Health Policy Commons^™

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).

Price Elasticity Of Expenditure Across Health Care Services, Fabian Duarte

Fabian Duarte

Policymakers in countries around the world are faced with rising health care costs and are debating ways to reform health care to reduce expenditures. Estimates of price elasticity of expenditure are a key component for predicting expenditures under alternative policies. Using unique individual-level data compiled from administrative records from the Chilean private health insurance market, I estimate the price elasticity of expenditures across a variety of health care services. I find elasticities that range between zero for the most acute service (appendectomy) and −2.08 for the most elective (psychologist visit). Moreover, the results show that at least one third of …

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 …

Commonhealth: Mass. A National Leader In Overdose Prevention, Leo Beletsky, Alexander Walley

Leo Beletsky

In this interview on Radio Boston, Leo Beletsky and Alexander Walley discuss their viewpoint piece, “Prevention of Fatal Opioid Overdose,” which appeared in the Nov. 14, 2012 issue of the Journal of the Medical American Association.

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.

Prevention Of Fatal Opioid Overdose, Leo Beletsky

Leo Beletsky

Opioid overdose is a burgeoning public health crisis, accounting for at least 16,000 deaths annually in the United States. Opioid overdose occurs across sex, ethnic, age, and geographic strata and involves both medical and nonmedical opioid use. To date, federal government response has focused primarily on monitoring and securing the drug supply. This Viewpoint suggests various steps necessary to support a more comprehensive approach.

The Likely Impact Of Mandated Paid Sick And Family-Care Leave On The Economy And Economic Development Prospects Of The State Of Ohio, Edward W. Hill, Spence Christopher, Daila Shimek, Ziona Austrian

Ziona Austrian

This report analyzes the potential impact of a proposed paid sick and family care leave legislation on the economy of the state of Ohio, the economic development prospects of the state and on the management of production processes that depend on highly integrate teams. The report also reviews the literature on the effect of mandated paid sick and family care leave on the industrial relations system—workplace performance and worker retention. Our analysis concludes that there would have been a net cost associated with the paid sick leave and family-care initiative proposed in Ohio with a lower bound estimate of $63.84 …

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 …

The Impact Of Health Care Reform On Emergency Medical Services, Richard N. Bradley, Sabina A. Braithwaite

Richard N Bradley

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. The reforms introduced through PPACA present a paradigm shift in the future delivery model of all health care, including Emergency Medical Services (EMS). Changes embodied in this law offer a variety of opportunities to improve the delivery of care in urgent and emergent medical situations in the out-of-hospital setting. PPACA offers a number of avenues for EMS to engage at a much higher level as professional members of the health care team going forward. Certain components of the law stand to facilitate and …

A Profile Of Nonurgent Emergency Department Use In An Urban Pediatric Hospital, Katrina Kubicek, Deborah Liu, Christy Beaudin, Jocelyn Supan, George Weiss, Yang Lu, Michele Kipke

Yang Lu

Objectives: This study was designed to develop a descriptive profile of parents and caregivers who bring their children to the emergency department (ED) for nonurgent issues and to explore the reasons for presenting to an urban hospital pediatric ED for nonurgent conditions. Such work is necessary to develop effective interventions.

Methods: A total of 106 parents/caregivers whose child was triaged with a nonemergent/urgent condition completed a 15- to 20-minute computerized survey (English and Spanish) in an urban pediatric ED.

Results: Most respondents described themselves as Latino (76%) and foreign born (62%). About one half (49%) reported having an annual income …

Selecting Measures Of Public Health Service Delivery: Results From A Delphi Survey For The Mprove Study, Glen Mays

Glen Mays

This database contains detailed, sortable results from the expert panel Delphi survey used to rate candidate measures of public health service delivery to be used in the Multi-Network Practice and Outcome Variation Examination Study (MPROVE), conducted by the Public Health Practice-Based Research Networks (PBRN) Program.

Selecting Measures Of Public Health Delivery: Results Of A Delphi Survey For The Mprove Study, Glen Mays

Glen Mays

The Multi-Network Practice and Outcomes Variation Examination Study (MPROVE) supports six participating public health practice-based research networks (PBRNs) in selecting a common set of service delivery measures for use in analyzing geographic variation in delivery across local communities. This report presents results from an expert panel Delphi survey used to rate candidate measures on a set of selection criteria, in order to select the final set of measures for study.

Inventory Of Public Health Service Delivery Measures: The Mprove Study, Glen Mays

Glen Mays

This database contains a searchable inventory of measures of public health service delivery that have been recommended as candidates for use in the MPROVE study of geographic variation in local public health service delivery.

Nonpunctuated And Sweeping Policy Change: Bhutan Tobacco Policy Making From 1991 To 2009, Michael S. Givel

Michael S. Givel

This paper examines policy outputs associated with the 2004 Bhutan antitobacco law, including 2009 amendments, to determine if the law is congruent with punctuated equilibrium or social policy realism theories of policy change. There was no direct and sudden tobacco policy output change in Bhutan due to a shock to the policy system contrary to what punctuated equilibrium theory would predict. Rather, policy change was sweeping but nonpunctuated. This paper reconfirms prior findings of social policy realism theory that various and complex policy output patterns occur due to a mixture of contingent and complex factors. Under social policy realism, a …

Reinventing The 21st Century Public Health Workforce: Directions From Practice-Based Research, Glen P. Mays

Glen Mays

Compelling opportunities exist for incorporating practice-based research to into the design, implementation, and evaluation of public health workforce training and development programs. Public Health Training Centers (PHTCs) can collaborate with practice-based research networks (PBRNs) to discover and disseminate evidence-based strategies for workforce development.

Foreword, Andrés Torres, James Green

James R. Green

Many important debates about public policy at the national level and in states like Massachusetts have centered on health care and human services, including welfare and the care of children, the abused, the disabled, the elderly, and those suffering from mental and physical illness. In this issue scholars and advocates examine a range of problems in the health care and human service fields from a perspective often lacking in the public policy discussion — that of the workforce and of the labor organizations that represent the workforce.

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

Glen Mays

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 …

Social Determinants Of Health In Canada: Are Healthy Living Initiatives There Yet? A Policy Analysis, Dana Gore, Anita Kothari

Anita Kothari

Introduction: Preventative strategies that focus on addressing the social determinants of health to improve healthy eating and physical activity have become an important strategy in British Columbia and Ontario for combating chronic diseases. What has not yet been examined is the extent to which healthy living initiatives implemented under these new policy frameworks successfully engage with and change the social determinants of health. Methods: Initiatives active between January 1, 2006 and September 1, 2011 were found using provincial policy documents, web searches, health organization and government websites, and databases of initiatives that attempted to influence to nutrition and physical activity …

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

Glen Mays

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

Quantifying The Value Of Public Health Investments, Glen Mays

Glen Mays

This session reviews recent findings from a series of studies that estimate the health and economic effects attributable to investments in public health services and delivery systems.

Developing Service Delivery Measures For Studies Of Practice Variation: The Mprove Study, Glen Mays

Glen Mays

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. Consequently, HHS recently used a consensus-based process to develop a framework for improving quality in public health and to identify a set of nine priority areas for improvement. As next steps in operationalizing this framework, 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. This presentation profiles the methodology developed …

Funding Public Health: A New Iom Report On Investing In A Healthier Future, Glen Mays, George Isham, Robert Kaplan

Glen Mays

A new Institute of Medicine report recommends establishing a national target for life expectancy and implementing new mechanisms for financing public health strategies to acheive this target.

Scale And Scope Effects In Public Health Delivery: Estimating Gains From Regionalization, Glen P. Mays

Glen Mays

OBJECTIVES: Current approaches to health system reform under the Affordable Care Act include efforts to enhance the delivery of public health services that promote health and prevent disease and injury on a population-wide basis. The nation’s public health delivery system comprises nearly 3000 local public health agencies that vary widely in size, resources, and capabilities. Economic pressures, workforce shortages, and new national accreditation standards are leading these agencies to explore mechanisms for pooling resources and expertise across local jurisdictions to enhance delivery and improve population health. This analysis uses longitudinal observations on a national sample of local public health agencies …

Expanding The Evidence Base For Accreditation And Qi: Progress In Practice-Based Research Networks, Glen Mays

Glen Mays

Studies that examine the implementation and impact of quality improvement strategies in public health are underway through the Public Health Practice-Based Research Networks.

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

Glen Mays

BACKGROUND: Policy strategies for reforming the U.S. health care system to control costs and improve health outcomes include the possibility of expanded support for public health activities that are designed to prevent disease and promote health on a population-wide basis. These activities include efforts to monitor and report on community health status, investigate and control disease outbreaks, educate the public about health risks and prevention strategies, develop and enforce laws and regulations to protect health, and inspect and assure the safety and quality of water, food, air and other resources necessary for health. The Patient Protection and Affordable Care Act …

Verbal Autopsy Tool For Infant Mortality, Vijay Kumar Chattu

Vijay Kumar Chattu

Information on causes of death is extremely important for policy-making, planning, monitoring and evaluation of health programs as well as for field research, comparisons and epidemic awareness.The Millennium Development Goal for India is to reduce infant mortality rate to 35 per 1000 & under-five mortality to 45 per 1000 live births by 2015.The incorporation of Verbal Autopsy (VA) in the existing Registration Systems is necessary in order to fulfil its ultimate goal of improving the information on causes of infant deaths in areas where Civil Registration and Death Certification are weak. VA provides information for local action by health authorities …

Mprove Measure Submission Form, Glen P. Mays

Glen Mays

This instrument allows participating public health PBRN networks to submit candidate measures for the Multi-Network Practice and Outcome Variation Examination (MPROVE) study.