Medicine and Health Sciences Commons^™

Evaluating Quality Improvement To Improve Hiv Reporting, Nandi A. Marshall, William C. Livingood, Angela Peden, Gulzar H. Shah, Russ Toal, Dayna Alexander, Alesha Wright, Sandra Jump, Shelby Freeman, Kay Davis, Lynn Woodhouse, Kellie Penix

Frontiers in Public Health Services and Systems Research

The incorporation and evaluation of Quality Improvement into Georgia’s public health systems continues to be a focus of the Georgia Public Health Practice Based Research Network. This report describes the process, preliminary results and lessons learned from incorporating Quality Improvement into one of Georgia’s public health districts.

Online Social Networks To The Rescue: Fulfilling The Ten Essential Public Health Services, Melanie D. Mason, Maureen P. Bezold

Frontiers in Public Health Services and Systems Research

Budget cuts and shortages in the public health workforce have contributed to the reduction of public health services in 91% of state health departments (SHDs). To adjust for these changes, health departments must discover novel ways to deliver essential public health services to their constituents. Researchers conducted a retrospective analysis of the content published on SHDs’ Twitter pages to determine if online social networks were used to fulfill the ten essential public health services. While 42 SHDs had a Twitter page, the volume and content of tweets varied. Although tweets were posted that related to all ten of the essential …

Efficiency In Public Health Service Delivery: An Analysis Of Clinical Health Services Provided By Local Health Departments In Florida, Simone R. Singh

Frontiers in Public Health Services and Systems Research

The ability of local health departments (LHDs) to provide public health services to improve the health of their communities depends to a large extent on their financial resources. More money by itself, however, does not necessarily translate into better population health. LHDs also have to use their resources in an efficient manner to achieve the best possible outcomes. This article first describes two techniques that LHDs can use to assess their efficiency at providing public health services: process costing, a technique used by management accountants, and stochastic frontier analysis, a technique used by economists. Using data for LHDs in Florida, …

Evidence Use In New York City Public Health Policymaking, Miriam J. Laugesen, Kimberley R. Isett

Frontiers in Public Health Services and Systems Research

New York City Mayor Michael R. Bloomberg has attracted national attention for his public health policy reforms. The policy process behind the reform program has received less scrutiny, especially the use of research by policymakers. We show that the process used to develop, promote, and evaluate polices is heavily based on five types of data and research. New York Department of Health and Mental Hygiene staff conducted in-depth appraisals of existing published research, used local health surveys and private laboratory surveillance data, engaged in “shoe-leather” field research, formed research collaborations within and outside government, and disseminated research to legitimize policy …

Commentary: Moving Beyond The Numbers, Effectively Using Research To Influence Policy, F. Douglas Scutchfield, Marylou Wallace

Frontiers in Public Health Services and Systems Research

This seventh issue of Frontiers reflects the variety of PHSSR. One emerging theme, however, is the notion of public health and its role in policy and policy development. PHSSR focuses on several potential users, researchers, practitioners and policy makers. As it concerns policy makers, PHSSR delivers research that allows them to make decisions about policy change that not only influences public health status, but creates healthy conditions. In this way, PHSSR essentially influences decisions about support for public health services.

Preliminary Findings From An Interventional Study Using Network Analysis To Support Management In Local Health Departments In Florida, Chin S. Park, Hado Byon, Jonathan W. Keeling, Leslie M. Beitsch, Jacqueline A. Merrill

Frontiers in Public Health Services and Systems Research

Management is the core service that integrates and coordinates essential public health services. Managers of local health departments (LHDs) are experts in practice but may not have expertise in organizational management. We conducted an evidence-based training intervention in 10 LHDs in Florida to support managers’ decision-making on organizational integration and coordination. We deployed a standard survey to collect organizational network measurements pre and post intervention. We presented results as evidence-based performance feedback and interviewed managers to document how they used the results in the context of each organization. Post intervention we found unexpected, significantly higher network centralization in daily work. …

Characteristics Of A Local Health Department Associated With The Use Of The Health Equity Index, Moira A. Lawson, Sharon Mierzwa, Michael Knapp

Frontiers in Public Health Services and Systems Research

Local health departments are tasked with understanding and addressing health inequities in the populations they serve. To meaningfully address health inequities, local health departments have identified the need for credible local data to better understand the relationship between community conditions and health outcomes. Yet, when given access to these data, we observe a very large variation in the level of interest between local health departments.

In this study, we offered Connecticut’s Local health departments access to the Health Equity Index, a web based tool that provides data on health outcomes and community conditions at the state, municipal or neighborhood levels. …

Evaluating Use Of Custom Survey Reports By Local Health Departments, Nadya M. Belenky, Christine A. Bevc, Elizabeth Mahanna, Carol Gunther-Mohr, Mary V. Davis

Frontiers in Public Health Services and Systems Research

This report demonstrates how providing survey feedback, like comparative reports, to survey respondents can result in improvement activities. For each of the past three years (2010-2013), the North Carolina Institute for Public Health (NCIPH) has invited local health departments (LHDs) from 40 states to participate in a preparedness capacities survey. In addition, NCIPH fielded a six-question evaluation survey to a subset of LHDs (n=70) to determine how LHDs use these reports. LHDs that reported using their custom reports compared their preparedness capacities to other LHDs, conducted strategic planning (e.g., benchmarking, setting preparedness goals), planned staff trainings, and disseminated the report …

Assessing A Quality Improvement Project In A Georgia County Health Department, Dayna S. Alexander, William C. Livingood, Nandi A. Marshall, Angela Peden, Russ Toal, Gulzar H. Shah, Alesha Wright, Purity Cummings, Ketty Gonzalez, Lynn Woodhouse

Frontiers in Public Health Services and Systems Research

The study and evaluation of quality improvement among Georgia’s public health systems continues to be a major priority for the Georgia Public Health Practice Based Research Network (GAPH-PBRN). This article focuses on the application and evaluation of a Quality Improvement project in a Georgia County Health Department. The QI team sought to reduce the waiting time in the teen clinic; thereby, increasing the Quality Improvement culture one project at a time in this Health Department. The project revealed that Quality Improvement is a continuous process that requires change and adaptation by employees. This initial Quality Improvement project was the first …

The Relationship Between Quality Improvement And Health Information Technology Use In Local Health Departments, Kendra Johnson, Kim K. Nguyen, Shimin Zheng, Robin P. Pendley

Frontiers in Public Health Services and Systems Research

This research examined if there is a relationship between engagement in quality improvement (QI) and health information technology (HIT) for local health departments (LHDs) controlling for workforce, finance, population, and governance structure. This was a cross-sectional study that analyzed data obtained from the Core questions and Module 1 in the NACCHO 2010 Profile of LHDs. Descriptive statistics, bivariate analyses, and logistic regression analyses were conducted. Findings suggest that LHD engagement in QI has a relationship with utilization of HIT including electronic health records, practice management systems, and electronic syndromic surveillance systems. This study provides baseline information about the HIT use …

Commentary: The Road To Quality In Public Health, A Long But Important Journey, F. Douglas Scutchfield, Glen Mays, Marylou Wallace

Frontiers in Public Health Services and Systems Research

Quality improvement (QI) in public health departments is a focus in this sixth issue of Frontiers. Data is important to the development of quality improvement efforts. As we see growth of and meaningful use of electronic health records, the health department is in a position to take the lead as a data hub and to use this information wisely to both improve their QI efforts and link that QI to outcomes.

Turning The Tide On An Epidemic: A Native Kentuckian Changes The Deadly Trajectory Of Hiv Infection, Dannette Smith Cook

Ex-Patt Magazine

Interview: Dr. Mina Hosseinipour did not know her research would positively change the trajectory of the worldwide HIV epidemic when she graduated with a bachelor’s degree from the University of Kentucky in the early 1990’s.

The Resilient Local Health Department: Surviving The 2008 Economic Crisis, Paul C. Erwin, Gulzar H. Shah, Glen P. Mays

Frontiers in Public Health Services and Systems Research

The purpose of this study was to identify potential modifiable factors that can protect local health departments (LHDs) from job losses and budget cuts during periods of economic stress. This was a retrospective cohort study based on the 2005 and 2010 surveys of LHDs conducted by the National Association of County and City Health Officials. The outcome of interest – resiliency of the LHD – represented financial resiliency for maintaining budgets during the 2008 recession, and was based on the ratio of observed-to-predicted expenditures per capita for 2010. LHDs which successfully weathered the economic recession of 2008 represented smaller populations …

Diffusion Of Innovation Across A National Local Health Department Network: A Simulation Approach To Policy Development Using Agent-Based Modeling, Mark Orr, Jacqueline Merrill

Frontiers in Public Health Services and Systems Research

The network that local health officials use to communicate about professional issues is sparsely connected, which may limit the spread of innovative practices. We used agent-based simulation modeling to find out if a policy to promote more connections improved the network’s capability to diffuse innovation. We found that unanticipated effects could result, depending on the requirements of the policy and the proportion of health officials involved. With carefully crafted assumptions and reliable data it is possible to untangle complex processes using simulation modeling. The results represent how the world might actually work which may provide useful decision support for policymakers …

Analysis Of Local Health Department Factors That Accelerate Population-Based Intervention Strategies: Preliminary Findings, M. Elizabeth Gyllstrom, Kim J. Gearin, William Riley

Frontiers in Public Health Services and Systems Research

Introduction: This practice-based research study capitalized on the statewide implementation of a comprehensive, locally-driven initiative to implement evidence-based policy, system and environmental changes related to obesity and tobacco use. The study examined local health department (LHD) performance and factors such as organizational quality improvement (QI) maturity, structure and governance.

Methods: State health department staff reviewed grant reports and documentation pertaining to all LHD grantees, which collectively represented all 87 counties and 4 cities in Minnesota (MN), in order to designate grantees as either: “Exceeds Expectations,” “Meets Expectations” or “Approaching Expectations.” A study team of state, local and academic partners then …

Community Health Assessment By Local Health Departments: Presence Of Epidemiologist, Governance, And Federal And State Funds Are Critical, Gulzar H. Shah, Barbara Laymon, Julia Joh Elligers, Carolyn Leep, Christine B. Bhutta

Frontiers in Public Health Services and Systems Research

Using the data from the National Association of County and City Health Officials’ (NACCHO) 2010 Profile of Local Health Departments (LHDs) our study investigates whether or not infrastructural characteristics of LHDs were associated with completion of community health assessment (CHA). Our results show that local and shared LHD governance, greater share of revenue from federal and state sources, smaller population size in LHD jurisdiction, and having an epidemiologist significantly increased the odds of CHA completion in the past, after controlling for community characteristics and other independent variables. These findings have important implications for LHDs, PHAB and its partners.

What’S In A Username? Finding Local Health Departments On Twitter, Jenine K. Harris, Ryan C. Maier, Nina Jolani

Frontiers in Public Health Services and Systems Research

Social media platforms such as Twitter may be useful for local health departments (LHDs) in providing the essential service of educating and informing constituents.¹ However, health departments have relatively few Twitter followers overall.¹ One of the challenges that may be associated with following LHDs on Twitter is knowing how to find an LHD Twitter feed. With no suggested or required conventions for LHDs adopting social media, practitioners are left to independently develop their name and description, resulting in much variety. This report examines the names and descriptions for LHDs using Twitter and uses the Twitter people search function …

Best Practice Use To Address Tobacco-Related Disparities By California Community Coalitions, Rodney K. Mccurdy

Frontiers in Public Health Services and Systems Research

Tobacco-related disparities (TRDs) are a major public health concern. This study surveyed community tobacco coalition project directors in California to determine the usage of 11 CDC-published best practices to address TRDs. Response rate was 80 percent. Communities had implemented, on average, one-half of the 11 practices surveyed. Differences were observed between rankings for best practice implementation and perceived level of importance in addressing TRDs in the community. Resource constraints and community context were the highest reported barriers to best practice use. Study findings could assist tobacco program officials and local coalitions in addressing TRDs in their communities.

From The Frontier: Translating Research To Practice…Qi As The Hinge Point, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

This article is number three in the series From the Frontier: Translating Research to Practice. The narrative describes the work of a practice-academic network in Minnesota which explored the degree to which having a culture of quality at the local health department level influenced the capacity to implement a new statewide initiative. The network conducted a mixed-methods study of grantees funded to develop and implement local policy, systems, and environmental change strategies to promote nutrition, increase activity, and reduce tobacco use and exposure. The results of their study indicated that grantees with higher performance levels in Quality Improvement (QI) …

Access To Primary Care: Comparing Driving Distance From Health Professional Shortage Area (Hpsa) Counties Versus Non-Hpsa Counties, Molly Cashion, Stephanie Jilcott-Pitts, Doyle Cummings, Christopher Duffrin, John Jones, Qiang Wu

Frontiers in Public Health Services and Systems Research

The criteria used to identify Health Professional Shortage Areas dates back to the 1970’s and very little has changed since then. This study examined driving distance from patient address to provider address as one component of a geographical HPSA. Primary care-related services located in adjacent areas to whole-county HPSAs are considered excessively distant when travel time exceeds 30 minutes or the equivalent of 20 miles in this study. We found similarities in travel distance to primary care-related services from patients living in HPSA counties compared to those living in non-HPSA counties. This could indicate the need to re-examine HPSA definitions …

Addressing Health Inequalities In The United States: Key Data Trends And Policy Action, Sara N. Bleich, Marian P. Jarlenski, Caryn N. Bell, Thomas A. Laveist

Frontiers in Public Health Services and Systems Research

Health inequalities, which have been well documented for decades, have recently become policy targets in the United States. This report summarizes current patterns and trends in health inequalities, commitments to reduce health inequalities, and progress made to eliminate health inequalities. Time trend data indicate improvements in health status and major risk factors but increases in morbidity, with black and lower-education individuals experiencing a disproportionate burden of disease. A common policy response has been priority setting in the form of national objectives or goals to address health inequalities. More research and better methods are needed to precisely measure relationships between stated …

Community Asset Identification In Support Of A Place-Based, Early Childhood Obesity Prevention And School Readiness Initiative, Cristi Carman, Bernice Raveche Garnett, Josefine Wendel, Justeen Hyde, Virginia Rall Chomitz

Frontiers in Public Health Services and Systems Research

Despite extensive community efforts that have resulted in obesity decreases in Cambridge, MA over the last decade, obesity among Black youth remains disproportionately high. Likewise, racial/ethnic academic achievement disparities persist and are evident at early ages.

Prior research and emerging national policy recommendations confirm the need for place-based, early childhood interventions to address persistent racial/ethnic disparities in obesity and school readiness. A community-based participatory research initiative is developing an intervention targeted to pre-kindergarten children and their families in a diverse Cambridge neighborhood. The intervention will partner with a Cambridge Public Schools (CPS) program designed to support school readiness through extended …

Do Phab Accreditation Prerequisites Predict Local Health Departments’ Intentions To Seek Voluntary National Accreditation?, Gulzar H. Shah, Kate Beatty, Carolyn Leep

Frontiers in Public Health Services and Systems Research

Accreditation has been identified as a crucial strategy for strengthening the public health infrastructure. As agencies prepare for accreditation, it is important to understand how intentions to seek accreditation are related to the current level of readiness based on the three Public Health Accreditation Board (PHAB) prerequisites. Using the National Association of County and City Health Officials’ (NACCHO) 2010 Profile Study, we examined the relationship between the PHAB accreditation prerequisites and local health department (LHD) intentions to seek PHAB accreditation using multinomial logistic regression. Our results indicate that completion of a community health assessment (CHA) or community health improvement plan …

Monitoring Qi Maturity Of Public Health Organizations And Systems In Minnesota: Promising Early Findings And Suggested Next Steps, Kimberly J. Miner Gearin, M. Elizabeth Gyllstrom, Brenda M. Joly, Renee S. Frauendienst, Julie Myhre, William Riley

Frontiers in Public Health Services and Systems Research

Public health departments and systems are increasing investments in quality improvement. This paper presents methods used to identify a select number of items from a previously validated QI Maturity Tool as the basis for calculating organizational and system-level QI maturity scores that could be followed over time. Findings suggest that the abbreviated tool measures variation in QI maturity across LHDs, and differences in scores among divisions within a state health department. Minnesota has incorporated the abbreviated tool into an annual reporting system for the MN Local Public Health Act, thereby enabling stakeholders to monitor a system median score and distribution …

Using The Qi Maturity Tool To Classify Agencies Along A Continuum, Brenda M. Joly, Maureen Booth, Prashant Mittal, Yan Zhang

Frontiers in Public Health Services and Systems Research

Major investments have been made to encourage health departments to implement quality improvement (QI) efforts. Yet, there are few empirically tested tools for public health agencies that assess these efforts and classify health departments along a QI continuum. This paper presents a new classification scheme for measuring QI Maturity in public health agencies based on a validated tool. The findings can be used to establish benchmarks, make comparisons and conduct future research linking QI and population health outcomes.

Rediscovering The Core Of Public Health, Steven Teutsch, Jonathan E. Fielding

Frontiers in Public Health Services and Systems Research

The success of public health has been its ability to understand contemporary health problems, to communicate the needs successfully, to identify solutions, and to implement them through programs and policies. In the past 50 years, those successes can be attributed largely to control of infectious disease, improved maternal and child health, delivery of other personal health care services, and changes in behaviors, particularly smoking. Yet health is primarily a product of our social, cultural, and physical environments. To continue to improve the nation’s health and reduce disparities, public health needs to return to its historical roots and engage with other …

From The Frontier: Translating Research To Practice...A Story Of Economic Survival, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

This article is number two in the series From the Frontier: Translating Research to Practice. The narrative describes the interactions between a local health department director and two academicians in addressing the impact of the 2008 financial crisis. In a first set of activities, practice-academic partners used Financial and Operational Ratio and Trend Analysis to identify periods of a negative total margin and the impact of that on the agency’s declining fund balance. The use of private sector processes of retrenchment, repositioning, and reorganization led to a financial turnaround for the agency. In a second set of activities, practice-academic …

Disparities In Public Health Service Indicators And Governance Structures: Learning Through Comparison Between Usa And Uk, Mark Mccarthy

Frontiers in Public Health Services and Systems Research

In the USA, indicators of public health service performance differ according to governance structures for the services. However, the UK also has disparities in public health indicators by geographical, but uniform public health service governance. The international comparison provides a caution for interpretation of correlation.

Using Learning Collaboratives To Improve Public Health Emergency Preparedness Systems, Michael A. Stoto, Harold Cox, Melissa Higdon, Kerry Dunnell, Donald Goldmann

Frontiers in Public Health Services and Systems Research

The U.S. National Health Security Strategy calls for the development and wide-spread implementation of quality improvement (QI) tools in public health emergency preparedness (PHEP), including the development of “learning collaboratives,” a structured way for organizations with common interests to close the gap between potential and practice by learning from each other. To test this approach, we developed and assessed separate learning collaboratives focused on PHEP emergency communications and on the use of Medical Reserve Corps (MRC) volunteers. Although participants carried out improvement projects that they felt were useful, each collaborative struggled to identify a common theme, participation was limited, and …

Evidence-Based Decision Making To Improve Public Health Practice, Ross C. Brownson, Jonathan E. Fielding, Christopher M. Maylahn

Frontiers in Public Health Services and Systems Research

Despite the many accomplishments of public health, greater attention on evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about 15 years ago. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community in decision making, conducting sound evaluation, and disseminating what is learned. Core competencies for EBPH are emerging, including not only technical skills but also attention to administrative practices in public health agencies. To better bridge evidence and practice, the concepts …