Health Policy Commons^™

Massachusetts Medicaid Members That Smoked In 2008: Characteristics Associated With Smoking Status In 2014, Alexis D. Henry, John Gettens, Judith A. Savageau, Doris Cullen, Anna Landau

Judith A. Savageau

The smoking rate among non-elderly Medicaid enrollees is more than double the rate for those privately insured; smoking-related conditions account for 15% of Medicaid expenditures. Under state health reform, Massachusetts Medicaid (MassHealth) made tobacco cessation treatment available beginning in 2006. We used surveys conducted in 2008 and 2014 to examine changes in smoking abstinence rates among MassHealth members identified as smokers and to identify factors associated with being a former smoker. Members previously identified as smokers were surveyed by mail or phone; 2008 and 2014 samples included 3,116 and 2,971 members, respectively. Surveys collected demographic and health information, asked members …

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

Shimin Zheng

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 …

When Does Marketisation Lead To Privatisation? Profit-Making In English Health Services After The 2012 Health And Social Care Act, Nick Krachler, Ian Greer

Ian Greer

Governments world-wide have attempted to use market mechanisms and privatisation to increase the quality and/or reduce the cost of healthcare. England’s Health and Social Care Act 2012 is an attempt to promote privatisation through marketisation in the National Health Service (NHS). While the health policy literature tends to assume that privatisation follows from private-sector entry points, we argue that this is more likely if firms expect to make a profit. This paper examines the link between privatisation and marketisation in England drawing on 32 semi-structured interviews with private-sector and public-sector respondents, campaigners, and other experts conducted 6-10 months after the …

National Health Security Preparedness Index: Recommendations From The National Advisory Committee, Glen P. Mays, Michael Childress, Anna Goodman Hoover, Chris Bollinger

Glen Mays

This meeting of the National Advisory Committee for the National Health Security Preparedness Index program discussed strategies for improving the theoretical framework, measures, and analytic methodologies used in assessing and comparing preparedness levels across U.S. states and the nation as a whole.

The Role Of Leadership In Creating A Strategic Climate For Evidence-Based Practice Implementation And Sustainment In Systems And Organizations, Gregory Aarons, Mark Ehrhart, Lauren Farahnak, Marisa Sklar

G A Aarons

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 …

Defining Comprehensive Public Health Delivery Systems, Glen P. Mays

Glen Mays

This brief describes the methodology for defining Comprehensive Public Health Delivery Systems using data from the National Longitudinal Survey of Public Health Systems. The systems meeting this definition have been shown to deliver a broader range of recommended public health services, using fewer resources, than the more prevalent types of U.S. public health systems that do not meet this definition. Over time, comprehensive systems are associated with larger gains in population health status than are their counterparts.

Measure Of Clinical Information Technology Adoption, Jinhyung Lee, Young-Taek Park

Jinhyung Lee

Objectives: The objective of this study was to create a new measure for clinical information technology (IT) adoption as a proxy variable of clinical IT use.

Methods: Healthcare Information and Management Systems Society (HIMSS) data for 2004 were used. The 18 clinical IT applications were analyzed across 3,637 acute care hospitals in the United States. After factor analysis was conducted, the clinical IT adoption score was created and evaluated. Results: Basic clinical IT systems, such as laboratory, order communication/results, pharmacy, radiology, and surgery information systems had different adoption patterns from advanced IT systems, such as cardiology, radio picture …

Estimation Of Uninsurance Rate: Comparison Of Four Estimation Methods, Jackie Zhang, Renee Hotchkiss, Thomas Wan

Thomas T.H. Wan

Objective: Although high percentage of the uninsured is an important public policy issue, the discrepancies in both state and national estimates of the numbers of uninsured are reported. This study compares four advanced estimation methods for uninsurance, by using Florida Health Insurance Survey data as an example. Design: The four predictive models include decision tree, neural network, general logistic regression, and two-stage logistic regression. Risk factors to uninsurance are identified. Population: The study sample comes from the Florida Health Insurance Study data collected for the Florida Agency of Health Care Administration in 1999, representing the first large-scale study designed exclusively …

How Will Public Health And Primary Care Come Together In Massachusetts?

Javier Crespo

The Patient Protection and Affordable Care Act aims to place public health and prevention practice closer to the clinical care delivery system by mandating basic preventive services and creating a national prevention plan. The Massachusetts health care system has a number of elements that can help foster closer linking of public health practices in the primary care setting. This research set out to examine whether the current healthcare system in Massachusetts will enable public health and primary care integration as intimated upon by the Affordable Care Act. This study will assess the current connection between public health and primary care …

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

Russell B. Toal

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.

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

Ankit Bangar

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.

Overview And Guidance Documents For Public Health Pbrns, Glen P. Mays

Glen Mays

This brief provides an inventory of guidance documents and tools for use in developing, implementing, and evaluating practice-based research networks (PBRNs) in public health settings.

The Value Of Public Health Financial Data, Glen P. Mays

Glen Mays

Effective policy and administrative decision-making in public health requires reliable information on the amount of resources invested in governmental public health programs and how these resouces are allocated and used across the U.S. public health system. This session examines current and potential uses of public health financial data in the U.S., and considers expanded roles for research in informing policy and administrative decisions.

Vital Statistics: The State Of The Public Health Pbrn Program, Glen Mays

Glen Mays

The Robert Wood Johnson Foundation's Public Health PBRN Program has continued to expand during the 2013 program year with new networks, new research projects, and expanded translation and dissemination initiatives. The program plays an increasingly powerful role in helping to transform the U.S. public health enterprise into a rapid-learning system for health improvement.

Testing Integrated Primary Care And Public Health Models For Prevention Delivery, Glen Mays

Glen Mays

Improving the delivery of evidence-tested prevention interventions to populations at greatest risk requires strong coordination between primary care providers and public health organizations. This presentation reviews current research on models for integrated delivery of primary care and public health services, and identifies emerging research needs and opportunities. Of particular interest are the roles that practice-based research networks (PBRNs) can play in building this evidence.

Public Health Roi: Evidence, Experience, And Remaining Questions, Glen Mays

Glen Mays

Expanding the delivery of efficacious public health and prevention strategies holds considerable potential for improving health outcomes and constraining costs across the U.S. health system. Unfortunately, lingering certainties about the costs required to expand public health delivery systems and about the health and economic effects of such expansions has muted private and public support for increased public health expenditures. This lecture examines recent evidence from public health services and systems research studies that examine the health and economic value of public health delivery, and identifies remaining research needs for the field.

Cost Estimation Methods: Strategies And Examples For Public Health Services & Systems Research, Glen P. Mays, Michael E. Morris

Glen Mays

This webinar reviews methods for conducting cost studies in public health settings, including strategies for estimating the financial and ecnomic costs of delivering public health services, and analytic approaches to identifying factors that influence delivery costs. These types of studies are of increasing importance to policy and practice stakeholders given the need for evidence about the return-on-investment (ROI) generated through public health delivery.

Accelerating And Expanding Knowledge Transfer In Public Health Settings, Glen Mays

Glen Mays

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

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

Glen Mays

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

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

Glen Mays

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

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

Glen Mays

Efforts to improve population health hinge on the performance of the complex and heterogeneous delivery systems that are charged with implementing public health programs and policies across the U.S. Rigorous research on public health delivery systems historically has been much more limited than research on the specific programs and policies they deliver. Correcting these gaps in knowledge and evidence will allow for accelerated progress in improving health and containing costs through prevention.

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

Glen Mays

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

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

Glen Mays

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

National Longitudinal Survey Of Public Health Systems: Comparative Report Of 2012 Results, Glen Mays

Glen Mays

The third wave of the National Longitudinal Survey of Public Health Systems was fielded in 2012 in a nationally-representative cohort of local communities. The survey measures the availability of 20 recommended public health activities in the community, the range of organizations that participate in performing each activity, and the perceived effectiveness of each activity. Prior waves of the survey were fielded in 1998 and 2006. Local health officials report data for this survey and receive a customized report of results that compare data for their community with national norms and with "peer groups" of similar communities. This document provides an …

Public Health Return On Investment: Making The Case, Glen Mays

Glen Mays

Fiscal pressures and policy imperatives have created a need for rigorous economic analyses of public health programs and policies. ROI analyses can reveal whether the benefits of public health strategies justify their costs, who realizes these benefits and costs, and under what circumstances.

Comparative Effectiveness Research And Patient-Centered Outcomes Research In Public Health Settings: Design, Analysis And Funding Considerations, Glen Mays

Glen Mays

The principles and methods of CER and PCOR have developed primarily with therapeutics in mind, but they must also be applied to the study of public health programs, policies, and delivery systems. This session surveys the emerging field, and provides examples of CER/PCOR methods applied in public health settings using practice-based research networks (PBRNs).

Data Acquisition Plan For The Public Health Multi-Network Practice And Outcome Variation (Mprove) Study, Glen Mays

Glen Mays

This brief details the steps to be followed in obtaining and compiling data on the core (and optional) measures of public health service delivery for the MPROVE study. MPROVE data will need to be obtained from several different sources. Data for some measures already exist in administrative records, surveillance systems, or other sources maintained by the local and state public health agencies that participate in your PBRN. For other measures, it may be necessary to obtain data from other agencies that collaborate with the public health agencies in your PBRN. In still other cases, it may be necessary to undertake …

Final Set Of Public Health Delivery Measures Selected For The Multi-Network Practice And Outcome Variation Examination (Mprove) Study, Glen Mays

Glen Mays

The Multi-Network Practice and Outcome Variation Examination Study (MPROVE) engages public health practice-based research networks (PBRNs) in the collection and analysis of measures of public health delivery across a large number of local practice settings in order to examine the causes and consequences of practice variation in public health. This document summarizes the final set of measures selected for the MPROVE study, including measures of the reach, volume, intensity, and quality of public health delivery in three domains of activity: chronic disease prevention, communicable disease control, and environmental health protection.

Public Health Return-On-Investment Template - Demonstration Version, Glen Mays

Glen Mays

The Public Health Return on Investment (ROI) Template is designed to help public health organizations estimate the economic returns from investments made in strategies that enhance public health service delivery, including quality improvement (QI) interventions. Depending on data availability, the template can be used to support retrospective analyses of actual investments as well as prospective analyses of potential future investments. The tool is designed to analyze economic returns realized through one ore more of the following pathways: (1) Reductions in routine operating costs; (2) Increases in revenue streams; (3) Increases in the outputs produced through agency services/functions; (4) Reductions in …

Estimating Scale And Scope Effects In Public Health Delivery: Implications For Regionalization, Glen P. Mays, Rachel A. Hogg, Rick Ingram, Kristina Rabarison

Glen Mays

OBJECTIVES: The nation's public health delivery system comprises nearly 3000 local public health agencies that vary widely in capabilities. Economic pressures, workforce shortages, and new national accreditation standards are leading these agencies to explore mechanisms for pooling resources to enhance delivery and improve population health. METHODS: A longitudinal cohort design is used to analyze changes in the availability and perceived effectiveness of services delivered by local public health providers. A stratified random sample of the nation's 3000 local public health agencies (n=497) were surveyed in 1998 and again in 2006 and 2011 (70% response) to measure the availability of 20 …