Addressing Social Determinants of Health in Rural Iowa Hospitals: Content Analysis of Community Health Needs Assessments

Abstract

Objectives: With the shift to value-based care, social needs screening and referrals and other means of addressing the social determinants of health (SDOH) have become important ways for hospitals to address population health, which is particularly important for rural communities. Our objective was to evaluate how Iowa rural hospitals identified SDOHs in their community health needs assessment (CHNAs). Design: We conducted content analysis on the most recent CHNAs, and corresponding implementation plans of 53 rural Iowa hospitals, capturing broad social needs terms (eg, social screening, social risk) and specific SDOH terms (eg, housing, food insecurity), and hospital-community partnerships. We conducted stratified analysis by hospital-level characteristics like ownership (not-for-profit, non-federal government), type, and Accountable Care Organizations participation, and sociodemographic characteristics of each hospital's defined community area. Results: The most frequently identified SDOH were food insecurity (94.4%), transportation (92.6%), and housing insecurity (83.3%). Implementation plans primarily addressed food insecurity (53.7%), transportation (48.1%), and housing insecurity (35.2%). The most common hospital partnerships were with schools (68.5%), local organizations (53.7%), and faith-based organizations (31.5%). A lower percentage of Critical Access Hospitals and non-federal government hospitals addressed SDOH in their implementation plans compared to rural prospective payment system hospitals and non-profit hospitals, respectively. Hospitals serving counties with higher social needs showed higher assessment but lower implementation addressing these needs. Conclusion: The disparities in screening and implementation efforts by hospital type, ownership, and payment models highlight the need for tailored policy interventions and infrastructure support to enhance social needs strategies, particularly in rural contexts.