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.

A new commentary by Dr. Georges Benjamin, president of the American Public Health Association, looks at how the Affordable Care Act (ACA) is impacting public health and how it will create new opportunities for better health for more people across the nation.

The Affordable Care Act affects all 10 essential public health services, writes Dr. Benjamin in the commentary published by the Institute of Medicine.  Dr. Benjamin says the ACA will influence the public health system in three major ways:

• Expanded insurance coverage will impact how public health departments offer clinical services: Governmental public health agencies currently providing clinical services may transfer cases to the private sector, such as routine childhood vaccinations.
• New care delivery models offer opportunities to integrate public health principles and enhance requirement for hospitals to define and utilize beneficial community efforts: Public health practitioners will have the opportunity to share their expertise on assessing the health of populations, implementing community and broad-based solutions, and evaluating the outcomes of these solutions.
• Public health services can reach more people: Programs and services such as, home visiting and other maternal child health programs and specialized behavioral health services will be made available to the general population, in addition to programs on prevention and protection.

“There is a lot to learn as we make this transformation to achieve better health and better value for our health investment. A transformed public health system is an essential element of that change,” Dr. Benjamin comments in the report.

>>Read the commentary.

>>Bonus links:

• Read a NewPublicHealth post on a convening of local, state and national public health leaders to develop guidance for transforming public health
• Read more on how states are implementing the ACA

There is great promise in leveraging the strengths and resources of both the health care and public health systems to create healthier communities. Hospital community benefit is one critical area of opportunity for greater collaboration. Historically, nonprofit hospitals, as a condition of their tax-exempt status, have been required to enhance the health and welfare of their communities. Through the Affordable Care Act, nonprofit hospitals will have the opportunity to direct their community benefit efforts toward public health interventions and collaborate more effectively with local health departments.

>>Read more and join the conversation about working together across public health and health care.

Paul Kuehnert, MS, RN, senior program officer and director of the Public Health Team at the Robert Wood Johnson Foundation (RWJF), shared his insights on the opportunities and challenges that lie in integrating health and health care. Prior to joining the Foundation, he was county health officer and executive director for health for Kane County, Ill., where he led a partnership between the health department, hospitals and other partners to assess and address the community’s health needs. Paul is a Pediatric Nurse Practitioner and worked as a primary care provider in schools and other community settings in Missouri and Illinois.

NewPublicHealth: There has been lots of conversation across the public health field about the need for more strategic coordination or integration with health care. Why is there so much focus on this now?

Paul Kuehnert: There are a couple of reasons for that. One of the primary reasons is that we know that there are increasingly limited dollars for public health. We really have to be as efficient and effective as we can be in trying to improve health in our communities. There’s a common interest between public health and health care around controlling the overall cost of health care. At the same time, we’re not getting the kinds of health outcomes we need. There’s this dynamic of mutual interest in controlling cost and finding ways to improve health and get to the best health outcomes for the community.

Inspired by the 2012 American Public Health Association (APHA) Annual Meeting, the Robert Wood Johnson Foundation recently talked with a range of national thought leaders to discuss what’s needed—and what works—to achieve better health.

Today, we're featuring video interviews Alex Briscoe, director of the Alameda County Health Care Services Agency.

In the first video, Briscoe talks about the connection between health, wealth, race and class. Briscoe says, "it's now harder to get out of poverty than in the history of our civilization." Watch the video:

Briscoe also talked about how we can shift the power dynamic that exists between consumer and physician. How can we empower patients to realize that they are their own best clinician? Briscoe shares his ideas:

Finally, Briscoe talks about "the trump card" in achieving better health outcomes: the resilience of communities and individuals. Watch the video:

Public health has experienced major economic, environmental, and technology upheavals in recent years. A new round of research supported by the Robert Wood Johnson Foundation (RWJF) will examine how recent dramatic changes in the operation of the nation’s public health system impact its effectiveness in such critical roles as emergency preparedness and reporting of disease outbreaks.

Seven new research awards are part of an initiative on “natural experiments” in public health delivery developed by the National Coordinating Center for Public Health Services and Systems Research (PHSSR), a RWJF-funded center housed at the University of Kentucky College of Public Health. The awards of $200,000 each are being administered by the National Network of Public Health Institutes.

NewPublicHealth spoke with Lainie Rutkow, PhD, JD, MPH, assistant professor at the Johns Hopkins Bloomberg School of Public Health, about her award to assess whether state laws influence the public health workforce’s willingness to respond in emergencies. The award will include collaboration with the National Registry of Emergency Medical Technicians; Butler County Health Department in Missouri; and the Multnomah County Health Department in Oregon. Rutkow, a member of the Eastern Region of the Network for Public Health Law, will also be presenting about some of her other emergency preparedness work at the Public Health Law Conference in Atlanta this week.

>>Follow NewPublicHealth coverage of the Public Health Law Conference, with speaker interviews, session coverage and more.

NewPublicHealth: Tell us about natural experiments and the opportunity they offer to better understand how the public health system can operate more effectively.

Lainie Rutkow: Natural experiments really capitalize on variations that already exist, particularly within the public health system, and as researchers we can analyze the public health impacts of a natural experiment over time and also in different settings. I see natural experiments as an opportunity to compare populations who are exposed to a particular policy with populations that have not been exposed to that policy. It would be very difficult or impossible to do that kind of thing in a controlled research setting. 

NPH: What is your particular award designed to look at?

The Transforming Public Health project supported by the Robert Wood Johnson Foundation (RWJF) and convened by RESOLVE brought together a group of local, state and national public health leaders to develop guidance for public health officials and policymakers in prioritizing critical public health functions in a changing political and funding landscape.

Recently, the Foundation hosted a webinar to discuss the Transforming Public Health project. Speakers included:

• Terry Cline, Oklahoma State Health Department
• David Fleming, Seattle-King County Health Department
• Abby Dilley, RESOLVE
• Abbey Cofsky, RWJF program officer
• Paul Kuehnert, senior program officer and director of the RWJF Public Health team

>>Read our recap of the discussion from the webinar.

But the conversation shouldn't stop there. We want to hear your thoughts on the future of public health. Below are some questions to get you started. Feel free to add your thoughts in the comments below, and help us chart the course for a new public health.

• How is your public health department adapting in the current changing landscape?
• How is your community prioritizing programs and services to take on new challenges in a time of declining resources?
• How have you engaged policy-makers and diverse partners in your community on issues critical to public health?

>>Read more: Check out these resources to get ready for the webinar and inform the discussion:

• Read the full Transforming Public Health report.
• Read a Q&A with Paul Jarris and Robert Pestronk on how the report’s findings can be implemented to help improve public health services and population health.
• Read our recap of the discussion during the webinar.

Last week’s Keeneland Conference included a session that looked at research in the area of law and legal process. The session was moderated by Scott Burris, JD, director of Public Health Law Research, a program of the Robert Wood Johnson Foundation, based at Temple University.

Burris noted several key presentations during the conference including one by Julia Costich, JD, PhD, who is an associate professor in the Department of Health Services Management at the University Of Kentucky College Of Public Health. Costich presented on the importance of how health agencies enforce the power they have. Burris says there is a huge body of literature from regulatory and governance sources on how effective regulators regulate—and that public health is only beginning to draw on. “That’s really opening a big important door, and we’ll see a lot more about that in future years.”

Jennifer Ibrahim, PhD, MPH, an associate professor of public health at Temple University, looked at how law is being figured out at the local level. Burris said that researchers both at the Public Health Law Research Program and collaborators have conducted research on the relationship between state and local health officers and their lawyers.

National Public Health Accreditation launched last fall, and since then 64 local health departments, three tribal health departments and one state department have submitted applications to the National Public Health Accreditation Board (PHAB). Carol Moehrle, chair of PHAB and director of public health for the Idaho North Central District, spoke about the accreditation process and benefits during a keynote speech at the Keeneland Conference. NewPublicHealth caught up with Carol Moehrle during the meeting.

NewPublicHealth: Are you pleased with the number of applicants you’ve seen so far?

Carol Moehrle: We are pleased. We knew we’d have some early adopters. And to have 68 complete their applications with the last seven months, that’s a great start. We’ve got a long way ahead, but we also know we have many applicants in the queue waiting to apply. We’re hearing lots of good energy, and departments beginning the process now can look to the earlier applicants for best practices, so applying will be easier as time goes on.

NPH: What is the process and timetable for accreditation application review?

The intersection of health and health care was an important theme at this year’s Keeneland Conference—during sessions on recent IOM reports, in hallway conversations, in discussions of Public Health Services and Systems Research that explores the most efficient ways to deliver public health services, and, notably, during the keynote address by Richard Umbdenstock, president and CEO of the American Hospital Association.

In his presentation, Umbdenstock talked about hospitals and public health, "collaborating for communities," and said that as health care providers, hospitals had tended to focus on treating the individual, rather than on prevention for the population. Now, he said, the money is gone and the public cares more about health, meaning it makes less and less sense for either hospitals or public health to be concerned with protecting their turf. “We need to incent health and deglamourize consumption.” Quoting a colleague, Umbdenstock said “what we need to do is create an epidemic of health.”

Umbdenstock spoke frankly when he told the attendees, “hospitals want to improve the lives of their patients, and not just their health care. Rather than wait for an [hospital] admission that won’t be paid, they’d rather get upstream on primary care.”

“Public health departments must be funded and supported so that wellness and prevention touches all and there are enough resources to do that,” said Umbdenstock. “And this is where research can play a big part—collaborative health research. We need to know the most effective collaborative models and the most effective ways to advocate for greater personal and community responsibility.”

NewPublicHealth caught up with Richard Umbdenstock following his talk.

NewPublicHealth: What are you hearing from hospitals about the new IRS community benefit requirement?

Richard Umbdenstock: Some hospitals have had similar responsibilities at the state level and many have had to put out accountability reports to their communities, so for many it’s not a new concept. In addition, hospitals have long been under a microscope and they also understand that community benefit is a wonderful community education tool. If they can tell it in a clear and consistent fashion, there’s a real opportunity for the public to better understand what hospitals and public health departments do.

NPH: Do hospitals and public health understand the critical community roles each one plays?

Richard Umbdenstock: I don’t think there’s any question what public health departments do after you’ve see them spring into action after a disaster, just as a lot of people don’t value what hospitals do until after they’ve been a patient. On a day-to-day basis we can all get so deep in our work that we just don’t see what the other person is doing. What we’re learning is that we all serve the same person.