SESSION 2B: System Structure & Performance-Capacity
Room: Thoroughbred 2
Wednesday, April 9, 2014, 9-10:15 am
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KC14 Session 2B on System Structure & Performance: Capacity by NCC for PHSSR
MODERATOR
Jessica Kronstadt, M.P.P.
PRESENTERS
Sarah Lampe, M.P.H.
Minimum Package of Public Health Services: Changes in Local Public Health Services as a result of Core Service Implementation
Co-Investigators: Adam Atherly, Ph.D., Lisa VanRaemdonck, M.P.H, M.S.W., Julie Marshall, Ph.D., Melanie Mason, M.P.A., Kathleen Matthews, M.P.H
Sarah Schmiege, Ph.D.
Background: In October 2011, the Colorado State Board of Health promulgated into rule a list of seven core public health services that local public health agencies (LPHAs) would be required to provide or assure. These seven broad core services include Administration and Governance; Vital Statistics; Assessment, Planning and Communication; Communicable Disease (CD); Prevention and Population Health Promotion (PPHP); Emergency Preparedness and Response; and Environmental Health (EH). Soon after the Colorado Core Services were promulgated into rule, the Institute of Medicine (IOM) released, For The Public Health: Investing in a Healthier Future, which recommended that all public health departments provide ‘a minimum package of public health services’, similar to the seven required core services in Colorado.
Study Design: Using a longitudinal, pre-post study design, this research measures the impact of the core services rule change on the delivery of services by LPHAs. Baseline data were collected in summer 2011 and follow-up data collected in summer 2013. Means testing was conducted to analyze the change in core service delivery. Linear regression will be conducted to test for system structure effects on the implementation of core services. The linear regression analysis is still in process to be completed in January 2014. Statistically significant increases were observed in CD (p=0.03) including Tuberculosis (p=0.03) and Influenza (p=0.005); PPHP including Chronic Disease (p=0.04) and Nutrition (p=0.01); and EH including Summer Camps (p=0.01).
Findings: In addition to services and programs, specific activities were seen to have significant increases, namely CD System-Based Services (p=0.01); EH Outreach and Education (p=0.0005); and PPHP Policy Development and Implementation (p=0.001) and Cultural/Linguistic Specific Programs (p=0.02). The significant activity increases were especially of note as they were all population and systems based services rather than direct services. This trend has been noted throughout the country with little evidence supporting it.
Implications: It is expected that this work will be informative to other states as the public health system looks to a minimum package of public health services and to understanding how to measure the implementation of these services.
Emmanuel Jadhav, Dr.P.H., M.Sc., B.S.
Embracing Change: Kentucky Local Health Department leaders as change agents
Co-Investigators: James Holsinger, M.D., Ph.D., Glen Mays, Ph.D., M.P.H, David Fardo, Ph.D.
Background: During the recent economic recession leaders of Kentucky’s local health departments (LHDs) used innovative approaches to maintain or grow their budgets. Leader demography research in for-profit organizations has yielded valuable insights into leader behavior and agency performance. This study characterizes the associations between LHD leaders experiential and demographic characteristics and openness to change.
Research Objective: 1. Classify socio-demographic characteristics of LHD leaders by variation in their openness to change (ACQ) score, 2. Characterize the association between LHD characteristics and leader demographic and experiential attributes on leader’s openness to change.
Data Sets & Sources: LHD leaders in the Commonwealth of Kentucky are the unit of analysis. Actual expenditures and revenues were available from the state health department. County level population estimates are from the national census data. Study-design: a cross-sectional survey of KY LHD leaders’ observable attributes relating to age, gender, race, educational background, leadership experience and openness to change was performed. Spearman rank correlations test was used to determine correlations between leaders’ ACQ score and leader and LHD characteristics. To identify differences in mean ACQ score the Wilcoxon-Mann-Whitney non-parametric test and the Kruskal Wallis test were used.
Analysis: The leaders had a generally high ACQ score with a mean of 20.46 (SD 2.70). Leader responses on the ACQ inventory did not vary widely. Other than the preceding year revenue, no other LHD characteristic appears to affect leader’s mean ACQ score significantly whereas leader demographic and experiential characteristics significantly affected the mean ACQ score.
Principal Findings: Approximately 45% LHD leaders had a high ACQ score. The spearman correlation test for the LHD characteristic, preceding year revenue was statistically significant with a negative relationship. The Wilcoxon-Mann-Whitney test for gender and race, and the Kruskal-Wallis test for highest degree obtained were statistically significant.
Conclusion: There are strong underlying relationships between leader experiential and demographic attributes with their openness to change. LHD leaders would benefit from including change management in the essential public health leader competency framework.
Implications for Public Health Practice & Policy: Change oriented behaviors are known to have strong implications on agency effectiveness. Formal public health leadership development programs will benefit from developing skills to modify their leadership behaviors.
Valerie Yeager, Dr.P.H.
Factors Associated with Intent to Apply for Public Health Accreditation
Co-Investigators: Alva Ferdinand, Dr.P.H., Leslie Beitsch, M.D., Nir Menachemi, Ph.D.
Background: Factors that may influence the intent of Local Health Departments (LHDs) to apply for voluntary national accreditation by the Public Health Accreditation Board have not previously been studied empirically.
Research Objective: This cross-sectional study examines the relationship between local public health department organizational variables and the intention to apply for voluntary public health accreditation.
Data Sets and Sources: This study utilizes data available from the NACCHO 2010 profile survey.
Analysis: Two variables denoting intention to participate in accreditation (1. at some future point or 2. within the first 2 years of accreditation) were used as the dependent variables in two separate logistic regression models. Independent variables included: whether an LHD reported the use of any formal quality improvement, having conducted a community health assessment within the last 3 years, the presence of a local board of health with governing authority, whether the LHD provides comprehensive primary care services, the number of full time equivalent (FTE) employees, and governance.
Principle Findings: Findings indicate that there is a positive association between self-reported formal quality improvement (QI) activities occurring in LHDs and intent to apply for accreditation. Negative correlations were found between the intention to apply for accreditation and having recently conducted a community health assessment and the presence of governing boards of health.
Conclusions and Implications for Public Health Practice and Policy: Investments in developing and expanding QI capacity may increase the intent of LHDs to apply for accreditation. It may also be valuable to develop targeted outreach to local boards of health to facilitate a better understanding of accreditation and its benefits. Further research is needed to continue to examine the role of QI and the role other factors may play as the national accreditation program matures.