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Articles 391 - 420 of 544
Full-Text Articles in Health Policy
Geographic Variation In The Delivery Of High-Value Public Health Services: Exploring Causes & Consequences, Glen P. Mays
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 …
Medicaid Expansions & Public Health Spending: Cross-Subsidies, Complementarities, And Crowd-Out, Glen P. Mays
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
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.
Optimizing Public Health Systems For Population Health Improvement: Institutions, Economics, And Metrics, Glen P. Mays
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 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 …
Local Health Department Collaborative Capacity To Improve Population Health, Hector P. Rodriguez, Jeffrey Mac Mccullough, Charleen Hsuan
Local Health Department Collaborative Capacity To Improve Population Health, Hector P. Rodriguez, Jeffrey Mac Mccullough, Charleen Hsuan
Frontiers in Public Health Services and Systems Research
Local health departments (LHDs) can more effectively develop and strengthen community health partnerships when leaders focus on building partnership collaborative capacity (PCC), including a multisector infrastructure for population health improvement. Using the 2008 National Association of County and City Health Officials (NACCHO) Profile survey, we constructed an overall measure of LHD PCC comprised of the five dimensions: outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages. We conducted a series of regression analyses to examine the extent to which LHD characteristics and contextual factors were related to PCC. The most developed PCC dimension was vision-focus balance, while infrastructure …
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
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
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
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
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
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
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.
Ending Failures, Showing Results, Improving Population Health: Insights From Research & Reform In The U.S., Glen P. Mays
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
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
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.
Racial Disparities In Access To Community Water Supply Service In Wake County, North Carolina, Jacqueline Macdonald Gibson, Nicholas Defelice, Daniel Sebastian, Hannah Leker
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
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
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.
Measures Of Highly Functioning Health Coalitions: Corollaries For An Effective Public Health System, Priscilla A. Barnes, Paul C. Erwin, Ramal Moonesinghe
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 …
How Will Public Health And Primary Care Come Together In Massachusetts?, Javier Crespo
How Will Public Health And Primary Care Come Together In Massachusetts?, Javier Crespo
Public Affairs Capstones Collection
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 …
An Assessment Of The Health Needs Of Maine Veterans And Their Access To Veterans Administration Health Care Services, Kristin Brawn
An Assessment Of The Health Needs Of Maine Veterans And Their Access To Veterans Administration Health Care Services, Kristin Brawn
Muskie School Capstones and Dissertations
On a state level, only a few assessments have been conducted, which indicate that Maine veterans are also experiencing similar mental and physical health issues; however, it does not appear that the adequacy of Maine’s VHA services to meet the needs of Maine’s veterans has been comprehensively evaluated. It is unknown whether the physical and mental health needs of Maine’s veterans are currently being met. Therefore, this project proposes to determine if there is a similar problem among Maine’s veterans in regard to health issues and lack of access to VHA health services, as has been reported at the national …
Caregiving And The Experience Of Health And Illness In Children Living With Hiv/Aids In Gulu District Northern Uganda: An Ethnographic Research Narrative, Constantine S.L. Loum Phd
Caregiving And The Experience Of Health And Illness In Children Living With Hiv/Aids In Gulu District Northern Uganda: An Ethnographic Research Narrative, Constantine S.L. Loum Phd
Patient Experience Journal
In this paper we discuss the experience of caregiving for children living with HIV in a resource poor environment in Gulu municipality in northern Uganda; the main research questions of the study were: what are the perceptions of caregivers on the care of children with HIV, and what barriers and enablers exist that undermine or promote better care for children respectively? The experience of caregivers and their perceptions on managing HIV in children is believed to shape the health seeking behaviour towards treatment and efforts to cope with its negative impact on the body. Women and children are the greatest …
The Role Of Governing Boards In Improving Patient Experience: Attitudes And Activities Of Health Service Boards In Victoria, Australia, Marie Bismark, Susan Biggar, Catherine Crock, Jennifer M. Morris, David M. Studdert
The Role Of Governing Boards In Improving Patient Experience: Attitudes And Activities Of Health Service Boards In Victoria, Australia, Marie Bismark, Susan Biggar, Catherine Crock, Jennifer M. Morris, David M. Studdert
Patient Experience Journal
The authors sought to determine the attitudes of public health service board members and senior executives toward patient experience and to describe the governance activities of the boards in this area. The study was based on an online survey of 322 board members from 85 public health services and semi-structured interviews with 35 board members and senior executives from 13 public health services in Victoria, Australia. The results showed that while some health service boards had high aspirations and clear plans for improving patient experience, others remained sluggish or even cynically resistant to changing their existing models of care. Interviewees …
Patients’ Experiences In The Uk: Future Strategic Directions, Sophie Staniszewska, Neil Churchill
Patients’ Experiences In The Uk: Future Strategic Directions, Sophie Staniszewska, Neil Churchill
Patient Experience Journal
Over the last decade policy has emphasised the importance of a good patient experience as a cornerstone of high quality health and social care in the UK, with many initiatives attempting to develop patient-centred practice. More recently, the Francis Inquiry has addressed the significant failings in care identified at Mid Staffordshire NHS Foundation Trust in England and has been pivotal in raising the importance of patient experience.1 The Francis report made 290 recommendations, with many emphasizing the importance of patient experience through their focus on specific ways in which the quality of experiences can be enhanced, for example, by …
What Matters Most To Patients? Participative Provider Care And Staff Courtesy, Andrew H. Van De Ven
What Matters Most To Patients? Participative Provider Care And Staff Courtesy, Andrew H. Van De Ven
Patient Experience Journal
Although there is growing recognition of the importance of having satisfied patients, we know little about what aspects of care matter most to patients. The sources of patient satisfaction and how care delivery can influence them need more empirical study. The objective of this study was to identify which aspects of a patient’s experience of care are most important to patient satisfaction, and how dimensions of care relate to clinic size, economic performance, and employee job satisfaction. To explore our question, longitudinal survey data were obtained on patients and employees over two years (1996 and 1997). Relationships between patient satisfaction …
Psychometric Properties Of The New Patients’ Expectations Questionnaire, Ann Bowling Bsc, Msc, Phd, Gene Rowe Phd
Psychometric Properties Of The New Patients’ Expectations Questionnaire, Ann Bowling Bsc, Msc, Phd, Gene Rowe Phd
Patient Experience Journal
The authors explore the development of the Patients’ Expectations Questionnaire (PEQ) and examination of psychometric characteristics it encompasses by reviewing surveys of primary care and hospital outpatients before and after their clinic visit. Three scales were developed for Pre-visit Ideal and Realistic expectations, and Post-visit Experiences (met expectations), based on literature review, semi-structured interviews, and subsequently piloted and refined. Patients completed the questionnaire about their ideal and realistic expectations before they saw the doctor, and were asked if their expectations had been met afterwards. The results show the scales met acceptability criteria for reliability (Cronbach’s alphas exceeded α 0.70), administration …
Factors In Patients’ Experience Of Hospital Care: Evidence From California, 2009–2011, Edmund R. Becker Phd, Jason M. Hockenberry Phd, Jaeyong Bae Ma, Ariel C. Avgar Phd, Sandra S. Liu Phd, Mba, Ira Wilson Md, Msc, Arnold Milstein Md, Mph
Factors In Patients’ Experience Of Hospital Care: Evidence From California, 2009–2011, Edmund R. Becker Phd, Jason M. Hockenberry Phd, Jaeyong Bae Ma, Ariel C. Avgar Phd, Sandra S. Liu Phd, Mba, Ira Wilson Md, Msc, Arnold Milstein Md, Mph
Patient Experience Journal
The use of measures of patient-centered care to evaluate hospital care is mandated by The Patient Protection and Affordable Care Act of 2010. Using three years of data from 315 California acute-care hospitals and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, we seek to evaluate patients’ hospital-care experience by (1) analyzing patients’ experience-of-care scores in light of these hospitals’ patient profiles, structural characteristics, and outcomes in 2011, and (2) determining and analyzing the extent of changes in patients’ experience of care over the three-year period 2009–2011. For 2011, we find significant …
Veterans’ Experiences Of Patient-Centered Care: Learning From Guided Tours, Sara M. Locatelli Phd, Stephanie Turcios Bs, Cepep, Sherri L. Lavela Phd, Mph, Mba
Veterans’ Experiences Of Patient-Centered Care: Learning From Guided Tours, Sara M. Locatelli Phd, Stephanie Turcios Bs, Cepep, Sherri L. Lavela Phd, Mph, Mba
Patient Experience Journal
In this paper the authors seek to examine Veterans’ experiences with patient-centered care (PCC) at 2 United States Veterans Affairs (VA) facilities. The authors conduct their research through a process of guided tours, in which the participant leads the evaluator through an environment and shares thoughts, feelings, and experiences. Tours were conducted in April 2013 with 30 Veterans receiving care at these VA facilities. Via the tours participants discussed aspects of the environment of care, and described some as ‘welcoming,’ while describing others as ‘chaotic.’ Participants provided multiple examples of PCC, frequently defining PCC in terms of accessibility of appointments, …
Patient Care Experiences And Perceptions Of The Patient-Provider Relationship: A Mixed Method Study, Jennifer Tabler Ms, Debra L. Scammon Ms, Phd, Jaewhan Kim Phd, Timothy Farrell Md, Andrada Tomoaia-Cotisel Mph, Mha, Michael K. Magill Md
Patient Care Experiences And Perceptions Of The Patient-Provider Relationship: A Mixed Method Study, Jennifer Tabler Ms, Debra L. Scammon Ms, Phd, Jaewhan Kim Phd, Timothy Farrell Md, Andrada Tomoaia-Cotisel Mph, Mha, Michael K. Magill Md
Patient Experience Journal
Improving interpersonal continuity of care—the personal relationship forged between a patient and their primary care provider (PCP) over time—is often considered a goal of primary care. Continuity of care is frequently assessed in terms of longitudinal continuity, or the proportion of encounters with one practitioner, overlooking aspects of the patient-provider relationship that are key to interpersonal continuity of care. Further, few studies explore patients’ perspectives regarding which care experiences enhance or detract from the patient-provider relationship. This study, using focus group interviews, a patient experience CAHPS-PCMH survey, and electronic medical records, explored how patients’ experiences at 10 primary care clinics …
The Impact Of The Resident Duty Hour Regulations On Surgical Patients’ Perceptions Of Care, Shital Shah Phd, Mary Katherine Krause Ms, Fache, Francis Fullam Ma, Susan Vanderberg-Dent Md, Amie E. Solber Ms
The Impact Of The Resident Duty Hour Regulations On Surgical Patients’ Perceptions Of Care, Shital Shah Phd, Mary Katherine Krause Ms, Fache, Francis Fullam Ma, Susan Vanderberg-Dent Md, Amie E. Solber Ms
Patient Experience Journal
Implementation of the 2003 Accreditation Council for Graduate Medical Education (ACGME) resident duty-hour regulations and access to publicly reported patient satisfaction measures have challenged administrators and clinicians to balance resident’s educational experience, patient care quality, and patients’ satisfaction and perceptions. A pre-post retrospective study design investigated association between implementation of ACGME regulations and patient satisfaction/perceptions using multinomial logistic regressions. The sample consisted of all surgical inpatients (July 2001 – June 2005), who responded to surveys at an academic medical center. Patients gave lower ratings for physician interactions (patient-physician interaction time, clinical updates, and courtesy) following the implementation of post-duty hour …