Medicine and Health Sciences Commons^™

Local Health Departments’ Level Of Engagement In Population Mental Health Promotion, Jonathan Purtle, Ann C. Klassen, Jennifer Kolker, Rachel M. Peters, James W. Buehler

Frontiers in Public Health Services and Systems Research

Background: Mental health conditions are highly prevalent in the U.S. and are associated with physical health problems. Federal initiatives recognize mental health as a public health priority, and local health departments (LHDs) have been identified as partners to promote population mental health. Little is known, however, about the extent to which LHDs address mental health or how LHD officials perceive mental health as a public health concern.

Purpose: To describe the cumulative level of LHDs’ engagement in activities to address population mental health and explore how LHD officials perceive their roles in promoting it.

Methods: Module 2 of the 2013 …

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 …

A Case Study Of Cross-Jurisdiction Resource Sharing: The Merger Of Two Tuberculosis Clinics In East Tennessee., Anne Kershenbaum, Margaret A. Knight, Martha L. Buchanan, Janet Ridley, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Cross-jurisdiction resource sharing is considered a possible means to improve efficiency and effectiveness of public health service delivery. A merger of the Tuberculosis (TB) clinics of a rural and a metropolitan jurisdiction in East Tennessee provided an opportunity to study service provision changes in real time. A mixed methods approach was used, including quantitative data on latent TB treatment outcomes and qualitative data from staff interviews, as well as documentation of changes in staffing time in TB services. Results showed a mix of efficiency changes, indicating probable increased pressure on key service providers after the merger, in addition to expected …

What “Community Building” Activities Are Nonprofit Hospitals Reporting As Community Benefit?, Erik Bakken, David Kindig, Jo Ivey Boufford

Frontiers in Public Health Services and Systems Research

In 2008, the Internal Revenue Service (IRS) revised and standardized the reporting policy for community benefit expenses for nonprofit hospitals. These expenses are required for tax exemption. At that time, the IRS designated some categories of activities as non-eligible as a community benefit, but still mandated their reporting on hospitals’ Form 990, the annual tax filing for nonprofit organizations. One such category was community building, which encompasses a broad range of nonmedical determinants of health and an important potential source of population health revenue. This is the first study to analyze community-building dollars at any level, examining New York State’s …

Frontiers In Phssr Is On The Move, F. Douglas Scutchfield

Frontiers in Public Health Services and Systems Research

Recently, Dr. Jenine Harris and her colleagues examined the use of journals by state chronic disease prevention staff to stay up-to-date on public health evidence. We, at Frontiers in PHSSR, are pleased to be included among the journals listed in the survey. Online open-access journals are shifting the paradigm of scientific publication, allowing free and rapid exchange of information. Another illustration of Frontier’s increasing utility is a forthcoming issue of the American Journal of Public Health (AJPH). We are pleased that AJPH has agreed to publish selected abstracts from Frontiers in PHSSR in their regular issue with links to …

Local Health Department Collaborative Capacity To Improve Population Health, Hector P. Rodriguez, Jeffrey Mac Mccullough, Charleen Hsuan

Frontiers in Public Health Services and Systems Research

Local health departments (LHDs) can more effectively develop and strengthen community health partnerships when leaders focus on building partnership collaborative capacity (PCC), including a multisector infrastructure for population health improvement. Using the 2008 National Association of County and City Health Officials (NACCHO) Profile survey, we constructed an overall measure of LHD PCC comprised of the five dimensions: outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages. We conducted a series of regression analyses to examine the extent to which LHD characteristics and contextual factors were related to PCC. The most developed PCC dimension was vision-focus balance, while infrastructure …

Editorial Comment: Understanding Cost Variation In Std Service Delivery As State And Federal Agencies Reduce Funding, Michael A. Preston, William W. Greenfield, Sharla A. Smith

Frontiers in Public Health Services and Systems Research

As health reform gains momentum, many changes have been seen in the way health services are delivered and financed. In an attempt to address the uncertainties and understand the costs of delivering STD prevention services, the authors examined the cost of STDs in a highly centralized public health agency system (PHAS). This commentary covers several implications that arise from this study.

Understanding Cost Variations In Std Service Delivery As State And Federal Agencies Reduce Funding, William C. Livingood, Lori Bilello, Bonita Sorensen

Frontiers in Public Health Services and Systems Research

Sexually transmitted diseases (STD) continue to be a major health problem in the U.S. Despite the persistence of STDs and the critical role of the public health sector in controlling these diseases, STD services continue to be reduced. A linear regression was performed using county demographic and cost variables. Many of these variables in county public health agencies and the populations they serve were not significantly correlated with cost of service. However, the availability of local tax funding for county health departments (CHDs), which varies extensively across counties within the state, is statistically linked to higher STD expenditure per case. …

The Role Of Leadership In Creating A Strategic Climate For Evidence-Based Practice Implementation And Sustainment In Systems And Organizations, Gregory A. Aarons, Mark G. Ehrhart, Lauren R. Farahnak, Marisa Sklar

Frontiers in Public Health Services and Systems Research

There is a growing impetus to effectively implement evidence-based practices (EBPs) in health and allied health settings in order to improve the public health impact of such practices. To support implementation and sustainment of EBPs, it is important to consider that health care is delivered within the outer context of public health systems and the inner context of health care organizations and work groups (3). This article identifies two relevant types of leadership for implementation and recommends steps that leaders can take in developing a strategic climate for EBP implementation and sustainment within the outer and inner contexts of health …

Editorial Comment: What Influences The Use Of Administrative Evidence-Based Practices In Local Health Departments?, Christopher M. Maylahn

Frontiers in Public Health Services and Systems Research

In 2012, Frontiers published an article by Allen et al. about identifying administrative and management practices that make up an evidence-based local health department.¹ They recommended that local health departments (LHDs) consider using such practices to implement sustained evidence-based policies, programs, and interventions. Strategies that should be given ‘high priority’ for implementation were highlighted. My accompanying editorial² acknowledged the value of this practical advice to LHDs in optimizing their performance and achieving desired health outcomes.

What Influences The Use Of Administrative Evidence-Based Practices In Local Health Departments?, Kathleen Duggan, Peg Allen, Ross Brownson, Paul C. Erwin, Robert Fields, Rodrigo S. Reis, Carson Smith, Katherine Stamatakis

Frontiers in Public Health Services and Systems Research

Evidence based public health (EBPH) in local health departments (LHDs) is a process that involves translating the best available scientific evidence into practice. However, EBPH and implementation of evidence based programs and policies in LHDs are not widespread. This report outlines the patterns and predictors of the use of administrative evidence based practices (A-EBPs) in a national sample of LHD directors. LHDs can improve performance, prepare for accreditation and ultimately improve community health by utilizing an administrative evidence based process.

Racial Disparities In Access To Community Water Supply Service In Wake County, North Carolina, Jacqueline Macdonald Gibson, Nicholas Defelice, Daniel Sebastian, Hannah Leker

Frontiers in Public Health Services and Systems Research

Anecdotal evidence suggests that historically African American communities on the fringes of cities and towns in North Carolina have been systematically denied access to municipal drinking water service. This paper presents the first statistical analysis of the role of race in determining water access in these fringe areas, known as extraterritorial jurisdictions. Using publicly available property tax data, we quantified the percentage of residences with municipal water service in each census block in Wake County (the second-largest by population in North Carolina). Using the resulting water service maps plus 2010 U.S. Census data, we employed a logistic regression to assess …

Economies Of Scale And Scope In Public Health: An Analysis Of Food Hygiene Services Provided By Local Health Departments In Florida, Simone Singh, Patrick M. Bernet

Frontiers in Public Health Services and Systems Research

Local health departments (LHDs) across the United States deliver a range of essential public health services, yet little is known about the costs that LHDs incur in providing these services and the factors that may cause costs to vary both within and across health departments. This report first describes the variations in the costs of one core public health activity commonly provided by LHDs: food hygiene services. It then analyzes the factors that drive LHDs' cost of service provision focusing on the role of economies of scale and economies of scope. Using data for all LHDs in Florida for 2008 …

Editorial Comment: Temporal Trends In Preparedness Capacity, Gulzar H. Shah

Frontiers in Public Health Services and Systems Research

In view of the critical role local health departments (LHDs) play among agencies responsible for responding to natural and man-made emergencies, Bevc et al. examined the LHDs’ emergency preparedness and capacity. They compared LHDs in North Carolina with those across the country for preparedness along eight domains. Significant declines in emergency preparedness were noted from 2010 to 2012 for five out of eight domains, raising questions about our national priority concerning this important function of public health agencies. These findings have numerous implications, some of which are covered in this commentary.

Measures Of Highly Functioning Health Coalitions: Corollaries For An Effective Public Health System, Priscilla A. Barnes, Paul C. Erwin, Ramal Moonesinghe

Frontiers in Public Health Services and Systems Research

In Tennessee, health coalitions provide guidance in conducting community assessments, health improvement plans and policies and delivering of health and human services, which are considered core functions of public health. In fact, it has been postulated that these coalitions may serve as the organizational embodiment of the local public health system (LPHS). This study identifies functional characteristics of 63 Tennessee County Health Councils (CHCs), advisory councils to local and regional governmental public health agencies on broad issues of health, that contribute to its ability to operate as the primary advising entity of the LPHS. Exploratory factor analysis was conducted on …

Editorial Comment: Changing The Rules In Vaccine Coverage For Vulnerable Populations, Nancy L. Winterbauer

Frontiers in Public Health Services and Systems Research

Increasing life expectancy through decreasing vaccine preventable deaths is a hallmark of modern public health in the United States (1). Two federal vaccine programs help insure coverage for vulnerable populations. The Vaccines for Children (VFC) Program provides vaccines to eligible children[1] at no cost, removing financial barriers to vaccinations. Close to half of US children and 30 percent of adolescents are vaccinated through the VFC program yearly (2). The federal Section 317 Immunization Grant Program (Section 317) complements VFC by supporting the national immunization infrastructure, primarily immunization workforce, delivery systems, and emergency response, as well as by providing vaccines …

The Effects Of The Changes In Section 317 Rules For Administration Of Federally Purchased Vaccines, Margaret A. Knight, Anne D. Kershenbaum, Martha Buchanan, Janet Ridley, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Section 317 of the Public Health Services Act is a federal program that provides funds for the purchase of vaccines. These annual Congressional allocations fluctuate from year to year as Congress responds to changes in national needs for immunizations. The Affordable Care Act requires first dollar coverage of immunizations and other preventive care, allowing a reduction in federal funding for vaccine purchase and a reallocation of funds to other uses such as infrastructure development. In fiscal year 2013, Section 317 rules redefined the population eligible for immunization with Section 317 purchased vaccines. In Tennessee, the response was a policy change …

Editorial Comment: A Method For Identifying Positive Deviant Local Health Departments In Maternal And Child Health, Sharla A. Smith, Michael A. Preston, Marylou Wallace

Frontiers in Public Health Services and Systems Research

Improving the well-being of mothers, infants, and children is a vital public health initiative in the United States. Local health departments are designated agents for addressing maternal and child health outcomes. Klaiman and colleagues used a positive deviant (PD) framework in identifying the modifiable activities and approaches for LHDs that contribute to better MCH outcomes.

A Method For Identifying Positive Deviant Local Health Departments In Maternal And Child Health, Tamar A. Klaiman, Athena Pantazis, Betty Bekemeier

Frontiers in Public Health Services and Systems Research

Local health departments (LHDs) are under increasing pressure to improve performance with limited resources. While research has found that financial resources may be associated with better health outcomes, there are some LHDs that maintain exceptional performance, even with limited budgets. Our interest was identifying LHDs that positively deviate in MCH outcomes compared to their peers while taking into account local context including geography and finances. We found that our method for identifying positive deviants was effective, and that LHD expenditures may not be linked to MCH outcomes. The next step in our work is to conduct in-depth analysis with positive …

Editorial Comment: Cost-Effectiveness Analysis For Prioritization Of Limited Public Health Resources - Tuberculosis Interventions In Texas, Kaja M. Abbas

Frontiers in Public Health Services and Systems Research

Public health departments have limited evidence to understand and analyze the costs and benefits of different health programs, including tuberculosis control and prevention programs. The study by Miller et. al addresses this challenge to estimate costs and benefits of tuberculosis prevention programs in Texas and identify cost-effective diagnostic and treatment combinations, thereby improving the evidence-based decision making power of the public health departments.

Editorial Comment: Differences In Definitions Of Ebph And Evidence: Implications For Communication With Practitioners, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Through interviews of 12 members of an expert panel – importantly, involving both practitioners and researchers/academicians – Aronson and colleagues sought to understand how evidence-based public health (EBPH) is defined, what counts as “evidence”, and what EBPH actually looks like when operationalized in a local health department. What Aronson and colleagues have shown us is how critical it is that in both creating and implementing EBPH, especially in practice-based research, practitioner and researcher/academician develop a shared understanding of EBPH before the dance begins, especially for practice-based research.

Differences In Definitions Of Ebph And Evidence: Implications For Communication With Practitioners., Robert E. Aronson, Kay Lovelace, Mark Smith, Gulzar H. Shah

Frontiers in Public Health Services and Systems Research

In this study, we interviewed twelve members of an expert panel to elicit their views on Evidence-based Public Health (EBPH), including how they define EBPH, what constitutes “evidence”, and what LHDs do that can be described as EBPH. Telephone interviews lasting 60 minutes were recorded and transcribed for basic content analysis. Experts differed in their definitions of EBPH and their views of what constitutes evidence. Definitions of EBPH ranged from the adoption and implementation of rigorously tested interventions to the application of evidence to decision making for population health improvement. Views on what constitutes evidence also varied, from strict “evidence …

Diffusion Theory And Knowledge Dissemination, Utilization And Integration, Lawrence W. Green, Judith M. Ottoson, César García, Robert A. Hiatt, Maria L. Roditis

Frontiers in Public Health Services and Systems Research

Part of the Community Health and Preventive Medicine Commons, Health and Medical Administration Commons, Health Policy Commons, Health Services Administration Commons, Health Services Research Commons, and the Public Health Education and Promotion Commons

Many accomplishments of public health have been distributed unevenly among populations. This article reviews the concepts of applying evidence-based practice in public health in the face of the varied cultures and circumstances of practice in these varied populations. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community and practitioners …

Community Health Assessment By Local Health Departments: Future Questions, Kay Lovelace

Frontiers in Public Health Services and Systems Research

This "Letter to the Editor" is a response to the article "Community Health Assessment by Local Health Departments: Presence of Epidemiologist, Governance, and Federal and State Funds are Critical" published in volume 2, issue 6 of this journal. It considers how LHDs develop CHAs in complex jurisdictions, the roles of other professionals in the development of CHAs, and the conduct, quality, and use of CHAs.

Evaluating Quality Improvement To Improve Hiv Reporting, Nandi A. Marshall, William C. Livingood, Angela Peden, Gulzar H. Shah, Russ Toal, Dayna Alexander, Alesha Wright, Sandra Jump, Shelby Freeman, Kay Davis, Lynn Woodhouse, Kellie Penix

Frontiers in Public Health Services and Systems Research

The incorporation and evaluation of Quality Improvement into Georgia’s public health systems continues to be a focus of the Georgia Public Health Practice Based Research Network. This report describes the process, preliminary results and lessons learned from incorporating Quality Improvement into one of Georgia’s public health districts.

Efficiency In Public Health Service Delivery: An Analysis Of Clinical Health Services Provided By Local Health Departments In Florida, Simone R. Singh

Frontiers in Public Health Services and Systems Research

The ability of local health departments (LHDs) to provide public health services to improve the health of their communities depends to a large extent on their financial resources. More money by itself, however, does not necessarily translate into better population health. LHDs also have to use their resources in an efficient manner to achieve the best possible outcomes. This article first describes two techniques that LHDs can use to assess their efficiency at providing public health services: process costing, a technique used by management accountants, and stochastic frontier analysis, a technique used by economists. Using data for LHDs in Florida, …

Evidence Use In New York City Public Health Policymaking, Miriam J. Laugesen, Kimberley R. Isett

Frontiers in Public Health Services and Systems Research

New York City Mayor Michael R. Bloomberg has attracted national attention for his public health policy reforms. The policy process behind the reform program has received less scrutiny, especially the use of research by policymakers. We show that the process used to develop, promote, and evaluate polices is heavily based on five types of data and research. New York Department of Health and Mental Hygiene staff conducted in-depth appraisals of existing published research, used local health surveys and private laboratory surveillance data, engaged in “shoe-leather” field research, formed research collaborations within and outside government, and disseminated research to legitimize policy …

Commentary: Moving Beyond The Numbers, Effectively Using Research To Influence Policy, F. Douglas Scutchfield, Marylou Wallace

Frontiers in Public Health Services and Systems Research

This seventh issue of Frontiers reflects the variety of PHSSR. One emerging theme, however, is the notion of public health and its role in policy and policy development. PHSSR focuses on several potential users, researchers, practitioners and policy makers. As it concerns policy makers, PHSSR delivers research that allows them to make decisions about policy change that not only influences public health status, but creates healthy conditions. In this way, PHSSR essentially influences decisions about support for public health services.

Preliminary Findings From An Interventional Study Using Network Analysis To Support Management In Local Health Departments In Florida, Chin S. Park, Hado Byon, Jonathan W. Keeling, Leslie M. Beitsch, Jacqueline A. Merrill

Frontiers in Public Health Services and Systems Research

Management is the core service that integrates and coordinates essential public health services. Managers of local health departments (LHDs) are experts in practice but may not have expertise in organizational management. We conducted an evidence-based training intervention in 10 LHDs in Florida to support managers’ decision-making on organizational integration and coordination. We deployed a standard survey to collect organizational network measurements pre and post intervention. We presented results as evidence-based performance feedback and interviewed managers to document how they used the results in the context of each organization. Post intervention we found unexpected, significantly higher network centralization in daily work. …