Category Archives: PHSSR
The impact of the economic crisis on budget coffers has prompted a growing number of state and local health department officials to consider cross-jurisdictional sharing as a strategy to cut costs and deliver services more effectively and efficiently. At the 2011 APHA meeting, a packed room of researchers and practitioners from across the country heard from a panel on this emerging topic, which included presentations on the experience of two states with vastly different sociopolitical landscapes: sprawling Colorado with its large rural expanses, and dense Massachusetts with its 351 local boards of health, just over half of which serve 10,000 people or less.
Despite the differences, two major themes dominated the discussion, which was moderated by Pat Libbey, former executive director of the National Association of County and City Health Officials and now a consultant and leading expert on cross-jurisdictional sharing: more information is needed to illuminate which approaches may be most appropriate for specific locales, and proactive stakeholder engagement is critical to gain buy-in for changes that may be seen as potential threats to local control.
"The minute you say regionalization, it’s a top-down approach," said Lisa VanRaemdonck, MPH, MSW, executive director of the Colorado Association of Local Public Health Officials and co-director for the Colorado Public Health Practice-Based Research Network, who shared findings from a recent examination to identify what types of service-sharing among local health agencies are most prevalent in the Centennial state, what the law allows, and why agencies have entered into these agreements and relationships. "Language and finding a careful balance is really important."
VanRaemdonck said the Colorado Public Health Act of 2008 allows the creation of district health departments to do regional work, and many agencies have begun regional approaches to provide services that were not previously available.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health.
In this era of declining resources for public health, and for that matter all of government, now more than ever it is imperative that we get the maximum bang for our buck. We simply cannot afford to be inefficient and ineffective in the delivery of public services. That means we need the best information, based on rigorous research, about how to provide public health services.
Public health services and systems research (PHSSR) provides answers. It guides us in how best to structure the public health delivery system and assure that what we do is the most efficient and effective way to keep people healthy and protected from disease. Just as good science needs to drive how we provide patient-centered, high quality, cost-effective health care services, we must have the information to assure population-centered, high quality, cost-effective public health services. PHSSR is the tool that allows that to happen.
A key session on the last day of NACCHO Annual 2011 was an invitation to attendees to weigh in on the preliminary research agenda for Public Health Services and Systems Research (PHSSR)--and that invitation is now being extended virtually as well.
Over the last few months, groups of interdisciplinary researchers under the direction of the Robert Wood Johnson Foundation, the Centers for Disease Control and Prevention and the Center for PHSSR Research at the University of Kentucky have worked together to create a preliminary agenda to assess the current state of PHSSR and set an updated research agenda, just posted to the Center’s site. The field of PHSSR helps to address critical limitations that exist in the U.S. public health infrastructure and provide a strong evidence base to help identify what works in public health and to support system improvements.
The preliminary agenda will be online for virtual comments for thirty days, during which users who come to the site are invited to vote on the final agenda items. After the comment period ends, feedback from sessions at public health meetings in the last few months, as well as the online comments now underway, will be used to inform and refine the research agenda. The agenda will be finalized and distributed in fall 2011.
The research categories include workforce; organization and structure; finance and technology; and data and methods.
Before voting, read an issue brief about the research agenda and read the suggestions and comments already posted on the site.
The National Association of County and City Health Officials (NACCHO) will hold its annual conference, NACCHO Annual 2011, in Hartford Connecticut later this week. NewPublicHealth spoke with Robert Pestronk, M.P.H., executive director of NACCHO, about the sessions, conversations and issues he expects to be highlights of the meeting.
NPH: If you could be a fly on the wall at the convention center, what conversations would you most likely expect to hear during the course of the conference?
Robert Pestronk: Since this is the largest annual single gathering of local health department officials in the United States, people will be greeting one another and talking with one another about how the year has gone since they last saw their colleagues. They will be talking about some of their successes and some of their challenges–trading information about things that have and haven’t worked. I think that people will be sharing information about their own careers and where they’re headed and how they’re finding their job as a local health official. There will also be conversations about a number of presentations because the presentations have been designed in many respects to stimulate conversations among the attendees about things that are current and forward-looking in the worlds of local health departments.
NPH: How can attendees maximize the value of the time they spend at the meeting in addition to the conversations with colleagues?
NACCHO 2011, the annual meeting of the National Association of County and City Health Officials, begins next week in Hartford, Connecticut. NewPublicHealth will be on the ground throughout the meeting covering workshops, general sessions and keynote speeches, as well as speaking with program speakers and conference attendees.
In advance of the meeting, NewPublicHealth spoke with Michael Caldwell, M.D., M.P.H., the Commissioner of Health in Dutchess County, New York, and a member of the NACCHO Annual Planning Committee.
NewPublicHealth: What is the theme of this year’s meeting?
Dr. Caldwell: The theme is “Moving Public Health Forward in Challenging Times.” Budget cuts, in particular, make this a time when we have to pull together and look at various opportunities that are afforded for local departments of health. A number of those opportunities are coming about because of the Patient Protection and Affordable Care Act, which is being implemented; the rolling out in the fall of public health department accreditation; and increased cooperation and collaboration between local departments of health and federally qualified health care centers.
NPH: You are the Chair of the Public Health Practice-Based Research Networks (PBRN) National Advisory Committee. What are PBRNs and what can conference attendees learn about them at the NACCHO meeting?
Glen Mays, M.P.H., Ph.D, Professor and Chair and director of research for the Department of Health Policy and Management at the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences, is a key researcher in the field of Public Health Services and Systems Research. Dr. Mays presented new findings both during the Annual Research Meeting and at the Public Health Services Research Interest Group meeting that followed the larger meeting. NewPublicHealth spoke with Dr. Mays about the presentations.
NPH: What were your key presentations at the Annual Research Meeting?
Glen Mays: Two presentations I’ve made here at the meeting I think get at some critical issues in terms of better understanding the contribution of Public Health Services and Systems Research (PHSSR) to overall health. One is a follow-up to some work we’ve been doing looking at public health spending patterns. Our most recent analysis looked at the effects of investments in public health on medical care spending to find out whether enhanced investments in public health can help to bend the medical care cost curve and help to alleviate some of the challenges that we have with affordability of medical care.
NPH: Talk a little bit about the tenth anniversary. You’ve seen the field grow--what practical applications are you seeing from the decade of research into PHSSR?
Mays: Well, I think we are really seeing a convergence now between the resources being produced in the research community and the demand and information needs of practitioners and policy makers to actually use that research. We are now seeing opportunities for using research and evidence to help inform practice and policy decisions. A good example is the current economic climate which is forcing some difficult choices--both in the policy level and the practice level --about what kinds of services to deliver and how to operate more efficiently.
NPH: What was your focus at the Interest Group meeting?
Mays: I spoke about our practice-based research networks--and looking at those networks as a mechanism for taking research findings and moving them into practice. So we’re studying the research process and our findings suggest that these networks, that bring together researchers, scientists, and practitioners, are actually helping to speed up that flow of information from research into decision-making in public health. We did a study with our initial cohort of five networks and looked at the membership of those networks. We surveyed over two hundred organizations that are part of those networks and looked at their engagement in the research process and their utilization of information that flows out of the research projects.
NPH: What is the best PHSSR question that anyone has asked you at this meeting?
Mays: I think one of the best questions that I’ve heard relates to how we define the public health delivery system and what are the attributes that make a system function as a coordinated system that address population health issues? That’s a question that we’ve danced around conceptually for a long time and we’re starting to think about how to better define and act on--and ultimately, improve the system aspects of public health.
For more, read a guest post by Glen Mays on Economic Shocks and Public Health Decision-making: How Can Research Help?
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Public Health Systems Research is the discipline that examines the organization, financing, and delivery of public health services and the impact of those activities on population health. The AcademyHealth PHSR Interest Group, which has grown to over 2,000 members, marked its tenth anniversary this week with a series of panel discussions about the field. NewPublicHealth spoke with two key presenters: Paul Erwin, M.D., co-principal investigator of the National Coordinating Center for PHSSR at the University of Kentucky; and Bridget Booske, senior scientist at University of Wisconsin’s Population Health Institutes and deputy director of the County Health Rankings.
NewPublicHealth: What did your presentation highlight?
Paul Erwin: I’m talking about health coalitions and in particular, examining health coalitions from the perspective of their being the organizing corollary for a local public health system. That’s important because health and health outcomes are the result of a number of different complex factors and if we want resolve these major problems, they can’t be solved by one entity alone. It’s all of the organizations, and individuals and entities that impact the health of the public at the community level.
NPH: And what is your current focus at the National Coordinating Center for PHSSR Research?
Paul Erwn: I’m working on providing a practical perspective on research, on the translation of research. In the last few months, we’ve gathered a working group together of people who have experience in the practice and academic worlds to answer questions such as who is successfully translating research into practice, how is it being done, what are the barriers, best practices and models for how we can support the practice world in this key area.
Taking this focus has importance in several key areas such as public health accreditation [which will launch in the fall of 2011.] One of the standards for accreditationhas to do with advancing new knowledge. The work we’re doing now at the Center has implications regarding improving the practice world’s capacity to deliver on this particular standard.
NPH: Bridget, what research did you present to the Interest Group?
Bridget Booske: The work is on media response to the release of the County Health Rankings in 2010, which is very important in terms of trying to engage broad segments of the community. The media is a key resource for reaching other stakeholders. We learned that we got very broad coverage in the better resourced communities, so we have to get more media coverage in less resourced communities. It’s harder to reach small media, but we need to keep working at it.
NPH: In what ways is the media coverage of the County Health Rankings important?
Bridget Booske: We want the media to continue to help us with the initial coverage, of the County Health Rankings, but we also have found that follow-up stories and letters to the editor to continually get the message out will only helps us improve the health of the community.
And it’s not just about getting the governmental public health folks, to write those letters and op-eds; we’ve had pretty attention grabbing op-eds from other key players such as hospital CEOs and head of local chambers of commerce. That’s great. We want to get other voices in there as well.
NPH: What input are you looking forward to from research colleagues at the PHSR Interest Group meeting?
Bridget Booske: I’m looking forward to getting input from other researchers in terms of how we really assess what we’re doing with the County Health Rankings. We have a logic model that says we’re trying to get attention from the media and have people use the information toward broad community attention and then to in turn implement evidence-based policies. We know we can get the media and we need researchers to help us with the rest of the logic model and ultimately to help improve what we do.
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Public Health Services and Systems Research is a featured topic at the 2011 AcademyHealth Annual Research Meeting in Seattle this week. Additionally, the AcademyHealth Public Health Services Research Interest Group will soon be holding its tenth anniversary meeting to share findings on topics including health disparities and best practices for public health systems.
To discuss the state of the PHSSR field, NewPublicHealth spoke with Debra Perez, Interim Assistant Vice President for Research and Evaluation at the Robert Wood Johnson Foundation, who is a key presenter at the AcademyHealth ARM this week.
NewPublicHealth: Tell us about the Robert Wood Johnson Foundation’s investment in Public Health Services and Systems Research.
Debra Perez: The Foundation has been investing in PHSSR since about 2004. We started our investment with support of the AcademyHealth PHSR Interest Group, as a matter of fact. That brought together about forty or so researchers to the AcademyHealth Annual Research Meeting. Subsequent to that, we expanded our work to broaden a connection with the practitioner community. The Interest Group meeting has grown to over 100 today. And our work has expanded with AcademyHealth as well to include training and support for people interested in doing PHSSR work.
Beyond that, we have done extensive work with the University of Kentucky, which heads the National Coordinating Center for PHSSR. Under them we have collaborated on data harmonization with three membership organizations of public health: the Association of State and Territorial Health Officers; the National Association of County & City Health Officials; and the National Association of Local Boards of Health. All of these organizations conducted profiles biannually or whenever they could get funding. So some of our investment in PHSSR was about stabilizing the funding source for these very critical data sets.
Our work has also included annual solicitations for investigator-initiated projects in PHSSR. We went from a $75,000 grant in 2004 to about a $60 million investment today.
NPH: AcademyHealth refers to Public Health Systems Research, while the Robert Wood Johnson Foundation refers to Public Health Services and Systems Research. Why is that?
Debra Perez: We felt it was important to include services in the definition. We didn’t want people to think of systems as something abstract. It was under the leadership of Jim Marks, senior vice president and group director of health of RWJF and formerly of the CDC. Jim pointed out that we wanted people to know what we meant by connecting systems to services. What we mean is that when you study food safety or vaccine programs or other issues under public health, it’s important to look at the infrastructure, workforce, governance, finance and general organization to better understand the quality of those services.
NPH: The Academy Health Public Health Services Research Interest Group is celebrating its tenth anniversary. What kind of growth in participation have you seen?
Debra Perez: The number of participants at the annual meeting has grown to over 100, but that’s just in-person. They have a broad electronic network of close to 1,500 . These ten years have been growth years, a burgeoning field that continues to grow and blossom. And we’re very proud of that.
NPH: You’ll be discussing the PHSSR research agenda at this meeting?
Debra Perez: Yes, there will be an opportunity to weigh in at the Interest Group meeting and we’ll also vet the research agenda at the upcoming NACCHO meeting and we’ll be looking for additional vetting opportunities.
NPH: How was the agenda developed?
Debra Perez: It has been a deliberate, exhaustive process to determine the research agenda in the four content areas: infrastructure, finance, data and technology, and workforce. Each group participated in at least two webinars and we did an exhaustive and systematic review of the literature, and this research agenda is identifying gaps. We hope to complete it by the end of the summer.
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What's the latest in health services research and current health policy issues?
You'll be able to find out at the AcademyHealth Annual Research Meeting, which takes place June 12-14 in Seattle. The annual meeting has been the premiere forum for health services research for close to thirty years. Key topics this year include health reform and using social media to disseminate research.
At the conclusion of the meeting, the Public Health Services Research Interest Group, funded by the Robert Wood Johnson Foundation, will be celebrating its tenth anniversary. Speakers include Debra Pérez, M.A., M.P.A., Ph.D., Interim Assistant Vice President for Research and Evaluation at the Foundation. You’ll be able to follow coverage of the conference here on NewPublicHealth.org.
In advanceof the Annual Research Meeting, NewPublicHealth spoke with Lisa Simpson, M.B., B.Ch., M.P.H., president and CEO of AcademyHealth, and David Colby, Ph.D., vice president of Research and Evaluation at the Robert Wood Johnson Foundation.
NPH: What are the key topics that will be discussed at the Annual Research Meeting?
Dr. Simpson: There is a rich set of presentations this year, as in other years. We’re lucky to receive terrific abstracts and presentations. One area where I’m particularly interested to hear and learn more is around what’s happening at the community level and the efforts on the ground to transform the delivery system. Some of those efforts are working very collaboratively with local public health and reaching beyond the traditional boundaries of medical care. For example, understanding how health information technology and different payment approaches are facilitating these newer organizational financing and collaborative models.
NewPublicHealth: From both your perspectives, can you talk about the intersection of health services research and public health services research?
Dr. Simpson: This is the tenth anniversary of the annual meeting of our Public Health Services Research Interest Group and we are reflecting on the progress we’re making in this field, how much public health services research is part of the family of health services research and how integral it is to advancing health. We have to have evidence to improve the delivery of care and the prevention agenda for population health. That’s where I think the future is going. I would also comment that increasingly we’re seeing alignments and recognition within the more traditional medical care delivery system of the need to focus on population health and the need for partnership and even more collaboration between the health system and the public health system.
Dr. Colby: Health services research is a young field and it’s a field that is interdisciplinary. So the boundaries around health services research are more like a fuzzy set than a brick wall. We have a strong tradition of looking at delivery, quality, and access in the medical care system. Yet the goal of many members of AcademyHealth, as expressed by David Kindig, M.D., the former chair, is to study how to maximize the health of individuals and the health of populations. The AcademyHealth board adopted a definition of health services research which included the impacts of social effects and personal behaviors on health and well-being. This means that research needs to focus on all the inputs into health from the health care system, personal behavior and characteristics, and the environment. There is a recognition that you have to take into account all of these things to influence people’s health.
Dr. Simpson: I agree with David. As a pediatrician we especially focus on factors outside of medical care and the health of children in particular is so dependent on that multidisciplinary approach to understand what works to maximize and optimize health outcomes for children and their families and their communities. There really are those fuzzy boundaries.
NPH: What is the conversation that needs to take place between health services delivery and public health?
Dr. Colby: Articles written in the early 1990s showed the most important inputs into the health of the public are not from the medical care system. If we want to improve the health of Americans, we have to be working on those areas that will produce the most leverage, and that is improving where people live, learn, work and play.
Dr. Simpson: As we think about public health, increasingly I think that we understand that what contributes to the health of the public goes well beyond public health departments or what is traditionally thought of as the institutions of public health. We’re seeing employers having a dramatic stake in public health, promoting employee wellness and health promotion and disease prevention. We’re seeing the health care delivery system moving more and more toward health as part of the triple aim which focuses on improving population health, the patient experience of care and cost. It is about how communities exist and structure their community institutions well beyond public health and health delivery--from transportation to food, the environment and the built environment--all of these contribute to achieving the health of the public--and so health services research is expanding its methods, approaches and data sets to bring in information that captures the dynamics and influences on the child, the family, the community. In that way, we are better able to tease out and understand the policy levers and the interventions that can optimize health outcomes.
Dr. Colby: One example is that the Federal Reserve became very interested in the impact of community development on the health of Americans. They have held several conferences around the country about the interface between what they do in housing and other policies and the health of Americans.
NPH: What do you think the Federal Reserve’s contribution can be that another entity might not be able to contribute?
Dr. Colby: When the Federal Reserve starts talking about health issues, it’s a ‘wow.’ The Fed controls significant amount of money that can be used to improve the health of Americans. Where and how you build houses, parks, sidewalks, and grocery stores will have an impact on health of Americans.
NPH: There are two sessions at the annual meeting that are devoted to helping researchers disseminate their findings. Are researchers finding it more or less difficult to get their information out to the stake-holders that need it and then make its way to the field?
Dr. Simpson: I think the answer is, like so many things in health policy, it depends. Our field is growing and vibrant. Our membership is at the highest point ever, almost 4,500, and we represent a very diverse field.
I think that there are many journal opportunities, and depending on which journal you’re working with, the competition and the difficulty in getting your work published in an academic journal varies tremendously--as might the delay in publication between when you have your findings and when it actually appears online. But I think that increasingly, researchers are recognizing that there need to be, and there are, many other venues for getting their findings into the hands of the decision makers who need evidence.At the same time, journals are moving toward more timely reviews and expedited online publishing.
There are also many other ways that researchers have been working increasingly to get their evidence into action--and we support a number of those methods. For example, learning networks where we identify a policy need and researchers and experts who have been publishing and working in that area and we bring them together. These networks create an opportunity for a researcher to very directly inform policymakers about their area of expertise and passion. Another example is the HCFO--Health Care Financing and Organization--a program of The Robert Wood Johnson Foundation managed by AcademyHealth. As the national program office for HCFO, we bring researchers together with their targeted users and audiences in small, focused discussions where you can really delve deeply into what is known and what is not. These sessions not only get information to the user more quickly, they actually help the researchers better understand what evidence is most needed. So, together with our members, we are really looking in very different ways to achieve our goal of moving knowledge into action.
NPH: Canyou talk about the impact of social media on evidence dissemination?
Dr. Colby: Health services researchers have to get used to social media for three separate purposes. One purpose is getting information out to people. Reporters follow tweets and that’s where they pick up some emerging stories. Obviously, the reporters will call up and get more in-depth information beyond 140 characters but Twitter provides the lead.
Another purpose is that social media tools are going to provide data for health systems researchers. For example, a project that we funded published an article on following tweets to figure out the impact of certain diseases, and an earlier article we funded used Google searches to show the spread of a disease. These studies represent a new epidemiology, which lets you know what’s going on before you get the official records.
Finally, I think that these social media tools are going to be very important in helping people improve their health. You could have an app on your phone that reminds you that you have to do specific things on a daily basis to improve your health.
Dr. Simpson: To build on what David has said, we see social media as the newest tool in our tool kit to support our mission of moving knowledge into action. I think there is enormous potential for the field to embrace these technologies and push them even further. In fact, one of the things that we’re announcing next week at an Institute of Medicine meeting around newly available data, and also at the Annual Research Meeting, is the REACH--Relevant Evidence to Advance Care and Health--Challenge. The REACH Challenge, which we are sponsoring in partnership with Health 2.0, offers a prize of $5,000 to a team of researchers, developers and other specialists who takes evidence-based research and data and translates them into an application that advances health and care.
This is really the future. Apps and social media are clearly an exciting new strategy for evidence dissemination and a new way to reach the audiences we need to target.
AcademyHealth has focused a lot more on social media in the last couple of years. You can follow us on Twitter, at @academyhealth or with the hashtag #ARM11 for the annual research meeting. We also have a blog at blog.academyhealth.org. And also new this year at the Annual Research Meeting is what I call "American Idol meets AcademyHealth," where we’re asking people at the meeting to choose their favorite poster presentation for inclusion in a first-ever “virtual poster session” by texting their vote to us. So we’re really trying to expand our approach and the various methods we use to engage our various audiences. At its core, it’s about matching up the content and the evidence with the medium and the messenger and the audience, and aligning all of these points so you’re delivering the right information in the right way to the right customer at the right time.
NPH: Will you both be tweeting at the meeting?
Dr. Simpson: David will be tweeting and I’m going to start learning how to tweet at the meeting!
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Faces of Public Health is a recurring editorial series on NewPublicHealth featuring individuals working on the front lines of public health and helping keep people healthy and safe. Today’s profile features Danielle Varda, Assistant Professor at the School of Public Affairs, University of Colorado Denver.
Danielle Varda has developed a unique — and potent — public health tool: a software program called PARTNER (Program to Analyze, Record and Track Networks to Enhance Relationships), which demonstrates the progress and benefits of collaboration to funders and others involved in public health services and systems (PHSSR) projects.
“Existing tools were insufficient to measure the effectiveness of collaboration,” says Varda, an Assistant Professor at the School of Public Affairs at the University of Colorado Denver and a guest lecturer at the Colorado School of Public Health in the Department of Health Systems, Management & Policy.
Varda says that stakeholders and funders want public health departments to collaborate with partners such as departments of education and the business community.
“So much of what is happening in public health is happening in a systems framework, so it’s important that everything is interconnected,” says Varda.
Working across boundaries by collaborating in social, political and economic domains brings tremendous value to health departments.
“Traditionally the goal in hiring people in health departments was to find staff with lots of knowledge,” says Varda. “Now an additional key goal is to also hire people who know how to find knowledge, because what you need to know will often be beyond your own specific discipline. It’s a key core competency to be able to find resources and to leverage those resources. That brings a new layer of what’s possible in public health.”
The software program, which the Colorado Department of Public Health and Environment recently used for a social network analysis for a coalition of public health teams, works on the assumption that partnerships and collaborations leads to improved outcomes.
At the 2011 Keeneland PHSSR Conference, held recently in Lexington, Ky., Varda presented PARTNER-derived data on twelve communities. The study looked at factors that contribute to successful collaboration — paying specific attention to how trust and the value that a partner might bring to a collaboration affects outcome.
“We showed that health departments are quite trusting of their partners — such as education and police departments — and that may be because public health is accepting of this shift, of needing partners,” Varda says.
As budget cuts continue at health departments across the country, Varda expects collaboration to be even more important — and for the PARTNER software to be a critical tool.
Editor’s Note: Danielle Varda has received a grant from the Robert Wood Johnson Foundation for work on the PARTNER software program.