Health Services Administration Commons^™

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.

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.

Playing To Our Strengths: An Academic/Health Department Collaboration To Facilitate Public Protections Against Tuberculosis, Thaddeus L. Miller, Erin K. Carlson, Nuha A. Lackan

Frontiers in Public Health Services and Systems Research

Background:

Economic modeling and analysis can facilitate evidence-based policy and practice. Such analyses may exceed the technical capacity and mission of public health agencies, yet may be critical to sustain health protections such as tuberculosis (TB) control. The net effect of TB prevention is incompletely understood, hampering objective value judgments of national TB elimination policies. This may promote inefficiencies and threaten individual and public health protections.

We describe how a HRSA-funded Texas Public Health Training Center (TPHTC) coordinated specialized analytical skills with the needs of a state public health department to create a user-friendly tool to inform planning and resource …

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.

Estimating The Costs Of Foundational Public Health Capabilities: A Recommended Methodology, Dwight V. Denison, Cezar B. Mamaril, Glen P. Mays, Lizeth C. Fowler, Workgroup On Public Health Cost Estimation

Health Management and Policy Reports

The Institute of Medicine’s 2012 report on public health financing recommended the convening of expert panels to identify the components and costs of a “minimum package of public health services” that should be available in every U.S. community. The report recommended that this minimum package include a core set of public health programs that target specific, high-priority preventable health problems and risks, along with a set of “foundational public health capabilities” that are deemed necessary to support the successful implementation of public health programs and policies. In response to this recommendation, the Robert Wood Johnson Foundation, in collaboration with the …

Reducing Cancer Disparities Through Community Engagement In Policy Development: The Role Of Cancer Councils, Michael A. Preston, Glen P. Mays, Rise' D. Jones, Sharla A. Smith, Chara N. Stewart, Ronda Henry-Tillman

Health Management and Policy Faculty Publications

Cancer is the second leading cause of death in the U.S and a source of large racial and ethnic disparities in population health. Policy development is a powerful but sometimes overlooked public health tool for reducing cancer burden and disparities. Along with other partners in the public health system, community-based organizations such as local cancer councils can play valuable roles in developing policies that are responsive to community needs and in mobilizing resources to support policy adoption and implementation. This paper examines the current and potential roles played by local cancer councils to reduce cancer burden and disparities. Responsive public …

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.

Online Social Networks To The Rescue: Fulfilling The Ten Essential Public Health Services, Melanie D. Mason, Maureen P. Bezold

Frontiers in Public Health Services and Systems Research

Budget cuts and shortages in the public health workforce have contributed to the reduction of public health services in 91% of state health departments (SHDs). To adjust for these changes, health departments must discover novel ways to deliver essential public health services to their constituents. Researchers conducted a retrospective analysis of the content published on SHDs’ Twitter pages to determine if online social networks were used to fulfill the ten essential public health services. While 42 SHDs had a Twitter page, the volume and content of tweets varied. Although tweets were posted that related to all ten of the essential …

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, …

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.

Public Health Research Implementation And Translation: Evidence From Practice-Based Research Networks, Glen P. Mays, Rachel A. Hogg, Doris M. Castellanos-Cruz, Anna G. Hoover, Lizeth C. Fowler

Health and Clinical Sciences Faculty Publications

BACKGROUND: Research on how best to deliver efficacious public health strategies in heterogeneous community and organizational contexts remains limited. Such studies require the active engagement of public health practice settings in the design, implementation, and translation of research. Practice-based research networks (PBRNs) provide mechanisms for research engagement, but until now they have not been tested in public health settings.

PURPOSE: This study uses data from participants in 14 public health PBRNs and a national comparison group of public health agencies to study processes influencing the engagement of public health settings in research implementation and translation activities.

METHODS: A cross-sectional network …

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. …

Characteristics Of A Local Health Department Associated With The Use Of The Health Equity Index, Moira A. Lawson, Sharon Mierzwa, Michael Knapp

Frontiers in Public Health Services and Systems Research

Local health departments are tasked with understanding and addressing health inequities in the populations they serve. To meaningfully address health inequities, local health departments have identified the need for credible local data to better understand the relationship between community conditions and health outcomes. Yet, when given access to these data, we observe a very large variation in the level of interest between local health departments.

In this study, we offered Connecticut’s Local health departments access to the Health Equity Index, a web based tool that provides data on health outcomes and community conditions at the state, municipal or neighborhood levels. …

Evaluating Use Of Custom Survey Reports By Local Health Departments, Nadya M. Belenky, Christine A. Bevc, Elizabeth Mahanna, Carol Gunther-Mohr, Mary V. Davis

Frontiers in Public Health Services and Systems Research

This report demonstrates how providing survey feedback, like comparative reports, to survey respondents can result in improvement activities. For each of the past three years (2010-2013), the North Carolina Institute for Public Health (NCIPH) has invited local health departments (LHDs) from 40 states to participate in a preparedness capacities survey. In addition, NCIPH fielded a six-question evaluation survey to a subset of LHDs (n=70) to determine how LHDs use these reports. LHDs that reported using their custom reports compared their preparedness capacities to other LHDs, conducted strategic planning (e.g., benchmarking, setting preparedness goals), planned staff trainings, and disseminated the report …

The Relationship Between Quality Improvement And Health Information Technology Use In Local Health Departments, Kendra Johnson, Kim K. Nguyen, Shimin Zheng, Robin P. Pendley

Frontiers in Public Health Services and Systems Research

This research examined if there is a relationship between engagement in quality improvement (QI) and health information technology (HIT) for local health departments (LHDs) controlling for workforce, finance, population, and governance structure. This was a cross-sectional study that analyzed data obtained from the Core questions and Module 1 in the NACCHO 2010 Profile of LHDs. Descriptive statistics, bivariate analyses, and logistic regression analyses were conducted. Findings suggest that LHD engagement in QI has a relationship with utilization of HIT including electronic health records, practice management systems, and electronic syndromic surveillance systems. This study provides baseline information about the HIT use …

Commentary: The Road To Quality In Public Health, A Long But Important Journey, F. Douglas Scutchfield, Glen Mays, Marylou Wallace

Frontiers in Public Health Services and Systems Research

Quality improvement (QI) in public health departments is a focus in this sixth issue of Frontiers. Data is important to the development of quality improvement efforts. As we see growth of and meaningful use of electronic health records, the health department is in a position to take the lead as a data hub and to use this information wisely to both improve their QI efforts and link that QI to outcomes.

Accreditation And Standardization In Local Public Health, Glen P. Mays

Health Management and Policy Presentations

Reducing harmful, wasteful, and inequitable variation in public health delivery is a central objective for administrative and policy decision-makers in public health, and is embedded in the national accreditation movement. The challenge lies in accomplishing this objective while preserving the benefits of customization in public health delivery that accrue through tailoring and targeting of resources to unique community needs and risks. Public health services and systems research (PHSSR) can help determine the optimal balance between standardization and customization in public health delivery.

Strengthening The Evidence Base For Accreditation: Progress In Phssr And Pbrns, Glen P. Mays

Health Management and Policy Presentations

With the launch of a voluntary national accreditation program for public health agencies, the field requires an expanding evidence base concerning which public health strategies work best, for which populations, and under what circumstances. The field of public health services and systems research (PHSSR) and practice-based research networks (PBRNs) are producing applied studies that can inform the future development and implementation of accreditation standards, and evaluate the impact of accreditation on the field of practice.

Public Health Practice-Based Research Networks: Creating Evidence For Practice, Glen P. Mays

Health Management and Policy Presentations

Powerful opportunities for learning from variation and change in public health delivery now exists across the U.S. health system. Practice-based research networks (PBRNs) provide the vehicles for harvesting evidence from applied, comparative studies -- and for feeding this information back into the delivery system.

Public Health Services & Systems Research: Concepts, Methods, And Emerging Findings, Glen P. Mays

Health Management and Policy Presentations

The field of public health services & systems research (PHSSR) increasingly is addressing the question of how to assess the value of investments in public health programs, infrastructure, and delivery systems. Progress in quasi-experimental research designs, measurement, estimation techniques, and data sources are yielding important insight.

Strengthening The Science Of Public Health Delivery Through Public Health Services Research, Glen P. Mays

Health Management and Policy Presentations

This session notes recent progress from the field of public health services and systems research (PHSSR) concerning the most promising directions for improving the delivery and impact of public health services, programs, and policies.

Diffusion Of Innovation Across A National Local Health Department Network: A Simulation Approach To Policy Development Using Agent-Based Modeling, Mark Orr, Jacqueline Merrill

Frontiers in Public Health Services and Systems Research

The network that local health officials use to communicate about professional issues is sparsely connected, which may limit the spread of innovative practices. We used agent-based simulation modeling to find out if a policy to promote more connections improved the network’s capability to diffuse innovation. We found that unanticipated effects could result, depending on the requirements of the policy and the proportion of health officials involved. With carefully crafted assumptions and reliable data it is possible to untangle complex processes using simulation modeling. The results represent how the world might actually work which may provide useful decision support for policymakers …

Community Health Assessment By Local Health Departments: Presence Of Epidemiologist, Governance, And Federal And State Funds Are Critical, Gulzar H. Shah, Barbara Laymon, Julia Joh Elligers, Carolyn Leep, Christine B. Bhutta

Frontiers in Public Health Services and Systems Research

Using the data from the National Association of County and City Health Officials’ (NACCHO) 2010 Profile of Local Health Departments (LHDs) our study investigates whether or not infrastructural characteristics of LHDs were associated with completion of community health assessment (CHA). Our results show that local and shared LHD governance, greater share of revenue from federal and state sources, smaller population size in LHD jurisdiction, and having an epidemiologist significantly increased the odds of CHA completion in the past, after controlling for community characteristics and other independent variables. These findings have important implications for LHDs, PHAB and its partners.

Application Of Situational Leadership To The National Voluntary Public Health Accreditation Process, Kristina Rabarison, Richard C Ingram, James W. Holsinger Jr.

Health Management and Policy Faculty Publications

Successful navigation through the accreditation process developed by the Public Health Accreditation Board (PHAB) requires strong and effective leadership. Situational leadership, a contingency theory of leadership, frequently taught in the public health classroom, has utility for leading a public health agency through this process. As a public health agency pursues accreditation, staff members progress from being uncertain and unfamiliar with the process to being knowledgeable and confident in their ability to fulfill the accreditation requirements. Situational leadership provides a framework that allows leaders to match their leadership styles to the needs of agency personnel. In this paper, the application of …

Geomapping Telehealth Access To Developmental-Behavioral Pediatrics, Neelkamal S. Soares, Andrew O. Johnson, Nitish Patidar

Health Management and Policy Faculty Publications

Background: Geographic information systems (GIS) mapping is fairly novel in describing utilization of health services. Our study is the first to use GIS to demonstrate that telehealth pediatric specialty service access would create substantial savings in travel time and distance compared with accessing a tertiary-care center for similar service.

Materials and Methods: A retrospective chart review of telehealth encounters and geocoding of patients' address were done with actual travel along road calculations to estimate travel time and distance for a visit, compared with a hypothetical visit to the nearest tertiary-care site for the similar service.

Results: Over a 2-year period, …

From The Frontier: Translating Research To Practice…Qi As The Hinge Point, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

This article is number three in the series From the Frontier: Translating Research to Practice. The narrative describes the work of a practice-academic network in Minnesota which explored the degree to which having a culture of quality at the local health department level influenced the capacity to implement a new statewide initiative. The network conducted a mixed-methods study of grantees funded to develop and implement local policy, systems, and environmental change strategies to promote nutrition, increase activity, and reduce tobacco use and exposure. The results of their study indicated that grantees with higher performance levels in Quality Improvement (QI) …

Access To Primary Care: Comparing Driving Distance From Health Professional Shortage Area (Hpsa) Counties Versus Non-Hpsa Counties, Molly Cashion, Stephanie Jilcott-Pitts, Doyle Cummings, Christopher Duffrin, John Jones, Qiang Wu

Frontiers in Public Health Services and Systems Research

The criteria used to identify Health Professional Shortage Areas dates back to the 1970’s and very little has changed since then. This study examined driving distance from patient address to provider address as one component of a geographical HPSA. Primary care-related services located in adjacent areas to whole-county HPSAs are considered excessively distant when travel time exceeds 30 minutes or the equivalent of 20 miles in this study. We found similarities in travel distance to primary care-related services from patients living in HPSA counties compared to those living in non-HPSA counties. This could indicate the need to re-examine HPSA definitions …