Category Archives: PHSSR

Apr 18 2012
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Keeneland Conference: A Conversation with IOM's Harvey Fineberg

HarveyFineberg Harvey Fineberg, Institute of Medicine

In 2009, the Robert Wood Johnson Foundation, requested the Institute of Medicine (IOM) to convene a committee to consider three major topics in public health: measurement, law and policy, and funding. The last of these reports, which recommends new health targets and changes in how public health is funded and organized, was released last week and has been a key topic of discussion at this week’s Keeneland Conference.

Harvey Fineberg, MD, president of the IOM, delivered a keynote address on these three reports, as well as another recent report on the potential for collaboration between public health and primary care. NewPublicHealth spoke to Dr. Fineberg about the reports and next steps.

>>We're on the ground in Kentucky all week. Follow our coverage for the latest news.

NewPublicHealth: How will the findings from the three-report series on public health be helpful to public health service delivery going forward?

Dr. Harvey Fineberg: I think of these reports as the contemporary trilogy of public health. They each stand on its own and yet are also connected in a vital way.

The first report looks at how we can know where we stand in public health. It emphasizes the importance of a standard core set of indicators. The aim is to make them a guide for policy and practice of public health, and to monitor where we are and what needs to be done.

The second report was on the legal foundation that provides the authority for health agencies to protect the public’s health. It turns out that many of the statutes have been on the books for decades and don’t necessarily have the specifics for dealing with contemporary needs such as the challenge of dealing with obesity or emerging infectious diseases or bioterrorism. The report pointed to the ten essential services of public health which set a standard of practice, and spoke to what state laws would be needed to make the ten core functions operable.

The third report dealt with essentially the resources that would be needed to carry out public health services. And the committee found that we grossly under-invest in public health. They recommended a conservative estimate of doubling the national investment and proposed a fee on dollars that flow through the medical system to be captured and reinvested in prevention, which they said would ultimately protect and improve health.

NPH: How important was the evidence base to the committee in producing the reports?

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Apr 18 2012
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Keeneland Conference Q&A: Debra Perez of RWJF

DebraPérez Debra Pérez, Robert Wood Johnson Foundation

Debra Joy Pérez, MA, MPA, PhD, assistant vice president for Research and Evaluation at the Robert Wood Johnson Foundation, was a keynote speaker at the Keeneland Conference yesterday and spoke about the evolution of public health services and systems research (PHSSR). NewPublicHealth asked Debra Pérez about that evolution.

>>Follow our continuing coverage of the Keeneland Conference.

NPH: Why is the field of PHSSR a priority for the Robert Wood Johnson Foundation?

Debra Pérez: Right now, I think more than ever we need evidence to provide decision-makers with the evidence for how best to apply limited resources. We know in the last year alone over 40,000 public health jobs were eliminated, so that means that health departments are struggling with staffing and infrastructure issues, and they need evidence to help them best apply the limited resources they have now.

NewPublicHealth: What’s the scope of the conference this year compared to previous years?

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Apr 17 2012
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Keeneland Conference: A Look Ahead with F. Douglas Scutchfield

Scutch Dr. Douglas Scutchfield, director of the National Coordinating Center for PHSSR

The annual Keeneland Conference kicked off today, where more than 300 public health services and systems researchers (PHSSR), public health officials and policy-makers have convened to discuss the latest issues in this growing field of research. PHSSR is aimed at establishing an evidence base to allow public health officials to make smarter, more-informed decisions with regard to resource allocation, staffing, operations and service provision.

NewPublicHealth is on the ground in Kentucky to capture the critical conversations and Q&As from leaders in the field. We spoke with F. Douglas Scutchfield, MD, director of the National Coordinating Center for PHSSR and the Peter Bosomworth endowed faculty in the University of Kentucky College of Public Health, to get his take on where the PHSSR field stands and the anticipated highlights of conference.

NewPublicHealth: What are the critical areas for public health as you head into the Keeneland Conference?

Dr. Scutchfield: I think there are several agendas that will be a backdrop against which Keeneland is taking place. One is a reformed healthcare system, with the Affordable Care Act and its implications for public health and public health’s relations with a variety of other service delivery systems, such as primary care and hospitals.

We will also see the rollout of a new research agenda, published as a supplement to the American Journal of Preventive Medicine,that will give us a new direction to pursue in terms of how we’re going to begin to try improving the infrastructure in the public health system.

NPH: What has been your sense in speaking with colleagues in the field about what kind of research is most in demand for public health leaders and decision-makers right now?

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Apr 17 2012
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Follow NewPublicHealth at the Keeneland Conference

Public health departments have always been on the frontlines of keeping people safe and healthy. But given budget realities, how can they do more with less? And where should they invest to make the most dramatic improvements in people’s health?

The annual Keeneland Conference, which focuses on the increasingly critical field of public health services and systems research (PHSSR), begins today in Lexington, Ky., hosted by the National Coordinating Center for Public Health Services and Systems Research at the University of Kentucky College of Public Health and the Robert Wood Johnson Foundation, and will bring together leading researchers and public health professionals to help begin to answer those questions and more.

This year’s conference features speakers and researchers from across many health and public health fields including Harvey Fineberg, MD, president of the Institute of Medicine, Thomas Frieden, MD, director of the Centers for Disease Control and Prevention, Richard J. Umbdenstock, president and CEO of the American Hospital Association, Ms. Carole Moehrle, chair of the board of directors of the Public Health Accreditation Board.

Key topics at this year’s meeting include the PHSSR research agenda, in development for several years by dozens of contributors from across public health, which Debra Joy Pérez, MA, MPA, PhD, assistant vice president for Research and Evaluation of the Robert Wood Johnson Foundation, will announce during the Keeneland Conference; as well as an introduction to Frontiers, a new online PHSSR journal.

Among several important plenary sessions is one on recent Institute of Medicine recommendations on public health financing and the alignment of primary care and public health. Glen Mays, MPH, PhD, professor at the University of Kentucky, will talk about financing, and Lloyd Michener, chair of the department of family and community health at the Duke University School of Medicine, will talk about primary care and public health. Additional participants during those sessions include Robert Pestronk, executive director of the National Association of County and City Health Officials, Paul Jarris, MD, executive director of the Association of State and Territorial Health Officials, and Judith Monroe, MD, director of the Office for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention.

NewPublicHealth is on the ground in Lexington. Follow our coverage of sessions and plenaries as well as interviews with many conference participants including Debra Perez, Richard Umbdenstock, Professor Douglas Scutchfield of the University of Kentucky, Professor Glen Mays and Dr. Fineberg.

Follow the conversation on Twitter at #PHSSRKC12.

Weigh In: Are you tweeting from Keeneland? Let us know!

Apr 11 2012
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Public Health Financing: NewPublicHealth Q&A with Marthe Gold and Steven Teutsch

A new report released this week by the Robert Wood Johnson Foundation-sponsored Institute of Medicine Committee on Public Health Strategies to Improve Health calls for significant reforms to refocus America’s public health system toward prevention of the chronic diseases that are taking a toll on the nation’s health and economy.

The report, For the Public’s Health: Investing in a Healthier Future, is the final in a series that is intended to help guide efforts by public health leaders, policymakers and other stakeholders to address the nation’s health challenges in the 21st century and beyond. The committee’s 10 recommendations include one that is focused on setting national targets for life expectancy, and another on establishing a basic array of programs and services that would enable every health department to provide a standard level of health protection in the communities they serve. The committee also recommended creating a stable, dedicated funding source. They favored a medical care transactions tax, and examined other taxes as well as less traditional funding sources such as community benefits, social investment bonds and collaboration with community development financial institutions.

NewPublicHealth spoke with Marthe Gold, MD, MPH, chair of the report committee and professor and chair of the Department of Community Health and Social Medicine at the Sophie Davis School of Biomedical Education of City College, and Steven Teutsch, MD, MPH, vice chair of the committee and Chief Science Officer for the Los Angeles County Department of Public Health, about the committee’s recommendations.

>>Read our earlier Q&A with Marthe Gold on the second report in the IOM series, titled For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges.

NewPublicHealth: What’s the big picture on the committee’s report and the recommendations around public health financing and how do you hope it will be used?

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Feb 16 2012
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Helping Health Departments Make Smart Decisions with Limited Resources: Q&A with Douglas Scutchfield

scrutch Dr. Douglas Scutchfield, National Coordinating Center for Public Health Systems and Services Research

Now more than ever public health officials and policy-makers need to make smart decisions about where to invest our limited public health resources, and public health services and systems research helps to uncover the data that points the way to sound decisions about the financing, staffing and structure of health departments.

Today, eleven new research projects on public health systems and services research were announced, to illuminate the best strategies and practices to enable state and local health departments to be effective and efficient in keeping people healthy and safe. The new grants, funded by the Robert Wood Johnson Foundation (RWJF), will examine the impact of budget reductions and program cuts on the health of the population. The grants will be administered by the National Network of Public Health Institutes, with guidance from the National Coordinating Center for Public Health Systems and Services Research, an RWJF-funded center housed at the University of Kentucky College of Public Health.

Research on best practices and strategies for delivering public health services continues to emerge. The Robert Wood Johnson Foundation’s Public Health Practice-Based Research Networks announced a new series of studies to focus on how to reduce health disparities in the delivery of public health and prevention strategies, and about roles that the public health system can play in eliminating health disparities.

NewPublicHealth spoke with Professor Douglas Scutchfield, MD, Director of the National Coordinating Center for Public Health Systems and Services Research, about the new grants and the importance of public health services and systems research.

NPH: What’s the goal of public health services and systems research (PHSSR) and of these specific grants?

Dr. Scutchfield: In order to improve the public’s health we have to be more efficient and effective in our efforts to try to improve health status, and unless and until we look at some of the issues surrounding the infrastructure of public health, then we’re not going to be able to answer those critical questions about efficiency and effectiveness in the public health system.

PHSSR provides these kinds of insights, in a way that is particularly applicable for state and local health departments. This research also has policy implications, and the extent to which we are able to convey to policymakers the results and implications of these research projects may well have substantial implications for policy and policy development.

These are trying times in any public service environment, and there’s a trend in these grants to look at kind of the natural experiment that we’re seeing in the economic downtown and its impact on public health and how best to cope with that. A substantial number look at how best, at the state and local levels, to cope with health department budget cuts both generally and in some very specific areas, notably maternal and child health. Another thing we’re seeing is a changing health care environment, and at least some of these grants look at handling changes that are the result of health system reform.

NPH: Why is this such a critical time for this research?

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Feb 16 2012
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Expanding the Breadth of Health Research Covered by the Media

Frakt Austin Frakt, The Incidental Economist

This week’s final plenary at the AcademyHealth annual National Health Policy Conference focused on the media’s role in health policy and featured Austin Frakt of The Incidental Economist (which is supported in part by the Robert Wood Johnson Foundation), Ezra Klein of the Washington Post and Merrill Goozner of The Fiscal Times. Frakt, a health economist, touched on virtually all of the points the speakers made during the one hour session, in a post on his blog the day of the plenary. Most important perhaps was that researchers need to do more than just issue a press release in order to disseminate their results. “I encourage researchers to get involved on Twitter and blogs. Promote the work of the community when it is timely and relevant,” wrote (and said) Frakt. Ezra Klein, who has an extensive following, invited researchers to email him and not shy away because they think he might be inundated. “Let me manage my inbox,” Klein said.

NewPublicHelath spoke with Frakt about the role of social media in reporting critical health information.

NewPublicHealth: Your training was not in health. What did you do before and did you get into the health field?

Austin Frakt: My training is in physics and engineering. I went through a PhD program in electrical engineering at MIT, and although what I was really doing was kind of applied math, I recognized during my studies that I really was interested in questions pertaining to policy. So I did finish my PhD, and the math and the rigor of it was valuable. I was intrigued by [health policy work at Abt Associates] and that’s where I ended up. It wasn’t that I was, at the time, particularly drawn to health, I just wanted to do something in the policy direction and I was particularly drawn to a rigorous, mathematical kind of evidence-based study.

NPH: And what made you focus on health policy?

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Feb 15 2012
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Public Health Services Research: Building the Evidence

AcademyHealth’s Public Health Systems Research Interest Group held a breakfast briefing yesterday, sponsored by the Robert Wood Johnson Foundation, during their National Health Policy Conference this week.

The session, “Evidence Matters: Research Findings to Inform Public Health Policy and Practice,” featured Glen Mays, PhD, the F. Douglas Scutchfield Endowed Professor at the University of Kentucky College of Public Health, and Randall R. Bovbjerg, a Senior Fellow at the Urban Institute’s Health Policy Center. The session was moderated by Paul Wallace, MD, Senior Vice President and Director of the Center for Comparative Effectiveness Research at the Lewin Group.

Paul Wallace pointed to two critical questions:

  • What are the strategic opportunities for public health in the health care landscape?
  • How do we preserve what we’ve got and anticipate the roadblocks?

Wallace reviewed events and decisions that created the current public health environment:

  • Public health and health care delivery have not always been separate domains
  • Health care took the biomedical route and left behind the social determinants of health, and “became quite enthralled” with technology
  • In 1960 the Rockefeller Foundation made the strategic decision to create schools of public health, creating a philosophical and organizational schism between public health and health care
  • The 1966 Fulsome Report looked at what it would take to find the common ground between public health and health care. Since then, every few years the issue of creating better alignment between public health and health care resurfaces, but none of those efforts have stuck.

What’s needed is not to merge or eliminate public health, said Wallace, but to find common ground between the fields. “How do we use public health as a convening area instead of a wrestling ground?”

Next steps discussed during the session include creating shared leadership and recognition that neither health care delivery nor public health is up to the task alone. New solutions are coming out of local experimentation. A good example is Chicago, which is working with public health, health care and other community partners to improve population health. “To be successful in population health, you need to have that third party. It doesn’t matter who it is; it could be schools or social services [for example],” said Wallace.

Glen Mays reiterated the need to make the business case—learning the value of investments in public health to inform policy decisions going forward, and reminded the group that only 3 percent of national spending goes toward public health and preventive services, while 97 percent goes toward medical care, treatment, rehab and long-term care.

Mays also says that public health needs to align themselves with emerging Accountable Care Organizations “because that is where the funding is.”

>>Read more on the value and return on investment in public health and prevention.

Weigh In: How is public health working with health care organizations in your community?

Dec 16 2011
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Call for Abstracts: Public Health Systems and Services Research Keeneland 2012 Conference

keenelandConference

For the fifth year, close to 400 researchers, practitioners and policymakers will come together in Lexington, Ky., to share innovative ideas on how to improve the public health system. The conference will take place April 17 to April 19, 2012, and will continue the conversation on the impact of specific public health strategies on the quality and performance of the United States public health infrastructure. The conference also provides an opportunity to share new research that will allow decision-makers to more efficiently use scarce resources to organize, finance and deliver services through the public health system.

Speakers at this year's conference include Harvey Fineberg, MD, MPP, PhD, President of the Institute of Medicine and Thomas Frieden, MD, MPH, Director of the Centers for Disease Control and Prevention.

The call for abstracts is open now through January 9, 2012 at 3 p.m. ET. Questions regarding submission guidelines should be sent to the national program office (email abstracts@publichealthsystems. org).

Learn more about the Keeneland 2012 Conference.

>>Read more about public health services and systems research.

Dec 7 2011
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Helping Health Departments Make Smart Decisions with Limited Resources: Q&A with Douglas Scutchfield

Now more than ever public health officials and policy-makers need to make smart decisions about where to invest our limited public health resources, and public health services and systems research helps to uncover the data that points the way to sound decisions about the financing, staffing and structure of health departments.

Today, eleven new research projects on public health services and systems research were announced [LINK], to illuminate the best strategies and practices to enable state and local health departments to be effective and efficient in keeping people healthy and safe. The new grants, funded by the Robert Wood Johnson Foundation (RWJF), will examine the impact of budget reductions and program cuts on the health of the population. The grants will be administered by the National Network of Public Health Institutes, with guidance from the National Coordinating Center for Public Health Services and Systems Research, an RWJF-funded center housed at the University of Kentucky College of Public Health.

NewPublicHealth spoke with Professor Douglas Scutchfield, MD, Director of the National Coordinating Center for Public Health Services and Systems Research, about the new grants and the importance of public health services and systems research.

NPH: What’s the goal of public health services and systems research (PHSSR) and of these specific grants?

Dr. Scutchfield: In order to improve the public’s health we have to be more efficient and effective in our efforts to try to improve health status, and unless and until we look at some of the issues surrounding the infrastructure of public health, then we’re not going to be able to answer those critical questions about efficiency and effectiveness in the public health system.

PHSSR provides these kinds of insights, in a way that is particularly applicable for state and local health departments. This research also has policy implications, and the extent to which we are able to convey to policymakers the results and implications of these research projects may well have substantial implications for policy and policy development.

These are trying times in any public service environment, and there’s a trend in these grants to look at kind of the natural experiment that we’re seeing in the economic downtown and its impact on public health and how best to cope with that. A substantial number look at how best, at the state and local levels, to cope with health department budget cuts both generally and in some very specific areas, notably maternal and child health. Another thing we’re seeing is a changing health care environment, and at least some of these grants look at handling changes that are the result of health system reform.

NPH: Why is this such a critical time for this research?

Dr. Scutchfield: It’s important to recognize that we’re going through a very tumultuous time in terms of the health care system—that the public health system is the backbone of our ability to maintain our health and our health status, and the extent to which we’re able to do through these trying times is going to be important.

There’s some indication, for example, that in some areas we’re actually seeing a downturn in life expectancy and I don’t think anybody wants to see that kind of thing occur as a result of all of these changes in the economic system. If that’s the case, then public health is key in order to maintain and improve health in these difficult times.

NPH: Who will benefit most from the research and findings created by the grants?

Dr. Scutchfield: It’s absolutely imperative that the results of these get translated to action on the part of people who practice public health—who actually are providing the services. These grants are intended to inform their decision-making, to help them understand and facilitate their capacity to deal with services and to rapidly evolve the public health system. So I think probably the most important thing that we need to think about is making sure that the results of these grants get transmitted to individuals who can operate on those—particularly state and local health directors, but also policy-makers and other public health officials.

NPH: Given the current economic environment, are there any studies that you expect will generate particular interest?

Dr. Scutchfield: One study [LINK] by the Johns Hopkins School of Public Health looks at the extent to which states are able to utilize mechanisms to protect public health in an economic downturn—what sorts of budget-setting and priority-setting processes, what sort of scenarios and consequential public impacts might have on outcomes at a state level.

At the same time, another group is looking at the implications of the economic climate at the local health department level. A team at the University of Washington School of Public Health is working with several of our PBRNs [practice-based research networks] to see how looking at how specific local health departments are going about the process of trying to cope with any of these economic changes, and if there are particular strategies that they have used or developed that appear to have broad applicability.

NPH: How is the National Coordinating Center for PHSSR helping with ongoing federal research into public health service delivery?

Dr. Scutchfield: One of the major functions of the National Coordinating Center is to, on a periodic basis, review the available literature on PHSSR and to make relevant studies available through the National Library of Medicine and through our websites.

In addition, two studies have been commissioned by the federal government in recent weeks to examine issues related to the financing of public health activities in the U.S. Both studies are seeking to review empirical literature, data, and related evidence concerning financing mechanisms and spending patterns for public health activities in the U.S., and the health and economic effects of these investments—who pays, how much, for what, through what financing mechanisms, how do these patterns vary across the U.S. and change over time, and what are their health and economic effects. We anticipate that our various resources are going to be used, and we’ve already had some contacts and discussions with researchers conducting one of the studies. And I anticipate hearing from GAO [Government Accountability Office] as well to help provide the information that will allow them to effectively look at the literature and try to draw some conclusions around these issues of financing public health services.