Evidence-Based Policy and Practice on Community Benefit: Information Support for Developing a Bibliography

Article excerpt


"Community benefit" (CB) is described in a revenue ruling from the Internal Revenue Service (IRS) that justifies the tax-exempt status of nonprofit hospitals and requires these hospitals to provide community services. According to the instructions for IRS form 990, schedule H, CB spans a wide array of potential activities, varying from clinical services, to research, to community outreach and workforce education [I]. As the nation continues to make changes to the health care delivery system, the contributions of nonprofit health care organizations to the community will likely remain a charged topic, one warranting empirical evidence to enhance understanding. Rigorous studies about CB can provide a more complete picture of its structure, management, and effectiveness, as well as its impact on the social, economic, and health status of the community. Frontline hospital administrators are striving to make the implementation of CB programs driven more by evidence of effectiveness than by dollar requirements or historical trends. Health care executives, policy analysts, and researchers all express an increased interest in data pertaining to CB.

Librarians will be asked to assist researchers and policy analysts in finding existing research studies and compiling future data. However, because the majority of the existing literature on CB pertains to practice or regulations, the definitions are complex, and the published literature is widely dispersed, this task can be immense and daunting. This article describes one approach to searching for research evidence about CB and recommends methods that will make such searches easier in the future.


Since 2007, the Saint Louis University (SLU) School of Public Health (SPH) has been promoting rigorous policy and health services research on CB. In an effort to move the field more toward evidence-based policy and programming, SLU SPH planned a conference, "Community Benefit: Moving Forward with Evidence-Based Policy and Practice," held on June 27, 2009, in Chicago [2]. The purpose of this invitational meeting was to develop the initial agenda for CB research and policy analysis for the next three years.

Given this orientation, the planning committee invited the SLU SPH liaison librarian to compile a bibliography with CB-related research literature published between 1990 and the present for the conference. The librarian then worked with an SPH research assistant between October 2008 and February 2009 to develop a comprehensive search on research literature pertaining to ten aspects of CB. These aspects included: (1) community leadership and health status; (2) community needs and population segments; (3) economics, finance, charity care, and bad debt; (4) ethics; (5) evaluation and program effectiveness; (6) governance; (7) quality and performance measurement; (8) health professions education; (9) state and federal policy; and (10) structure and staffing. These ten aspects are derived from IRS form 990, schedule H, and are used by the practitioners in nonprofit hospitals to organize their CB portfolios.

The immediate goal of the literature search was to develop a representative bibliography on CB research and policy studies that could be used by conference participants to prepare for the meeting. The longerterm goal was to make widely available a bibliography on CB that would expedite the work of researchers and policy analysts, as well as of health administrators, health educators, and health sciences librarians.


Database identification

The conference sought to develop a research agenda on CB, and thus research articles were the major component of the bibliography. Online databases covering the field of health care administration were the initial resources for the search. The databases available at the SLU Medical Center Library during the period when the search was conducted included MEDLINE (OvidSP platform), Health Management (ProQuest), Global Health (EBSCO platform), ABI/ Inform (ProQuest), Academic Search Premier, Sociological Abstracts, and Web of Science. …