The Design Utility of Rural Hospital Community Health Needs Assessments

Objective: A secondary analysis of community health needs assessment data was used to determine access and barriers to primary, specialty and hospital-based care in a rural, frontier-designated Montana critical access hospital (CAH) to establish alignment between the physical healthcare facility infrastructure design approach and community healthcare service needs. Background: The lack of physical infrastructure and integrated equipment/technological resources in CAHs can be a contributing factor in closures when means are absent to be responsive to the needs of an ageing population, updated technology, and heightened acuity level of care. Method: Inferential and predictive analyses of a cross-sectional survey was used to understand the care access based on the community members demographics as well as perceptions of their personal health, the community's health, knowledge of health services, and insurance coverage. Results: Important associations and predictors for the use of primary, hospital-based and specialty care among the rural residents were positive perceptions of health of themselves and their community (60%+) and good to excellent insurance coverage (70%+). Predictive decision tree modeling determined notable variation in access and use of specialty care and current employment status. These results indicate most respondents did not delay care due to transportation, distance, childcare or work. Insurance coverage and its cost were critical in accessing all types of care but especially specialty care. Conclusions: Community health needs assessments are conducted to retain tax status for CAHs, and as such are available sources of stakeholder perspectives that may expedite design approaches and strategic planning.