Publications

CONTEXT: Environmental impacts on human health are an urgent concern, requiring greater focus and action from health care organizations. Nonprofit hospitals can address community needs through investing in environmental improvement (EI) projects aimed at reducing harm to the community from environmental hazards. These expenditures provide a useful model for understanding how hospitals can respond to environmental influences on health, but national patterns of EI expenditures are under-researched.

OBJECTIVE: To assess nationwide trends in nonprofit hospital EI spending from 2010 to 2021.

DESIGN: Observational study using Internal Revenue Service tax data.

SETTING: US nonprofit hospitals.

MAIN OUTCOMES AND MEASURES: We assessed associations between reported EI spending and hospital organization and community characteristics (hospital revenue (quintiles); bed size (<50, 50-199, 200-399, 400 +); participation in group reporting (yes/no); teaching affiliation (yes/no); rurality status; geographic region (Northeast, Midwest, West, and South), and county poverty (quartile).

RESULTS: There were 36 093 nonprofit hospital-years included in our analysis. 10.4% of hospitals reported EI spending. EI spending was positively associated with higher revenue and being in the Midwest region and negatively associated with area poverty. The years 2020 and 2021 were significantly associated with a lower likelihood of spending relative to 2010. 40% of hospitals included utilized group reporting. Only 6% of independently reporting hospitals reported EI spending. Among hospital organizations with any reported community-building expenses, the percentage of their total operating budget dedicated to EI averaged 0.002% each year (0%-1.52%).

CONCLUSIONS: Though EI investments are small relative to community-building spending, the characteristics of hospitals reporting these investments provide insight into EI trends over time and which hospitals are conducting these efforts. Future research should consider the specific gaps to stimulating EI, what environmental needs hospitals are equipped to fill, and their relevance to broader environmental health policies and initiatives.

BACKGROUND: Programs that aim to increase access to substance use disorder (SUD) treatment in hospital-based settings have proliferated in recent years. These efforts include transitional opioid programs (TOPs), which navigate patients to community-based SUD treatment programs post-discharge. Successful navigation from TOPs to outpatient treatment hinges on effective coordination between hospitals and post-discharge endpoints, yet it is unclear how hospitals can best develop effective partnerships with outpatient treatment organizations. The objective of this study is to synthesize the common themes underpinning the development of partnerships to facilitate care transitions between TOPs and ongoing SUD treatment.

METHODS: Qualitative study with staff and providers from hospitals affiliated with four safety-net health systems (n = 21) and leaders from community-based organizations (CBOs) and treatment facilities that had established referral partnerships with one of the four health systems in our study (n = 4).

RESULTS: Analysis of interview transcripts revealed seven common themes that underpinned the development of care transitions partnerships: (1) Active, intentional outreach; (2) Responding to a community need; (3) External Enabling Factors; (4) Leveraging reputations and community connections; (5) Focusing on operations; (6) Reciprocal relationships; and (7) Building Infrastructure and Processes to Ensure Collaboration. The seven identified themes were categorized into three groups corresponding to different partnership development stages. The first group revolves around the initial stage of meeting and developing a relationship (themes #1-4). The second set focuses on navigating and resolving challenges that arise in the partnership (themes #5-6). Lastly, the third group pertains to sustaining a partnership long-term (theme #7).

CONCLUSIONS: This study identifies seven core themes underlying the development of care transition partnerships for SUD patients within four safety net health systems and their CBO partners. These themes demonstrate how partner organizations can establish the trust, reciprocity, and commitment necessary to support patients through the critical transition period.