Public Health Commons^™

Do Phab Accreditation Prerequisites Predict Local Health Departments’ Intentions To Seek Voluntary National Accreditation?, Gulzar H. Shah, Kate Beatty, Carolyn Leep

Frontiers in Public Health Services and Systems Research

Accreditation has been identified as a crucial strategy for strengthening the public health infrastructure. As agencies prepare for accreditation, it is important to understand how intentions to seek accreditation are related to the current level of readiness based on the three Public Health Accreditation Board (PHAB) prerequisites. Using the National Association of County and City Health Officials’ (NACCHO) 2010 Profile Study, we examined the relationship between the PHAB accreditation prerequisites and local health department (LHD) intentions to seek PHAB accreditation using multinomial logistic regression. Our results indicate that completion of a community health assessment (CHA) or community health improvement plan …

Monitoring Qi Maturity Of Public Health Organizations And Systems In Minnesota: Promising Early Findings And Suggested Next Steps, Kimberly J. Miner Gearin, M. Elizabeth Gyllstrom, Brenda M. Joly, Renee S. Frauendienst, Julie Myhre, William Riley

Frontiers in Public Health Services and Systems Research

Public health departments and systems are increasing investments in quality improvement. This paper presents methods used to identify a select number of items from a previously validated QI Maturity Tool as the basis for calculating organizational and system-level QI maturity scores that could be followed over time. Findings suggest that the abbreviated tool measures variation in QI maturity across LHDs, and differences in scores among divisions within a state health department. Minnesota has incorporated the abbreviated tool into an annual reporting system for the MN Local Public Health Act, thereby enabling stakeholders to monitor a system median score and distribution …

Using The Qi Maturity Tool To Classify Agencies Along A Continuum, Brenda M. Joly, Maureen Booth, Prashant Mittal, Yan Zhang

Frontiers in Public Health Services and Systems Research

Major investments have been made to encourage health departments to implement quality improvement (QI) efforts. Yet, there are few empirically tested tools for public health agencies that assess these efforts and classify health departments along a QI continuum. This paper presents a new classification scheme for measuring QI Maturity in public health agencies based on a validated tool. The findings can be used to establish benchmarks, make comparisons and conduct future research linking QI and population health outcomes.

Rediscovering The Core Of Public Health, Steven Teutsch, Jonathan E. Fielding

Frontiers in Public Health Services and Systems Research

The success of public health has been its ability to understand contemporary health problems, to communicate the needs successfully, to identify solutions, and to implement them through programs and policies. In the past 50 years, those successes can be attributed largely to control of infectious disease, improved maternal and child health, delivery of other personal health care services, and changes in behaviors, particularly smoking. Yet health is primarily a product of our social, cultural, and physical environments. To continue to improve the nation’s health and reduce disparities, public health needs to return to its historical roots and engage with other …

Accelerating And Expanding Knowledge Transfer In Public Health Settings: Frontiers In Phssr, Glen P. Mays

Health Management and Policy Presentations

Creating a "rapid-learning" system in public health requires mechanisms for the continuous exchange of knowledge and evidence among researchers, practice settings, and policy decision-makers. The open-access platform Frontiers in Public Health Services and Systems Research provides a new mechanism for this exchange.

Building The Science Of Public Health Delivery: Advances In Public Health Services And Systems Research, Glen P. Mays

Health Management and Policy Presentations

Efforts to improve the health and economic performance of the U.S. health system require evidence about how best to deliver public health strategies that protect health and prevent disease and injury on a population-wide basis. The field of public health services and systems research is building a "science of delivery" in public health that complements the evidence-based practice movement in medical care.

From The Frontier: Translating Research To Practice...A Story Of Economic Survival, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

This article is number two in the series From the Frontier: Translating Research to Practice. The narrative describes the interactions between a local health department director and two academicians in addressing the impact of the 2008 financial crisis. In a first set of activities, practice-academic partners used Financial and Operational Ratio and Trend Analysis to identify periods of a negative total margin and the impact of that on the agency’s declining fund balance. The use of private sector processes of retrenchment, repositioning, and reorganization led to a financial turnaround for the agency. In a second set of activities, practice-academic …

Disparities In Public Health Service Indicators And Governance Structures: Learning Through Comparison Between Usa And Uk, Mark Mccarthy

Frontiers in Public Health Services and Systems Research

In the USA, indicators of public health service performance differ according to governance structures for the services. However, the UK also has disparities in public health indicators by geographical, but uniform public health service governance. The international comparison provides a caution for interpretation of correlation.

Using Learning Collaboratives To Improve Public Health Emergency Preparedness Systems, Michael A. Stoto, Harold Cox, Melissa Higdon, Kerry Dunnell, Donald Goldmann

Frontiers in Public Health Services and Systems Research

The U.S. National Health Security Strategy calls for the development and wide-spread implementation of quality improvement (QI) tools in public health emergency preparedness (PHEP), including the development of “learning collaboratives,” a structured way for organizations with common interests to close the gap between potential and practice by learning from each other. To test this approach, we developed and assessed separate learning collaboratives focused on PHEP emergency communications and on the use of Medical Reserve Corps (MRC) volunteers. Although participants carried out improvement projects that they felt were useful, each collaborative struggled to identify a common theme, participation was limited, and …

Evidence-Based Decision Making To Improve Public Health Practice, Ross C. Brownson, Jonathan E. Fielding, Christopher M. Maylahn

Frontiers in Public Health Services and Systems Research

Despite the many accomplishments of public health, greater attention on evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about 15 years ago. 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 in decision making, conducting sound evaluation, and disseminating what is learned. Core competencies for EBPH are emerging, including not only technical skills but also attention to administrative practices in public health agencies. To better bridge evidence and practice, the concepts …

Commentary: A Public Health And Hospital System Collaboration For Conducting Community Health Assessments And Community Health Improvement Plans: Seven Hospital Systems In Oregon And Washington And Four County Public Health Departments In Oregon And One In Washington, Lillian Shirley, Andrew S. Davidson, Marti Franc, Kathleen O'Leary, Priscilla Lewis, Marni Storey, Christine Sorvari

Frontiers in Public Health Services and Systems Research

The following narrative describes the innovative partnership and approach to create comprehensive, meaningful, and coordinated community health assessments and community health improvement plans that fulfill the specific needs of hospital systems, local public health, and coordinated care organizations (Oregon’s version of Accountable Care Organizations).

Public Health Delivery Systems And Population Health: What We Know And Need To Learn, Glen P. Mays

Health Management and Policy Presentations

Despite high overall health expenditures, the U.S. continues to fall behind other high-income countries on many measures of population health. While health care delivery systems are now studied intensively for solutions to U.S. cost and quality problems, the nation's delivery systems for public health programs and policies are only now becoming the subject of rigorous empirical study. This presentation examines recent studies of public health delivery systems and important directions for future inquiry.

Estimating The Health And Economic Effects Of Public Health Spending, Glen P. Mays

Health Management and Policy Presentations

Preventable health conditions account for more than 75% of the $2.7 trillion spent annually on health care in the U.S., yet less than 5% of these expenditures are devoted to public health programs and services that are designed to prevent and control disease and injury rather than to treat the downstream consequences of these conditions. Such limited expenditures in public health may contribute to the higher rates of preventable morbidity, mortality and excess medical costs experienced in the U.S. compared to other high-income countries. In this presentation, I update previous estimates of the health effects and medical cost offsets associated …

Hpv Vaccination Among Young Adult Women: A Perspective From Appalachian Kentucky, Laurel A. Mills, Katharine J. Head, Robin C. Vanderpool

Health, Behavior & Society Faculty Publications

INTRODUCTION: Few studies have assessed barriers to human papillomavirus (HPV) vaccination uptake and adherence, particularly among women of Appalachian Kentucky, a population with higher rates of cervical cancer, lower rates of HPV vaccination, and lower socioeconomic status compared with the rest of the nation. The objective of this study was to address women's reasons for declining the HPV vaccine and, among women who initiated the vaccine series, barriers to completion of the 3-dose regimen.

METHODS: We recruited 17 women aged 18 to 26 from a Federally Qualified Health Center who participated in in-depth, semistructured telephone interviews. All interviews were audio-recorded …

Motor Vehicle Injuries Among Semi Truck Drivers And Sleeper Berth Passengers, Terry L. Bunn, Svetla Slavova, Medearis Robertson

Kentucky Injury Prevention and Research Center Faculty Publications

Introduction: Injuries and fatalities due to large truck and other vehicle crashes have decreased over the last decade, but motor vehicle injuries remain a leading cause of death for both the working and general populations. The present study was undertaken to determine semi truck driver and sleeper berth passenger injury risk in a moving semi truck collision using a matched-pair cohort study.

Method: Study data were obtained from the Kentucky Collision Report Analysis for Safer Highways (CRASH) electronic files for 2000 - 2010. A matched-pair cohort study was used to compare the odds of injury of both drivers …

Alcohol And Prescription Drug Safety In Older Adults, Faika Zanjani, Aasha I. Hoogland, Brian G. Downer

Graduate Center for Gerontology Faculty Publications

BACKGROUND: The objectives of this study were to investigate older adults' knowledge of prescription drug safety and interactions with alcohol, and to identify pharmacists' willingness to disseminate prescription drug safety information to older adults.

METHODS: The convenience sample consisted of 48 older adults aged 54-89 years who were recruited from a local pharmacy and who completed surveys addressing their alcohol consumption, understanding of alcohol and prescription drug interactions, and willingness to change habits regarding alcohol consumption and prescription drugs. To address pharmacist willingness, 90 pharmacists from local pharmacies volunteered and answered questions regarding their willingness to convey prescription drug safety …

Drivers Killed Due To Tire Failures, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

To Prevent Tire Failures,

Employers should:

• Ensure that routine maintenance is performed on work vehicles
• Implement and enforce an employer seat belt safety program

Employees should:

• Be properly trained in safe work vehicle operation
• Perform routine pre-trip and post-trip inspections, including inspection of the tires
• Ensure that tires do not run below 80% of the recommended pressure

Two Semis Collide - Fire Ensues; Both Drivers Perish, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

One summer’s night, a 49 year-old semi-truck driver (D1), pulling a flatbed loaded with salvage cars for recycling traveled north on a three-lane state highway. D1 topped a hill, drove through a right curve when the unit rolled onto the driver’s side, slide across the center line and entered a straight stretch approximately half way to the bottom of a hill. As D1’s unit was sliding down the hill in the south bound lanes, a 52 year-old semi-truck driver (D2) hauling bottled beverages was traveling south in the straight stretch up the hill. As D1 slide down the hill, D2 …

Commentary: Models Of Dissemination And Implementation In Public Health, Glen Mays

Frontiers in Public Health Services and Systems Research

As public health researchers and public health practitioners, we need to become much more skilled in applying dissemination and implementation models within our research designs and within our delivery systems if we want the accumulating scientific knowledge to result in improvements in population health. Many of our standard public health tools can be affective in facilitating D&I – regulation, education, measurement and reporting, peer pressure, social media, and economic incentives – but context really matters. The basic message behind this article is clear: choose your D&I model carefully and strategically to maximize the likelihood of success.

Models In Dissemination And Implementation Research: Useful Tools In Public Health Services And Systems Research, Rachel G. Tabak, Elaine C. Khoong, David Chambers, Ross C. Brownson

Frontiers in Public Health Services and Systems Research

Dissemination and implementation (D&I) science seeks to understand how to systematically facilitate utilization of evidence. Theories and frameworks (hereafter called models) augment D&I research by enhancing efforts to spread evidence-based interventions (EBIs). D&I models are relevant for public health services and systems research, which also explores the uses of evidence. This report: 1) develops an inventory of models; 2) synthesizes this information; and 3) provides guidance on how to select a model. The research team used snowball sampling to collect models. This article uses three author-defined variables: construct flexibility, focus on dissemination and/or implementation activities, and socio-ecological framework level to …

A Patient-Centered Approach For Evaluating Public Health Roles Within Systems Of Care For Children With Special Healthcare Needs, Danielle M. Varda, Ayelet Talmi

Frontiers in Public Health Services and Systems Research

Despite the apparent success that local and state health departments have had integrating a public health approach to provide programs and services for families with children who have complex health needs, there continues to be mixed results in terms of satisfaction and degree of support from this system. Current evaluations collect performance data from system stakeholders, rarely including the patient perspective. Examining the system holistically using Social Network Analysis, to include both the stakeholder and patient perspectives of how well the system is functioning affords greater understanding of how a public health approach to systems of care leads to more …

Commentary: Changing The Channel: Public Health Communication In The 21st Century, Anna Goodman Hoover

Frontiers in Public Health Services and Systems Research

This commentary asserts the need for research examining the use and efficacy of social media as a tool for meeting public health stakeholders’ information needs. The author points to several potential research questions for the field, situates studies addressing these questions within the PHSSR Research Agenda, and introduces the work of Harris et al. that is included in this issue of Frontiers. The commentary closes with a call for horizontal stakeholder communication that supports evidence-based decision-making.

Social Media Adoption In Health Departments Nationwide: The State Of The States, Jenine K. Harris, Doneisha Snider, Nancy Mueller

Frontiers in Public Health Services and Systems Research

Web-based social media sites are increasingly being used by the public to find and share health information. Public health organizations, including state health departments (SHDs), have begun adopting social media to disseminate health information to consumers. The purpose of this study was to examine adoption patterns and characteristics associated with social media adoption in SHDs across the U.S. In early 2012, we used web searches to identify which SHDs had adopted Facebook or Twitter and the adoption date. Adoption of social media has grown steadily since 2008, with 28 SHDs using Facebook and 41 using Twitter as of February 2012. …

Commentary: Hospital Tax-Exempt Policy: A Comparison Of Schedule H And State Community Benefit Reporting Systems, Laura L. Hitchcock

Frontiers in Public Health Services and Systems Research

In Hospital Tax-Exempt Policy: A Comparison of Schedule H and State Community Benefit Reporting Systems, Rosenbaum et aldescribe the numerous variations between current state law in 24 states and federal requirements regarding nonprofit hospitals’ community benefit activities. The potential for nonprofit hospitals to help shape community health is great, and how states choose to address requirements regarding community benefit, and potentially reinforce the new federal requirements to incentivize hospital participation in addressing root causes of poor health, should be of significant interest to the public, policy makers and public and population health experts, given the large percentage of …

Hospital Tax-Exempt Policy: A Comparison Of Schedule H And State Community Benefit Reporting Systems, Sara Rosenbaum, Maureen Byrnes, Amber M. Rieke

Frontiers in Public Health Services and Systems Research

The Patient Protection and Affordable Care Act (ACA) revises federal tax exemption standards for nonprofit hospitals by clarifying and augmenting their community benefit obligations. The ACA amendments followed the 2009 launch of Schedule H – the form on which hospital community benefit, financial, and institutional activities are reported and which must be appended to each facility’s annual Form 990 nonprofit institution information return. Schedule H effectively creates a nationwide, standardized, facility-specific, transparent, and fully publicly accessible reporting system covering the nation’s more than 2,900 nonprofit hospitals. Schedule H delineates financial assistance and bad debt, and requires identification of community health …

Carrots, Sticks And False Carrots: How High Should Weight Control Wellness Incentives Be? Findings From A Population-Level Experiment, Harald Schmidt

Frontiers in Public Health Services and Systems Research

Employers are increasingly using wellness incentives, including penalties for unhealthy behavior. Survey data suggests that people are willing to accept the principle of penalizing those perceived to take health risks, but the equally relevant question of the magnitude of acceptable penalties is unclear.

While the principle of penalizing overweight and obese people has some support, findings from a population-level experiment (n=1,000) suggest that the acceptable size of penalties is comparatively small, around $50: more than 10-fold below levels favored by advocates. Reward-based incentives are favored over penalty-based ones by a factor of 4. Of two different ways of framing penalty …

Learning By Doing For Public Health Improvement, Glen P. Mays

Frontiers in Public Health Services and Systems Research

All too often, the knowledge gained through learning-by-doing in public health fails to be fully harvested and disseminated because of missed opportunities to carefully study the experiences and innovations occurring in practice. The field of public health services and systems research (PHSSR) has emerged to capitalize on these opportunities before they are missed.

Semi-Truck Driver Dies After Being Struck By Flatbed Driver In Crossover Collision, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

In the winter of 2011, a 46-year-old semi-truck driver (D1) hauling a flatbed trailer was traveling north in the right lane on a four lane interstate. Several minutes ahead of the semi was a pickup truck hauling an extension ladder that fell out onto the northbound travel lanes. A car behind the pickup swerved to avoid the falling ladder. Other cars swerved to avoid the ladder. The semi came upon the ladder and swerving cars. To avoid striking the cars and ladder, the semi driver swerved to the right, over-corrected to the left, drove across the northbound lanes, over a …

Public Health Expenditures, Public Health Delivery Systems, And Population Health, Glen P. Mays

Health Management and Policy Presentations

This seminar examines a series of approaches for estimating the health and economic effects attributable to public health expenditures in the U.S., along with a novel method for estimating economies of scale and scope in the delivery of public health services. The use of instrumental-variables techniques and network analytic methods are described in these research approaches.

Getting To The Other Side: An Exploration Of The Head And Neck Cancer Treatment Experience, Heather M. Wallace

Theses and Dissertations--Gerontology

Diagnosis of head and neck squamous cell carcinoma (HNSCC) presents a multifarious problem. Late stage diagnosis, uncertainty regarding appropriate clinical treatment, as well as the high potential for disfigurement and functional loss resulting in diminished quality of life, contributes to anxiety, stress, fear, and uncertainty throughout the cancer treatment experience. This qualitative study sought to explore the cancer treatment experience of adults with newly diagnosed HNSCC, including laryngeal, esophageal, and oral cancers. Study participants were recruited from the University of Kentucky Ear Nose and Throat Clinic in Lexington KY. Participants agreed to be interviewed after receipt of their cancer diagnosis …