Public Health Commons^™

Racial Disparities In Emergency General Surgery: Do Differences In Outcomes Persist Among Universally Insured Military Patients?, Cheryl Zogg, Wei Jiang, Muhammed Ali Chaudhary, John Scott, Adil A. Shah, Stuart R. Lipsitz, Joel S. Weissman, Zara Cooper, Ali Salim, Stephanie L. Nitzschke, Louis L. Nguyen, Lorens A. Helmchen, Linda G. Kimsey, Samuel Olaiya, Peter A. Learn, Adil H. Haider

Health Policy and Management Faculty Presentations

Research Objective: Described as one of the most serious health problems affecting the nation, racial disparities are estimated to account for >83,000 deaths, >$57 billion per year. They have been identified in multiple surgical settings, including differences in outcomes by race among emergency general surgery(EGS) patients. As many minority patients are uninsured, increasing access to care is thought to be a viable solution to mitigate inequities. The objectives of this study were to determine whether racial disparities in 30/90/180day outcomes exist within a universally-insured population of military/civilian-dependent EGS patients and whether differences in outcomes differentially persist in care received at …

Use Of Facebook By Local Health Departments: Activity And Focus Areas, Rakhi Trivedi, Gulzar H. Shah

Health Policy and Management Faculty Presentations

This presentation was given at the Keeneland Conference for Public Health Systems and Services Research.

Assessing Changes In Safety Net Providers Since The Passage Of The Affordable Care Act, Arlesia Mathis, Julia Burke, Gulzar H. Shah

Health Policy and Management Faculty Presentations

The passage of the Affordable Care Act presented opportunities and challenges for safety net providers. Significant investments in provider capacity promised much needed expansion of services; and in 2014, the law extended coverage to millions of previously uninsured Americans. However, safety net providers are concerned that changes to financing brought about by changes in the ACA may threaten their ability to provide services to millions more who still lack insurance. This is a preliminary study of changes occurring with maternal and child health services among safety-net providers.

Levels And Predictors Of Lhds' Engagement In Community Health Assessment, 2002-2013, Gulzar H. Shah, Kay Lovelace, Daniel F. Linder

Health Policy and Management Faculty Presentations

This presentation was given at the Keeneland Conference for Public Health Systems and Services Research.

Factors Driving Local Health Department’S Collaboration With Other Organizations In The Provision Of Personal Healthcare Services, Huabin Luo, Nancy L. Winterbauer, Ashley Tucker, Gulzar H. Shah

Health Policy and Management Faculty Presentations

Background: Recent work has highlighted the necessity of integrating primary care services and public health to improve quality and reduce the cost of healthcare.

Research Objectives: To describe levels of partnership between local health departments (LHD) and other organizations in the community in the provision of personal healthcare services; and to assess LHD organizational characteristics and community factors that contribute to partnerships.

Data Sets and Sources: Data were drawn from the 2013 NACCHO Profile Study (Module 1) and the Area Health Resource File. A total of 490 LHDs responded to Module 1, where LHDs were asked to describe the level …

Characteristics Of Local Health Departments Associated With Their Implementation Of Electronic Health Records And Other Informatics System, Gulzar H. Shah, Jonathon P. Leider, Brian C. Castrucci, Karmen S. Williams, Huabin Luo

Health Policy and Management Faculty Presentations

Background: Information technology and information systems (IT/IS) play a critical role in the daily operation of local health departments (LHDs). Assessing LHDs’ informatics capacities is important, especially within the context of broader, system-level health reform efforts.

Research Objective: This study assesses a nationally representative sample of LHDs’ level of adoption of information systems, technology, and the factors associated with adoption/implementation. Specifically, five areas of public health informatics were examined: electronic health records (EHRs), health information exchange (HIE), immunization registry (IR), electronic disease reporting system (EDRS), and electronic lab reporting (ELR).

Data Sets and Sources: Data from NACCHO’s 2013 National Profile …

The Impact Of State Mandated Healthcare-Associated Infection Reporting On Infection Prevention And Control Departments In Acute Care Hospitals: Results From A National Survey, Carolyn T. A. Herzig, Monika Pogorzelska-Maziarz, Julie Reagan, Elaine Larson, Patricia W. Stone

Health Policy and Management Faculty Presentations

Background: In addition to federally mandated reporting, most US states have adopted legislation requiring hospitals to submit healthcare-associated infection (HAI) data. Evidence that state HAI laws have increased patient safety and reduced HAI rates is inconsistent, however, and resources needed to comply are considerable. We evaluated the impact of state HAI laws on infection prevention and control departments (IPCD).

Methods: Web-based survey of a national sample of hospital IPCD was conducted in Fall 2011; all non-VA hospitals enrolled in the National Healthcare Safety Network were eligible to participate. States with HAI laws effective prior to Fall 2011 were identified using …

Lhds' Implementation And Evaluation Of Strategies To Target Psychological, Mental Health, And Other Behavioral Healthcare Needs Of The Underserved Population, Gulzar H. Shah, Huabin Luo, Carolyn J. Leep, Nancy L. Winterbauer

Health Policy and Management Faculty Presentations

Background: Underserved subgroups face barriers when accessing behavioral healthcare. Local health departments (LHDs) are charged with “linking people to needed personal health services and assure the provision of healthcare when otherwise unavailable”.

Research Objectives: 1) To assess the extent to which LHDs implement and evaluate strategies to target the behavioral healthcare needs for the underserved populations; 2) To identify factors that are associated with these undertakings.

Datasets and Sources: Data were drawn from the 2013 National Profile of Local Health Departments Study conducted by National Association of County and City Health Officials The Module 2 questionnaire of the Profile contained …

Local Public Health In Financial Crises: Common Decision Drivers For Changes In Services Due To Economic Downturn, Gulzar H. Shah

Health Policy and Management Faculty Presentations

We measured the impact of the 2008-2010 economic recession on local health departments (LHDs) across the United States. Between 2008 and 2010, we conducted 3 Web-based, cross-sectional surveys of a nationally representative sample of LHDs to assess cuts to budgets, workforce, and programs. By early 2010, more than half of the LHDs (53%) were experiencing cuts to their core funding. In excess of 23 000 LHDs jobs were lost in 2008-2009. All programmatic areas were affected by cuts, and more than half of protecting the health of the public, such as monitoring health status to identify and solve community health …

Community Health Assessment Activity By Lhds: The Influence Of Local Health Agency And Community Characteristics, Gulzar H. Shah, Barbara Laymon, Carolyn Leep, Julia Elligers

Health Policy and Management Faculty Presentations

Research Objective: This study investigates organizational and community characteristics associated with the likelihood of local health departments to conduct community health assessments (CHAs).

Study Design: For this observational study, we used data from the 2010 National Profile of Local Health Departments Study (Profile). Using the FIPS codes for the county and place, additional data were merged with Profile data to capture community characteristics. To compute estimates of community characteristics for LHDs involving multiple cities/counties, we computed population weighted averages. In order to estimate unbiased population parameters, we used appropriate statistical weights in all analyses, to account for disproportionate non-responses …

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

Health Policy and Management Faculty Presentations

Research Objective: The purpose of this study was to identify potential modifiable factors that can protect local health departments from job losses and budget cuts during periods of economic stress.

Study Design: This was a retrospective cohort study which used data from census surveys of local health departments (LHDs) which were conducted in 2005 and 2010 by the National Association of County and City Health Officials. The 2005 survey data served as the source of independent variables, which were grouped around domains of organization, revenue, and services. The outcome of interest - resiliency of the LHD - represented financial resiliency …

Local Health Departments’ Plan To Seek Voluntary National Accreditation And Its Association With Phab Accreditation Prerequisites, Gulzar H. Shah, Kate Beatty, Carolyn Leep

Health Policy and Management Faculty Presentations

Research Objective: To examine the nature of relationship between LHDs’ intentions to seek Public Health Accreditation Board (PHAB) accreditation in the future and having completed within five years the three PHAB pre-requisites: community health assessment (CHA), community health improvement plan (CHIP), and the agency-wide strategic plan.

Data Sets And Sources: We used data from the NACCHO’s 2010 National Profile of Local Health Departments (2010 Profile Study) survey, administered to 2,656 LHDs, with a module sent to a nationally representative stratified random sample of 625 LHDs which contained questions on LHDs’ plans to seek voluntary national accreditation (the dependent …

Clarifying And Expanding Concepts Of Cross-Jurisdictional Sharing: Early Lessons Learned From Conducting Qi With Georgia’S Health Districts, William C. Livingood, Nandi A. Marshall, Angela Peden, Ketty Gonzales, Gulzar H. Shah, Dayna S. Alexander, Alesha Wright, Russell B. Toal, Lynn S. Woodhouse, Deanna Keene

Health Policy and Management Faculty Presentations

Research Objective: Assess the legal and organization cultural foundations for Cross-Jurisdictional Sharing (CJS) in support of local public health accreditation and QI in Georgia.

Data Sets and Sources: Archival data (primarily state statutes), secondary data from previous qualitative comparative research on Deep South public health organization, secondary data from previous surveys, and oral interviews and written communication.

Study Design: Primarily Qualitative design combining ethnographic and participatory research methods.

Analysis: Qualitative Content analysis based on predetermined and emergent themes.

Principal Findings: Georgia’s Health Districts have emerged as major CJS entities that support delivery of essential services and local public health (LPH) …

There Is No “I” In Team: Players, Leaders, And Team Performance In Public Health Emergency Response, William Riley, Paige Anderson Bowen, Micky Scullard, Cheryl Petersen-Kroeber, Gulzar H. Shah

Health Policy and Management Faculty Presentations

Research Objective: Research objectives are to: 1) assess effect of controller-led in situ simulation on emergency response capacity of state health department; 2) study effects of training on team function, dynamics, and communications among staff responsible for emergency operations at state health department; and 3) train public health teams for high reliability.

Data Sets and Sources: Thirty trials (one-hour functional exercises) conducted in the state department operations center over a 16-month period (May 2010 to September 2011). Data gathered using in situ simulation methodology (recording, live viewing, playback analysis). Behavioral markers data collected using event set observational tool …

Predictors Of Evidence-Based Decision Making And Population Health Practice In Lhds, Kay Lovelace, Robert Aronson, Kelly Rulison, Gulzar H. Shah, Mark Smith

Health Policy and Management Faculty Presentations

Research Objective: To identify the frequency with which LHDs carry out Evidence-Based Decision Making (EBDM) and population health strategies in LHDs and state-, LHD-, and community-levels predictors of LHDs' use of these strategies.

Data Sets and Sources: Harmonized PHSSR dataset consisting of 2010 NACCHO Profile of Local Health Departments Survey, Module 2 respondents, 2010 ASTHO Profile of State Health Departments, US Census data, and Area Resource File data.

Study Design: The study used multivariate analysis to identify predictors of EBDM and population health. We identified items in the 2010 NACCHO Profile Survey representing EBDM and population health strategies and …

Using Expert Panels To Elicit Potential Indicators And Predictors Of Ebph In Local Health Departments, Robert Aronson, Kay Lovelace, Mark Smith, Gulzar H. Shah

Health Policy and Management Faculty Presentations

Research Objective: To identify appropriate indicators of local health department (LHD) use of EBPH strategies and factors that influence their use.

Data Sets and Sources: Transcripts of interviews with 12 members of an expert panel representing researchers and practitioners working in PHSSR and Evidence-Based Public Health.

Study Design: Participants responded to a series of questions regarding: their definition of EBPH; ways to identify and assess the use of EBPH strategies; and perceived barriers/enablers to the use of these strategies at the state and local levels.

Analysis: Content analysis performed using QSR NVivo V. 9. Data matrices …

Health Districts As Quality Improvement Collaboratives And Multi-Jurisdictional Entities, William C. Livingood, Nandi A. Marshall, Angela Peden, Ketty Gonzales, Gulzar H. Shah, Dayna S. Alexander, Kellie O. Penix, Russell B. Toal, Lynn D. Woodhouse

Health Policy and Management Faculty Presentations

Research Objective: The Georgia Public Health PBRN assessed the utility of the Multi-county Health District as a structured Quality Improvement Collaborative (QIC), and as multi jurisdictional entities for purposes of meeting standards for accreditation by the Public Health Accreditation Board.

Data Sets and Sources: Data were collected from online surveys followed up with phone interviews or paper surveys to maximize participation. A newly developed clinical care QIC instrument (Schouten et al, 2010) was modified to collect data with a revised focus on QICs for public health. We retained QI culture constructs in the instrument while shifting the focus …

The Resilient Local Health Department: Attributes Of Survival During The Economic Crisis, Paul C. Erwin, Gulzar H. Shah

Health Policy and Management Faculty Presentations

The purpose of this research is to explore the attributes of local health departments (LHDs) which have survived the recent economic crises without loss of staff. A retrospective cohort study is being conducted, using the 2005 and 2010 Profile of Local Health Departments datasets from the National Association of County and City Health Officials. LHDs which responded to both surveys and which provided data on full-time equivalents (FTEs) and expenditures are included for analysis. LHDs are categorized as resilient or non-resilient based on whether the LHD gained or did not lose FTEs between 2005 and 2010 (“resilient LHD”) vs. those …

Extent And Nature Of Resource Sharing Among Local Health Departments, Joshua Vest, Gulzar H. Shah

Health Policy and Management Faculty Presentations

Objective: Collaborative arrangements between local health departments (LHDs) by which they share services, responsibilities, or staff, is a growing occurrence in the US. This phenomenon is referred to as regionalization, resource sharing, or intra-state resource sharing. Participants of this session will learn about the current state of resource sharing among LHDs in terms of the public health activities, nature of the relationships, and geography. We will also discuss which characteristics of LHDs are associated with resource-sharing.

Data Source: Data for this analysis come from the National Association of City & County Health Official's 2010 Profile of Local Health Departments. The …

Diffusion Of Practice-Based Research In Local Public Health: What Differentiates Adopters From Non-Adopters?, Gulzar H. Shah, Kay Lovelace, Reba Novich

Health Policy and Management Faculty Presentations

Objective: To improve session-participants’ understanding of level of local health departments’ (LHDs) involvement in various practice-based research (PBR) activities. Practice-based public health research is gaining increased recognition for improving the efficiency and effectiveness of public health practice.

Data: Data are drawn from NACCHO’s 2010 National Profile of LHDs Study. Questions about LHDs’ participation in PBR were administered to a stratified random sample of 625 LHDs.

Findings: Over the 12 months prior to the study 38 percent of LHDs did not participate in any PBR activity and another five percent of respondents did not know if their health department …

Local Health Departments’ Governance: A Visual Display Using Lhd Shape Files, Gulzar H. Shah Dr., Carolyn J. Leep, Reba Novich

Health Policy and Management Faculty Presentations

Analyses conducted for public health systems and services research (PHSSR) frequently include a variable that represents the relationship between state and local health departments (i.e., a governance category) in their analyses, either as an explanatory variable or a control variable. A number of organizations and researchers has categorized states according to governance, but the categorizations have been inconsistent across studies. This lack of agreement regarding governance category has been problematic for PHSSR.

The Association of State and Territorial Health Officials (ASTHO) in conjunction with NORC at the University of Chicago and with input from the National Association of County and …