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Full-Text Articles in Medicine and Health Sciences
Geographic Variation In The Implementation Of Public Health Services: Organizational, Economic, And Network Determinants, Glen P. Mays
Geographic Variation In The Implementation Of Public Health Services: Organizational, Economic, And Network Determinants, Glen P. Mays
Glen Mays
An expanding body of research-tested public health interventions exist to prevent disease and injury and promote health on a population-wide basis, such as those profiled in the CDC’s Guide to Community Prevention Services, but adoption and implementation of these strategies vary widely across states and communities. Public health services are delivered through diffuse constellations of governmental agencies and their private-sector and community-based counterparts using implementation mechanisms that are poorly understood. The studies in this panel examine how organizational, economic, and inter-organizational network characteristics influence the implementation of public health services across states and communities.
Inter-Organizational Network Effects On Public Health Service Implementation, Outcomes, And Disparities Across U.S. Communities, Glen P. Mays
Glen Mays
Background: The Affordable Care Act created new incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing inter-organizational relationships and expanding implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities; (2) whether network changes attenuate or exacerbate disparities in public health implementation across communities; and (3) how network changes affect preventable mortality and resource use.Methods: We follow a longitudinal cohort of 360 …
Estimating Health And Economic Gains From Public Health Delivery System Transformation, Glen Mays
Estimating Health And Economic Gains From Public Health Delivery System Transformation, Glen Mays
Glen Mays
Objectives: The Affordable Care Act created new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing the structure of public health delivery systems and expanding the implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, which we use as indicators of public health system change; and (2) the effects of these changes on preventable mortality and resource use. Methods: …
Kentucky's Public Health Strategic Plan: Strengthening Foundational Services & Improving Population Health, Glen P. Mays
Kentucky's Public Health Strategic Plan: Strengthening Foundational Services & Improving Population Health, Glen P. Mays
Glen Mays
This session examines recent progress toward the 2012 Institute of Medicine recommendation to identify the components and costs of a "minimum package" of public health services and foundational capabilities to be available across the U.S. Research about the health and economic benefits of Foundational Public Health Services has begun to shape Kentucky's strategic plan for transforming the public health system.
Trends In Health Care Delivery Systems: Implications For Cancer Prevention And Control, Glen P. Mays
Trends In Health Care Delivery Systems: Implications For Cancer Prevention And Control, Glen P. Mays
Glen Mays
The Affordable Care Act and larger economic forces are leading both health care providers and public health agencies to renegotiate their roles and responsibilities within the U.S. health system. This session reviews major changes occurring in both health care and public health delivery systems, with a focus on the implications for cancer prevention and control. The information infrastructure created by cancer registries and other health information systems are increasingly important for enabling greater coordination, alignment and accountability within the nation's changing delivery systems.
Improving The National Health Security Preparedness Index: Recommended Updates For 2015-16, Glen P. Mays
Improving The National Health Security Preparedness Index: Recommended Updates For 2015-16, Glen P. Mays
Glen Mays
This report describes proposed updates in methodology and measures for the 2015-16 release of the National Health Security Preparedness Index
Using Research And Roi To Drive Partnerships In Public Health Delivery Systems, Glen P. Mays
Using Research And Roi To Drive Partnerships In Public Health Delivery Systems, Glen P. Mays
Glen Mays
Stimulating public-private partnerships (PPP) for health and economic development initiatives requires research that can answer key questions: (1) what are the health and economic returns likely to be realized; (2) over what time frames and with what certainty; (3) what investments are required to achieve results; and (4) what are the implementation strategies most likely to succeed. This presentation reviews ongoing research on the PPPs used to deliver public health services in the U.S., and explores the lessons this research offers PPPs in low and middle income countries. We examine how scientific evidence on public health delivery systems and their …
Foundational Public Health Services And Health System Reform: Evidence, Economics, And Implementation, Glen P. Mays
Foundational Public Health Services And Health System Reform: Evidence, Economics, And Implementation, Glen P. Mays
Glen Mays
The Institute of Medicine's 2012 report on public health financing recommended a national initiative to identify the components and costs of a "minimum package" of public health programs and infrastructure that should be available in every U.S. community. In response, efforts are now underway to reach consensus on a set of "Foundational Public Health Services" for the nation, and to identify resource requirements for implementing these services. This presentation reviews existing research on the current availability of Foundational Public Health Services across the U.S. and the health and economic effects attributable to these services. We also review progress on ongoing …
Fundamentals Of Economic Evaluation For Public Health, Glen P. Mays
Fundamentals Of Economic Evaluation For Public Health, Glen P. Mays
Glen Mays
This workshop provides an overview of the design and implementation of economic evaluation studies of public health programs and policies. Strategies for integrating economic evaluation principles, measurement strategies, analytic approaches, and results into the routine operations of public health agencies are examined.
Medicaid Crowd-Out Of Other Public Health Spending: Modeling Economic And Health Effects, Glen P. Mays
Medicaid Crowd-Out Of Other Public Health Spending: Modeling Economic And Health Effects, Glen P. Mays
Glen Mays
MOTIVATION: Thirty states are expanding Medicaid eligibility under the Affordable Care Act (ACA) as of 2015, and while federal funds cover most costs for newly eligible recipients, states must share the additional costs of covering previously-eligible state residents who enroll in Medicaid. States, together with their local government counterparts, also provide the vast majority (87%) of public sector funds for public health programs designed to promote health and prevent disease and injury on a population-wide basis. Fiscal constraints and generous federal matching funds create strong budgetary incentives for states to channel their health-related spending to Medicaid rather than to other …
Using Network Analysis To Understand Public Health Delivery Systems & Community Health Initiatives, Glen P. Mays
Using Network Analysis To Understand Public Health Delivery Systems & Community Health Initiatives, Glen P. Mays
Glen Mays
The increasingly connected world of health care delivery relies on an expanding frontier of multi-stakeholder structures and processes, from interdisciplinary patient-centered care teams, to virtual accountable care organizations (ACOs), to complex community-level interventions. This session highlights recent advances in applying social network analysis (SNA) methods to study the implementation and impact of these types of innovations. This methods workshop examines the benefits and limits of novel SNA applications based on the expanding availability of large, linkable electronic clinical and administrative data sources with dependent data structures. This paper profiles examples of using SNA principles and methods to study the implementation …
Learning From Network Analysis: Care Transitions, Market Competition, And Community Interventions, Glen P. Mays
Learning From Network Analysis: Care Transitions, Market Competition, And Community Interventions, Glen P. Mays
Glen Mays
The increasingly connected world of health care delivery relies on an expanding frontier of multi-stakeholder structures and processes, from interdisciplinary patient-centered care teams, to virtual accountable care organizations (ACOs), to complex community-level interventions. This methods workshop highlights recent advances in applying social network analysis (SNA) methods to study the implementation and impact of these types of innovations. This session will examine the benefits and limits of novel SNA applications based on the expanding availability of large, linkable electronic clinical and administrative data sources with dependent data structures.
Learning From Delivery System Behavior, Dynamics, And Interactions To Advance A Culture Of Health, Glen P. Mays
Learning From Delivery System Behavior, Dynamics, And Interactions To Advance A Culture Of Health, Glen P. Mays
Glen Mays
A new "Systems for Action" national research program flows directly from the Robert Wood Johnson Foundation's Culture of Health action framework. This program will build evidence on how best to align the delivery and financing systems for medical care, public health, and community services & supports so as to promote wellbeing and resiliency, realize efficiencies in resource use, and reduce inequities in health.
Changes In Public Health System Capital And Long-Run Health And Economic Outcomes: 1998 To 2014, Glen P. Mays, Cezar B. Mamaril
Changes In Public Health System Capital And Long-Run Health And Economic Outcomes: 1998 To 2014, Glen P. Mays, Cezar B. Mamaril
Glen Mays
Research Objective: The Affordable Care Act created new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing the structure of public health delivery systems and expanding the implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, which we use as indicators of public health “system capital”; and (2) the effects of these changes on preventable mortality and resource use. …
Cost Estimation In Public Health Services & Systems Research, Glen P. Mays
Cost Estimation In Public Health Services & Systems Research, Glen P. Mays
Glen Mays
Considerable uncertainty persists about the resources required to implement public health programs and policies, and about the factors that drive variation in resource needs and utilization across community and institutional settings. This paper reviews several alternative approaches to cost estimation that we have used in the field of public health services & systems research (PHSSR). This review was prepared for an expert panel meeting convened as part of a study commissioned by the U.S. Assistant Secretary for Planning and Evaluation (ASPE) to estimate the costs associated with public health emergency preparedness capabilities.
Geographic Variation In The Delivery Of Public Health Services: Understanding Causes And Consequences, Glen P. Mays
Geographic Variation In The Delivery Of Public Health Services: Understanding Causes And Consequences, Glen P. Mays
Glen Mays
The implementation and reach of evidence-based prevention and public health programs varies widely across the U.S., as does the availability of cross-cutting infrastructure and foundational capabilities required to support these interventions. This talk profiles ongoing research to uncover the causes and consequences of variation in public health delivery. This research points to policy and administrative strategies that can reduce inequities and inefficiencies in public health protections.
Refining And Improving The Methodology For The National Health Security Preparedness Index, Glen P. Mays, Michael Childress, Dominique Zephyr
Refining And Improving The Methodology For The National Health Security Preparedness Index, Glen P. Mays, Michael Childress, Dominique Zephyr
Glen Mays
This first meeting of two newly reconstituted Working Groups for the National Health Security Preparedness Index Program examined opportunities for improving and refining the Index's measurement, scaling, weighting, and aggregation methodologies. Methodological improvements will enhance the Index's utility for education, planning, policy development, and quality improvement efforts focused on improving national preparedness and resiliency for large-scale health threats.
Estimating The Costs Of Foundational Public Health Services, Glen P. Mays
Estimating The Costs Of Foundational Public Health Services, Glen P. Mays
Glen Mays
The Institute of Medicine’s 2012 report on public health financing called for the convening of expert panels to identify the components of a “minimum package” of public health services and cross-cutting capabilities that should be available in every U.S. community to protect and improve population health. This report also called for studies to identify the resources required to make these services universally available across the country. This research brief describes the research methodology in use to generate first-generation estimates of current resource use and estimated resource needs for implementing foundational public health services and capabilities.
Defining Comprehensive Public Health Delivery Systems, Glen P. Mays
Defining Comprehensive Public Health Delivery Systems, Glen P. Mays
Glen Mays
This brief describes the methodology for defining Comprehensive Public Health Delivery Systems using data from the National Longitudinal Survey of Public Health Systems. The systems meeting this definition have been shown to deliver a broader range of recommended public health services, using fewer resources, than the more prevalent types of U.S. public health systems that do not meet this definition. Over time, comprehensive systems are associated with larger gains in population health status than are their counterparts.
Aca Implementation In The South: The Political Economy Of Full Participation In Kentucky, Glen P. Mays
Aca Implementation In The South: The Political Economy Of Full Participation In Kentucky, Glen P. Mays
Glen Mays
This analysis, conducted as part of the ACA Implementation Research Network, examines economic and political forces shaping Kentucky's early experience with implementation of the Patient Protection and Affordable Care Act.
The Economics Of Implementing Population Health Strategies, Glen P. Mays
The Economics Of Implementing Population Health Strategies, Glen P. Mays
Glen Mays
Successful strategies to scale up and spread complex community-level interventions require an understanding of the resources required for implementation, how best to distribute them among supporting institutions, and how resource consumption and distribution varies across settings. This session reviews methods and early findings from the RWJF’s Public Health Delivery and Cost Studies (DACS) Initiative, which includes 12 inter-related studies examining the causes and consequences of variation in the costs of delivering complex community-level prevention strategies across more than 300 community settings in 12 states. Findings from these studies highlight the value of studying the economics of implementation, the measurement and …
The Dynamics Of Medicaid & Public Health Spending: Implications For Aca Implementation, Glen P. Mays
The Dynamics Of Medicaid & Public Health Spending: Implications For Aca Implementation, Glen P. Mays
Glen Mays
We estimate the dynamics and interactions of governmental spending on Medicaid and other public health services in all 50 states over a 15 year period. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions.
Geographic Variation In The Delivery Of High-Value Public Health Services:Exploring Causes & Consequences, Glen P. Mays
Geographic Variation In The Delivery Of High-Value Public Health Services:Exploring Causes & Consequences, Glen P. Mays
Glen Mays
OBJECTIVES: A growing body of evidence indicates that the delivery of public health activities varies widely across states and communities, creating missed opportunities for prevention as well as inequities in health protection. Measures of quality in public health are needed to guide public health improvement initiatives and to support research on the comparative effectiveness of alternative public health strategies. The Multi-network Practices and Outcomes Variation Examination Study (MPROVE), uses the infrastructure of six Public Health Practice-Based Research Networks (PBRNs) across the U.S. to develop and validate a “starter set” of measures and to analyze geographic variation delivery across diverse public …
Medicaid Expansions & Public Health Spending: Cross-Subsidies, Complementarities, And Crowd-Out, Glen Mays
Medicaid Expansions & Public Health Spending: Cross-Subsidies, Complementarities, And Crowd-Out, Glen Mays
Glen Mays
In this paper we estimate the causal impact of state Medicaid enrollment expansions and expenditures on state and local resources allocated to other public health programs and services. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions.
Optimizing Public Health Systems For Population Health Improvement: Institutions, Economics, And Metrics, Glen P. Mays
Optimizing Public Health Systems For Population Health Improvement: Institutions, Economics, And Metrics, Glen P. Mays
Glen Mays
This lecture reviews the evidence concerning the institutional and economic characteristics of public health delivery systems and their impact on population health. Emerging findings from these studies suggest promising pathways for transforming the U.S. public health system in ways that strengthen its effectiveness, efficiency and equity in producing health. .
Value And Cost-Effectivess Of Community Health Worker Programs: Implications For Home Care Workers, Glen P. Mays
Value And Cost-Effectivess Of Community Health Worker Programs: Implications For Home Care Workers, Glen P. Mays
Glen Mays
This presentation reviews studies on the health and economic value of strategies to improve the coordination of medical care, public health, and social support services for high-need and high-risk populations. Community health worker (CHW) programs feature prominently in these strategies, particularly for rural and low-resource community settings. Home care workers have the potential to function as CHWs in many settings, and as such present powerful opportunities for scaling up CHW programs that connect medical care, public health, and social services delivery.
Ending Failures, Showing Results, Improving Population Health:Insights From Research & Reform In The U.S., Glen P. Mays
Ending Failures, Showing Results, Improving Population Health:Insights From Research & Reform In The U.S., Glen P. Mays
Glen Mays
A growing body of empirical research supports the value of aligning the delivery systems for public health, medical care, and social services for populations with shared needs and risk factors. This presentation reviews selected studies from the field of public health services & systems research (PHSSR) in the U.S. that suggest pathways for achieving greater system alignment in the Canadian context.
How Can Public Health Economics Help Health Systems Focus Upstream?, Glen P. Mays
How Can Public Health Economics Help Health Systems Focus Upstream?, Glen P. Mays
Glen Mays
Research on the health and economic impact of public health strategies can help newly evolving health care delivery systems focus on upstream health determinants and make evidence-informed decisions about resource allocation across the prevention-treatment spectrum. Examples from research underway in the U.S. have particular relevance for Canada's evolving regional health authorities and their integrated approaches to medical care and public health delivery.
Tougher Than Rocket Science, Or Just Messier? Using Research To Improveu.S. Public Health Delivery, Glen P. Mays
Tougher Than Rocket Science, Or Just Messier? Using Research To Improveu.S. Public Health Delivery, Glen P. Mays
Glen Mays
Advances in the field of public health services & systems research (PHSSR) are incorporating complexity in theory and methods to derive strong inferences about the health and economic effects attributable to public health strategies. Opportunities for comparative international research in Canada and the U.S. promise to strengthen these avenues of inquiry.
The National Longitudinal Survey Of Public Health Systems: Selected Findings And Applications For Monitoring The Affordable Care Act, Glen P. Mays
Glen Mays
This presentation reviews the National Longitudinal Survey of Public Health Systems and its applicability for monitoring the effects of the Affordable Care Act on public health delivery within the U.S.