a group, rate the need against each criteria. You
can use your own rating scale, but here we have used 3 = criterion met well 2 = criterion
met 1 = criterion not met.
Step 3 (optional): If you would like to weight the criteria, add that to the table. For
example, if criteria 1 is twice as important as the others, its “weight” could be 1 and the
others .5, etc..
Tools for Prioritization

Prioritization Ranking* (individually
then discussed by group)

Weighted ranking* (different weights
assigned to different categories of need)

Verite Weighted Ranking Adaptation*
(scoring based on benchmarks and
interviews)

Multi-Voting (gradual narrowing of
priorities)

Strategy grid* (e.g., high score, high
severity)

Simplex* (questionnaire with scaled
response for various criteria)

Hanlon Method* (criteria and feasibility
factors)

Discussion-based Voting (public or
private)
*included in Appendix B
Step 4: Calculate the priority score. If you are not weighting the criteria, this will
simply be a sum of the score for each criterion by need. If you are using weights, multiply
each criterion score by the appropriate weight, then sum for a total need score.
Step 5 (optional): If the ranking was first done by individuals and needs to be tallied
for a group “score,” then simply sum each individual score for the overall, group priority
score by health need.
Step 6: Rank the health needs by the priority score.
Updated August 2015
Kaiser Permanente National Community Benefit
15
Introduction
Process
Pre-Assessment
Secondary
Web-based
Map
Data
Community
Data
andGuidelines
Platform
Purpose
Needs
CHNA Toolkit Part 2 Prioritizing
CHNA Prioritization Matrix: Example, Continued
Clear Disparities
Health Need
(weight: 1)
Community
Severity of issue Prioritizes Issue
Over Other Issues
(weight .75)
(weight .5)
Priority Score
Asthma (related to
smoking and air quality)
3(*1) = 3
2(*.75)=1.5
3(*.5)=1.5
6
Lack of Physical Activity
2(*1)=2
1(*.75)=.75
2(*.5)=1
3.75
Step 7: Develop your priority list according to the prioritization categories you
have determined. For example, here Asthma would be a “high priority” and healthy living
a “low priority” in relation to each other.
As you work through the prioritization process, keep in mind that each one of the identified needs will be included on your final list, and that you will be working from the entire
list when it comes time for selecting the needs that KP will address.
Updated August 2015
Kaiser Permanente National Community Benefit
16
Introduction
Process
Pre-Assessment
Secondary
Report
Map
Data
andGuidelines
Purpose
CHNA Toolkit Part 2 CHNA
IV. CHNA Report
Federal CHNA Guidelines requires non-profit hospitals to:
 Write a CHNA Report that includes
 Description of service area and community served
 Process for identifying and prioritizing needs
 Prioritized list and description of health needs
 Community assets aligned with each need
 An evaluation of impact for strategies implemented since the last CHNA
In this section:




Overview
Community Assets
Health Needs Profile
Evaluation of Impact
Overview
Each individual hospital will be responsible for completing a CHNA Report (see
report outline in Appendix C), regardless of whether or not the identification and
prioritization process was completed as a collaborative. The report is intended to
respond to the IRS requirements as well as to illustrate the linkages between data
and process in determining the community’s health needs.
KP hospitals will be required to write their CHNA Report using a specific template.
An outline of the report template is provided on the following page. Note that in
addition to a list of prioritized health needs, KP hospitals will be asked to include a
list of assets available to address the identified health needs, health need profiles,
and an evaluation of impact for strategies implemented since the last CHNA.
Once the CHNA Report has been completed, KFH hospitals will need to secure
local leadership approval before submitting the report to Regional Community
Benefit. KP is required to first secure approval from the Board of Directors before
making the reports widely available to the public on the KP website.
Updated August 2015
Kaiser Permanente National Community Benefit
17
Introduction
Process
Pre-Assessment
Secondary
Report
Map
Data
andGuidelines
Purpose
CHNA Toolkit Part 2 CHNA
Identifying Community Assets
Once you have identified your list of health needs you are required to identify the
assets available in your community to meet those needs. The list of assets (and
any identified gaps in assets) can be helpful when considering how to prioritize or
select the health needs to address and when it comes time to develop
implementation strategies. Some assets, such as hospitals, can be identified using
the CHNA Data Platform. You should also draw on your knowledge of the
community and its resources as well as the knowledge of your partners and
community stakeholders.
Health Needs Profiles
The health need profiles are designed to provide greater transparency and detail
for each health need. An example of how a health need profile might be organized
is provided in Appendix D, and a customizable template is available on the CHNA
Resources page of the CHNA Data Platform (www.chna.org/kp).
Evaluation of Impact
The final Federal CHNA Guidelines added language requiring the CHNA Report to
include an evaluation of the impact of actions taken by the hospital to address the
significant health needs identified in the hospital's previous CHNA/IS. Kaiser
Permanente has developed an approach to guide KFH facilities in reporting on the
impact of strategies implemented since the previous CHNA. Each KFH facility is
required to track metrics for internal CB programs, grantmaking, collaborations and
partnerships, and in-kind resources. These metrics include, but are not limited to,
number of individuals reached by the strategy, dollars spent, number of grants, and
results to date. For more details please see the Kaiser Foundation Hospital CHNA
Report template (available on the CHNA Resources page of the CHNA Data
Platform (www.chna.org/kp).
Updated August 2015
Kaiser Permanente National Community Benefit
18
Introduction
Community
and Purpose
Needs
CHNA Toolkit Part 2 Identifying
GLOSSARY
Updated August 2015
Kaiser Permanente National Community Benefit
19
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
GLOSSARY
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
The following table includes definitions of key CHNA terms referenced in this toolkit. In order to standardize the process and to ensure
compliance with the ACA regulations a shared understanding of these terms is important.
CONCEPT
Community Served
EXAMPLES
Kaiser Permanente defines community served as those individuals 
residing within its hospital service area. A hospital service area
includes all residents in a defined geographic area surrounding the
hospital and does not exclude low-income or underserved
populations.
Kaiser Permanente Northern
California Region definition of
hospital service area (pg. 7)
Behavioral, environmental, and clinical care factors as well as
more upstream social and economic factors that impact health.

Smoking

Park Access
Snapshots of diseases in a community that can be described in
terms of both morbidity and mortality.

Breast Cancer
Indicator
A characteristic of an individual, population, or environment which
is subject to measurement (directly or indirectly) and can be used
to describe one or more aspects of the health of an individual or
population.

Diabetes Incidence
Core Indicator
Indicators that directly relate to a health outcome of the potential
health need

Asthma Prevalence is a core
indicator for the Asthma
Related Indicator
Indicators that are upstream “drivers” to the potential health need

Air quality is a related indicator for
Asthma
Something that serves as a standard by which others may be
measured or judged.1

Healthy People 2020
Health Driver
Health Outcome
Benchmark
Potential Health Need Score
1.
DEFINITION
A number used to identify how well or poorly a Potential Health
Need category of indicators perform against benchmarks
“Benchmark”, Merriam –Webster Dictionary, Web: http://www.merriam-webster.com/dictionary/benchmark.
Updated August 2015
Kaiser Permanente National Community Benefit
i
Introduction
Community
and Purpose
Needs
CHNA Toolkit Part 2 Identifying
APPENDICES
Updated August 2015
Kaiser Permanente National Community Benefit
ii
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX A: Health Need Identification Toolbox
Identification Tool 1: Data Culling Tool
This table is an example of a tool to help outline the health outcomes and drivers (including specific themes and indicators) that
emerge from the data. A check list is provide to an help identify which potential health needs meet the criteria for a health need. For
additional tools and Excel templates, visit the CHNA Resources page at www.CHNA.org/KP.
Updated August 2015
Kaiser Permanente National Community Benefit
iii
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX A: Health Need Identification Toolbox
Identification Tool 2: Data Culling Tool
This table is another example of a tool to help outline the health outcomes and drivers (including categories and specific indicators)
that emerge from the data. Outlining the flagged data (against a benchmark for quantitative data) can help identify which outcomes
and categories meet the criteria for a health need. For Excel templates, visit the CHNA Resources page at www.CHNA.org/KP.
Updated August 2015
Kaiser Permanente National Community Benefit
iv
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX B: Health Need Prioritization Toolbox (page 1 of 7)
Prioritization Tool 1: Prioritization Matrix
A prioritization matrix is one of the more commonly used tools for prioritization and is ideal when health problems are considered
against a large number of criteria. Although decision matrices are more complex than alternative methods, they provide a visual
method for prioritizing and account for criteria with varying degrees of importance.
Step-by-Step Instructions: The following steps outline the procedure for applying a prioritization matrix to prioritize health issues.
1. Create a matrix – List all health needs vertically down the y-axis (vertical axis) of the matrix and all the criteria horizontally across the xaxis of the matrix so that each row is represented by a health issue and each column is represented by a criterion. Include an additional column
for the priority score.
2. Rate against specified criteria – Fill in cells of the matrix by rating each health issue against each criterion (KP required and any
relevant recommended criteria). An example of a rating scale can include the following:
3 = criterion met well 2 = criterion met 1 = criterion not met
3. Weight the criteria (optional) – If each criterion has a differing level of importance, account for the variations by assigning weights
to each criterion. For example, if ‘Criterion 1’ is twice as important as ‘Criterion 2’ and ‘Criterion 3,’ the weight of ‘Criterion 1’ could be .5 and the
weight of ‘Criterion 2’ and ‘Criterion 3’ could be .25. Multiply the rating established in Step 2 with the weight of the criteria in each cell of the
matrix. If the chosen criteria all have an equal level of importance, this step can be skipped.
4. Calculate priority scores – Once the cells of the matrix have been filled, calculate the final priority score for each health problem by
adding the scores across the row. Assign ranks to the health problems with the highest priority score receiving a rank of ‘1.’
5. Summing scores (optional) – If the ranking was first done by individuals and needs to be tallied for a group “ score,” then simply
sum each individual score for the overall, group priority score by health need.
6. Prioritize – Rank the health needs by the priority score.
Updated August 2015
Kaiser Permanente National Community Benefit
v
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX B: Health Need Prioritization Toolbox (page 2 of 7)
Prioritization Tool 1: Prioritization Matrix, Continued
Prioritization Matrix Template
Health Need
(criterion 1)
(criterion 2)
(criterion 3)
Priority Score
National Association of County and City Health Officials. First things first: Prioritizing health problems. Available at http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-Summaries-andExamples.pdf. Accessed August 22, 2012.
The following table represents an adaptation developed for CHNA by Verite Healthcare Consulting:
Need
Ex. Smoking
Secondary Data
Primary Data
County
Healthy
Ranking
Score
State Health
Department
Score
BRFSS
Criteria
Secondary
Data –
Weighted
Average
(50%)
Interviews
Score
Survey
Score
Primary
Data –
Weighted
Average
(50%)
1
-
1
(1+1)/2*.5=.5
2
2
(2+2)/2*.5=1
Scoring Key
Final
Score
(Sum)*
1.5
*Typically results are
validated by the
community
-
Not measured by source
0
Compares favorably to state, national or peer benchmarks
1
Compares slightly unfavorably to state, national, or peer benchmarks
2
Compares highly unfavorably to state, national or peer benchmarks
Verite Healthcare Consulting, LLC. Setting Priorities, Making Decisions. Presented at the CHA/VHA Conference: Assessing and Addressing Community Health Needs, July 24th, 2012.
Updated August 2015
Kaiser Permanente National Community Benefit
vi
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX B: Health Need Prioritization Toolbox (page 3 of 7)
Prioritization Tool 2: Multi-Voting
Multi-voting is typically used when a long list of health problems or issues must be narrowed down to a top few. Outcomes of Multivoting are appealing as this process allows a health problem which may not be a top priority of any individual but is favored by all, to rise to the
top. In contrast, a straight voting technique would mask the popularity of this type of health problem making it more difficult to reach a consensus.
Step-by-Step Instructions:
1. Round 1 Vote – Once a list of health problems has been established, each participant votes for their highest priority items. In this
round, participants can vote for as many health problems as desired or, depending on the number of items on the list, a maximum number of
votes per participant can be established.
2. Update List - Health problems with a vote count equivalent to half the number of participants voting remain on the list and all other health
problems are removed from further rounds (e.g. if 20 participants are voting, only health problems receiving 10 or more votes remain).
3. Round 2 Vote – Each participant votes for their highest priority items of this condensed list. In this round, participants can vote a number of
times equivalent to half the number of health problems on the list (e.g. if ten items remain on the list, each participant can cast five votes).
4. Repeat – Step 3 should be repeated until the list is narrowed down to the desired number of top health priorities.
Three-round Multi-voting Template
Health Need
Round 1 Vote
Round 2 Vote
Round 3 Vote
Instructions:
1. Fill in items to be prioritized under the ‘Health Need’ column
2. Tally votes for each round of voting in the respective column
National Association of County and City Health Officials. First things first: Prioritizing health problems. Available at http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-Summaries-andExamples.pdf. Accessed August 22, 2012.
Updated August 2015
Kaiser Permanente National Community Benefit
vii
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX B: Health Need Prioritization Toolbox (page 4 of 7)
Prioritization Tool 3: Strategy Grid
Strategy grids facilitate agencies in refocusing efforts by shifting emphasis towards addressing problems that will yield the greatest
results. Strategy grids can provide a mechanism to take a thoughtful approach to achieving maximum results with limited resources.
Step-by-Step Instructions:
1. Select criteria – Identify the criteria to be used for prioritization. Competing needs will be evaluated against how well this set of criteria is met.
2. Create a grid – Set up a grid with four quadrants and assign one broad criteria to each axis. Create arrows on the axes to indicate ‘high’ or
‘low,’ as shown below.
3. Label quadrants – Based on the axes, label each quadrant as either ‘High Need/High Feasibility,’ ‘High Need/Low Impact,’ ‘Low Need/High
Feasibility,’ ‘Low Need/Low Feasibility.’
4. Categorize & Prioritize - Place competing activities, projects, or programs in the appropriate quadrant based on the quadrant labels.
The example below depicts ‘Need’ and ‘Feasibility’ as the criteria and items have been prioritized as follows:
• High Need/High Feasibility – With high demand and high return on investment, these are the highest priority items and should be given
sufficient resources to maintain and continuously improve.
• Low Need/High Feasibility – Often politically important and difficult to eliminate, these items may need to be re-designed to reduce
investment while maintaining impact.
• High Need/Low Feasibility – These are long term projects which have a great deal of potential but will require significant investment.
Focusing on too many of these items can overwhelm an agency.
• Low Need/Low Feasibility – With minimal return on investment, these are the lowest priority items and should be phased out allowing for
resources to be reallocated to higher priority items.
National Association of County and City Health Officials. First things first: Prioritizing health problems. Available at http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-Summaries-andExamples.pdf. Accessed August 22, 2012.
Updated August 2015
Kaiser Permanente National Community Benefit
viii
APPENDIX B: Health Need Prioritization Toolbox (page 5 of 7)
Prioritization Tool 3: Strategy Grid (continued)
ix
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX B: Health Need Prioritization Toolbox (page 6 of 7)
Prioritization Tool 4: Simplex Method
The Simplex Method is a strategy for quantitatively gathering an individual’s input anonymously for prioritization.
Steps:
1. Create a questionnaire with close-ended questions for each health need, based on the selected criteria. All answers must be associated with
a score (low scores = low priority) and scores must be comparable across all needs (e.g. a four-point scale used for each, where 1=lowest
priority and 4=highest).
2. Administer questionnaire to the priority-setting group participants.
3. Average scores to calculate a final score for each need.
4. Questions can be pre-weighted if there are varying degrees of importance across questions.
Verite Health Consulting, LLC. Setting Priorities, Making Decisions. Presented at the CHA/VHA Conference: Assessing and Addressing Community Health Needs, July 24th, 2012.
Updated August 2015
Kaiser Permanente National Community Benefit
x
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX B: Health Need Prioritization Toolbox (page 7 of 7)
Prioritization Tool 5: Hanlon Method
Developed by J.J. Hanlon, the Hanlon Method for Prioritizing Health Problems is a well-respected technique which objectively takes into
consideration explicitly defined criteria and feasibility factors. Though a complex method, the Hanlon Method is advantageous when the desired
outcome is an objective list of health priorities based on baseline data and numerical values.
Step-by-step Instructions:
1. Rate against specified criteria – Once a list of health needs has been identified, on a scale from zero through ten, rate each health need on
the selected criteria. Determine the value for each level of the scale (e.g. 10=very severe; 5=relatively severe; 0=not severe at all).
2. Apply the ‘PEARL’ test - Once health needs have all been rated by criteria, use the ‘PEARL’ Test, to screen out health issues based on the
following feasibility factors:
Propriety – Is a program for the health problem suitable?
Economics – Does it make economic sense to address the problem? Are there economic consequences if a problem is not carried out?
Acceptability – Will a community accept the program? Is it wanted?
Resources – Is funding available or potentially available for a program?
Legality – Do current laws allow program activities to be implemented?
The answer to each question must be yes. Put any health needs that receive an answer of “No” to any of the above questions to the bottom
of the list (as “low priority” or “not urgent”).
3. Calculate priority scores – Apply the following formula to calculate scores for the needs that have not failed the PEARL test:
D = [A + (2 x B)] x C
Where: D = Priority Score; A = Size of health problem; B = Seriousness of health problem; C = Effectiveness of potential intervention
*Note: Seriousness of health problem is multiplied by two because according to the Hanlon technique, it is weighted as being twice as
important as size of health problem.
4. Rank the health needs – Based on the priority scores calculated in Step 3 of the Hanlon Method, rank the needs from highest to lowest.
Make sure the results are logical based on participant knowledge of the community and make adjustments if needed.
National Association of County and City Health Officials. First things first: Prioritizing health problems. Available at http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-Summaries-andExamples.pdf. Accessed August 22, 2012.
Updated August 2015
Kaiser Permanente National Community Benefit
xi
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX B: Health Need Prioritization Toolbox (page 7 of 7)
Prioritization Tool 5: Hanlon Method
Developed by J.J. Hanlon, the Hanlon Method for Prioritizing Health Problems is a well-respected technique which objectively takes into
consideration explicitly defined criteria and feasibility factors. Though a complex method, the Hanlon Method is advantageous when the desired
outcome is an objective list of health priorities based on baseline data and numerical values.
Step-by-step Instructions:
1. Rate against specified criteria – Once a list of health needs has been identified, on a scale from zero through ten, rate each health need on
the selected criteria. Determine the value for each level of the scale (e.g. 10=very severe; 5=relatively severe; 0=not severe at all).
2. Apply the ‘PEARL’ test - Once health needs have all been rated by criteria, use the ‘PEARL’ Test, to screen out health issues based on the
following feasibility factors:
Propriety – Is a program for the health problem suitable?
Economics – Does it make economic sense to address the problem? Are there economic consequences if a problem is not carried out?
Acceptability – Will a community accept the program? Is it wanted?
Resources – Is funding available or potentially available for a program?
Legality – Do current laws allow program activities to be implemented?
The answer to each question must be yes. Put any health needs that receive an answer of “No” to any of the above questions to the bottom
of the list (as “low priority” or “not urgent”).
3. Calculate priority scores – Apply the following formula to calculate scores for the needs that have not failed the PEARL test:
D = [A + (2 x B)] x C
Where: D = Priority Score; A = Size of health problem; B = Seriousness of health problem; C = Effectiveness of potential intervention
*Note: Seriousness of health problem is multiplied by two because according to the Hanlon technique, it is weighted as being twice as
important as size of health problem.
4. Rank the health needs – Based on the priority scores calculated in Step 3 of the Hanlon Method, rank the needs from highest to lowest.
Make sure the results are logical based on participant knowledge of the community and make adjustments if needed.
National Association of County and City Health Officials. First things first: Prioritizing health problems. Available at http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-Summaries-andExamples.pdf. Accessed August 22, 2012.
Updated August 2015
Kaiser Permanente National Community Benefit
xii
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX C: CHNA Report Outline
Authors, Acknowledgements, and Table of Contents
I.
Executive Summary
Community Health Needs Assessment Background*
Summary of Prioritized Needs
Summary of Needs Assessment Methodology and Process
* Some sections of the report template will likely
be pre-populated with Region-wide language in
order to reduce the burden on each hospital and
to create some consistency across reports. Each
hospital may add to these sections if they wish.
II. Introduction/Background
About Kaiser Permanente*
About Kaiser Permanente Community Benefit*
Purpose of the Community Health Needs Assessment (CHNA) Report
KP’s Approach to Community Health Needs Assessment*
III. Community Served
Kaiser Permanente’s Definition of Community Served*
Map and Description of Community Served
IV. Who Was Involved in the Assessment
Identity of Hospitals Who Collaborated on the Assessment
Other Partner Organizations Who Collaborated on the Assessment
Identity and Qualifications of Consultants Used to Conduct the Assessment
V.
Process and Methods Used to Conduct the CHNA
Secondary Data*
Community Input*
Written Comments*
Data Limitations and Information Gaps*
VI. Identification and Prioritization of Community’s Health Needs
Identifying Community Health Needs*
Process and Criteria Used to for Prioritization of Health Needs
Prioritized Description of All Community Health Needs Identified Through the
CHNA
Community Resources Available to Respond to the Identified Health
Needs of the Community
Updated August 2015
Kaiser Permanente National Community Benefit
xiii
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX C: CHNA Report Outline
VII. Evaluation of Impact
Purpose of 2013 Implementation Strategy Evaluation of Impact*
2013 Implementation Strategy Evaluation of Impact Overview*
2013 Implementation Strategy Evaluation of Impact by Health Need
VIII. Appendix
Health Need Profiles
Primary Data Collection Tool
KP CHNA Data Sources and Dates
Updated August 2015
Kaiser Permanente National Community Benefit
* Some sections of the report template will likely
be pre-populated with Region-wide language in
order to reduce the burden on each hospital and
to create some consistency across reports. Each
hospital may add to these sections if they wish.
xiv
Introduction
Process
Pre-Assessment
Secondary
Web-based
Primary
Data
Map
Data
Data
and
Guidelines
Guidelines
Platform
Purpose
CHNA Toolkit Part 2 APPENDICES
APPENDIX D: Sample Health Needs Profiles
Simplified Health Need Profile
Updated August 2015
Kaiser Permanente National Community Benefit
xv