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Full-Text Articles in Social and Behavioral Sciences

Geographic Variation In The Implementation Of Public Health Services: Organizational, Economic, And Network Determinants, Glen P. Mays Dec 2015

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 Dec 2015

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 ...


Estimating Health And Economic Gains From Public Health Delivery System Transformation, Glen Mays Nov 2015

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 Oct 2015

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.


Analytic Approaches For Causal Inferences With Complex Multi-Component Interventions: Project Achieve's Study Of Managing Care Transitions, Glen P. Mays Oct 2015

Analytic Approaches For Causal Inferences With Complex Multi-Component Interventions: Project Achieve's Study Of Managing Care Transitions, Glen P. Mays

Glen Mays

Estimating the causal effects of complex, multi-component health interventions is a task with many challenges in measurement and methodology. This presentation profiles the methods being used as part of the PCORI-funded Project Achieve, a national study to estimate the comparative effectiveness of heterogeneous care transition programs designed to help hospitalized patients and their caregivers navigate care delivery systems effectively and return back to the community with optimal health and wellbeing.


Trends In Health Care Delivery Systems: Implications For Cancer Prevention And Control, Glen P. Mays Sep 2015

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.


The National Health Security Preparedness Index: Proposed Updates For 2015-16, Glen P. Mays Sep 2015

The National Health Security Preparedness Index: Proposed Updates For 2015-16, Glen P. Mays

Glen Mays

The U.S. Centers for Disease Control and Prevention (CDC) initiated development of the National Health Security Preparedness Index in 2012 to create a platform for measuring 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. As a measurement tool, the Index is designed to summarize levels of preparedness achieved within individual states and for the nation as a whole. This session summarizes proposed updates to the Index for 2015-16 that are designed to improve the validity and reliability of Index ...


Improving The National Health Security Preparedness Index: Recommended Updates For 2015-16, Glen P. Mays Aug 2015

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 Aug 2015

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 ...


Estimating Patient-Centered And Community-Centered Treatment Effects: Examples From Medical Care And Public Health, Glen P. Mays Aug 2015

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

Glen Mays

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: Evidence, Economics, And Implementation, Glen P. Mays Aug 2015

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 ...


Fundamentals Of Economic Evaluation For Public Health, Glen P. Mays Aug 2015

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 Jul 2015

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 Jun 2015

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 Jun 2015

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 Jun 2015

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 Jun 2015

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 ...


National Health Security Preparedness Index: Recommendations From The National Advisory Committee, Glen P. Mays, Michael Childress, Anna Goodman Hoover, Chris Bollinger Jun 2015

National Health Security Preparedness Index: Recommendations From The National Advisory Committee, Glen P. Mays, Michael Childress, Anna Goodman Hoover, Chris Bollinger

Glen Mays

This meeting of the National Advisory Committee for the National Health Security Preparedness Index program discussed strategies for improving the theoretical framework, measures, and analytic methodologies used in assessing and comparing preparedness levels across U.S. states and the nation as a whole.


Cost Estimation In Public Health Services & Systems Research, Glen P. Mays Jun 2015

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 Mar 2015

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 Mar 2015

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 Feb 2015

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 Feb 2015

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 Jan 2015

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 Dec 2014

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 ...


Opportunities And Future Directions For The National Health Security Preparedness Index, Glen P. Mays Dec 2014

Opportunities And Future Directions For The National Health Security Preparedness Index, Glen P. Mays

Glen Mays

This presentation examines options and opportunities for future development of the National Health Security Preparedness Index, created through a partnership of national public health and health care organizations led by the U.S. Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Health Officials (ASTHO).


The Dynamics Of Medicaid & Public Health Spending: Implications For Aca Implementation, Glen P. Mays Nov 2014

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.


Aca Implementation In Kentucky: Experiences Of An Expansion State, Glen P. Mays Nov 2014

Aca Implementation In Kentucky: Experiences Of An Expansion State, Glen P. Mays

Glen Mays

Kentucky's implementation of the Affordable Care Act has included early successes with insurance coverage expansion through Medicaid and a state-operated health insurance exchange. Signals of improvements in health care accessibility and delivery of preventive services are evident in the first year after coverage expansions. Challenges associated with political opposition, delivery system transformation, and public health financing remain on the state's policy agenda.


Geographic Variation In The Delivery Of High-Value Public Health Services:Exploring Causes & Consequences, Glen P. Mays Nov 2014

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 ...


Cost Estimates Of Foundational Public Health Services:#11;Results From Piloting An Expert Consensus Methodology, Cezar B. Mamaril, Glen P. Mays Nov 2014

Cost Estimates Of Foundational Public Health Services:#11;Results From Piloting An Expert Consensus Methodology, Cezar B. Mamaril, Glen P. Mays

Glen Mays

We review preliminary estimates from pilot testing a cost estimation methodology developed to identify the resources required to implement a set of Foundational Public Health Services as recommended by the Institute of Medicine and defined by the Public Health Leadership Forum.