Category Archives: Accreditation
State legislatures recently got underway across the country and many will be considering some critical public health law measures, according to a recent blog post from the Network for Public Health Law.
Critical issues include:
- A smoking ban in Kentucky which could stall in committee
- A bill in Kentucky which could restrict the work of local boards of health.
- A law in Ohio that would require health departments to enter into agreements for shared services and to become accredited.
- Read the Network blog post.
- Use the state legislative tracking page from the Association of State and Territorial Health Officials to follow state public health agendas for 2013.
Today the Public Health Accreditation Board (PHAB) granted 5-year accreditation to 11 public health departments. The national program is jointly supported by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention and aims to improve and protect the health of the public by advancing the quality and performance of the nation’s state, tribal, local and territorial public health departments.
The accreditation program sets standards for the nation’s more than 3,000 public health agencies to improve the quality of their services and performance. Since the program’s launch in September 2011, more than 125 health departments have applied to PHAB for accreditation, and hundreds of public health practitioners from across the nation have been trained to serve as volunteer peer site visitors for the program.
NewPublicHealth spoke with Terry Cline, PhD, health commissioner of Oklahoma, about how his department engaged in the accreditation process and what it means for public health in the state.
NPH: Explain the significance of public health accreditation.
Cline: This is that external validation that tells [the public and policymakers] that this isn’t just what we think of ourselves as an organization. This is accreditation from an organization that was developed through a consensus project that developed the standards that are critical to the advancement of public health across our country. Policymakers don’t have the time, and the public typically isn’t able, to evaluate the performance capabilities for health departments, so they rely on other reputable organizations to do that type of assessment. And now the Public Health Accreditation Board is providing that external validation. It’s a peer process, just as we use for peer reviewed journals. Who’s going to be more critical than the actual experts in the field?
Eleven Public Health Departments First to Achieve National Accreditation Status
The Public Health Accreditation Board (PHAB) has awarded 5-year accreditation to eleven public health departments. The national program, which is jointly supported by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention, aims to improve and protect the health of the public by advancing the quality and performance of the nation’s state, tribal, local and territorial public health departments. The newly accredited agencies are the first of hundreds currently preparing to seek national accreditation through PHAB, an independent organization that administers the national accreditation program. “With accreditation, we now have national standards that promote continuous quality improvement for public health and a mechanism for recognizing high performing public health departments,” said PHAB President and CEO Kaye Bender, PhD, RN, FAAN. “These are the first of many health departments that we look forward to being able to recognize for achieving national standards that foster efficiency and effectiveness, and promote continuous quality improvement.”Read more on accreditation.
Report: HIV Cured in Baby
Researchers from the Johns Hopkins Children’s Center will report today that a baby in rural Mississippi has been cured of HIV through aggressive use of anti-retroviral drugs following birth. The finding will be presented at the Conference on Retroviruses and Opportunistic Infections in Atlanta. The findings have not been yet been published in a peer review journal and the researchers say the findings may not apply to adults. Read more on HIV/AIDS.
Public Health and Sequestration
Several public health organizations has issued statements on the potential impact of sequestration, across the board budget cuts to the federal budget, including the Association of State and Territorial Health Officers (ASTHO), the National Association of County and City Health Officials (NACCHO) and the American Public Health Association (APHA). Read more on budgets.
First Grade Math Skills Set Foundation for Critical Skills Needed Later in Life
Children who failed to acquire basic math skills in first grade scored far behind their peers by seventh grade on a test of the mathematical abilities needed to function in adult life, according to new research supported by the National Institutes of Health. The basic skills tested include the ability to relate a quantity to the numerical symbol that represents it, to manipulate quantities and to make calculations. The researchers say these skills, called numeracy, are the foundation of all other mathematics abilities, including those necessary for functioning as an adult member of society. Starting with poor number knowledge can put children so far behind that they never catch up, according to the researchers, who also reported that more than 20 percent of U.S. adults do not have the eighth grade math skills needed to function in the workplace. Read more on education.
About One in Five U.S. Adult Cigarette Smokers Have Tried an Electronic Cigarette
In 2011, about 21 percent of adults who smoke traditional cigarettes had used electronic cigarettes, also known as e-cigarettes, up from about 10 percent in 2010, according to a study by the U.S. Centers for Disease Control and Prevention (CDC). Overall, about six percent of all adults have tried e-cigarettes, with estimates nearly doubling from 2010. During 2010-2011, adults who have used e-cigarettes increased among both sexes, non-Hispanic Whites, those aged 45–54 years, and those living in the South, according to the CDC. In both 2010 and 2011, e-cigarette use was significantly higher among current smokers compared to both former and never smokers. Awareness of e-cigarettes rose from about four in 10 adults in 2010 to six in 10 adults in 2011. Read more on tobacco.
The Public Health Quality Improvement Exchange (PHQIX) is a brand new online community designed to be a communication hub for public health professionals interested in learning and sharing information about quality improvement (QI) in public health. PHQIX was created by RTI International and funded by the Robert Wood Johnson Foundation. The key goal of the site is to share national QI efforts by health departments of all sizes so that public health experts can learn from the experience of their colleagues across the country. NewPublicHealth recently spoke with Jamie Pina, PhD, MSPH, PHQIX project director, and Pamela Russo, senior program director at the Robert Wood Johnson Foundation about the new resource and its promise for helping health departments continuously improve their performance and achieve the national standards set forth by the Public Health Accreditation Board.
NewPublicHealth: What’s the vision of PHQIX, and how did it come about?
Pamela Russo: Public health departments are looking for ways to be more and more efficient and to eliminate waste and to make their limited budgets have the maximum possible impact. That’s the major value of QI, to show what works and where you can improve.
The new issue of Frontiers in Public Health Services and Systems Research (PHSSR), an online journal that looks at early research on issues related to public health services and delivery, focuses on quality improvement in practice-based research networks.
This issue’s commentary, from the journal’s editor, Glen Mays, PhD, MPH, is about a series of studies sponsored by the Robert Wood Johnson Foundation that look at how public health decision-makers are responding to accreditation, quality improvement, and public reporting initiatives during ongoing fiscal problems. Mays is co-principal Investigator of the National Coordinating Center on PHSSR, Director of the Public Health Practice-Based Research Networks and the F. Douglas Scutchfield Endowed Professor at the University of Kentucky College of Public Health. Mays says that, overall, the current evidence shows that “these initiatives represent promising strategies for strengthening evidence-based decision-making and expanding the delivery of evidence-tested programs and policies in local public health settings.”
Mays adds that continued comparative research and evaluation activities are needed to provide more definitive evidence about which combination of strategies work best, for which population groups, in which community and organizational settings, and why.
Over 100 health departments have engaged with the Public Health Accreditation Board on their accreditation journey, according to PHAB CEO Kaye Bender in an email exchange with NewPublicHealth, and more health departments enter the system each week. “One year post launch of voluntary national public health department accreditation, PHAB is excited about the progression of health departments through the process,” Bender wrote. “The first site visits began last month, and more are scheduled. We expect to announce the first accredited health departments in early 2013!”
At the recent APHA 2012 conference, representatives from California’s state and local health departments led a session offering their peers a first look at the accreditation process underway in California. As PHAB states, “the goal of national public health accreditation program is to improve and protect the health of the public by advancing the quality and performance of all health departments in the country – state, local, territorial and tribal.” All of the California representatives made a case for why accreditation is a priority for their respective departments.
“Accreditation equals opportunity,” said Dr. Ron Chapman, California Department of Public Health director. “Quality improvement is about problem solving. Infuse quality into what you do every day and you will see transformation.”
>>Watch a VIDEO with Ron Chapman about new opportunities to transform public health by making quality improvement a way of life.
Dr. Alonzo Plough, Emergency Preparedness and Response Program director for the Los Angeles County Public Health Department, said accreditation’s quality improvement standards align well with the “triple aim” goals of: improving patients’ experience of care, improving the health of populations and reducing the cost of health care.
Plumas County Public Health Agency director, Mimi Hall, talked about how building relationships with local hospitals and community and business leaders can help meet public health goals.
“We have to redefine the role of public health and work with outside organizations to get the best benefit for the community,” said Hall. “Accreditation pulls it all together.”
Several sessions at this year’s American Public Health Association meeting include brass-tacks guidelines for initiating and furthering partnerships between public health and hospitals to improve community health. In a session yesterday, Michael Bilton, who co-founded and leads the Association for Community Health Improvement of the American Hospital Association, spoke about the value of partnerships between public health and hospitals, since both have requirements to complete similar community needs assessments.
Health departments seeking public health accreditation must complete a community needs assessment, and non-profit hospitals must complete community benefits reports every three years under the Affordable Care Act.
Bilton pointed out that for many communities, the collaboration won’t be one that starts from scratch. San Francisco has had a community benefit requirement for non-profit hospitals since 1994, “which promoted a sense of collaboration in many communities,” Bilton told the audience at the APHA session.
Bilton says the collaboration also aligns with the National Prevention Strategy, released by the Surgeon General last year, which is promoting partnerships across federal agencies to improve community health.
>>Read an interview series on the National Prevention Strategy on NewPublicHealth.
Bilton says the Strategy specifically points to community needs assessments as a way to identify and begin working on many of the priorities in the Strategy. “And those priorities have already been identified by many hospitals,” says Bilton. The joined forces of hospitals and public health departments also help achieve the “triple aim” of additional goals stressed in the Affordable Care Act including improving improving care, improving health care quality and reducing costs. These collaborations underscore the notion that helping to manage population health is the role of hospitals as well, said Bilton.
Bilton advised public health officials anxious to collaborate with hospitals on community benefit requirements to do several things including:
- Become acquainted with hospital regulations
- Approach hospitals as early as possible in your process
- Find out who is leading the assessment
- Ask hospitals about their assessment process and goals
- Offer to help hospitals with with data, communications, facilitation or staff expertise, as appropriate
- Balance short term needs such as fulfilling IRS or accreditation requirements with longer term opportunities—sustained health improvement collaboration.
>>Bonus Link: Read a NewPublicHealth interview with Laurie Cammisa from Children's Hospital Boston on community benefit collaboration.
The Office for State, Tribal, Local and Territorial Support (OSTLTS) at the Centers for Disease Control and Prevention (CDC), was launched in 2009 as a central office dedicated to advancing public health at the state and local levels and identifying both gaps and opportunities for collaboration. Judith Monroe, the office's director, spoke to us last year about challenges facing health departments in a tough time. Recently, at the ASTHO Annual Meeting, we had a chance to catch up with Dr. Monroe to hear what she and her office have been up to since we last spoke in the summer of 2011.
>>Read our earlier Q&A with Dr. Monroe.
NewPublicHealth: The focus of the ASTHO annual meeting this year is on the intersection of health care and public health. What efforts is CDC engaged in right now in that intersection?
Dr. Monroe: We’ve been involved in a number of areas. The IOM report on the integration of primary care and public health, was co-funded by the Health Resources and Services Administration and CDC. And CDC had a seat at the table when ASTHO and the IOM came together to develop the strategic map for the integration. We’re excited about that and we continue to be on those calls.
We have an office here at CDC recently created called the Office of Prevention Through Healthcare that is looking at this intersection and where the gains might be, working with the Centers for Medicare and Medicaid Services very closely. And, in addition, our office—the Office of State, Tribal, Local and Territorial Support—has forged a relationship with all of the primary care residency programs across the nation. That’s dear to my heart because I was a residency program director in family medicine for a number of years. We’ve had a number of educational venues taking the science from CDC and packaging it in a way that the residency programs can use. We’re looking toward some quality improvement projects with the residency programs as well as “playing matchmaker” in many ways, between health departments and residency programs. And, I am the point person here at CDC for our relationships between the American Academy of Family Physicians and the American College of Physicians so we have a lot going on. Those are the biggies, but there are many daily activities taking place as well.
NPH: Thank you for that overview. Since you’ve been at OSTLTS, what are some successes that you’d point to?
A highlight of last week's Public Health Systems Research Interest Group meeting, which followed the AcademyHealth Annual Research Meeting, was a “Critical Opportunities” reception during which several presenters pitched their ideas for a law that could be used to improve or solve critical public health issues. The presenters were timed, given only five minutes to share the background of the issue to be addressed, their idea for the law, evidence that it could work and the feasibility of implementing the change. Attendees were encouraged to vote on their favorite to see which Critical Opportunity ranked highest--see below for the results!
This was the second such event since this year’s debut of Critical Opportunities for Public Health Law, an initiative of the Public Health Law Research Program (PHLR), a Robert Wood Johnson Foundation program at Temple University. The goal is to make the case for laws that can improve current critical public health needs by:
- Identifying important ways to use law to improve the public’s health
- Enhancing public and professional recognition of law as a vital force for better public health
- Guiding public health law research
NewPublicHealth caught up with two of the invited presenters, who also accrued the most votes on their topics--Tamar Klaiman, assistant professor at the Jefferson School of Population Health in Philadelphia, and Georgia Heise, DrPh, director of the Three Rivers District Health Department in Kentucky, and recently elected vice president of the National Association of County and City Health Officials.
NewPublicHealth: What did you both present on?
Tamar Klaiman: The policy that I addressed is about requiring physicians to offer new parents TDAP (pertussis) vaccines because infants who are [less than] six months of age are at the highest risk of mortality from pertussis, and so parents can protect their children by being vaccinated. Around 80 percent of pertussis cases in infants, when they can track where the pertussis came from, come from parents. The policy that I talked about is having providers offer pertussis vaccine to new parents prior to leaving the hospital or birth center with the newborn.
NPH: Why would that be valuable?
Tamar Klaiman: Newborns are not fully protected against pertussis until after their 6-month booster so vaccinating parents offers the best protection. So it’s a very low risk, high reward policy.
NPH: Are there states that are already implementing this law?
Tamar Klaiman: None as far as I know.
NPH: Georgia, what’s your critical opportunity?
Georgia Heise: I talked about voluntary public health department accreditation for local health departments. Accreditation encompasses a myriad of standards that cover the mission of public health and what health departments should be doing. This would standardize public health across the nation and force into place a lot of preventive measures and assessments and best practices that the health department would be doing things that would actually make a difference in population health.
NPH: Why is this a critical opportunity?
Georgia Heise: I think that across the United States we operate on a medical model, which means we don’t really put enough funding into anything that would teach people how to be healthy or keep them healthy. We put a lot of money into taking care of somebody once they’re sick or dying. We need to push in the opposite direction and focus on keeping people healthy, and these accreditation standards are a framework for health departments to start that. There’s now an opportunity for health departments to become accredited at the national level. It’s in place and ready to go, however, not all the health departments have opted in yet.
Results of the Critical Opportunities Vote at AcademyHealth
About 100 people texted their votes for the presentations at the Interest Group meeting. The results were as follows:
- Requiring physicans to vaccinate parents of newborns against pertussis (whooping cough) to better protect young babies: 50 percent of votes
- A law requiring that states health departments be accredited and that funding be provided to go through the accreditation process: 24 percent of votes
- Establishing comprehensive laws to deal with designer drugs such as synthetic marijuana that would be broad enough to encompass new drugs as they are introduced: 18 percent of votes
- Creating standards for public health department contracts with private entities: 9 percent of votes
>>Watch YouTube videos of Critical Opportunities presentations at the Public Health Law Research Program meeting earlier this year.