Digital Commons Network^™

Using Electronic Health Record Data To Improve Community Health Assessment, Brian E. Dixon, Jian "Frank" Zou, Karen F. Comer, Marc Rosenman, Jennifer L. Craig, P Gibson

Frontiers in Public Health Services and Systems Research

Background: Community health assessments assist health departments in identifying health needs as well as disparities, and they enable linking of needs with available interventions. Electronic health record (EHR) systems possess growing volumes of clinical and administrative data, making them a valuable source of data for ongoing community health assessment.

Purpose: To produce population health indicators using data from EHR systems that could be combined and visually displayed alongside social determinants data, and to provide data sets at geographic levels smaller than a county.

Methods: Data from multiple EHR systems used by major health systems covering >90% of the population in …

A Conceptual Framework For The Study Of Hospital Interaction And Investment In Public Health Systems, Danielle M. Varda, Lisa Vanraemdonck, Gregory Tung, Rachel A. Hogg, Adam Atherly

Frontiers in Public Health Services and Systems Research

Background: Health care reform has resulted in changes throughout the health system, including the Affordable Care Act (ACA) and IRS requirements that nonprofit hospitals conduct community health needs assessments and develop implementation plans to guide greater investment in their respective communities. This has led to questions of which factors influence hospital interaction and investment in PH systems.

Purpose: This paper presents a comprehensive framework, informed by a literature review and expert panel that introduces hypothesized factors related to these outcomes.

Methods: To develop a conceptual framework that identifies hypothesized indicators of increased hospital interaction and investment in PH systems, we …

Visualizing Complex Adaptive Systems: A Case Study Of The Missouri Maternal, Infant, And Early Childhood Home Visiting Program, Julie M. Kapp, Sara Schlemper, Riyad Haq, Sofia Campos Vidal Pires, Eduardo J. Simoes

Frontiers in Public Health Services and Systems Research

Background: The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program was created by the 2010 Patient Protection and Affordable Care Act. MIECHV provides comprehensive services to at-risk families through evidence-based home visiting programs.

Purpose: The following question is addressed: Does the Missouri MIECHV system meet the definition of a complex adaptive system (CAS)?

Methods: A systematic review was conducted of documents related to MIECHV programs (federal, state, and local levels), and to affiliated programs with a home visiting and early childhood (aged birth to 5 years) scope. The organizations’ fit was identified for the scope of early childhood home …

An Accredited Local Health Department’S Use Of The Qi Roadmap To Build A Culture Of Quality, Whitney Webber, Vanessa Au, Aimee Reedy, Rocio Luna, Erica Mireles, Teddy Daligga, Laura Brunetto

Frontiers in Public Health Services and Systems Research

Studies that exist on quality improvement efforts within local health departments indicate that there needs to be clearer approaches for achieving a culture of quality. This study describes how a local health department used the National Association of County and City Health Officials (NACCHO’s) Roadmap to an Organizational Culture of Quality Improvement (QI Roadmap) to successfully build a quality culture on its journey to becoming accredited, as reflected in results from a February 2016 survey. Local health departments who invest in and promote QI efforts that are aligned with strategic priorities; establish the necessary infrastructure to regularly track and report …

Local Health Departments’ Involvement In Hospitals’ Implementation Plans, Simone Singh, Erik Carlton

Frontiers in Public Health Services and Systems Research

Background: More than half of all local health departments (LHDs) in the U.S. are involved in collaborations with nonprofit hospitals on a community health needs assessment (CHNA), yet little is known about the role that LHDs play in hospitals’ implementation plans.

Purpose: This study aims to explore the current state of hospital–LHD collaborations around the implementation plan using data from a survey of LHDs across the country.

Methods: The study sample included 457 LHDs that completed both the 2015 Forces of Change survey and the 2013 Profile survey conducted by the National Association of County and City Health Officials. Univariate …

Multi-Sectoral Partnerships And Patient-Engagement Strategies In Accountable Care Organizations, Margae Knox, Hector P. Rodriguez, Stephen M. Shortell

Frontiers in Public Health Services and Systems Research

Background: Patient-engagement strategies are increasingly recognized for enriching traditional medical care and improving population health. Accountable Care Organizations (ACOs) may be well positioned to leverage multi-sector organizational partnerships to improve the reach of their patient-engagement strategies, particularly given incentives to meet cost, quality and population health goals. Little is currently known about the relation of multi-sector partnerships and patient engagement in ACOs.

Purpose: To examine the relation of patient-engagement strategies and breadth of multi-sectoral organizational partnerships in 71 primary care practices affiliated with one of two ACOs.

Methods: Clinical and administrative leaders from each practice were surveyed. Questions assessed practice …

Enhancing Sexually Transmitted Infection Notification: A Quality Improvement Collaborative Case Report, William C. Livingood, Lori Bilello, Katryne Lukens-Bull, Ulyee Choe

Frontiers in Public Health Services and Systems Research

This case study illustrates how a quality improvement (QI) Collaborative supports an implementation study of using mobile phone texting technology for notification of sexually transmitted infections (STI) test results. The County Health Departments making up the QI Collaborative meet monthly to discuss their progress in using QI to advance the use of texting for STI test results. The main purpose of QI Collaboratives is to maximize implementation outcomes through sharing of successes and challenges. The case study report describes how implementation research can adapt to the context of each unique CHD and the users of new knowledge rather than emphasizing …

Systematic Identification Of Coordination Gaps In Pediatric Care, Diana M. Prieto, Anil Kumar, Catherine L. Kothari, Cheryl Dickson

Frontiers in Public Health Services and Systems Research

In the United States, the status of coordination among pediatric care services is not well understood. Through the use of quality improvement (QI) techniques, coordination gaps were systematically identified in the interagency network of pediatric services in Kalamazoo MI. Gaps were found in transportation resources, follow-up procedures, awareness of services, interagency communication, insurance limitations, population behaviors, and resource utilization. This preliminary study reveals the need for (1) protocols for intra- and inter-agency communication, (2) mechanisms for easy and fast retrieval of pediatric resources, and (3) health information exchange.

Using Process Mining To Assess The Fidelity Of A Home Visiting Program, Riyad Haq, Sofia Campos Vidal Pires, Julie M. Kapp, Sara Schlemper, Eduardo J. Simoes

Frontiers in Public Health Services and Systems Research

Background: The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is a federal public health initiative which supports at-risk families through evidence-based programs and promising approaches for pregnant women, and childhood development for children aged 0 to 5. These public health program funding mechanisms commonly include process evaluation mandates.

Purpose: The use of process mining was explored as a methodology to assess the fidelity of the MIECHV programs’ actual workflow to that of their intended models.

Methods: Research Electronic Data Capture (REDCap) data files that were populated with program process data elements from the local implementing agencies were …

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 …

Revenue Reporting By Illinois Local Health Departments: Observations And Recommendations, Georgeen Polyak Phd, Monica Vargas

Frontiers in Public Health Services and Systems Research

Background: The lack of a stable and adequate funding system for local health departments in the U.S. has been well documented. The lack of a comprehensive financial reporting system in public health, including a uniform chart of accounts, hampers the ability of local health departments to make a case to legislators and administrators for increased funding from local and state sources.

Purpose: This study examined potential sources of revenue reporting by local health departments in Illinois to identify an accurate picture of total revenues and sources of revenues being invested.

Methods: A literature review identified four sources of revenue reporting: …

A Tool To Cost Environmental Health Services In North Carolina Local Health Departments, Nancy L. Winterbauer, Simone Singh, Ashley Tucker, Lisa M. Harrison

Frontiers in Public Health Services and Systems Research

Introduction: The cost of providing a basic set of public health services necessary not been well-described. Recent work suggests public health practitioners are unlikely to have the empirically-based financing information necessary to make informed decisions regarding practice. The purpose of this paper is to describe the development of a costing tool used to collect primary data on the number of services provided, staff employed, and costs incurred for two types of mandated environmental health services: food and lodging inspections and onsite water services.

Methods: The tool was iteratively reviewed, revised, and piloted with local health department (LHD) environmental health and …

Sharing Local Public Health Services Across Jurisdictions: Comparing Practice In 2012 And 2014, Kusuma Madamala, Susan Zahner, Roger Brown

Frontiers in Public Health Services and Systems Research

Objective: Describe cross-jurisdiction service sharing (CJS) by local and tribal health departments (LHD) in Wisconsin in 2014 compared to 2012.

Design: An online survey of 91 LHD directors in Wisconsin was conducted. Results were compared to the results of a 2012 survey. Characteristics of CJS arrangements and differences in results by population size, geographic region, and governance type were described. Standardized proportion differences (h) were estimated using the arcsin transformation. Confidence intervals were estimated using unconditional exact confidence intervals for the difference of proportions.⁸ A forest plot of the estimates and confidence intervals was generated to visualize change in …

Trends In Clinical Billing By Local Health Departments, J. Mac Mccullough

Frontiers in Public Health Services and Systems Research

Background: Billing for clinical services is perceived to be increasingly important for local health departments (LHDs). Yet very little evidence exists regarding the frequency and relative financial importance of clinical billing revenues.

Purpose: The purpose of this study is to report on trends in the frequency and financial scope of clinical billing by LHDs from 2008 to 2013.

Methods: The study used data from the 2008, 2010, and 2013 National Association of City and County Health Officials Profile report surveys. Per capita revenues from clinical billing and percent of total LHD revenues from clinical billing were calculated. …

Tuberculosis And Local Health Department Expenditures On Tuberculosis Services, Michelle P. Yip, Betty Bekemeier

Frontiers in Public Health Services and Systems Research

Background: Although tuberculosis (TB) morbidity and mortality have decreased in recent decades, challenges exist regarding disproportionate distributions of TB among specific populations and geographic areas. Inconsistent local health department (LHD) funding for TB programs poses difficulties for LHDs to sustain resources and personnel that predisposes communities to risks of future outbreaks of TB and drug-resistant TB diseases.

Purpose: This study examined relationships between annual TB incidence rates and LHD expenditures on TB-related services to elucidate potential impacts of TB incidence on LHD TB spending.

Methods: This dataset included county-level TB incidence data with comparable, annual (2000–2010) TB-related service expenditures for …

The Cost Of Public Health Services, F. Douglas Scutchfield Md

Frontiers in Public Health Services and Systems Research

Paying for public health services is and remains a consistent concern among local health departments. The data on the impact of the 2008 recession on public health nationally demonstrated the problems with maintaining staff and services in the face of a declining resource base. This capacity to provide funding for provision of public health services has prompted a number of mechanisms to provide support for dealing with revenue shortfalls. The papers in this issue of Frontiers in PHSSR continue to echo that concern of how best to deal with loss of funding, measuring it and developing tools to ascertain the …

The Public Health Information Technology Maturity Index: An Approach To Evaluating The Adoption And Use Of Public Health Information Technology, Kenyon Crowley, Robert S. Gold, Sruthi Bandi, Ritu Agarwal

Frontiers in Public Health Services and Systems Research

Background: Public health information technology (PHIT) has the potential to improve the effective and efficient use of information in achieving public health objectives. Information technology maturity models have been extensively used in other domains to guide information technology assessment and planning, but an information technology maturity model tailored for public health departments has heretofore been unavailable.

Purpose: The purpose of this study was to develop a Public Health Information Technology Maturity Index.

Methods: An extensive literature review and content analysis was conducted of information system adoption, use, and maturity in general and in the public health systems and services research …

An Exploration Of Core Values And Values Congruence In Local Public Health, Ross Graham, Christopher Mackie, Shannon L. Sibbald

Frontiers in Public Health Services and Systems Research

Background: Understanding and aligning staff core values with organizational values has been shown to contribute to positive work attitudes and increased organizational performance in the private sector. Little is known about the role of values in local public health.

Purpose: To identify public health staff core values, and to improve the alignment between staff values and organizational values (known as values congruence).

Methods: A Tribal Leadership exercise was used as part of a multi-stage strategic planning process at Canada’s largest autonomous local public health agency.

Results: Five sessions were held with 146 public health staff; 156 different values were reported. …

Evidence For The Role Of Resource-Sharing Networks In Coalition Development, Margaret Mcgladrey, Angela Carman Drph

Frontiers in Public Health Services and Systems Research

Background: Accreditation bodies and sponsors of community health projects increasingly require the use of health coalitions in community health planning efforts to ensure buy-in, leverage resources, and distribute health information. Despite a substantive body of research documenting the characteristics of successful health coalitions, little is known about how team dynamics in these coalitions evolve.

Purpose: The goal of this study was to employ social network analysis techniques to evaluate whether coalitions’ relative stages in Tuckman’s stages of team development model were associated with specific patterns of advice-, information-, and resource-sharing among the eight coalitions participating in a region-wide …

Local Health Department Clinical Service Delivery Along The Urban/Rural Continuum, Kate E. Beatty, Nathan Hale, Michael Meit, Paula Masters, Amal Khoury

Frontiers in Public Health Services and Systems Research

Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities.

Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities.

Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting …

A “Health In All Policies” Evolution In New York City’S Planyc, Stephanie Noble, Kimberley R. Isett

Frontiers in Public Health Services and Systems Research

Background: Health in All Policies (HiAP) is a framework requiring that the promotion of health be embedded in all substantive policy areas to have a comprehensive approach to the health and well-being of local citizens.

Purpose: To determine the extent to which the Bloomberg Administration in New York City used an HiAP approach to promote attention to health outcomes in peer agencies (outside the Department of Health and Mental Hygiene) within the city bureaucracy.

Methods: Document analysis was completed on a hallmark sustainability plan in New York City, called PlaNYC: the 2007 PlaNYC report, 2011 PlaNYC update, …