Public Health Research and Evidence: A NewPublicHealth Q&A with Paul Erwin
NewPublicHealth is on the road this week at the AcademyHealth Annual Research Meeting in Baltimore, Maryland and the International Making Cities Livable Conference meeting in Portland, Oregon.
AcademyHealth is a key organization in the United States for the study of health services research—a discipline that looks at how people get access to health care, how much care costs and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance and deliver high-quality care; reduce medical errors; and improve patient safety.
An important focus of this week’s Annual Research Meeting is the translation and dissemination of research into health practice. The Public Health Systems Interest Group, AcademyHealth’s largest interest group with close to 3,000 members, is meeting this week as well and has a particular focus on translating and disseminating public health systems and services research to the public health practitioners who could benefit from practical findings.
NewPublicHealth recently spoke with Paul Erwin, MD, MPH, and head of the department of public health at the University of Tennessee School of Public Health, about the importance of having strong evidence available for public health practitioners.
NewPublicHealth: Why is the translation and dissemination of Public Health Services and Systems Research (PHSSR) so important?
Paul Erwin: Ultimately PHSSR is meant to go out into the practice community so that research can actually make a difference. I think historically that is part of what has set PHSSR apart from closely related research disciplines. PHSSR really is intended to help produce the kinds of evidence-based practices that are more effective with limited resources, and likely to move the needle on population health.
NPH: Does the discipline rely on practitioners looking to PHSSR for the evidence base?
Erwin: I think the PHSSR community must do a better job itself of actually conducting research that is more likely to be translatable, and to try to think about that from the moment of formulating a research question. And I think the likelihood that the output of PHSSR will be translatable is certainly increased when practitioners are involved in actually formulating the research question itself.
One promising trend is the growing presence we’re seeing of PHSSR investigators who are closely tied to the practice community, including many who have spent time working in local and state health departments. That is a critical first step in increasing the likelihood that PHSSR will be translated and applied in a public health setting.
While most academicians disseminate their information through peer review journals, we know that only a minority of public health practitioners actually look for information in peer review journals—so there’s a huge gap there. So at the same time as practitioners are getting more involved in this research, we also need to get a better understanding of where they look for information that might help them make decisions in their work.
In an article in the American Journal of Preventive Medicine, Ross Brownson [professor at the Institute for Public Health at Washington University in St. Louis] identified five domains where public health research findings can be implemented in a short timeframe, with fairly minimal costs, in areas where the literature says will make a difference in public health. Two of these were workforce development and participatory decision making on the part of the health department leader. It requires mutual commitment on the part of the researcher and the practitioner to do this work. Just the researcher working in isolation isn’t necessarily privy to the real questions that the practitioner sees as of immediate value in helping them do their work more efficiently and effectively.
NPH: For this kind of communication to become prevalent, what has to happen next?
Erwin: There’s got to be a stronger engagement between the academic community and practitioners. It’s certainly happening. It’s happening through the public health practice-based research networks, for example. But there needs to be more of it, and we in the public health academic community need to do a better job of making this a focus of our curricula. I think you are beginning to see a growing presence of PHSSR at places like the National Association of County and City Health Officials (NACCHO) annual meeting. Frontiers in PHSSR, the new online open access journal from the Center for PHSSR at the University of Kentucky, for example, has recently been made available to all NACCHO members.
The public health practice community needs to have better access to information and exposure to a larger academic community so that research can be designed to respond to issues that are important.