Health Services Research Commons^™

Understanding Hiv Care Delays In The Us South And The Role Of The Social-Level In Hiv Care Engagement/Retention: A Qualitative Study, Courtenay Sprague, Sara E. Simon

Center for Peace, Democracy and Development Publications

Introduction: In a significant geographical shift in the distribution of HIV infection, the US South - comprising 17 states - now has the greatest number of adults and adolescents with HIV (PLHIV) in the nation. More than 60% of PLHIV are not in HIV care in Alabama and Mississippi, contrasted with a national figure of 25%. Poorer HIV outcomes raise concerns about HIV-related inequities for southern PLHIV, which warrant further study. This qualitative study sought to understand experiences of low-income PLHIV on the AIDS Drug Assistance Program in engagement and retention in continuous HIV care in two sites in Alabama. …

The Public Health Pbrn Program: A Status Update, Glen P. Mays

Health Management and Policy Presentations

As of 2014 the Robert Wood Johnson Foundation's Public Health Practice-Based Research Networks Program has engaged more than 1600 U.S. public health agencies in research production and application, generating more than 60 ongoing and completed empirical studies, 70 peer-reviewed publications, and 200 presentations and professional and scientific meetings.

Creating Learning Systems: Lessons From Public Health Practice-Based Research Networks, Glen P. Mays

Health Management and Policy Presentations

Practice-based research networks (PBRNs) provide powerful mechanisms for implementing research studies that evaluate the health and economic effects of delivery system innovations. This presentation reviews strategies, emerging findings, and lessons learned from PBRNs and related studies conducted in U.S. public health settings. We give special focus to studies that examine multi-organizational and cross-sectoral strategies for population health improvement.

Strengthening The Science Of Public Health Delivery: Complexities In Implementation, Inference & Translation, Glen P. Mays

Health Management and Policy Presentations

Delivery systems for public health programs and policies are diffuse and heterogeneous across the U.S., reflecting wide variation in the capacity to implement population-level health improvement strategies. This lecture examines strategies for evaluating the causes and consequences of variation in public health delivery across the U.S., with a focus on identifying pathways for improving the health and economic effects of policy and practice.

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 …

The Status Of Public Health Services & Systems Research In The Us: Implications For British Columbia, Glen P. Mays

Health Management and Policy Presentations

Research on the organization, financing, and delivery of public health services has accelerated in the U.S. in recent years. This applied scholarship has been fueled in part by the changes and natural experiments created by global economic recession and by comprehensive federal and state health reforms. Co-occuring changes in public health organization and financing have occurred in Canada and more specifically in British Columbia, where valuable scholarship on public health delivery is also underway. This presentation reviews the progress and current directions of PHSSR scholarship in the U.S., and identifies opportunities and implications for British Columbia.

Exploring Perceptions And Experiences With Research Ethics In Bolivia, Sarah Sullivan, Armando Basagoitia, Annette Aalborg, Oscar Lanza, Jacqueline Cortez

Background: In Bolivia, there is increasing interest in the necessity of incorporating research ethics into study designs and procedures, but there is minimal data on the perceptions and experiences of Bolivian health science faculty, researchers, and national health administrators on research ethics. The Touro University California (TUC) Public Health Program is partnering with Bolivian universities to develop a comprehensive Research Education Ethics Program. In 2013, The Universidad Mayor de San Andrés received a National Institute of Health/Fogarty International Center Planning Grant award to develop the program. The two central aims of this program needs assessment are to describe the …

Estimating The Costs Of Public Health Services, Glen P. Mays

Health Management and Policy Presentations

The National Academy of Sciences Institute of Medicine recommended in 2012 that the federal government undertake work to identify the components and costs of a "minimum package" of public health programs, services, and capabilities that should be available in every American community. This presentation summarizes work that is currently underway through the Robert Wood Johnson Foundation-supported Public Health Practice-Based Research Networks (PBRN) Program to estimate the costs of public health delivery.

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

Health Management and Policy Presentations

Studying variation and innovation in public health delivery can identify pathways for improving the organization, financing, and implementation of programs and policies that protect and promote health.

Shared Learning In An Interconnected World: Innovations To Advance Global Health Equity, Agnes Binagwaho, Cameron T. Nutt, Vincent Mutabazi, Corine Karema

Dartmouth Scholarship

The notion of "reverse innovation"--that some insights from low-income countries might offer transferable lessons for wealthier contexts--is increasingly common in the global health and business strategy literature. Yet the perspectives of researchers and policymakers in settings where these innovations are developed have been largely absent from the discussion to date. In this Commentary, we present examples of programmatic, technological, and research-based innovations from Rwanda, and offer reflections on how the global health community might leverage innovative partnerships for shared learning and improved health outcomes in all countries.

Hospital Contributions To Public Health Activities Before And After Aca: Incentives, Constraints & Crowd-Out, Glen P. Mays

Health Management and Policy Presentations

Research Objective: The Affordable Care Act created enhanced IRS requirements for not-for-profit hospitals regarding the provision of community benefits, potentially stimulating new approaches to community health needs assessment, priority setting, and engagement with public health agencies and other community stakeholders. Yet the economic downturn has constrained hospital earnings and increased demand for uncompensated care, potentially crowding out hospital contributions to public health activities. This study uses data from 1998-2012 on a national cohort of communities to examine: (1) the extent and nature of change in hospital contributions to public health activities; and (2) the economic, institutional, and policy-related factors that …

Analyzing Return On Investment In Public Health: Implications And Future Directions, Glen P. Mays

Health Management and Policy Presentations

Return on investment (ROI) analyses of public health programs, policies, and services are being undertaken with increasing frequency to provide assessments of the value of these activities. This presentation reviews current initiatives and future directions for improving the quality of ROI studies and their application to real-world public health policy and administrative decisions.

The Public Health Pbrn Program: Building The Science Of Public Health Delivery, Glen P. Mays, Anna Goodman Hoover

Health Management and Policy Presentations

This session describes public health practice-based research networks (PBRNs) and emerging opportunities for collaboration with injury control research centers to advance the science of injury prevention practice.

Public Health Delivery Systems And Population Health, 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 Return On Investment: Approaches And Methods, Glen P. Mays

Health Management and Policy Presentations

Continuing fiscal constraints in the public sector and large-scale policy changes associated with health reform implementation in the U.S. are giving heightened attention to questions about the health and economic value of public health programs, services, and policies -- strategies designed to protect health and prevent disease and injury on a population-wide basis. This session provides an overview of approaches for conducting return-on-investment (ROI) analyses and related economic evaluation studies in public health settings in order to inform policy and administrative decision-making. New opportunities and resources created through CDC's National Public Health Improvement Initiative (NPHII) and RWJF's Public Health Practice-based …

Patterns Of Interaction Public Health Pbrns: Insight From Network Analysis, Rachel A. Hogg, Glen P. Mays

Health Management and Policy Reports

This report presents data from a network analysis survey conducted with public health practice-based research networks (PBRNs) to examine patterns of interaction among researchers and public health practitioners who participate in the networks. These data provide a baseline for tracking the types and frequencies of interaction that occur within networks, and reveal opportunities for promoting more productive patterns of engagement in applied public health research. Over time, these types of data can reveal how and under what circumstances PBRNs facilitate the production and application of research about public health services and delivery systems. The analysis includes data on more than …

Making The Case For Public Health: Estimating Roi And Value, Glen P. Mays

Health Management and Policy Presentations

This presentation describes recent progress and new directions for estimating the value of public health strategies and infrastructure.

Public Health Governance And Population Health Outcomes, Scott P. Hays, Janine Toth, Matthew J. Poes, Peter F. Mulhall, David M. Remmert, Thomas W. O'Rourke

Frontiers in Public Health Services and Systems Research

Research reviews have identified a gap in understanding the diversity of health department governance structures and in understanding how the variations in governing relates to health outcomes. This report details the categorization of local public health governance and reveals that certain governance types may be better suited to achieve better population health outcomes. State systems achieve the poorest health outcomes, but the best health outcomes are achieved when the political branches have a key role in local public health governance. Public health systems should consider greater local control and involvement in governance; but local governance should include the political branches …

Estimating Medical Cost Offsets Attributable To Public Health Spending, Glen P. Mays

Health Management and Policy Presentations

Uncertainty about the magnitude and timing of economic returns associated with spending on public health services has contributed to policy debates about the optimal role of the federal government in financing these services.

National Longitudinal Survey Of Public Health Systems: 2011-2012 Wave, Public Health Practice-Based Research Networks

Health Management and Policy Reports

Since 1998, researchers have followed a nationally representative cohort of U.S. communities to examine the types of public health activities performed within the community, the range of organizations contributing to each activity, and the perceived effectiveness of each activity in addressing community needs. This information, obtained through a validated survey of local public health officials, provides an in-depth view of the structure and function of local public health delivery systems and how these systems evolve over time. Originally conducted with support from the U.S. Centers for Disease Control and Prevention, the National Longitudinal Survey of Public Health Systems (NLSPHS) was …

Using Public Health Pbrn Research To Inform Policy & Practice, Public Health Practice-Based Research Networks

Health Management and Policy Reports

The Public Health Practice-Based Research Networks Program is a national program of the Robert Wood Johnson Foundation that supports research networks dedicated to producing new scientific knowledge on how best to organize, finance, and deliver public health strategies in realworld practice settings. This body of scientific inquiry, known as Public Health Services and Systems Research (PHSSR), is a rapidly developing area of scholarship within the larger fields of public health research and health services research. A public health practice-based research network (PBRN) brings multiple public health organizations into collaboration with an academic research center for the purposes of designing and …

Building A Sustainable Public Health Pbrn: Tips For Securing Ongoing Research Funding, Public Health Practice-Based Research Networks

Health Management and Policy Reports

Diversify your network’s research funding base. The Public Health PBRN Program funding made available by the Robert Wood Johnson Foundation provides start-up resources and initial research support for networks, but networks will require larger and more sustainable sources of funding for public health research as they progress. The most ample sources can be found in federal funding agencies that operate competitive extramural research programs, include CDC, NIH, AHRQ, HRSA, USDA, and NSF. Public health research funding is also available from state and foundation sources, and even corporate sources (e.g. Pfizer’s Public Health Research Fellowship Program). For sustainability, networks should look …

Public Health Pbrns: Generating Evidence For Policy & Practice, Public Health Practice-Based Research Networks Program

Health Management and Policy Reports

The Public Health Practice-Based Research Networks Program is a national program of the Robert Wood Johnson Foundation that supports the development of research networks for studying the comparative effectiveness, efficiency and equity of public health strategies deployed in real-world practice settings. A practice-based research network (PBRN) brings multiple public health agencies together with research partners to design and implement studies of population-based strategies that prevent disease and injury and promote health. Participating practitioners and researchers collaborate to identify pressing research questions of interest, design rigorous and relevant studies, execute research effectively, and translate findings rapidly into practice. As such, PBRNs …

Southern Lagoon And Village Of Gales Point, Belize, Ca: Water Uses, Water Quality, And Potential Health Impacts, Rasmi Nair, Ritchie Taylor

Impact Belize

An International Health Service Learning Program, Impact Belize 2010, was conducted by Western Kentucky University. Faculty and students worked closely with Gales Point villagers to gain an insight into the use of Southern Lagoon. The objective of the study was to assess fecal coliform levels in Southern lagoon, its primary and secondary contact use by villagers and its potential impact on health. Study methodology involved collection of water samples, both near shore and offshore, in the lagoon and incubating them using ColiQuant EZ method approved by EPA. A questionnaire was administered to villagers attending the WKU clinic to collect data …

Provision Of Health Care Services In Canada: Challenges And Opportunities, Rosa Rodriguez-Monguio, Enrique Seoane-Vazquez, Fernando Antoñanzas Villar

Pharmacy Faculty Articles and Research

The Canadian health care system provides comprehensive coverage of hospital and outpatient care, including therapeutic, diagnostic and preventive services. The level of coverage of services varies across the country. This study examines the key characteristics of the Canadian health and long-term care systems; presents a structured analysis of the insurance, financing and provision of health and long-term care services in Canada; describes the main challenges of the Canadian health and long-term care systems; and concludes with feasible opportunities for the Canadian health policy.

Main challenges to the Canadian system are related to population ageing; prevalence of avoidable diseases caused by …

Designing A Successful Practice-Based Research Network In Public Health: Key Concepts, Glen P. Mays, Sharla A. Smith

Health Management and Policy Reports

Successful public health practice-based research networks (PBRNs) will require organizational, financial, and intellectual resources that allow practitioners and researchers to mount relevant studies in real-world public health settings. This brief outlines characteristics likely to be important to the success of public health PBRNs, based on the experience of PBRNs in other practice settings

Finding Order In Complexity: A Typology Of Local Public Health Delivery Systems, Glen P. Mays, F. Douglas Scutchfield, Michelyn Bhandari, Sharla A. Smith

Health Management and Policy Reports

Public health decision-makers and researchers currently lack an evidence-based framework for describing, classifying, and comparing public health delivery systems based on their organizational components, operational characteristics, and division of responsibility. Related typologies developed in the health services sector have proven extremely valuable for policy and administrative decision-making as well as for ongoing research. Performance assessment, quality improvement, and accreditation activities are now blossoming in public health—adding urgency to the need for classification and comparison frameworks. This brief describes a newly-developed empirical typology for local public health systems and highlights its policy and managerial applications.

Preventive Medicine: A "Cure" For The Healthcare Crisis, Janice L. Clarke, Deborah Meiris

College of Population Health Faculty Papers

Introductory Editorial: Few would dispute the premise that prevention, early detection, and early intervention form the first line of defense on the disease management (DM) continuum. That being the case, our national statistics on preventive health should be raising concerns throughout the industry. The US healthcare delivery system continues to fall woefully short of its prevention targets. On the international scene, the United States lags behind countries with less wealth and less technological savvy. Commentaries abound on the problems, but recently I became aware of an organization with an exciting goal and a novel solution for bringing preventive medicine …

Cardiovascular Comorbidities Among Public Health Clinic Patients With Diabetes: The Urban Diabetics Study, Jessica M. Robbins, Chris N. Sciamanna, David A. Webb

College of Population Health Faculty Papers

BACKGROUND:We sought to determine the frequency and distribution of cardiovascular comorbidities in a large cohort of low-income patients with diabetes who had received primary care for diabetes at municipal health clinics.

METHODS:Outpatient data from the Philadelphia Health Care Centers was linked with hospital discharge data from all Pennsylvania hospitals and death certificates.

RESULTS:Among 10,095 primary care patients with diabetes, with a mean observation period of 4.6 years (2.8 after diabetes diagnosis), 2,693 (14.3%) were diagnosed with heart disease, including 270 (1.4%) with myocardial infarction and 912 (4.8%) with congestive heart failure. Cerebrovascular disease was diagnosed in 588 patients (3.1%). Over …

Use Of Hospitals, Physician Visits, And Hospice Care During Last Six Months Of Life Among Cohorts Loyal To Highly Respected Hospitals In The United States, J. E. Wennberg, Elliot S. Fisher, Therese A. Stukel, Jonathan S. Skinner

Dartmouth Scholarship

Objective: To evaluate the use of healthcare resources during the last six months of life among patients of US hospitals with strong reputations for high quality care in managing chronic illness.