System Structure & Performance-Service Sharing
Room: Thoroughbred 4
Wednesday, April 9, 2014, 2-3:15 pm
Back to Conference Agenda
MODERATOR
Nikki Rider, Sc.D., M.P.P.
PRESENTERS
Gianfranco Pezzino, M.D., M.P.H.
A roadmap to successful Cross Jurisdictional Sharing agreements: how do we get there?
Co-Investigators: Patrick Libbey, Grace Gorenflo
Background: Cross-jurisdictional sharing (CJS) is the deliberate exercise of public authority to enable collaboration across jurisdictional boundaries to deliver essential public health services to solve problems that cannot be easily solved by single organizations or jurisdictions. The Center for Sharing Public Health Services (CSPHS) serves as a national resource on CJS, building the evidence and producing and disseminating tools, methods and models to assist public health agencies and policymakers as they consider and adopt CJS approaches.
Research Objectives: To identify factors for success in planning and implementing CJS initiatives.
Data Sets and Sources: Literature review and 16 demonstration projects in 14 states. Study Design A review of peer reviewed and other published documents was conducted to identify known factors of success for CJS initiatives. Through a competitive process, 16 demonstration projects were selected that encompass a diverse spectrum of CJS initiatives, from small-scale initiatives to full consolidation of health departments. Through continuous monitoring and feedback, site visits, and regular conference calls with the demonstration projects, CSPHS staff identified common themes and challenges.
Analysis: Using the information found in the literature review and generated through the demonstration projects we had created a Roadmap To Develop Cross-Jurisdictional Sharing Initiatives and a document describing common themes and challenges.
Principal Findings: The Roadmap describes three phases to guide jurisdictions through the CJS process: • Explore • Prepare and Plan • Implement and Improve During each phase, we propose a series of questions be answered before moving to the next phase. We also identify factors for success, which we group into prerequisites, facilitating factors, and project characteristics.
Conclusions: To be successful, CJS initiatives require careful consideration of multiple internal and external factors, as well as attention to the sequence in which certain steps are decided and implemented.
Implications for Public Health Practice and Policy: Implementing CJS initiatives may be resource-intensive and occasionally, if not done carefully, may lead to long-lasting damage in important relationships among partners. The empirical evidence being collected through a diverse set of demonstration projects complement a growing, but still scarce body of published material to assist in this endeavor.
Anne Kershenbaum, M.D., M.P.H.
A case-study of cross-jurisdiction resource sharing: the merger of TB clinics in East Tennessee.
Co-Investigators: Margaret Knight, Ph.D., M.P.H, M.S., B.A., Martha Buchanan, M.D., Janet Ridley, M.S.N., B.S., RN, Paul Erwin, M.D., Dr.P.H.
Background: Historically, Knox County Health Department (KCHD) and East Tennessee Regional Health Office (ETRO) have maintained two separate TB programs. In October 2011, the TB clinics merged. The incentive for the merger was a need to cover physician services, but the merger took place in the context of a lower burden of TB cases in the region.
Research Objectives: To determine whether the merging of the clinics resulted in changes in service provision efficiency, and to describe the problems and coping strategies adopted by staff as a result of the clinic merger.
Data Sets and Sources: Expenditures on the TB programs are collected from the local health departments. The charts of latent TB cases assessed in 2010-2012 are reviewed to extract time from positive test to practitioner consultation, and proportion starting and completing treatment. Staff opinions and perspectives are collected to investigate the effect of the merger on service provision, time required to provide services, problems encountered and methods used to solve them, and perceived advantages and disadvantages of the merger.
Study Design: Mixed methods approach combining qualitative data on processes and quantitative data on inputs and outcomes.
Analysis: Outcomes regarding latent TB are compared before and after the merger, using the Mann-Whitney test for continuous variables and the Chi-square for proportions. Data from staff interviews will be analyzed using qualitative data analysis methods.
Principal Findings: The total yearly expenditure on TB services did not show a decrease post-merger. Interim analysis of latent TB outcomes shows no decrease in the time from positive test to clinic assessment and a higher treatment initiation rate after the merger.
Conclusions: In the year following the merger, no improvements in efficiency measures were detected. Efficiency improvements may be difficult to achieve during a period of adoption of new working arrangements. Further follow up over the coming years could show how efficiency measures change with time since the merger.
Implications for Public Health Practice and Policy: Cross-jurisdictional mergers may be required to enable continuation of service provision, particularly when case numbers are decreasing. However the period of change may require an initial increase in resources.
Justeen Hyde, Ph.D.
Impact of a District Incentive Grant Program on Regional Cross-Jurisdictional Public Health Services in Massachusetts
Co-Investigators: Nazmim Bhuiya, M.P.H. (Presenting), Maeve Conlin, M.P.H., Michael Coughlin, M.S., Geoffrey Wilkinson, M.S.W.
Background: In 2010, Massachusetts Department of Public Health (MDPH) received a grant from the Centers for Disease Control and Prevention through their National Public Health Improvement Initiative to develop regional public health districts that focus on cross-jurisdictional service sharing through a 5-year incentive grant program. After awarding one year planning grants to 18 prospective districts, MDPH chose five districts across the state to receive four year implementation grants through the Public Health District Incentive Grant (DIG) program. The districts encompass 57 municipalities that comprise nearly a sixth of the state’s population. The Institute for Community Health (ICH), in collaboration with MDPH, is evaluating the process and outcomes associated with movement from independent to shared public health service delivery.
Data Sets and Sources: For this evaluation, ICH has focused on state mandated services such as food and beach inspection, Board of Health member training, and communicable disease management, lead screening capacity, sharps disposal access, governance, and workforce qualifications. Information was gathered from MDPH and through local input as well as district meeting minutes. An annual data dashboard was compiled for each district summarizing their progress to meeting key deliverables of the DIG program since baseline year 2010 (prior to program implementation). Additionally, a survey was distributed to all grantees to gather information about the perceived organization, leadership, resources, partnerships, and outcomes associated with the work of each DIG collaborative.
Findings: This paper will highlight preliminary findings from the data dashboards. The data demonstrates that there has been improvement in several domains from 2010 to 2012. There has been an increase in municipalities meeting state mandated food and beach inspectional requirements, an increase in number of trained local Board of Health members, an increase in access to sharps disposal sites, and improvements in communicable disease management.
Conclusions & Implications: This work is among first of evaluations to assess the impact of service sharing among local DPHs. The findings implicate that municipalities working together can improve the delivery of essential public health services.