A Systematized Review of Prioritization Methods Utilized in Community Health Needs Assessments Among Nonprofit...

This systematized review aimed to identify the most common methods used to prioritize health needs among 501(c)(3) nonprofit hospital systems in the US since the implementation of the Affordable Care Act.

Of the approximately 6000 hospitals in the US, 50% are 501(c)(3) nonprofits. These 501(c)(3)s are tax-exempt with surplus revenue serving their communities and must meet the community benefit standard provided by Internal Revenue Code (IRC) section 501(c)(3) and Revenue Ruling 69-545. Additionally, the Patient Protection and Affordable Care Act (ACA) (2010) requires all 501(c)(3) nonprofit hospitals to conduct a Community Health Needs Assessment (CHNA) every 3 taxable years. The Internal Revenue Service (IRS) provides broad guidelines for these needs assessments, but no guidance on prioritizing the needs identified.

A systematized review was utilized to review commonly used methods in CHNAs. The PubMed database was utilized to find recent, peer-reviewed articles. A librarian was consulted for the generation of Boolean search terms. Filters included articles in English, peer-reviewed, and time-bound from 2010 to 2025. Data extracted focused on the type of prioritization method used by CHNAs.

Out of 1076 records initially identified, 37 peer-reviewed studies met the final inclusion criteria. Three broad categorical approaches of prioritizing needs were identified: community-driven approaches, structured prioritization frameworks, and a combination of approaches. Prioritization methods include the nominal grouping technique, multivoting technique, community-based participatory research, concept mapping, the Delphi technique, descriptive statistics & regressions, and the Hanlon method.

There are many evidence-based methods for prioritizing health needs. Some are better suited to specific situations and communities than others. Aggregating the examples of prioritization methods in CHNAs will aid hospitals and communities in selecting the right method to best serve their community. Ultimately, this research provides guidance to communities creating a useful CHNA and a healthier equitable community. Future research should investigate the effect of these prioritization methods on health outcomes and quantifying subsequent community benefit.