Background: Patient-engagement strategies are increasingly recognized for enriching traditional medical care and improving population health. Accountable Care Organizations (ACOs) may be well positioned to leverage multi-sector organizational partnerships to improve the reach of their patient-engagement strategies, particularly given incentives to meet cost, quality and population health goals. Little is currently known about the relation of multi-sector partnerships and patient engagement in ACOs. Purpose: To examine the relation of patient-engagement strategies and breadth of multi-sectoral organizational partnerships in 71 primary care practices affiliated with one of two ACOs. Methods: Clinical and administrative leaders from each practice were surveyed. Questions assessed practice use of 12 different partnership sectors and the adoption of 14 patient-engagement strategies. Bivariate tests examined associations between patient-engagement strategies and practice use of partnership sectors. Multivariate linear regression estimated the extent to which practices with a greater number of multi-sector organizational partnerships had greater adoption of patient-engagement strategies. Results: Practices reported partnering with a mean of 3.2 (standard deviation, SD= 2.1) out of 12 sectors and implementing a mean of 7.1 (SD=3.4) out of 14 patient-engagement strategies. Each additional type of multisector partnership was associated with greater adoption of patient-engagement strategies (β = 0.59, 95% CI = 0.23–0.95, for all partnerships and β = 0.92, 95% CI = 0.42–1.43, when restricted to nonmedical partnerships) Implications: Practices with a greater breadth of multi-sector partnerships, particularly nonmedical partnerships, use a wider range of strategies to engage patients in their own care.
OBJECTIVE:Describe cross-jurisdiction service sharing (CJS) by local and tribal health departments (LHD) in Wisconsin in 2014 compared to 2012.DESIGN:An online survey of 91 LHD directors in Wisconsin was conducted. Results were compared to the results of a 2012 survey. Characteristics of CJS arrangements and differences in results by population size, geographic region, and governance type were described. Standardized proportion differences (h) were estimated using the arcsin transformation. Confidence intervals were estimated using unconditional exact confidence intervals for the difference of proportions.8 A forest plot of the estimates and confidence intervals was generated to visualize change in CJS for each population category.RESULTS:Seventy-eight percent of respondents in 2014 reported currently sharing services compared to 71% of respondents in 2012. Positive effect sizes indicate increased sharing in year 2014 relative to 2012. CJS was more frequent for LHD serving smaller jurisdictions, consistent with both 2012 survey results and national findings. All governance types continue to engage in sharing public health services.IMPLICATIONS:Cross jurisdictional service sharing is widespread and increasing in Wisconsin, implying that it is a useful strategy for providing public health services under some circumstances. Educating public health practitioners and students about CJS strategies in public health is recommended.
The research community faces a growing need to deliver useful data and actionable evidence to support health systems and policymakers on ways to optimize the health of populations. Translating science into policy has not been the traditional strong suit of investigators, who typically view a journal publication as the endpoint of their work. They are less accustomed to seeing their data as an input to the work of communities and policymakers to improve population health. This article offers four suggestions as potential solutions: (1) shaping a research portfolio around user needs, (2) understanding the decision-making environment, (3) engaging stakeholders, and (4) strategic communication.
BACKGROUNDThe multi-state fungal meningitis outbreak started in September 2012 in Tennessee. The cause of the outbreak was injection of contaminated lots of methylprednisolone acetate used in epidural spinal injections. Roanoke and New River Valley were the epicenter of this outbreak in Virginia, with two clinical centers having administered the contaminated injections to their patients. New River Health District, in coordination with hospitals, and state and federal agencies, deployed its resources to control the local impact of the outbreak.PURPOSEThe objective of this study was to conduct an economic evaluation of the fungal meningitis outbreak response in New River Valley of Virginia, from the local public health department perspective.METHODSThe health department conducted the outbreak investigation from October 2012 until March 2013 to ascertain that all possible cases were identified and treated. Data were collected on the costs associated with the local health department in the outbreak response, and the epidemiologic effectiveness estimated, using the metric of disability adjusted life years (DALYs).RESULTSThe cost incurred by the local health department was estimated to be $30,493; the epidemiologic effectiveness was estimated to be 138 DALYs averted among the patients, for an incremental cost-effectiveness ratio of $221 per DALY averted.IMPLICATIONSThe incremental cost effectiveness ratio of the fungal meningitis outbreak response in New River Valley assists the local health department to analyze the costs and epidemiologic effectiveness of the outbreak response.
BACKGROUNDCervical cancer places a substantial economic burden on our healthcare system. The three-dose human papillomavirus (HPV) vaccine series is a cost-effective intervention to prevent HPV infection and resultant cervical cancer. Despite its efficacy, completion rates are low in young women aged 18 through 26 years. 1-2-3 Pap is a video intervention tested and proven to increase HPV vaccination completion rates.PURPOSETo provide the full scope of available evidence for 1-2-3 Pap, this study adds economic evidence to the intervention's efficacy. This study tested the economies of scale hypothesis that the cost of 1-2-3 Pap intervention per number of completed HPV vaccine series would decrease when offered to more women in the target population.METHODSUsing cost and efficacy data from the Rural Cancer Prevention Center, a cost analysis was done through a hypothetical adaptation scenario in rural Kentucky.RESULTSAssuming the same success rate as in the efficacy study, the 1-2-3 Pap adaptation scenario would cover 1000 additional women aged 18 through 26 years (344 in efficacy study; 1346 in adaptation scenario), and almost three times as many completed series (130 in efficacy study; 412 in adaptation scenario) as in the original 1-2-3 Pap efficacy study.IMPLICATIONSDetermination of the costs of implementing 1-2-3 Pap is vital for program expansion. This study provides practitioners and decision makers with objective measures for scalability.
Public health departments have limited evidence to understand and analyze the costs and benefits of different health programs, including tuberculosis control and prevention programs. The study by Miller et. al addresses this challenge to estimate costs and benefits of tuberculosis prevention programs in Texas and identify cost-effective diagnostic and treatment combinations, thereby improving the evidence-based decision making power of the public health departments.
Part of the Community Health and Preventive Medicine Commons, Health and Medical Administration Commons, Health Policy Commons, Health Services Administration Commons, Health Services Research Commons, and the Public Health Education and Promotion Commons. Many accomplishments of public health have been distributed unevenly among populations. This article reviews the concepts of applying evidence-based practice in public health in the face of the varied cultures and circumstances of practice in these varied populations. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community and practitioners in decision making, conducting sound evaluation, and disseminating what is learned. The usual application of these principles has overemphasized the scientific evidence as the starting point, whereas this review suggests engaging the community and practitioners as an equally important starting point to assess their needs, assets and circumstances, which can be facilitated with program planning frameworks and use of local assessment and surveillance data.
Local health departments (LHDs) can more effectively develop and strengthen community health partnerships when leaders focus on building partnership collaborative capacity (PCC), including a multisector infrastructure for population health improvement. Using the 2008 National Association of County and City Health Officials (NACCHO) Profile survey, we constructed an overall measure of LHD PCC comprised of the five dimensions: outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages. We conducted a series of regression analyses to examine the extent to which LHD characteristics and contextual factors were related to PCC. The most developed PCC dimension was vision-focus balance, while infrastructure development and community linkages were the least developed. In multivariate analyses, LHDs that were locally governed (rather than governed by the state), LHDs without local boards of health, and LHDs providing a wider range of clinical services had greater overall PCC. LHDs serving counties with higher uninsurance rates had lower overall PCC. LHDs with lower per capita expenditures had less developed partnership infrastructure. LHD discontinuation of clinical services may result in an erosion of collaborative capacity unless LHD partnerships also shift their foci from services delivery to population health improvement.
Employers are increasingly using wellness incentives, including penalties for unhealthy behavior. Survey data suggests that people are willing to accept the principle of penalizing those perceived to take health risks, but the equally relevant question of the magnitude of acceptable penalties is unclear. While the principle of penalizing overweight and obese people has some support, findings from a population-level experiment (n=1,000) suggest that the acceptable size of penalties is comparatively small, around $50: more than 10-fold below levels favored by advocates. Reward-based incentives are favored over penalty-based ones by a factor of 4. Of two different ways of framing penalty programs, poorer and higher weight groups appear to find the one that is more overtly penalizing less acceptable. Levels of incentives matter on effectiveness as well as on ethical grounds, as it cannot be assumed that it is equally easy for all to meet health targets to secure a benefit or avoid a penalty. Programs should be designed to engage, not to frustrate those most in need of health improvement. Employee involvement in determining incentive types and levels, and explicit justification for program design can help both employees and employers to reap benefits.
Background: Chronic obstructive pulmonary disease (COPD) is a known predictor of decreased long-term survival after coronary artery bypass grafting (CABG). Differences in survival by race have not been examined. Methods: A retrospective cohort study was conducted of CABG patients between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. Results: A total of 984 (20%) patients had COPD (black n = 182; white n = 802) at the time of CABG (N = 4,801). The median follow-up for study participants was 4.4 years. COPD was observed to be a statistically significant predictor of decreased survival independent of race following CABG (no COPD: HR = 1.0; white COPD: adjusted HR = 1.9, 95% CI = 1.7–2.3; black COPD: adjusted HR = 1.6, 95% CI = 1.1–2.2). Conclusion: Contrary to the expected increased risk of mortality among black COPD patients in the general population, a similar survival disadvantage was not observed in our CABG population.
Great variation exists in the nature of LHD service delivery and it varies, in part, relative to jurisdiction population size. Larger LHD jurisdictions may achieve an economy of scale in WIC service delivery that is not matched in smaller areas. Overall, we found that WIC service provision appears relatively consistent across study states and in the presence of increasing need, with greater responsiveness to need in urban areas. As demand for some preventive services increases LHDs in rural areas may need greater support than LHDs in large jurisdictions for meeting local demand. Unlike WIC, LHD-provided services that have less consistently maintained service-delivery guidelines may have a harder time responding to increasing need. The relative consistency of a federally-funded program such as WIC may serve as a good baseline for further study of less consistently delivered programs among LHDs. LHD service statistics can serve as useful data sources in measuring volume of service delivery relative to need.
