Estimating the Costs of Foundational Public Health Services

The Institute of Medicine’s 2012 report on public health financing called for the convening of expert panels to identify the components of a “minimum package” of public health services and cross-cutting capabilities that should be available in every U.S. community to protect and improve population health. This report also called for studies to identify the resources required to make these services universally available across the country. This research brief describes the research methodology in use to generate first-generation estimates of current resource use and estimated resource needs for implementing foundational public health services and capabilities

Cost Estimates of Foundational Public Health Services: Results from Piloting the Expert Consensus Methodology in Kentucky

We developed a methodology for estimating the resources required to deliver a set of foundational public health capabilities as recommended in the 2012 Institute of Medicine report on public health financing. The capabilities are based on IOM recommendations and defined by a national expert panel convened as part of the Public Health Leadership Forum. This paper presents preliminary estimates from a pilot test of the cost estimation methodology in Kentucky, and outlines plans for the national estimation strategy

Bone stable isotope evidence for infant feeding in Mediaeval England

This paper is a first study of duration of breastfeeding using bone stable isotopes in infants in a British palaeopopulation, from the deserted Mediaeval village of Wharram Percy, England. Nitrogen stable isotope analysis suggests cessation of breastfeeding between 1 and 2 years of age. Comparison with Mediaeval documentary sources suggests that recommendations of physicians regarding infant feeding may have influenced common practice in this period

Cost Estimates of Foundational Public Health Capabilities: Pilot Test Results of an Expert Consensus Methodology in Kentucky

The Institute of Medicine\u27s 2012 report on U.S. public health financing recommended research to identify the components and costs of a minimum package of public health services and foundational capabilities to be made available in every U.S. community. We present results from pilot testing of a proposed methodology for estimating the costs and resource requirements for a set of foundational public health capabilities identified by the Public Health Leadership Forum. Using pilot data from Kentucky public health settings, we estimate both current and projected costs under a range of assumptions about the resources required to fully implement the capabilities at state and local levels of the public health system

Cost Estimates of Foundational Public Health Services: Results from Piloting an Expert Consensus Methodology

We review preliminary estimates from pilot testing a cost estimation methodology developed to identify the resources required to implement a set of Foundational Public Health Services as recommended by the Institute of Medicine and defined by the Public Health Leadership Forum

Patients' experiences of the choice of GP practice pilot, 2012/2013: a mixed methods evaluation.

OBJECTIVES: To investigate patients' experiences of the choice of general practitioner (GP) practice pilot. DESIGN: Mixed-method, cross-sectional study. SETTING: Patients in the UK National Health Service (NHS) register with a general practice responsible for their primary medical care and practices set geographic boundaries. In 2012/2013, 43 volunteer general practices in four English NHS primary care trusts (PCTs) piloted a scheme allowing patients living outside practice boundaries to register as an out of area patient or be seen as a day patient. PARTICIPANTS: Analysis of routine data for 1108 out of area registered patients and 250 day patients; postal survey of out of area registered (315/886, 36%) and day (64/188, 34%) patients over 18 years of age, with a UK mailing address; comparison with General Practice Patient Survey (GPPS); semistructured interviews with 24 pilot patients. RESULTS: Pilot patients were younger and more likely to be working than non-pilot patients at the same practices and reported generally more or at least as positive experiences than patients registered at the same practices, practices in the same PCT and nationally, despite belonging to subgroups of the population who typically report poorer than average experiences. Out of area patients who joined a pilot practice did so: after moving house and not wanting to change practice (26.2%); for convenience (32.6%); as newcomers to an area who selected a practice although they lived outside its boundary (23.6%); because of dissatisfaction with their previous practice (13.9%). Day patients attended primarily on grounds of convenience (68.8%); 51.6% of the day patient visits were for acute infections, most commonly upper respiratory infections (20.4%). Sixty-six per cent of day patients received a prescription during their visit. CONCLUSIONS: Though the 12-month pilot was too brief to identify all costs and benefits, the scheme provided a positive experience for participating patients and practices

Awareness of CPR-Induced Consciousness by UK Paramedics

Objectives: Guidelines for the management of hospital cardiac arrest advocate minimally interrupted chest compressions in order to maintain cerebral perfusion pressures and improve the likelihood of a positive outcome. One condition that may lead to interruptions in the delivery of chest compressions is Cardiopulmonary Resuscitation Induced Consciousness (CPR-IC). This study investigates the understanding that UK paramedics have of CPR-IC and how they came by their knowledge. Methods: This study was a cross-sectional survey of paramedics who were registered with the Health and Care Professions Council (HCPC) and practising in the United Kingdom (UK) at the time of the survey. Participants completed an online survey; the first two sections are reported here. Section one asked for demographic data pertinent to the study outcomes and section two asked participants to explain what they understood about CPR-IC and the source of their information. Results: 293 eligible participants completed the survey. Most had over 5-years’ experience as a paramedic and declared no specialist clinical role. Over 50% of respondents said that they had heard of CPR-IC prior to the study and the majority of those provided an explanation that demonstrated some understanding when compared with the definition used by the study team. Over 40% of respondents became aware of CPR-IC having witnessed it in clinical practice. Conclusion: Nearly half of the study population were not aware of CPR-IC and few have had formal training on the phenomenon. There is a clear need for further education on CPR-IC in order for paramedics to better manage CPR-IC when presented with it in practice

An exploration of UK Paramedics' experiences of Cardiopulmonary resuscitation induced consciousness

Introduction: Consciousness may occur during cardiopulmonary resuscitation despite the absence of a palpable pulse. This phenomenon, known as CPR-Induced Consciousness (CPR-IC) was first described over three decades ago and there has been an increase in case reports describing CPR-IC. However, there remains limited evidence in relation to the incidence of CPR-IC and to practitioners’ experiences of CPR-IC. Methods: A mixed methods, cross-sectional survey of paramedics who were registered with the Health and Care Professions Council (HCPC) and working in the United Kingdom (UK) at the time of the survey. Participants who had experienced CPR-IC were asked to provide details about the number of episodes, a description of how consciousness was manifested, and whether or not it interfered with resuscitation. Results: 293 eligible participants completed the study and 167 (57%) said that they had witnessed CPR-IC. Of those, over 56% reported that they had experienced it on at least two occasions. CPR-IC was deemed to interfere with resuscitation in nearly 50% of first experiences but this fell to around 31% by the third experience. The most common reasons for CPR-IC to interfere with resuscitation were; patient resisting clinical interventions, increased rhythm and pulse checks, distress, confusion and reluctance to perform CPR. Conclusions: The prevalence of CPR-IC in our study was similar to earlier studies; however, unlike the other studies, we did not define what constituted interfering CPR-IC. Our findings suggest that interference may be related as much to the exposure of the clinician to CPR-IC as to any specific characteristic of the phenomenon itself

Model Robust Calibration: Method and Application to Electronically-Scanned Pressure Transducers

This article presents the application of a recently developed statistical regression method to the controlled instrument calibration problem. The statistical method of Model Robust Regression (MRR), developed by Mays, Birch, and Starnes, is shown to improve instrument calibration by reducing the reliance of the calibration on a predetermined parametric (e.g. polynomial, exponential, logarithmic) model. This is accomplished by allowing fits from the predetermined parametric model to be augmented by a certain portion of a fit to the residuals from the initial regression using a nonparametric (locally parametric) regression technique. The method is demonstrated for the absolute scale calibration of silicon-based pressure transducers