2025 Community Health Needs Assessment
Town-level population, age, poverty, disability, and community access findings were extracted from the DHMC-APD fiscal year 2025 CHNA.
Original local analysis • Upper Valley • applied implementation
Use local evidence to decide who must be heard and what leaders should do next.
This page applies the APE toolkit to Dartmouth Hitchcock Medical Center and Alice Peck Day Memorial Hospital's 2025 Upper Valley service-area data. The municipality-level data, denominator, calculations, interpretation, and limitations are available for direct review.
Why this matters
Population context changes PFAC design.
A PFAC can be structurally present and still miss the people most affected by access barriers. The 2025 CHNA defines a 72,736-person primary service area and emphasizes populations facing barriers related to income, age, disability, and social or physical isolation. This analysis converts those local data into recruitment, participation, agenda, and accountability requirements.
Method
A reproducible descriptive re-analysis of public local data.
Population-weighted exposure to above-average local conditions
For each of 19 municipalities, the analysis flags whether poverty, disability, or age 65+ exceeds the corresponding service-area average. It then sums the populations of those municipalities and divides by the 72,736-person service-area population.
Planning analysis, not a risk score
The derived percentages are descriptive screening signals for PFAC representation and access planning. They are not validated cut points, clinical risk estimates, causal findings, or measures of PFAC effectiveness.
Original local analysis
Explore the 19-municipality calculation.
Select a characteristic, filter municipalities, and sort the view. The chart and supporting table use the same source file and retain the full 72,736-person denominator for the headline calculation.
Rows shown19 of 19
Residents shown72,736
Residents in above-average towns48.4%
Above-average municipalities6 towns
Poverty: 48.4% of the 72,736 service-area residents live in 6 municipalities where the published poverty percentage is above the 8% service-area average. Recruitment and participation should account for cost, compensation, transportation, time, and other economic barriers.
Interactive local viewPoverty by municipality
View municipality data table
| Municipality | 2023 population | Selected characteristic | Service-area average | Comparison |
|---|---|---|---|---|
| Canaan | 3,801 | 13% | 8% | Above service-area average |
| Dorchester | 431 | 17% | 8% | Above service-area average |
| Enfield | 4,488 | 13% | 8% | Above service-area average |
| Fairlee | 1,042 | 11% | 8% | Above service-area average |
| Hartford | 10,713 | 11% | 8% | Above service-area average |
| Lebanon | 14,759 | 9% | 8% | Above service-area average |
Interactive analysis loading all 19 municipalities.
Three validated headline results remain fixed for review: 48.4% for poverty, 60.5% for disability, and 47.9% for age 65+. The controls reveal the municipality-level data behind those estimates; they do not alter the underlying analysis.
Local access signals
The strongest operational signal is access and navigation.
The CHNA reports that 42% of community respondents had difficulty accessing primary care, while 54% of residents and 58% of community leaders said primary-care access had worsened. Mental health access was difficult for 35% of respondents; among those reporting difficulty, 68% cited long waits and 62% cited practices not accepting new patients.
72% of community leaders and service providers identified insufficient local capacity as an access barrier.
59% identified difficulty navigating the health care system.
55% identified isolated populations, including homebound or very rural residents, as not adequately served by local resources.
Applied example
The toolkit is applied to an Upper Valley access and navigation use case.
This is an applied example, not a claim that Dartmouth Health has adopted the recommendations. The problem, population context, PFAC workstream, measurement logic, and next decisions are populated so leaders can assess the approach with local teams.
View implementation detail table
| Implementation element | Completed in the APE | Local confirmation needed |
|---|---|---|
| Problem definition | Access, navigation, capacity, wait-time, and rural or isolation signals are extracted from the 2025 CHNA and converted into a defined PFAC workstream. | Confirm which access pathway should be prioritized first. |
| Population and representation | Age, disability, poverty, geography, isolation, transportation, caregiver, and technology considerations are built into the representation and access logic. | Compare current PFAC composition and participation options with local service-area context. |
| Governance and action | A standing access and navigation agenda lane, leadership disposition, accountable owner, due date, escalation, and report-back requirement are specified. | Assign the actual executive sponsor and operational owners. |
| Measurement | Proposed measures include time to leadership disposition, action closure, report-back completion, and representation or access barriers mitigated. | Select locally available data sources and review cadence. |
| Domain 5 traceability | The workstream is connected to patient and family engagement infrastructure, local evidence, accountable roles, actions, and validation sources. | Validate any evidence used for organizational attestation or formal reporting. |
Applied proof
What this demonstrates.
CEPH 4: the project includes a transparent, reproducible local data analysis with calculations and interpretation for public health practice.
CEPH 7: the target population is defined using the 19-municipality Upper Valley service area, and local needs, assets, and participation barriers are translated into PFAC design requirements.
Implementation: the reusable toolkit is demonstrated against a current Dartmouth Health service-area problem using public evidence while preserving the boundary between proposed action and completed organizational change.
Sources and validation
Public evidence used for the local analysis.
- Dartmouth Hitchcock Medical Center, Alice Peck Day Memorial Hospital, and Visiting Nurse and Hospice for Vermont and New Hampshire. Fiscal Year 2025 Community Health Needs Assessment. Dartmouth Health. Accessed September 7, 2026. Source.
- Dartmouth Health. Strategic Plan 2030. Strategic Goal 2 identifies value, safety, quality, access, patient experience, and system-wide improvement as priorities. Accessed September 7, 2026. Source.
Calculation note: all percentages shown as original re-analysis were recalculated from the municipality-level values and 2023 population estimates published in the 2025 CHNA. Because source percentages are rounded, derived population shares should be interpreted as descriptive approximations.
Safety and payment context
HAI Alert > pay-for-performance incentives.
CMS links hospital quality performance to Medicare payment through national value-based programs. Healthcare-associated infection measures contribute to Hospital Value-Based Purchasing, while the Hospital-Acquired Condition Reduction Program applies a payment reduction to hospitals in the worst-performing quartile using a measure set that includes CLABSI, CAUTI, surgical-site infection, MRSA bacteremia, and C. difficile infection.
Evidence boundary: This establishes the national policy connection between HAI performance and payment. It does not establish Dartmouth Health's current scores, eligibility, payment adjustment, incentive amount, or local causal impact; those require current hospital-specific CMS and local finance data.