Ensuring a Strong Public Health Workforce for the 21st Century: Reflections on PH WINS 2017

The success of any organization can be attributed to one thing: its people. This is particularly true for local health departments (LHDs) and state health agencies (SHAs), as the public health workforce is fundamental to achieving organizational goals and improving the health outcomes of populations

Deficient Response to COVID-19 Makes the Case for Evolving the Public Health System

Coronavirus disease 2019 (COVID-19) has affected more than 14 million individuals and caused more than 600,000 deaths as of July 20, 2020, rapidly spreading across large cities as well as many rural areas. In parallel with rising cases and deaths globally, the situation in local communities fluctuates daily while knowledge about the disease and transmission evolves. Public health agencies play a critical role in managing disease epidemics. Agencies are on the front lines to conduct disease surveillance, facilitate resource distribution including personal protective equipment (PPE), establish alternative care sites, and provide diagnostic support through laboratory testing. The public health response to COVID-19 has been criticized for being too slow, lacking transparency, and insufficient. This essay examines reasons behind the sluggish response to COVID-19. The authors then argue for an evolved public health system following the crisis, which is better prepared for emergencies and equipped to support population health for the future

The Contributions of Managed Care Plans to Public Health Practice: Evidence from the Nation's Largest Local Health Departments

OBJECTIVE: The authors examine the extent and nature of managed care plans participating in local public health activities. METHODS: In 1998, the authors surveyed the directors of all US local health departments serving jurisdictions of at least 100,000 residents to collect information about public health activities performed in their jurisdictions and about organizations participating in the activities. Multivariate logistic and linear regression models were used to examine organizational and market characteristics associated with managed care plan participation in public health activities. RESULTS: Managed care plans were reported to participate in public health activities in 164 (46%) of the jurisdictions surveyed, and to contribute to 13% of the public health activities performed in the average jurisdiction. Plans appeared most likely to participate in public health activities involving the delivery or management of personal health services and the exchange of health-related information. Managed care participation was more likely to occur in jurisdictions with higher HMO penetration, fewer competing plans, and larger proportions of plans enrolling Medicaid recipients. Participation was positively associated with the overall scope and perceived effectiveness of local public health activities. CONCLUSIONS: Although plans participate in a narrow range of activities, these contributions may complement the work of public health agencies

Bayesian estimation of SARS-CoV-2 prevalence in Indiana by random testing

From 25 to 29 April 2020, the state of Indiana undertook testing of 3,658 randomly chosen state residents for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, the agent causing COVID-19 disease. This was the first statewide randomized study of COVID-19 testing in the United States. Both PCR and serological tests were administered to all study participants. This paper describes statistical methods used to address nonresponse among various demographic groups and to adjust for testing errors to reduce bias in the estimates of the overall disease prevalence in Indiana. These adjustments were implemented through Bayesian methods, which incorporated all available information on disease prevalence and test performance, along with external data obtained from census of the Indiana statewide population. Both adjustments appeared to have significant impact on the unadjusted estimates, mainly due to upweighting data in study participants of non-White races and Hispanic ethnicity and anticipated false-positive and false-negative test results among both the PCR and antibody tests utilized in the study

Preventing Leader Derailment—A Strategic Imperative for Public Health Agencies

Public health leaders, such as those who serve as state health officials (SHOs), routinely face challenges that are uncertain and complex. Those who reflect on the challenges they face and use those reflections to improve themselves and their teams develop into more effective leaders. Not addressing challenges can lead to the risk of premature “derailment.” In this column, we review research from the Center for Creative Leadership (CCL), a global authority in leadership development, which explores the underlying dynamics of derailment. We also share insights gained from ongoing research into SHO success discussed in prior Management Moment columns.1 , 2 Finally, we offer several thoughts on strategies for preventing derailment among senior public health leaders

High Turnover Among State Health Officials/Public Health Directors: Implications for the Public's Health

State health officials (SHOs) serve a critical role as the leaders of state public health systems. Despite their many responsibilities, there is no formal process for preparation to become an SHO, and few requirements influence the selection of an SHO. Furthermore, to date, no studies have examined SHO tenure or their experiences

Primary Care Case Conferences to Mitigate Social Determinants of Health: A Case Study from One FQHC System

Objective: Given the increasing difficulty healthcare providers face in addressing patients’ complex social circumstances and underlying health needs, organizations are considering team-based approaches including case conferences. We sought to document various perspectives on the facilitators and challenges of conducting case conferences in primary care settings. Study Design: Qualitative study using semi-structured telephone interviews Methods: We conducted 22 qualitative interviews with members of case conferencing teams, including physicians, nurses, and social workers from a Federally Qualified Health Clinic, as well as local county public health nurses. Interviews were recorded, transcribed, and reviewed using thematic coding to identify key themes/subthemes. Results: Participants reported perceived benefits to patients, providers, and healthcare organizations including better care, increased inter-professional communication, and shared knowledge. Perceived challenges related to underlying organizational processes and priorities. Perceived facilitators for successful case conferences included generating and maintaining a list of patients to discuss during case conference sessions and team members being prepared to actively participate in addressing tasks and patient needs during each session. Participants offered recommendations for further improving case conferences for patients, providers, and organizations. Conclusions: Case conferences may be a feasible approach to understanding patient’s complex social needs. Participants reported that case conferences may help mitigate the effects of these social issues and that they foster better inter-professional communication and care planning in primary care. The case conference model requires administrative support and organizational resources to be successful. Future research should explore how case conferences fit into a larger population health organizational strategy so that they are resourced commensurately

Overview of the spectrometer optical fiber feed for the Habitable-zone Planet Finder

The Habitable-zone Planet Finder (HPF) is a highly stabilized fiber fed precision radial velocity (RV) spectrograph working in the Near Infrared (NIR): 810 - 1280 nm . In this paper we present an overview of the preparation of the optical fibers for HPF. The entire fiber train from the telescope focus down to the cryostat is detailed. We also discuss the fiber polishing, splicing and its integration into the instrument using a fused silica puck. HPF was designed to be able to operate in two modes, High Resolution (HR- the only mode mode currently commissioned) and High Efficiency (HE). We discuss these fiber heads and the procedure we adopted to attach the slit on to the HR fibers.Comment: Presented at 2018 SPIE Astronomical Telescopes + Instrumentation, Austin, Texas, USA. 18 pages, 25 figures, and 2 table

How Many SARS-CoV-2–Infected People Require Hospitalization? Using Random Sample Testing to Better Inform Preparedness Efforts

Context: Existing hospitalization ratios for COVID-19 typically use case counts in the denominator, which problematically underestimates total infections because asymptomatic and mildly infected persons rarely get tested. As a result, surge models that rely on case counts to forecast hospital demand may be inaccurately influencing policy and decision-maker action. Objective: Based on SARS-CoV-2 prevalence data derived from a statewide random sample (as opposed to relying on reported case counts), we determine the infection-hospitalization ratio (IHR), defined as the percentage of infected individuals who are hospitalized, for various demographic groups in Indiana. Furthermore, for comparison, we show the extent to which case-based hospitalization ratios, compared with the IHR, overestimate the probability of hospitalization by demographic group. Design: Secondary analysis of statewide prevalence data from Indiana, COVID-19 hospitalization data extracted from a statewide health information exchange, and all reported COVID-19 cases to the state health department. Setting: State of Indiana as of April 30, 2020. Main Outcome Measure(s): Demographic-stratified IHRs and case-hospitalization ratios. Results: The overall IHR was 2.1% and varied more by age than by race or sex. Infection-hospitalization ratio estimates ranged from 0.4% for those younger than 40 years to 9.2% for those older than 60 years. Hospitalization rates based on case counts overestimated the IHR by a factor of 10, but this overestimation differed by demographic groups, especially age. Conclusions: In this first study of the IHR based on population prevalence, our results can improve forecasting models of hospital demand—especially in preparation for the upcoming winter period when an increase in SARS CoV-2 infections is expected

Infection Fatality Ratios for COVID-19 Among Noninstitutionalized Persons 12 and Older: Results of a Random-Sample Prevalence Study

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