Category Archives: Research
During opening remarks at this year’s Keeneland Conference, hosted by the National Coordinating Center for Public Health Systems and Services Research (PHSSR) based at the University of Kentucky in Lexington, Professor Douglas Scutchfield, director of the Center, proudly announced that three of the first health departments to be accredited by the Public Health Accreditation Board (PHAB) earlier this year were in Kentucky. Accreditation had its own track during the conference scientific sessions, including a presentation from Jessica Kronstadt, MPP, PHAB’s director of research and evaluation.
NewPublicHealth caught up with Kronstadt to talk about her presentation on some very early findings from an internal evaluation of the accreditation process.
>>Read more on national public health department accreditation.
NewPublicHealth: What information is PHAB seeking to gain from an evaluation of the accreditation process?
Jessica Kronstadt: Just as we’re asking health departments to engage in quality improvement, PHAB is very much committed to engaging in quality improvement of the accreditation program. So these evaluation efforts will really help us understand what is working well in our accreditation program, and what the experience was like from the perspective of the health departments and the site visitors. This evaluation will allow us to continue to improve the accreditation process.
The last session of the Keeneland Conference focused on translation and dissemination of public health systems and services research, with the critical goal of more efficient and effective delivery of public health services and improving population health. NewPublicHealth spoke with Ross Brownson, PhD, of the Prevention Research Center at Washington University in St. Louis. Dr. Brownson has received funding from the Robert Wood Johnson Foundation to explore evidence-based decision making at local health departments.
NewPublicHealth: How far back does evidence-based public health go?
Ross Brownson: The formal underpinnings of evidence-based public health were developed in the late 1990s, so at least the formal literature has been around for probably about 15 years. Of course, research on effective interventions has been around for many more decades. The newer field of public health services and systems research is much newer, just within the last five years or so, and these different bodies of research are now converging.
The early research focused a lot on identifying evidence-based interventions. The newer research is more on the process of evidence-based public health—regardless of the intervention, how do you develop and implement an evidence-based health department?
We identified five domains that are really important:
- leadership of the agency;
- ability to develop, formalize and maintain good partnerships within the community;
- workforce training and development;
- focus on organizational climate and culture; and
- effective financial and budgeting processes.
The ultimate goal is to make the population healthier and we know that the way to improve the overall health of the public is largely through state and local governmental public health. To reach that ultimate goal you want to have the most effective health department possible and also make the most efficient use of resources. We’re always in a time of tight resources, but probably now more than ever. That calls on us to be as effective and efficient as we can be in the delivery of public health services.
NPH: How will you disseminate these best practices and this evidence base to state and local public health officials?
Today’s plenary speaker at the 2013 Keeneland Conference is William Roper, MD, MPH, dean of the school of medicine, vice chancellor for medical affairs and CEO of the UNC Health Care System at the University of North Carolina at Chapel Hill. Earlier in his career, Dr. Roper was senior vice president of Prudential HealthCare, president of the Prudential Center for Health Care Research, director of the Centers for Disease Control and Prevention and administrator of the Health Care Financing System, the precursor to the Center for Medicare and Medicaid Services.
NewPublicHealth spoke with Dr. Roper on his way to the Keeneland Conference about the drive to better use data, instead of anecdotes and personal beliefs, to drive decision-making.
NewPublicHealth: What were some of the early efforts you were involved in that set the stage for the field of public health services and systems research we know today?
Dr. Roper: I didn’t do this by myself; I did it with a lot of other people, but one of the critical early efforts was the publication of Medicare mortality information on all American hospitals beginning in 1986 and continuing for a number of years thereafter. Another was creation of the Agency for Healthcare Policy and Research in 1989, which has since been renamed the Agency for Healthcare Research and Quality. Another was the launching of the Prevention Effectiveness Initiative at CDC in the early 90s. And then subsequently, work that I’ve done at the University of North Carolina, first at the School of Public Health and then at the School of Medicine using the tools of health services research broadly in health care and in public health.
NPH: What are some of the fruits of those efforts?
A constant theme of this year’s Keeneland Conference is the emergence of the discipline of public health systems and services research (PHSSR) from strict research and evaluation to results that are beginning to be used by public health departments and agencies. So who better a dinner speaker than Joe Selby, MD, MPH, head of the Patient-Centered Outcomes Research Institute (PCORI), authorized by Congress under the Affordable Care Act. PCORI’s role is to conduct research and provide information about the best available evidence to help patients and health care providers make more informed decisions. The Institute's goals include:
- Substantially increase the quantity, quality, and timeliness of useful, trustworthy information available to support health decisions.
- Speed the implementation of patient-centered knowledge into practice.
- Influence clinical and health care research funded by others to be more patient-centered.
NewPublicHealth spoke with Dr. Selby about PCORI’s work so far and the critical goal of disseminating scientific research to improve health.
NewPublicHealth: Tell us about your talk at the Keeneland Conference.
Dr. Selby: I’ll start by talking about the historical trends that led to PCORI’s formation. I think that these trends are bringing what we do, which is called comparative clinical effectiveness research, together with quality improvement and with public health systems and services research. There is a convergence of interests between what the conference attendees do as public health practitioners and public health researchers and systems-based researchers and what the quality improvement world is doing and what we’re trying to do at PCORI. There are many common bonds and a new appreciation for that.
It has suddenly dawned on everyone that you’ve got to put your patients or, in the case of public health, your communities, at the center of the research activity. And I know that in the public health world, they are involving communities and patients within communities and clients and consumers in their planning and intervention activities. That is one of the bonds that ties us together and that leads to enhanced productivity whether we’re doing clinical research like PCORI does, whether we’re doing quality improvement, or whether we’re doing public health.
Public Health Law Research, a national program of the Robert Wood Johnson Foundation housed at the Temple University Beasley School of Law, recently released a new, comprehensive online portal called LawAtlas that allows users to explore variation in laws across U.S. states and over time. Having more information about state laws, and their effect on health over time, is a critical step toward understanding what works to improve health. LawAtlas offers:
- Interactive Law Maps to show how certain laws differ by state and how they have changed over time.
- Policy Surveillance Reports to summarize the state of various public health laws across the country
- Data that public health law researchers can work with to expand upon existing research
NewPublicHealth caught up with Damika Webb, JD, Law Fellow at the Center for Health Law Policy and Practice at Temple University, at last week’s APHA Annual Meeting to chat about LawAtlas and how it can be used to better understand why policy surveillance is critical, and what we can learn from a program like LawAtlas.
NewPublicHealth: Why is it important to conduct research to know whether particular laws and policies are working to improve public health?
Damika Webb: By measuring the dimensions of a law, you can figure out which components of the law are having a positive or negative effect on health outcomes.
NPH: Why is it important to track how public health laws and policies differ from state to state?
A new analysis of three years of clinical trial data published on ClinicalTrials.gov, a registry maintained by the National Institutes of Health, found that many of the trials were too small and of too poor quality to provide sufficient results for practitioners. The study authors, who published their findings in the Journal of the American Medical Association, reported that their “analysis raises questions about the best methods for generating evidence, as well as the capacity of the clinical trials enterprise to supply sufficient amounts of high-quality evidence needed to ensure confidence in guideline recommendations.”
The Department of Housing and Urban Development has awarded more than $56 million to 76 tribal communities to improve housing conditions and promote community development. Funding can be used for a variety of projects such as rehabilitating housing , building new homes, to purchase land to support new housing construction, to build infrastructure such as roads, water and sewer facilities and to build community and health centers.
Examples of the new projects include:
- The Caddo Nation in Oklahoma will build a community facility for elderly low income residents.
- The Ho-Chunk Nation in Wisconsin will install solar photovoltaic panels on low-income single-family home and apartment rental units to decrease resident energy costs by 24 percent, and to decrease emissions.
- The Cook Inlet Tribal Council in Alaska will help build a group home for Alaska Native youth to reduce the number of homeless youth and increase academic stability and support.
- The Chemehuevi Indian Tribe of California will use its grant to upgrade the reservation’s old sewer lines.
The theme of Older Americans Month 2012 is “You’re Never Too Old to Play.”
Seniors can find resources for mental and physical health-related activities on this site, maintained by the National Institute on Aging.
Frontiers in Public Health Services & Systems Research: Making Critical Research Accessible, Quickly
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Glen Mays, MPH, PhD, F. Douglas Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health, talks about the launch of a brand new online journal covering public health systems and services research, and why it is so critical right now, to inform smart investments in public health and prevention. The new journal, Frontiers in PHSSR, is designed to disseminate the most critical early findings from PHSSR research much faster—making these findings accessible far in advance of the fully-developed scientific manuscript. To be eligible for inclusion in Frontiers, findings must have the potential to guide future public health practice, health policy, and research. Mays is the editor in chief of the new journal.
Portions of the post below are adapted from the opening commentary in Frontiers, authored by Mays, F. Douglas Scutchfield, Paul K. Halverson, William Riley and Peggy Honore.
The need for a strong and effective public health system in the United States is perhaps more urgent today than at any other time in our nation’s history. Preventable diseases and injuries account for more than three-fourths of the $2.6 trillion in health care expenditures incurred annually in the U.S. The growing prevalence of obesity, diabetes and other preventable conditions constrains the nation’s economic productivity and global competitiveness. The American public health system—the diffuse constellation of governmental public health agencies and their peers and partners in community-based settings and the private sector—is tasked with developing and delivering strategies that promote health and prevent disease and injury on a population-wide basis. They share the mission of creating conditions in which people can be healthy.
The public health system is uniquely positioned—but not optimally equipped or resourced—to take on these challenges. Only about 3 percent of the nation’s $2.6 trillion in annual health expenditures is devoted to public health activities. Some of our greatest uncertainties now lie in how best to organize, finance, and deliver effective public health prevention strategies to communities across the U.S. The field of public health services and systems research (PHSSR) has emerged to fill this void.
Frontiers in PHSSR
The American public health system and the populations it serves do not have the luxury of waiting the 15 years typically required to get research-tested solutions widely adopted into practice. The costs associated with missed opportunities for disease prevention and health promotion are straining government and household budgets now.
To help develop and grow this scientific learning community, we have launched a new, open-access, peer-reviewed journal, Frontiers in Public Health Services and Systems Research. This journal provides a platform for rapidly and widely communicating emerging findings and lessons learned from studies of public health services and delivery systems. Frontiers will feature brief descriptions of preliminary findings from ongoing or recently completed empirical studies and quality improvement projects that answer important questions regarding the organization, financing, and delivery of public health services.
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?
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?
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?