Category Archives: Research
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!
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?
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?
Lawrence Gostin wrote two of the founding books on public health law and developed some of the most influential public health model policies of our time. NewPublicHealth spoke with Lawrence Gostin, JD, Linda D. and Timothy J. O’Neill Professor of Global Health Law at the Georgetown University Law Center and director of the O’Neill Institute for National and Global Health Law, about his keynote address at this week’s Public Health Law Research (PHLR) Annual Meeting and emerging trends in public health law.
>>NewPublicHealth will be covering the PHLR Annual Meeting all week, including Q&As with some of the top researchers and influencers who are presenting. Follow our coverage here.
NewPublicHealth: What do you plan to speak about at the PHLR meeting?
Lawrence Gostin: I’m going to speak about global health law and global health governance. The idea is to talk about something that’s innovative and exciting and I have a proposal for a Framework Convention on Global Health, which is a global health treaty that the UN Secretary General has endorsed and many countries now are on board. So it’s an exciting, fascinating and vital time for global health. We’re really expanding the horizons beyond America to how we can make sure that all the world’s people have good health, and particularly those who are poor and vulnerable.
NPH: That’s very interesting. What is the treaty about?
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.
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.
Read previous NewPublicHealth.org Q&As with newsmakers and difference makers in public health.
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!
Read previous NewPublicHealth.org Q&As with newsmakers and difference makers in public health.
May is Mental Health Month. While that observance is more than sixty years old, mental health has only recently started to take its place as a critical public health action item.
Why the gap between observance and action?
In a recent report in Mental Illness, Law, and a Public Health Law Research Agenda (pdf) for the National Public Health Law Research Program — an initiative of the Robert Wood Johnson Foundation and the Temple University Beasley School of Law — John Petrila, J.D., LL.M, a professor at the University of South Florida, and Jeffrey Swanson, a professor at the Duke University School of Medicine, say a variety of reasons have fueled the disconnect. They tick off stigma about mental illness; previous doubts about whether mental illness was a “real” illness; and the fact that mental health patients were often kept away from the community, limiting the public health focus on their needs.
“In the last decade, however,” say the authors, “numerous policymakers have concluded that the integration of mental health within public health is essential to improving care for people with or at risk for mental illnesses.”
Law has already played a role in shaping mental health policy and practice:
- Constitutional principles have been used to challenge institutional confinement
- Legislation has provided parity in insurance coverage for physical and mental illnesses
- Legislation has reduced the impact of mental disabilities on access to employment and public accommodations.
- State and federal laws also have expanded the use of coercion and denied people with mental illnesses access to products, such as guns, available to most citizens
The authors say the research agenda going forward should include items such as the legal infrastructure for dealing with mental illness; mapping state statutes on public health laws; studies on interventional law; and studies on implementing law that could improve care for people with mental illness.
Additional resources for helping improve care for people with mental illness are available from the American Public Health Association. Their resource site includes journals, research centers, government sites and community referral information.
Weigh in: Has your community increased its efforts on mental health issues?
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today’s contributor is Glen P. Mays, Professor and Chair and director of research for the Department of Health Policy and Management in the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences.
The economic downturn — combined with a shifting political landscape and changing policy priorities — is forcing state and local public health professionals to confront difficult choices on a daily basis.
This raises a series of critical questions:
- As budget cuts are made, how should public health officials make decisions on which activities to reduce and eliminate so as to minimize population health risks and harm?
- Are there alternative ways of organizing, staffing and delivering core public health services, so that officials can better produce efficiencies and reduce resource needs?
- Are there alternative ways of re-allocating the division of labor among state and local agencies, as well as among governmental and private-sector organizations, so as to maximize health protections and minimize costs?
- How much discretion do public health officials have in using evidence and economic imperatives to reconfigure their delivery systems?
The many uncertainties surrounding these issues create an urgent demand for new research to inform policy and practice. Next week in Lexington, Ky., the 2011 Public Health Systems and Services Research (PHSSR) Keeneland Conference will provide a unique forum for research and practice communities to brainstorm, share preliminary findings and identify improved approaches for applying this type of evidence to the real world.
Among other research, the event will showcase the work of RWJF’s Public Health Practice-Based Research Networks (PBRN), which fields real-time and relevant studies to inform public health decision-making in a time of economic shocks and resource constraints:
- A recent study from North Carolina demonstrates how local health departments have responded to reduced Medicaid support for maternity case management services by improving delivery efficiency rather than cutting services or clients.
- Research underway in Colorado demonstrates how public health agencies are utilizing multi-organizational coalitions to deliver chronic disease prevention activities effectively and efficiently.
- New research from Wisconsin shows that the public health activities most vulnerable to economy-related cuts are those financed through local taxes and not mandated by state law.
- Research from Florida finds that cross-cutting, infrastructure-related public health capacities (such as surveillance and health assessment) are least likely to be funded by categorical funding streams — and therefore especially vulnerable to economy-related funding reductions.
Several other PBRN studies to be presented at the conference will address barriers and facilitators to evidence-based public health decision-making in the face of economic constraints.
These Keeneland Conference sessions will likely stimulate considerable discussion and debate concerning the health and economic impacts of changes in public health service delivery across the United States, as well as how research can be used to estimate and learn from these effects. Estimating these effects undoubtedly will require longer time lags and additional analytic horsepower, but studies to accomplish these tasks are already underway.
PBRNs are a relatively new concept within public health, operating “below the radar” in many communities. Nevertheless, they may prove to be the missing ingredient needed to drive science-based improvements in practice and practice-relevant advances in science. Researchers and practitioners who share this vision of an evidence-producing community of practice should be sure to attend the conference sessions and get involved.