The National Center for Rural Health Works has provide community health needs assessment for many years. The “OLD” process is the Community Health Engagement Process (CHEP) and is still a very viable assessment tool. CHEP is illustrated below with attachments that explain the process in detail and the products developed with this tool.
With the passing of the “2010 Affordable Care Act,” all 501(c)(3) hospitals (not-for-profit or non-profit hospitals) must conduct a community health needs assessment process to meet the U.S. Department of Treasury and Internal Revenue Service (IRS) rules. The “NEW” process is a more streamlined process, referred to as the Community Health Needs Assessment (CHNA) template. The CHNA template was developed over the last year by the National Center. The CHNA template is illustrated below in detail. The CHNA template will enable hospitals to conduct the process themselves or allow other organizations to facilitate the process for the hospitals. The CHNA template includes the documents for each product in their original formats, i.e., Microsoft Word, Excel, and/or Powerpoint, in order for the documents to be easily utilized and replicated.
Either process may be utilized and can fulfill the new legislative requirements. CHEP has more detailed products, typically more meetings, and derives community input through a phone survey conducted by an outside contractor (higher costs). The CHNA template has more streamlined products, fewer meetings, and options for community input that include focus groups or surveys. The analysis of the community input method is typically performed locally to avoid high costs.
If you have any problems utilizing this webpage, please contact Cheryl St. Clair or Fred Eilrich through email or call 405-744-6083.
Community Health Engagement Process (CHEP) –
“OLD” Health Assessment Template
CHEP is described in the attached brochure:
Overview of Community Health Engagement Process
An example of each of the products developed through the CHEP process (example from St. James Parish, Louisiana) are included below:
Economic Impact Study (PowerPoint)
Health Services Directory
Data and Information Study (PowerPoint)
Health Survey Results (Phone Survey) (PowerPoint)
Primary Care and Specialty Physicians
Community Health Needs Assessment Template (CHNA template) -
“NEW” Health Assessment Template
The CHNA Template in Adobe Acrobat format is included here. Due to the size of the document and limited capabilities of the software, the CHNA Template is included in five (5) parts:
CHNA Template – Text of All Chapters WITHOUT APPENDICES
CHNA Template – Appendix A through Appendix E
CHNA Template – Appendix F through Appendix J
CHNA Template – Appendix K through Appendix M
CHNA Template – Appendix N through Appendix O
The “CHNA Template – Text of All Chapters WITHOUT APPENDICES” attachment explains the entire template and discusses what is included in each Appendix to determine which Appendix you may want to download. All of the documents above are in Adobe Acrobat format.
Below are the individual components of the CHNA template. Documents necessary to utilize the template are included in their original format; i.e., Microsoft Word, Excel, and/or Powerpoint, for anyone to download and utilize to develop the studies/products. This will enable users to easily replicate any of the studies/products.
Diagram of Two-Meeting Process
Diagram of Two-Meeting Process in Microsoft Word
Diagram of Three-Meeting Process
Diagram of Three-Meeting Process in Microsoft Word
Example Agendas
Example Agenda for Meeting #1
Example Agenda for Meeting #2
Example Powerpoints
Example GENERIC CHNA Overview Slides
Example Community CHNA Overview Slides
Example Community Economic Impact Slides
Example Community Demographic and Economic Data Slides
Example Community Health Indicators/Health Outcomes Slides
Example Community Health Survey Results Slides
Example Community Meeting #1 Consolidated Slides
Appendix A – National Advisory Team Members
National Advisory Team Members
Appendix B – Contact Informaton – State Offices of Rural Health (SORHs)
Contact Informaton – State Offices of Rural Health (SORHs)
Appendix C – Contact Information – State Hospital Associations
Contact Information – State Hospital Associations
Appendix D – Community Advisory Committee – Potential Committee Members and Example Invitation Letters
Potential Committee Members
Example Community Leader Invitation Letter
Second Example – Invitation Letter
Appendix E – Example of Hospital Services/Community Benefits
Example of Hospital Services/Community Benefits
Appendix F – Example Demographic and Economic Data Report
Build Demographic and Economic Data in Excel
Draw Map of Medical Service Area in Word
Cover Sheet for Demographic and Economic Data ReportFinal Demographic and Economic Data Report in Adobe Acrobat
Appendix G – Example Community Health Survey Questionnaire
Example – Survey Instructions to Community Advisory Committee
Example Community Health Survey Questionnaire
Example GENERIC Health Survey Questionnaire
Example – Community Health Survey Cover
Appendix H – Example Focus Group Questions
Example – Focus Group Questions
Appendix I – Powerpoint Illustrating Average Impact of Rural Hospital on Local Economy
Generic Powerpoint Illustrating Average Impact of Rural Hospital on Local Economy
Appendix J – Example Economic Impact Study
Example – Data Collection Form for Economic Impact Study
Example – Building the Economic Impact Tables in Excel
Example Community Economic Impact Study
Example Generic XYZ Economic Impact Study Format
Example – Steps on “HOW TO” Prepare Economic Impact Study
Example – “HOW TO” Run IMPLAN Model to Derive Multipliers for Economic Impact Study
IMPLAN Price Sheet for 2010 Data
Appendix K – Powerpoint Illustrating CHNA Process
Overview of CHNA Template – Slides
Appendix L – Example Community Health Indicators/Health Outcomes Report
Instructions for Health Indicators/Health Outcomes Report
Build Tables 1 thru 5 in Excel
Build Tables 6 thru 8 in Excel
Example Community Health Indicators/Health Outcomes Report
Appendix M – Example Community Input Summary Report (Health Survey Questionnaire)
Instructions on Analyzing Community Health Survey Questionnaire
Example Community Health Survey Questionnaire
Example GENERIC Health Survey Questionnaire
Example Survey Instructions to Community Advisory Committee
Example Spreadsheet to Analyze Community Health Survey Questionnaire
Example Cover Sheet for Community Health Survey Summary Report
Example of Community Health Survey Summary Results Report
Appendix N – Example of Summary of Community Health Needs and Recommended Implementation Strategies – To be submitted to Hospital
Example Summary of Community Health Needs and Recommended Implementation Strategies/Responsibilities
Example – Table to Assist Community Advisory Committee to List Community Health Needs, Implementation Strategies, and Responsibilities
Appendix O – Suggested IRS Final Report Outline and IRS Reporting Forms
Suggested Summary Report Outline
IRS Form 990
IRS Form 990 Schedule H
If you have any problems utilizing this webpage or accessing the CHNA template components, please contact Cheryl St. Clair or Fred Eilrich through email or call 405-744-6083.