Medicine and Health Sciences Commons^™

Accounting For Indirect Costs In Public Health Cost Analyses, Melanie D. Whittington, Adam Atherly, Lisa Vanraemdonck

Frontiers in Public Health Services and Systems Research

Background. There is a gap in research regarding the resources needed to deliver public health activities, which inhibits informed decision making around investments in public health and the allocation of funds among activities. When conducting cost analyses in public health, it is important to include costs from all cost components, including personnel, non-personnel, and indirect costs. However, defining, identifying, and measuring indirect costs is challenging and can impede studies of this type. Purpose. The purpose of this pilot study is to create a catalog of the methodologies public health researchers have used to account for indirect costs. Methods. We surveyed …

Assessment Of Quality Improvement In Ontario Public Health Units, Madelyn P. Law, J. Ross Graham, Erica Bridge

Frontiers in Public Health Services and Systems Research

Background: Quality Improvement (QI) approaches are used extensively in healthcare settings and increasingly in public health. However, the proliferation of QI in Canadian public health settings is unknown.

Purpose: The purpose of this study was to (a) assess the QI maturity in Ontario local public health units in Canada, and (b) to determine the relevance of the QI Maturity Tool in a Canadian setting

Methods: The QI Maturity Tool (Version 5) was used to conduct a cross-sectional assessment of the QI maturity of 36 local public health units in Ontario, Canada. After tool items were reviewed for relevance, individuals most …

Cross-Sector Partnerships And Public Health: Challenges And Opportunities With The Private Sector, Lee Johnston, Diane Finegood

Frontiers in Public Health Services and Systems Research

Over the past few decades, cross-sector partnerships that include the private sector have become an increasingly accepted practice in public health, particularly in efforts to address infectious disease in low and middle income countries. Now they are becoming a popular tool in efforts to reduce and prevent obesity and the epidemic of non-communicable disease. Partnering with business presents a means of acquiring resources, as well as opportunities to influence the private sector toward more healthful practices. Collaboration is a core principle of public health practice; however public-private or non-profit-private partnerships present risks and challenges that warrant specific consideration. In this …

Speaking The Language Of The Decision-Makers, Angela Carman Drph

Frontiers in Public Health Services and Systems Research

In a system experiencing dwindling resources, public health practitioners must be able to explain their goals, services, and impact via terms and concepts understood by policymakers, governmental representatives, and community members. The use of concepts such as private sector partnership development, quality improvement, expense management, and cost analysis can provide public health practitioners means for growth and improvement, as well as the ability to communicate value to decision makers.

Utilizing Performance Management To Harness The Power Of Quality Improvement In Public Health, Leslie M. Beitsch, Valerie A. Yeager, John W. Moran

Frontiers in Public Health Services and Systems Research

Widespread adoption of quality improvement activities in public health trails other U.S. sectors. Launching the national public health accreditation program of the Public Health Accreditation Board (PHAB) has propelled health department momentum around quality improvement uptake. Domain 9 of the PHAB standards focuses on evaluation and improvement of performance, and is acting as a strong driver for quality improvement and performance management implementation within health departments. Several performance management models have received broad acceptance, including among government and nonprofits, and have direct public health application. Turning Point is a model designed specifically for public health users. All models in current …

Public Health Surveillance Using Electronic Health Records: Rising Potential To Advance Public Health, Guthrie S. Birkhead, Michael Klompas, Md Mph, Nirav R. Shah

Frontiers in Public Health Services and Systems Research

Background: Public health surveillance has traditionally relied on manual processes including paper-based reporting by clinicians. The introduction of electronic laboratory reporting increased the efficiency and completeness of infectious disease surveillance but clinical and risk factor data are often still collected manually. The use of electronic health records (EHR) has significant promise to enrich surveillance by collecting these data automatically and by expanding surveillance to chronic diseases (e.g., diabetes, hypertension, obesity). However, the extent of the use of EHRs for public surveillance is not well studied.

Evidence Acquisition: The peer-reviewed medical literature was searched for descriptions of the use of EHRs …

Measuring Population Care Performance: Development Of The Population-Patient Satisfaction Survey For Use With Community Groups, Michele Issel, Christine Lurie, Betty Bekemeier

Frontiers in Public Health Services and Systems Research

Background: Assessing the satisfaction of the “population-patient” requires conceptualizing the dimensions of satisfaction differently from that of individual patients.

Purpose: The focus of this study was to develop and pilot test a short questionnaire that can reliably assess satisfaction with the care provided by public health nurses (PHNs) carrying out population-level activities in their communities.

Methods: An instrument-development approach was used. With input from five experts, items were developed to assess seven dimensions of population-patient satisfaction, and then refined before use in the community with a convenience sample of community participants recruited by PHNs in six counties across two states. …

Local Health Departments’ Costs Of Providing Environmental Health Services, Simone Singh, Nancy L. Winterbauer, Ashley Tucker, Lisa Macon Harrison

Frontiers in Public Health Services and Systems Research

Background: A detailed understanding of the costs that local health departments (LHDs) incur in the provision of public health services plays an important role in their efforts to provide services in an effective and efficient manner. However, surprisingly little evidence exists about the key cost components that LHDs incur in the provision of services.

Purpose: The purpose of this report was to provide empirical estimates of LHDs’ cost structure.

Methods: Using cost information for 2012 from 15 LHDs in North Carolina for two public health services—food and lodging and onsite water—this report first presents estimates of the total costs per …

Use Of Facebook By Local Health Departments: Usage, Public Health Themes, And Maintenance, Rakhi Trivedi, Gulzar H. Shah, Ankit Bangar

Frontiers in Public Health Services and Systems Research

Background: Recent research shows that social media offer unprecedented opportunities for communications with stakeholders in public health and other industries.

Purpose: This study examines the manner in which U.S. local health departments (LHDs) use Facebook. Public health program themes discussed on Facebook profiles of LHDs were analyzed and ranked by the frequency of mentions on Facebook.

Methods: LHDs included in the study were those indicating use of Facebook in the 2010 National Profile of Local Health Departments. Using the list from the profile study, the primary data from LHDs’ public Facebook profiles were collected over a period of 4 months. …

Applying Failure Modes And Effects Analysis To Public Health Models: The Breathe Easy At Home Program, Johnna S. Murphy, Margaret Reid, Amanda Ali, Laura Harrington, Megan Sandel

Frontiers in Public Health Services and Systems Research

Failure Modes and Effects Analysis (FMEA) is a structured process used to identify and prioritize risks by ranking them based on severity, occurrence, and detectability. Historically, FMEA has been used within industries, including automotive and health care. This project explored the adaption of the FMEA template to a small public health program designed to improve asthma outcomes. The Breathe Easy at Home (BEAH) program is a multi-sector partnership that uses a web-based system to link clinical sites with housing code inspections and enforcement for patients with asthma.

In July and August 2014, an FMEA was conducted to uncover risks within …

Economic Evaluation Of Fungal Meningitis Outbreak Response In New River Valley: Local Health Department Perspective, Kaja M. Abbas, Nargesalsadat Dorratoltaj, Margaret L. O’Dell, Paige Bordwine, Thomas M. Kerkering, Kerry J. Redican

Frontiers in Public Health Services and Systems Research

Background: The multi-state fungal meningitis outbreak started in September 2012 in Tennessee. The cause of the outbreak was injection of contaminated lots of methylprednisolone acetate used in epidural spinal injections. Roanoke and New River Valley were the epicenter of this outbreak in Virginia, with two clinical centers having administered the contaminated injections to their patients. New River Health District, in coordination with hospitals, and state and federal agencies, deployed its resources to control the local impact of the outbreak.

Purpose: The objective of this study was to conduct an economic evaluation of the fungal meningitis outbreak response in New River …

Implementation Of Electronic Disease Reporting Systems By Local Health Departments, Gulzar H. Shah, Karmen Williams, Bushra G. Shah

Frontiers in Public Health Services and Systems Research

Background: Electronic disease reporting systems (EDRSs) are imperative for local health departments (LHDs) operating in the post-H1N1 and evidence-based public health practice era. Studies regarding functionality and factors responsible for variation in implementation are important but rare.

Purpose: This primary objective for this study was to provide evidence regarding the level to which LHDs have implemented electronic disease reporting systems and factors associated with variation in implementation of electronic disease reporting systems.

Methods: A quantitative analysis was performed of the 2013 Profile of Local Health Departments Survey conducted by the National Association of County and City Health Officials (NACCHO). The …

Impact Of Organizational Networks On The Cost Of Core Services In Ohio’S Local Health Departments, Jason E. Orcena, Michael Petros, Patrick M. Bernet

Frontiers in Public Health Services and Systems Research

Introduction: Although several studies have linked population size to the cost of service delivery in local health departments, none have looked at the network position of the LHD. This study expands the understanding of how the position of an LHD in Ohio’s local health department network affects its expenditures in providing core, or nonclinical, services.

Methods: In 2014, 44% (55 of 124 eligible) of Ohio’s health officers responded to the PARTNER survey, a web-based network analysis program, with the analysis completed by the spring of 2015. Network data were then included in a regression analysis of the Core Plus-Scale model …

Measuring Changes In Local Surveillance And Investigation Capacity, Christine A. Bevc, Mary V. Davis, Anna P. Schenck

Frontiers in Public Health Services and Systems Research

Background: The outbreak of Ebola virus disease in West Africa and confirmation of the first cases in the United States highlight the need for robust and responsive public health surveillance system. With a 25% decline in funding since 2007, the impact on local surveillance capacities has not previously been described.

Purpose: The Surveillance & Investigation domain of the Local Health Department Preparedness Capacities Survey (PCAS) was reweighted to reflect the national profile of LHDs. Changes in subdomain performance of capacities and the effect of population size on subdomain capacity performance were examined over time.

Methods: Participating LHDs (n=208) …

High-Risk Travel Distance And Number Of Primary Care Visits In A North Carolina Medicaid Population, Justin Allred, Christopher Duffrin, Jason Brinkley, John Jones

Frontiers in Public Health Services and Systems Research

Background: With nearly 20% of the U.S. population in rural areas, a lack of access to primary care may cause rural residents to forego recommended preventive care procedures, and suffer higher morbidity rates than their urban counterparts.

Methods: Medicaid billing data from 2009 to 2011 were analyzed to calculate the distance and duration that a Medicaid patient population had to travel when seeking primary care in the 29 rural counties of eastern North Carolina. Primary care codes were analyzed to detect any differences in access patterns for various complexity levels of physician visits. Data were also used to evaluate health …

A Cost Analysis Of The 1-2-3 Pap Intervention, Kristina M. Rabarison, Rui Li, Connie L. Bish, Robin C. Vanderpool, Richard A. Crosby, Mehran S. Massoudi

Frontiers in Public Health Services and Systems Research

Background: Cervical cancer places a substantial economic burden on our healthcare system. The three-dose human papillomavirus (HPV) vaccine series is a cost-effective intervention to prevent HPV infection and resultant cervical cancer. Despite its efficacy, completion rates are low in young women aged 18 through 26 years. 1-2-3 Pap is a video intervention tested and proven to increase HPV vaccination completion rates.

Purpose: To provide the full scope of available evidence for 1-2-3 Pap, this study adds economic evidence to the intervention’s efficacy. This study tested the economies of scale hypothesis that the cost of 1-2-3 Pap intervention per number of …

Preliminary Evaluation Of The Disease Surveillance System During Influenza Outbreaks Of Pandemic Scale, Eric Meisheri, Diana M. Prieto, Peter Holvenstot, Richard Vanenk

Frontiers in Public Health Services and Systems Research

In the United States it is currently unknown whether the influenza surveillance system is capable of producing timely and accurate data for case estimation during an outbreak of pandemic scale. This simulation provides a preliminary evaluation of the surveillance system’s ability to collect data and produce timely and accurate trends of cases confirmed with an influenza virus. For the evaluation, a computer-based simulation of the data-collection process was used, which was validated with real demographic and epidemiologic information. The results were analyzed to determine the most significant behavioral and operational factors influencing the data collection and to propose the exploration …

Perceptions Of School And Health Department Emergency Preparedness Collaboration, Kaitlin A. O'Keefe, Katharine D. Arrington, Michael Prelip, Kimberley I. Shoaf

Frontiers in Public Health Services and Systems Research

Background: School systems often have the vital responsibility of protecting students during emergency situations. Collaborations with the local health department (LHD) can be invaluable in helping schools effectively fulfill this responsibility.

Purpose: An evaluation of existing organizational collaborations is needed to describe attitudes toward current efforts and to form recommendations for enhancing the effectiveness of future joint programs.

Methods: Questionnaires regarding perceptions of existing collaborations were distributed to a sample of LHDs and schools districts in spring and summer 2011. Participant responses from each organization were paired on jurisdictional area, forming 25 paired observations. Analyses were conducted in …

Rear-Facing Child Car Seats: Are Laws Requiring Them Effective?, Eli Friedman, Henry J. Carretta, Joshua Jordan, Leslie M. Beitsch

Frontiers in Public Health Services and Systems Research

Introduction: Motor vehicle crashes are a leading cause of death in children aged ≤ 2 years in the U.S. The American Academy of Pediatrics advised that children should remain in rear-facing child car seats to mitigate injury from the most common type of severe collision (frontal). Several states have passed laws following these recommendations.

Methods: In 2013 publicly available statutes and comprehensive motor vehicle fatality data from the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System database were used to investigate whether there is a relationship between motor vehicle crash fatality rates for children under 1 year of age …

Answering The Call To Integrate: Simple Strategies From Public Health And Healthcare Executives In One Urban County, Erik L. Carlton, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Background: As the Affordable Care Act transforms the practice of both public health and health care, it also provides opportunity for both to become more closely linked through improved integration and collaboration. Yet, while public health agencies are increasingly called to work with healthcare partners to address population health needs, both public health leaders and their healthcare counterparts may not be well equipped to answer that call. Although recent studies have begun exploring the collaborative strategies and capacity of public health system partners, there is still much to learn. The purpose of this study was to identify, through the perspective …

Accreditation Intent, Community Health Assessments, And Local Health Department–Hospital Collaboration, Erik L. Carlton, Simone Singh

Frontiers in Public Health Services and Systems Research

Background: Community health assessments (CHAs) are among the most core of activities conducted by local health departments (LHDs), and many LHDs have been conducting CHAs on a regular basis for years. More recently, completing a CHA has also become a prerequisite for LHDs seeking accreditation by the Public Health Accreditation Board (PHAB). Similarly, under the Affordable Care Act, tax-exempt hospitals are required to conduct periodic community health needs assessments. Opportunities thus exist for LHDs and tax-exempt hospitals to engage in collaborations related to CHAs. Yet, it remains unclear whether interest in PHAB accreditation provides incentive to LHDs to engage in …