Health Services Research Commons^™

Ethics And Economics Of The Covid-19 Pandemic In The United States, Peter Hilsenrath, Tyrone F. Borders

Health Management and Policy Faculty Publications

The Covid-19 experience provides a natural experiment in personal and social ethics. Difficult decisions are routinely made to optimize lives and livelihoods. This commentary provides background and insight into the ethical and economic foundations underpinning dilemmas of this historic pandemic.

Cross Jurisdictional Boundaries To Build A Health Coalition: A Kentucky Case Study, Angela L. Carman, Margaret L. Mcgladrey

Health, Behavior & Society Faculty Publications

Cross-jurisdictional sharing is accomplished through collaboration across jurisdictional boundaries to deliver essential public health services and solve problems that cannot be easily addressed by single organizations or jurisdictions. Partners across 10 counties and three public health jurisdictions of the Barren River Area Development District (BRADD) convened as Barren River Initiative to Get Healthy Together (BRIGHT), a community health improvement coalition. Focus groups and interviews with BRIGHT members indicate that the use of effective strategies to focus collaborative health improvement efforts fosters a cohesive coalition even when the group is populated by individuals from across public health jurisdictional boundaries. Focusing strategies …

Injury-Related Infant Deaths: A State Analysis Of A Public Health, Health Care, Policy Network, Sharla Smith, Xi Zhu, Mary Aitken

Frontiers in Public Health Services and Systems Research

Introduction: This research examines a state-level public health, health care, and policy network focused on efforts to reduce unintentional childhood injuries. The network is composed of 12 organizations: four public health, four health care, and four policy.

Methods: A 23-item survey was administered to the 12 organizations between January and June 2015. Analyses were conducted using HyperResearch and UCInet 6.

Results: More organizations worked together on assessment and planning efforts that identify and quantify the nature of at-risk infants in the community and strategies for reducing injury-related infant deaths. The Injury Prevention Center, the most central organization, interacted most frequently …

Public Health Spending And Its Contributions To The Total Spend On Health, Glen P. Mays

Health Management and Policy Presentations

This presentation provides an overview of recent research on governmental public health expenditures and their interaction with medical spending, carried out through the Robert Wood Johnson Foundation supported initiatives on Public Health Services and Systems Research (PHSSR) and the new Systems for Action research program. This work illustrates the value of tracking resource use across multiple sectors that influence health and well-being in American communities. As such, this work can inform the ongoing dialogue about methodologies for summarizing total health spending for the U.S. and for state and local areas.

Summary Of Results From The 2016 National Health Security Preparedness Index, Glen P. Mays, Michael T. Childress, Pierre Martin Dominique Zephyr, Anna Goodman Hoover

Health Management and Policy Reports

The National Health Security Preparedness Index tracks the nation’s progress in preparing for, responding to, and recovering from disasters and other large-scale emergencies that pose risks to health and well-being in the United States. Because health security is a responsibility shared by many different stakeholders in government and society, the Index combines measures from multiple sources and perspectives to offer a broad view of the health protections in place for nation as a whole and for each U.S. state. The Index identifies strengths as well as gaps in the protections needed to keep people safe and healthy in the face …

Measuring Comprehensive Public Health Delivery Systems And Their Contributions To Population Health, Glen P. Mays, Rick Ingram

Health Management and Policy Presentations

We review methods for measuring the structure of public health delivery systems using data from the National Longitudinal Survey of Public Health Systems. A growing body of research using these measures demonstrates how multiple sectors contribute to core public health functions, and how these functions influence community health status over time. We end with a summary of how the Comprehensive Public Health System measure will be used in monitoring the impact of the 21st Century Public Health System initiative.

Measuring Multi-Sector Contributions To Public Health Delivery Systems & Population Health, Glen P. Mays

Health Management and Policy Presentations

The National Longitudinal Survey of Public Health Systems has followed a nationally-representative cohort of U.S. communities since 1998 to measure the scope of public health activities implemented in each community and the range of organizations and sectors that contribute to each activity. With 16 years of follow-up observations, this survey allows us to study the effects of demographic, economic, and policy shocks on public health delivery systems, and estimate the health effects attributable to delivery system change.

Measuring Comprehensive Public Health Delivery Systems And Their Contributions To Population Health, Glen P. Mays

Health Management and Policy Presentations

Delivery and financing systems for public health services vary widely across U.S. communities, raising questions about the comparative effectiveness and efficiency of alternative structures. We summarize recent approaches for measuring alternative system configurations and estimating their health and economic effects.

Employing The Precautionary Principle To Evaluate The Use Of E-Cigarettes, Ashley M. Bush, James W. Holsinger Jr., Lawrence D. Prybil

Health Management and Policy Faculty Publications

Electronic cigarettes (e-cigarettes) have emerged onto the public market as an alternative to tobacco cigarettes; however, science is inconclusive as e-cigarettes have not been thoroughly investigated, including their short- and long-term risks and benefits (1, 2). The question arises of whether e-cigarettes will become the future tobacco crisis. This paper connects the precautionary principle to the use of e-cigarettes in an effort to guide decision-makers in the prevention of adverse health outcomes and societal costs.

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 …

Kentucky’S Public Health Strategic Plan: Strengthening Foundational Services & Improving Population Health, Glen P. Mays

Health Management and Policy Presentations

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.

Estimating Patient-Centered And Community-Centered Treatment Effects: Examples From Medical Care And Public Health, Glen P. Mays

Health Management and Policy Presentations

Health services researchers face growing clinical and policy imperatives for estimating how the effectiveness of medical and public health interventions vary across patients, population groups, and community settings. Recent advances in local instrumental variables estimation techniques allow for the estimation of person-specific and community-specific treatment effects in the presence of unobserved heterogeneity. This presentation explores examples from both medicine and public health following the local IV methods developed by Basu et al. (2013).

Foundational Public Health Services And Health System Reform, Glen P. Mays

Health Management and Policy Presentations

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, Cezar Mamaril

Health Management and Policy Presentations

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.

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 …

Medicaid Crowd-Out Of Other Public Health Spending: Modeling Economic & Health Effects, Glen P. Mays

Health Management and Policy Presentations

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

Health Management and Policy Presentations

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 …

Changes In Public Health System Capital And Long-Run Health And Economic Outcomes: 1998 To 2014, Glen P. Mays, Cezar B. Mamaril

Health Management and Policy Presentations

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

Health Management and Policy Presentations

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

Health Management and Policy Presentations

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.

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 …

Practice-Based Research Networks For Next-Generation Public Health, Glen P. Mays

Health Management and Policy Presentations

U.S. public health agencies face an existential imperative to transform their work from a collection of discrete programs and policies into a coherent enterprise for population-wide health improvement. Practice-based research networks (PBRNs) and the advancing science of public health delivery systems can help to achieve this transformation.

Collective Impact Through Public Health And Academic Partnerships: A Kentucky Public Health Accreditation Readiness Example, Angela L. Carman

Health Management and Policy Faculty Publications

In the ever-changing, resource-limited public health environment, the use of partners found in the faculty and students of Colleges of Public Health can provide training, consultation, and technical assistance needed to increase local health department (LHD) workforce capacity to meet new public health demands including national public heath accreditation. This manuscript describes the provision of the backbone support activities of facilitation, data management, and project management by University of Kentucky’s College of Public Health to Kentucky’s LHDs seeking national public health accreditation.

The Journey Toward Voluntary Public Health Accreditation Readiness In Local Health Departments: Leadership And Followership Theories In Action, Angela L. Carman

Health Management and Policy Faculty Publications

Local health department directors’ intent on getting their organizations ready for accreditation must embrace the blurring of leader/follower lines and create an accreditation readiness team fueled not by traditional leader or follower roles but by teamship.

Defining Comprehensive Public Health Delivery Systems, National Coordinating Center For Public Health Services And Systems Research

Health Management and Policy Reports

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.

Improving Measures Of Public Health Activity At Local And State Levels: The Multi-Network Practice And Outcome Variation Examination Study (Mprove), Glen P. Mays

Health Management and Policy Presentations

Implementation of high-value public health strategies for chronic disease prevention, communicable disease control, and environmental health protection vary widely across U.S. states and communities. The Multi-Network Practice and Outcome Variation Examination Study (MPROVE) supported by the Robert Wood Johnson Foundation creates the measurement and analytic foundation for investigating the causes and consequences of practice variation in public health.

Exploring The Process, Models, And Outcomes Of Hospital-Public Health Partnerships, Danielle M. Varda, Jessica H. Retrum, Carrie Chapman

Frontiers in Public Health Services and Systems Research

Health care reform has resulted in changes throughout the health system, including the Affordable Care Act (ACA) requirement that hospitals conduct community health needs assessments, taking into greater consideration the public health of their respective communities. This has led to growing strategies to develop partnerships between hospitals and public health (PH) as a way to meet these needs¹. Meantime, there is a need for data on Hospital-PH partnerships, due to the growing emphasis that these types of partnerships get implemented in practice. In this paper we analyze a secondary data set to explore how hospitals and public health …

Medicaid Expansions & Public Health Spending: Cross-Subsidies, Complementarities, And Crowd-Out, Glen P. Mays

Health Management and Policy Presentations

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.

Geographic Variation In The Delivery Of High-Value Public Health Services: Exploring Causes & Consequences, Glen P. Mays

Health Management and Policy Presentations

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 …

How Can Public Health Economics Help Health Systems Focus Upstream?, Glen P. Mays

Health Management and Policy Presentations

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.