Health Services Research Commons^™

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

Health Management and Policy Presentations

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 public …

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

Health Management and Policy Presentations

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.

Medicaid Expansions & Public Health Spending: Cross-Subsidies, Complementarities, And Crowd-Out, Glen P. Mays

Health Management and Policy Presentations

In this paper we estimate the causal impact of state Medicaid enrollment expansions and expenditures on state and local resources allocated to other public health programs and services. 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

Health Management and Policy Presentations

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.

Cost Estimates Of Foundational Public Health Services: Results From Piloting The Expert Consensus Methodology In Kentucky, C. B. Mamaril, Glen P. Mays

Health Management and Policy Presentations

We developed a methodology for estimating the resources required to deliver a set of foundational public health capabilities as recommended in the 2012 Institute of Medicine report on public health financing. The capabilities are based on IOM recommendations and defined by a national expert panel convened as part of the Public Health Leadership Forum. This paper presents preliminary estimates from a pilot test of the cost estimation methodology in Kentucky, and outlines plans for the national estimation strategy.

Optimizing Public Health Systems For Population Health Improvement: Institutions, Economics, And Metrics, Glen P. Mays

Health Management and Policy Presentations

This lecture reviews the evidence concerning the institutional and economic characteristics of public health delivery systems and their impact on population health. Emerging findings from these studies suggest promising pathways for transforming the U.S. public health system in ways that strengthen its effectiveness, efficiency and equity in producing health. .

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 …

Policymakers Identify Priorities For Phssr, Katherine Froeb Papa

Frontiers in Public Health Services and Systems Research

A major goal for the health services research community is to provide evidence policymakers can use to improve the public’s health. However, it can be difficult to know what evidence policymakers want and how they decide what research to fund.

In order to understand where policymakers turn for evidence and how they make funding decisions amid fiscal and political constraints, AcademyHealth conducted a 3-part Fireside Chat series in the spring of 2014. This editorial summarizes the evidence gaps identified, and provides strategies for communicating with decision makers.

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.

Value And Cost-Effectivess Of Chw Programs: Implications For Home Care Workers, Glen P. Mays

Health Management and Policy Presentations

This presentation reviews studies on the health and economic value of strategies to improve the coordination of medical care, public health, and social support services for high-need and high-risk populations. Community health worker (CHW) programs feature prominently in these strategies, particularly for rural and low-resource community settings. Home care workers have the potential to function as CHWs in many settings, and as such present powerful opportunities for scaling up CHW programs that connect medical care, public health, and social services delivery.

Cost Estimates Of Foundational Public Health Capabilities: Pilot Test Results Of An Expert Consensus Methodology In Kentucky, C. B. Mamaril, Glen P. Mays

Health Management and Policy Presentations

The Institute of Medicine's 2012 report on U.S. public health financing recommended research to identify the components and costs of a "minimum package" of public health services and foundational capabilities to be made available in every U.S. community. We present results from pilot testing of a proposed methodology for estimating the costs and resource requirements for a set of foundational public health capabilities identified by the Public Health Leadership Forum. Using pilot data from Kentucky public health settings, we estimate both current and projected costs under a range of assumptions about the resources required to fully implement the capabilities at …

Ending Failures, Showing Results, Improving Population Health: Insights From Research & Reform In The U.S., Glen P. Mays

Health Management and Policy Presentations

A growing body of empirical research supports the value of aligning the delivery systems for public health, medical care, and social services for populations with shared needs and risk factors. This presentation reviews selected studies from the field of public health services & systems research (PHSSR) in the U.S. that suggest pathways for achieving greater system alignment in the Canadian context.

How Can Public Health Economics Help Health Systems Focus Upstream?, Glen P. Mays

Health Management and Policy Presentations

Research on the health and economic impact of public health strategies can help newly evolving health care delivery systems focus on upstream health determinants and make evidence-informed decisions about resource allocation across the prevention-treatment spectrum. Examples from research underway in the U.S. have particular relevance for Canada's evolving regional health authorities and their integrated approaches to medical care and public health delivery.

Tougher Than Rocket Science, Or Just Messier? Using Research To Improve U.S. Public Health Delivery, Glen P. Mays

Health Management and Policy Presentations

Advances in the field of public health services & systems research (PHSSR) are incorporating complexity in theory and methods to derive strong inferences about the health and economic effects attributable to public health strategies. Opportunities for comparative international research in Canada and the U.S. promise to strengthen these avenues of inquiry.

Public Health Services Research: Informing Public Health Practice & Policy, Glen P. Mays

Health Management and Policy Presentations

Heterogeneity in the mechanisms used for organizing and financing public health strategies creates opportunities for comparative effectiveness research (CER) in public health that examine which organization and financing mechanisms work best, for whom, and under what circumstances. Findings from these types of studies have direct utility in shaping public health policy and practice decisions.

Laboratories And The Value Stream Of Next-Generation Public Health, Glen P. Mays

Health Management and Policy Presentations

Public health laboratories are the information engines for public health agencies and delivery systems. Measuring the value stream that flows from this information can support objective assessments of the health and economic benefits attributable to laboratory infrastructure and information.

Governmental Public Health And The Economics Of Adaptation To Population Health, Glen P. Mays

Health Management and Policy Presentations

Research on the organization and financing of public health strategies offers valuable insight for governmental public health agencies seeking to adapt to a population health improvement perspective under health system reform.

Exploring Barriers: An Analysis Of Access To Effective Tuberculosis Care In Cape Town, Yvonne Okaka

Independent Study Project (ISP) Collection

My independent study project (ISP) examines factors that hinder access to tuberculosis (TB) healthcare and its effective implementation in Cape Town. In order to expand research on the topic, important barriers will be examined and explained. This project is relevant due to the high prevalence and mortality rates of tuberculosis in South Africa, as well as the fact that an overwhelming emphasis on HIV can lead to overlooking the serious nature of TB as a public healthcare issue. It is hoped that this study will provide more insight into improving access to TB care, and be a resource for those …

Community Health Centers: A 2012 Profile And Spotlight On Implications Of State Medicaid Expansion Decisions, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2012 nearly 1,200 federally funded community health centers were providing access to care for a predominantly low-income population in medically underserved areas across the country. As health insurance coverage expands under the Affordable Care Act (ACA) and the demand for primary care increases, the role of health centers is likely to increase, and the ACA’s large investment in the health center program provides new resources to help meet growing needs.

This brief provides a pre-ACA snapshot of health centers that can help in understanding the impact of state decisions about the ACA Medicaid expansion on health centers as health …

A Qualitative Examination About Providers’ Perceptions And Recommendations Regarding The Role Of Public Librarians In Addressing Communities’ Health Literacy., Van Ta Park, Lili Luo, Denise Rosidi

Faculty Publications

We assessed health care providers’ perspectives on libraries as a source of health information and elicited input on how to adequately prepare public librarians to provide health information services. Sample text-based reference transactions were shown to determine whether they think the health inquiries were adequately answered. Results showed that participants had favorable perspectives about public libraries, and thought that the public librarians’ role includes addressing the health literacy community needs. Participants provided recommendations for public librarians to improve health literacy. To enhance the ability of public librarians to meet the health literacy needs of their communities, diverse perspectives such as …

Asupan Karbohidrat Sebagai Faktor Dominan Yang Berhubungan Dengan Kadar Gula Darah Puasa, Aprilya Roza Werdani, Triyanti Triyanti

Kesmas

Peningkatan kadar gula darah memicu peningkatan produksi hormon insulin yang erat hubungannya dengan diabetes melitus. Berdasarkan data Riskesdas, prevalensi diabetes melitus di Indonesia meningkat dari 1,1% (2007) menjadi 2,1% (2013). Penelitian ini bertujuan untuk mengetahui faktor dominan yang berhubungan dengan kadar gula darah puasa pegawai pemberdayaan masyarakat & keluarga dan pegawai sekretariat daerah Kota Depok. Desain penelitian yang digunakan adalah potong lintang dan melibatkan 105 sampel. Variabel independen penelitian meliputi karakteristik individu, asupan zat gizi, hipertensi, aktivitas fisik, status gizi dan pengetahuan gizi. Analisis data yang dilakukan adalah analisis univariat, analisis bivariat menggunakan uji korelasi dan uji beda dua mean, …

Optimalisasi Sistem Pelayanan Kesehatan Berjenjang Pada Program Kartu Jakarta Sehat, Fachmi Idris

Kesmas

Peningkatan jumlah kunjungan pasien ke rumah sakit pada awal masa pemberlakuan program Kartu Jakarta Sehat (KJS) disebabkan belum optimalnya sistem pelayanan kesehatan berjenjang. PT Asuransi Kesehatan (PT Askes) bersama Dinas Kesehatan DKI Jakarta melakukan berbagai upaya dalam bentuk paket intervensi untuk mengoptimalkan sistem tersebut. Penelitian ini bertujuan untuk mengevaluasi efektivitas paket intervensi PT Askes dan Dinas Kesehatan DKI Jakarta dalam meningkatkan optimilisasi sistem rujukan pelayanan kesehatan. Penelitian ini menggunakan survei potong lintang dengan metode pengambilan sampel acak pada puskesmas di DKI Jakarta terhadap hasil intervensi PT Askes. Hasil intervensi diukur melalui wawancara pada kepala puskesmas atau petugas yang mewakili. Data …

Pendapatan Daerah, Pembiayaan Kesehatan, Dan Gizi Buruk Pada Balita: Studi Korelasi Tingkat Kabupaten/Kota, Septyana Choirunisa, Asri C. Adisasmita

Kesmas

Pendanaan kesehatan merupakan salah satu faktor penting dalam memengaruhi derajat kesehatan, termasuk salah satu masalah gizi pada balita yang disebut gizi buruk. Oleh karena itu, penelitian ini bertujuan mendeskripsikan pendapatan daerah dan pembiayaan kesehatan serta korelasinya dengan gizi buruk pada balita di tingkat kabupaten/kota di Indonesia tahun 2007. Penelitian ini merupakan studi ekologi/korelasi. Data pendapatan daerah dan pembiayaan kesehatan didapat dari Kementerian Keuangan, sedangkan data gizi buruk menggunakan data Riset Kesehatan Nasional tahun 2007. Sebanyak 250 kabupaten/kota yang diteliti dengan tidak mengikutsertakan kabupaten/kota yang datanya tidak lengkap atau tidak valid. Secara nasional, hanya persentase pendapatan asli daerah (PAD) per total …

Penelitian Genom Dan Implikasinya Dalam Kesehatan Masyarakat Di Indonesia, Doni Hikmat Ramdhan

Kesmas

Penelitian genom yang mengkaji kaitan antara setiap gen dengan suatu penyakit sekaligus mekanismenya untuk mendapatkan pengetahuan yang menyeluruh dalam pengobatan, telah membawa perubahan besar dunia kedokteran dalam mengobati berbagai penyakit. Namun demikian, penelitian genom seharusnya tidak hanya dimanfaatkan untuk pengobatan tetapi juga untuk pencegahan penyakit. Artikel ini membahas masalah kesehatan masyarakat dan peluang pemanfaatan penelitian genom dalam pencegahan penyakit. Penelitian genom yang dapat dimanfaatkan pada bidang kesehatan masyarakat adalah toksikogenomik dan nutrigenomik. Penelitian toksikogenomik mengkaji respons gen akibat pajanan toksikan yang berdampak pada kesehatan manusia. Penelitian nutrigenomik mengkaji respons gen terhadap makanan yang berdampak pada kesehatan manusia. Penelitian toksikogenomik dan …

Fertilitas Remaja Di Indonesia, Mugia Bayu Raharja

Kesmas

Fertilitas remaja merupakan isu penting dari segi kesehatan dan sosial karena berhubungan dengan tingkat morbiditas serta mortalitas ibu dan anak. Tujuan penelitian adalah mempelajari faktor-faktor yang memengaruhi fertilitas remaja di Indonesia. Data yang digunakan adalah hasil Survei Demografi dan Kesehatan Indonesia tahun 2012 dengan unit analisis wanita usia subur yang termasuk dalam kategori usia remaja (15 - 19 tahun). Jumlah sampel sebanyak 6.927 responden. Analisis dilakukan dengan metode deskriptif dan inferensial menggunakan model regresi logistik biner. Hasil analisis menunjukkan bahwa satu dari sepuluh remaja wanita tersebut pernah melahirkan dan atau sedang hamil saat survei dilakukan; sebesar 95,2% dari remaja yang …

Pengaruh Pendekatan Child Healthcare Modeldan Transtheoretical Model Terhadap Asupan Makan Anak Overweight Dan Obesitas, Kadek Ayu Erika, Elly Nurachmah

Kesmas

Overweight dan obesitas pada anak merupakan suatu masalah yang kompleks disebabkan multifaktor, yaitu interaksi genetik dan lingkungan. Gaya hidup perkotaan dipicu oleh asupan makanan yang berlebih pada anak overweight dan obesitas. Strategi untuk menurunkan asupan makan berlebih pada anak adalah dengan pendekatan child healthcare model dan transtheoretical model sehingga dapat mengendalikan gaya hidup anak. Penelitian ini bertujuan membuktikan pengaruh pendekatan child healthcare dan transtheoretical model terhadap asupan karbohidrat anak overweight dan obesitas. Penelitian ini dilaksanakan di wilayah kecamatan Biringkanaya dan Tamalanrea, Makassar, pada bulan Agustus 2013 sampai Maret 2014. Desain yang digunakan adalah quasy experiment yaitu pretest and posttest with …