Predicting HPV Vaccination Coverage Rates Using Indicators of Health Department Clinic Access: A Case Study with South Carolina and Georgia

Since its introduction in 2006, the human papilloma virus (HPV) vaccine has made substantial developments. The use of the vaccine was expanded to include males. The completion dose series was decreased from three to two shots, if started before the age of 15. The cost of the vaccine is fully covered by private insurance and public programs for various ages ranging from 9 to 26 years old1. With these improvements the HPV vaccine has the capability to safely and significantly prevent and reduce many cancers that cause the deaths of women and men across the United 1,2. Therefore, the underuse of the HPV vaccine is a serious but correctable threat to progress against cancer3,4. During 2012-2016, an estimated average of 34,800 HPV-attributable cancers were diagnosed each year. Among these estimated cancers, 92% were attributable to the HPV types that are included in the 9-valent HPV vaccine and could have been prevented if HPV vaccine recommendations were followed5. However, HPV vaccination rates across the U.S. remain low6. Using public health data sources, choropleth maps, new variables of Health Department (HD) clinic access and prediction modeling, this research advanced the field of health services research by informing the third goal of the President’s Cancer Panel 2012-2013 report: maximize access to HPV vaccination3. The short-term impact of this research quantified and located HPV vaccination for adolescents, in addition to highlighting prognostic indicators of access and identifying barriers to HPV vaccination uptake among HD clinics at the county level in Georgia. The long-term impact of this research provided greater insight for targeting efforts to optimize HPV vaccine uptake at the county level in South Carolina and in other states with low HPV vaccination coverage. This research demonstrated the important use of small area estimation by public health professionals in states with low HPV vaccination coverage and limited or no immunization registry data for small geographic areas. This research provided valuable data toward the access of vaccination services and the dissemination and implementation of HPV vaccination interventions at the county level. Ultimately the findings from this study may be used to predict correlations to the incidence of HPV-associated cancers, which may help reduce public health costs, morbidity and mortality related to HPV infections in the United States

State Medicaid Policy Levers Related to Successful Health Information Exchange Among Providers

Background: In the U.S., patients seek health care across a variety of settings. Many providers must manage care without needed information about the patient’s history, past services or experiences. Health information exchange (HIE), the process of securely and appropriately sharing a patient’s medical data electronically, can enable coordinated, effective and efficient care by providing a fuller picture of the patient’s health. Despite legislative and regulatory efforts, meaningful sharing of clinical information for patient care remains elusive. States as payers of Medicaid may be poised to effect successful HIE. Purpose: To assess whether state Medicaid policy actions implemented in the context of the 2009 Health Information Technology for Economic and Clinical Health Act promoted HIE among health care providers.Methods: A coincidence analysis, a mathematical, cross-case approach, was conducted to assess which levers implemented by Medicaid agencies in 20 states could be considered difference makers for HIE among health care providers. States were categorized as having HIE based on the proportion of providers that reported exchanging data outside their systems. Results were reviewed with a Medicaid stakeholder panel to inform a plan for change. Results: State Medicaid agencies assessed in this study used a variety of policy levers in the areas of technical assistance, infrastructure investment and financial incentives and mandates. The coincidence analysis revealed two strategies that were consistently present among states that demonstrated data sharing. States that had HIE were those that assisted with electronic clinical quality measure submissions and used financial incentive programs to incentivize HIE, or invested in a statewide HIE organization and laboratory infrastructure but lacked financial incentive programs. Conclusion: Combining Medicaid policy levers in at least one of two ways made a difference for HIE. The success of specific forms of infrastructure investment was conditional on the use or absence of financial incentive programs, which suggests the burden of increased requirements on clinicians engaged in multiple quality improvement efforts may distract from HIE. State Medicaid stakeholders supported these conclusions and recommended actions such as aligning HIE efforts across programs and capitalizing on strategic priorities for Medicaid in order to address the complex issue of HIE.Doctor of Public Healt

The Role of Agency in Community Health Outcomes: Local Health Departments and Childhood Immunization Coverage Rates

Organizational culture is defined as a system of shared meaning held by members of an organization that distinguishes it from other organizations. How organizational culture is experienced in the public sector, particularly local health departments (LHDs), is not well understood. The purpose of this study was to determine whether LHD organizational culture impacts childhood immunization coverage rates. I used a modified organizational culture survey tool, the Organizational Management Survey, to quantify organizational culture and determine whether an LHD\u27s organizational culture helps explain variations in childhood immunization coverage rates. In addition, qualitative data from an earlier study of LHD immunization staff were used to enhance the quantitative results. I used factor analysis and hierarchical regression analyses to explore organizational and demographic factors associated with variations in community childhood immunization coverage rates. The factors included organizational culture, organizational leadership, type of LHD, agency size, jurisdiction type, and participation in an immunization coalition. Among the LHD immunization programs in the study sample, organizational culture and type of LHD were significant predictors of immunization rate variation. This two-item model explained 6% of the variation in vaccination coverage levels among the respondents. The other variables did not contribute significantly. This study identified key issues for better understanding how organizational culture functions in LHDs. This research provides information on the impact that organizational culture has on work method and outcomes. Some specific changes can take place or be implemented once this is understood. The electronic version of this Dissertation is at OhioLink ETD Center, www.ohiolink.edu/et

The Role of Agency in Community Health Outcomes: Local Health Departments and Childhood Immunization Coverage Rates

Organizational culture is defined as a system of shared meaning held by members of an organization that distinguishes it from other organizations. How organizational culture is experienced in the public sector, particularly local health departments (LHDs), is not well understood. The purpose of this study was to determine whether LHD organizational culture impacts childhood immunization coverage rates. I used a modified organizational culture survey tool, the Organizational Management Survey, to quantify organizational culture and determine whether an LHD\u27s organizational culture helps explain variations in childhood immunization coverage rates. In addition, qualitative data from an earlier study of LHD immunization staff were used to enhance the quantitative results. I used factor analysis and hierarchical regression analyses to explore organizational and demographic factors associated with variations in community childhood immunization coverage rates. The factors included organizational culture, organizational leadership, type of LHD, agency size, jurisdiction type, and participation in an immunization coalition. Among the LHD immunization programs in the study sample, organizational culture and type of LHD were significant predictors of immunization rate variation. This two-item model explained 6% of the variation in vaccination coverage levels among the respondents. The other variables did not contribute significantly. This study identified key issues for better understanding how organizational culture functions in LHDs. This research provides information on the impact that organizational culture has on work method and outcomes. Some specific changes can take place or be implemented once this is understood. The electronic version of this Dissertation is at OhioLink ETD Center, www.ohiolink.edu/et

Assessing the potential of national strategies for electronic health records for population health monitoring and research

"Initiated in October 2004, this project builds upon two previous reports that portray a new landscape for health statistics: Shaping a Health Statistics Vision for the 21st Century: The Final Report, a joint report developed by the National Committee on Vital and Health Statistics, the Centers for Disease Control and Prevention's National Center for Health Statistics, and the U.S. Department of Health and Human Services' Data Council (Friedman, Hunter, Parrish 2002); and Information for Health: A Strategy for Building the National Health Information Infrastructure, a report released by the National Committee on Vital and Health Statistics (2001)." - p. 1"The purpose of this report is to assess the potential of national strategies for electronic health records for population health monitoring and research. The emphasis in this report is upon those types of population health monitoring typically used to develop health statistics, such as population-based registries, population-based surveys, and administrative health data, rather than those types of population health monitoring used to detect health events and diseases for the purposes of immediate public health interventions. More specifically, this report has a fourfold purpose: first, to describe the current status of national strategies for electronic health records and their supporting national health information infrastructures in Australia, Canada, England, and New Zealand, especially as those national strategies relate to population health monitoring to produce health statistics and research employing health statistics; second, to summarize themes about the potential contributions, and barriers to those contributions, of national strategies for electronic health records for population health monitoring and research and barriers that emerged from key informant interviews with experts in the same four countries; third to summarize themes emerging from key informant interviews with U.S. experts; and fourth, to delineate major fundamental issues in the relationship between national strategies for electronic health records and population health and monitoring." -.p. 1-21. Introduction -- 2. Methods -- 3. Factors impacting on national strategies for electronic health records -- 4. Nation snapshots: Australia, Canada, England, and New Zealand -- 5. Common themes in interviews with expert informants in Australia, Canada, England, and New Zealand -- 6. Common themes in interviews with expert informants in the U.S. -- 7. Fundamental issues in the relationship of national strategies for electronic health records to population health monitoring and research -- References -- Acronyms and glossary -- Tables -- Figures -- Appendix 1. Structured search criteria -- Appendix 2. Journals and newsletters reviewed -- Appendix 3.Typical interview guide (English expert) -- Appendix 4. Key informants"January 2006."Author: Daniel J. Friedman, Population and Public Health Information Services.Also available via the World Wide Web.Includes bibliographical references (p. 61-70)

Alaska health profile 2001

Each year, the Centers for Disease Control and Prevention (CDC) publishes a State Health Profilefor each state and the District of Columbia. This publication series uses selected \u201chealth statusindicators\u201d to describe the health status of the United States on a state-by-state basis. Thisinformation is presented through user-friendly graphics and narrative interpretation. The series alsohighlights selected demographic information, prevention and control efforts aimed at specific health conditions, and CDC funding for and partnership agreements with all 50 states and the District of Columbia

Quality Management and Improvement Practices for Home and Community-based Care: Literature Review

The Centers for Medicare and Medicaid Services (CMS) have contracted with the Muskie School of Public Service to develop a technical assistance guide for use by states and CMS regional offices to assess and improve the quality of home and community-based care (HCBC) to Medicaid beneficiaries. 1 The project will identify tools, measures, standards, and oversight mechanisms for performance measurement and quality improvement of long term care services delivered under federal and state-funded HCBC programs, exclusive of consumer-directed services. In addition to highlighting promising state practices, the project will describe the opportunities and challenges of applying advancements in the field of quality management, so broadly used in other sectors of health care, to improve the quality of HCBC services. This paper reviews published literature and provides a summary of major CMS initiatives in the area of quality measurement and improvement over the last five years. In conducting this review, a wide lens was applied to identify quality strategies in settings of care and delivery systems both within and outside long term care. This paper will serve as background for a meeting with federal and state policymakers and quality experts to assess the relevance and limitations of identified methods to improve the quality of services and outcomes in HCBC programs. Based on findings from the meeting and additional structured interviews with stakeholders, a technical assistance guide will be prepared

Blueprint for a Healthier America: Modernizing the Federal Public Health System to Focus on Prevention and Preparedness

Outlines a federal policy guide for modernizing the public health system. Includes recommendations on funding, restructuring, accountability, recruitment and retention, and integrating public health with health care, and a summary of agencies and budgets