Category Archives: Research
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?
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?