Health Services Research Commons^™

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.

Temporal Trends In Local Public Health Preparedness Capacity, Christine A. Bevc, Mary V. Davis, Anna P. Schenck

Frontiers in Public Health Services and Systems Research

Local health departments (LHDs) are essential to emergency preparedness and response activities. Since 2005, LHD resources for preparedness, including personnel, are declining in the face of continuing gaps and variation in the performance of preparedness activities. The effect of these funding decreases on LHD preparedness performance is not well understood. This study examines the performance of preparedness capacities among NC LHDs and a matched national comparison group of LHDs over three years. We observe significant decreases in five of eight preparedness domains from three years of survey data collected from 2010 through 2012. Most notably, we observe significant decreases in …

Developing A Tool To Assess Administrative Evidence-Based Practices In Local Health Departments, Rodrigo S. Reis, Kathleen Duggan, Peg Allen, Katherine A. Stamatakis, Paul C. Erwin, Ross C. Brownson

Frontiers in Public Health Services and Systems Research

There is need for assessing the practices undertaken by local health departments in order to improve the implementation of evidence-based actions. This paper describes the development and testing of a survey instrument for assessing Administrative Evidence-Based Practices (A-EBPs) in Local Health Departments. A-EBPs identified through a review of the literature were used to develop a survey composed of nine sections and tested in a sample of local health department practitioners. The resulting tool showed adequate test-retest reliability and internal consistency. Practitioners and researchers may apply this tool in practice-based and evaluation research.

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.

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 …

Exploring The Association Between Long-Term Hpsa Designation And County Population-To-Physician Ratio, Christopher Duffrin, Natalie A. Jackson

Frontiers in Public Health Services and Systems Research

Federal, state, local and public health officials utilize Health Professional Shortage Area (HPSA) designations to manage health and physician workforce development in underserved regions. HPSA designation length by county was examined to determine if there is significant association with population-to-primary care physician ratio since the inception of HPSA designations in 1978. Counties were grouped in 5 categories based on consecutive designation length and analyzed with demographic variables. This report examines the relationship of long-term HPSA status and changes in primary care physician workforce.

The Effects Of The State Of Tennessee Immunization Policy Change Of 2011 - 2012 On Vaccination Uptake In East Tennessee, Margaret A. Knight, Anne D. Kershenbaum, Martha Buchanan, Janet Ridley, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

In the United States, funding for the purchase of vaccines depend on annual Congressional allocations. These 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 2012, the loss of funds allocated from the American Recovery and Reinvestment Act required action by states to ensure appropriate use of remaining funds. In Tennessee, the response was a …

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 …

Public Health Services Most Commonly Provided By Local Health Departments In The United States, Gulzar H. Shah, Huabin Luo, Sergey Sotnikov

Frontiers in Public Health Services and Systems Research

The primary purpose of this research is to identify the most commonly performed public health services by local health departments (LHDs) and highlight variation by LHD characteristics. Data were drawn from the 2008 and 2010 National Profile of LHDs, conducted by the National Association of County and City Health Officials (NACCHO). The descriptive analysis aims to further the essential dialogue triggered by a recent Institute of Medicine (IOM) report about the standard minimum set of services that all LHDs should provide. This study identified a set of 22 activities performed by LHDs that are common in jurisdictions of all sizes. …

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.

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 …

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. …

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 …

Assessing A Quality Improvement Project In A Georgia County Health Department, Dayna S. Alexander, William C. Livingood, Nandi A. Marshall, Angela Peden, Russ Toal, Gulzar H. Shah, Alesha Wright, Purity Cummings, Ketty Gonzalez, Lynn Woodhouse

Frontiers in Public Health Services and Systems Research

The study and evaluation of quality improvement among Georgia’s public health systems continues to be a major priority for the Georgia Public Health Practice Based Research Network (GAPH-PBRN). This article focuses on the application and evaluation of a Quality Improvement project in a Georgia County Health Department. The QI team sought to reduce the waiting time in the teen clinic; thereby, increasing the Quality Improvement culture one project at a time in this Health Department. The project revealed that Quality Improvement is a continuous process that requires change and adaptation by employees. This initial Quality Improvement project was the first …

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.

The Resilient Local Health Department: Surviving The 2008 Economic Crisis, Paul C. Erwin, Gulzar H. Shah, Glen P. Mays

Frontiers in Public Health Services and Systems Research

The purpose of this study was to identify potential modifiable factors that can protect local health departments (LHDs) from job losses and budget cuts during periods of economic stress. This was a retrospective cohort study based on the 2005 and 2010 surveys of LHDs conducted by the National Association of County and City Health Officials. The outcome of interest – resiliency of the LHD – represented financial resiliency for maintaining budgets during the 2008 recession, and was based on the ratio of observed-to-predicted expenditures per capita for 2010. LHDs which successfully weathered the economic recession of 2008 represented smaller populations …

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 …

Analysis Of Local Health Department Factors That Accelerate Population-Based Intervention Strategies: Preliminary Findings, M. Elizabeth Gyllstrom, Kim J. Gearin, William Riley

Frontiers in Public Health Services and Systems Research

Introduction: This practice-based research study capitalized on the statewide implementation of a comprehensive, locally-driven initiative to implement evidence-based policy, system and environmental changes related to obesity and tobacco use. The study examined local health department (LHD) performance and factors such as organizational quality improvement (QI) maturity, structure and governance.

Methods: State health department staff reviewed grant reports and documentation pertaining to all LHD grantees, which collectively represented all 87 counties and 4 cities in Minnesota (MN), in order to designate grantees as either: “Exceeds Expectations,” “Meets Expectations” or “Approaching Expectations.” A study team of state, local and academic partners then …