From the Frontier: Translating Research to Practice…QI as the Hinge Point

This article is number three in the series From the Frontier: Translating Research to Practice. The narrative describes the work of a practice-academic network in Minnesota which explored the degree to which having a culture of quality at the local health department level influenced the capacity to implement a new statewide initiative. The network conducted a mixed-methods study of grantees funded to develop and implement local policy, systems, and environmental change strategies to promote nutrition, increase activity, and reduce tobacco use and exposure. The results of their study indicated that grantees with higher performance levels in Quality Improvement (QI) were much more likely to exceed expectations in local initiatives compared to grantees with lower levels of “QI maturity”. The study results are being used at the local level to advocate for authority to bolster QI and at the state level to establish baseline capacity of new grantees in order to customize technical assistance. This provides further evidence that systems-level research is possible in such practice-academic networks, and that findings from such research are immediately translatable

Editorial Comment: Differences in Definitions of EBPH and Evidence: Implications for Communication with Practitioners

Through interviews of 12 members of an expert panel – importantly, involving both practitioners and researchers/academicians – Aronson and colleagues sought to understand how evidence-based public health (EBPH) is defined, what counts as “evidence”, and what EBPH actually looks like when operationalized in a local health department. What Aronson and colleagues have shown us is how critical it is that in both creating and implementing EBPH, especially in practice-based research, practitioner and researcher/academician develop a shared understanding of EBPH before the dance begins, especially for practice-based research

From the Frontier: Translating Research to Practice...a Story of Economic Survival

This article is number two in the series From the Frontier: Translating Research to Practice. The narrative describes the interactions between a local health department director and two academicians in addressing the impact of the 2008 financial crisis. In a first set of activities, practice-academic partners used Financial and Operational Ratio and Trend Analysis to identify periods of a negative total margin and the impact of that on the agency’s declining fund balance. The use of private sector processes of retrenchment, repositioning, and reorganization led to a financial turnaround for the agency. In a second set of activities, practice-academic partners analyzed consolidation of multiple local health departments as one option for improving long-term financial stability. These connected activities provide examples of both implementation science and practice-based research

From the Frontier: Translating Research to Practice

The purpose of this invited article is to describe the process of translating research into public health practice. An example is provided, showing how questions arose in the practice setting, a researcher was identified to help answer the questions, and findings from the research were applied in the practice setting. In this example, Dr. Lea LaFave (Community Health Institute/JSI in New Hampshire) worked with Dr. Danielle Varda (Assistant Professor at the University of Colorado/ Denver, School of Public Affairs) to use social network analysis to better understand a network of coalitions focused on underage substance abuse. The social network analysis revealed that networks varied significantly in the number and depth of collaborations (from none to fully integrated) within each network. The larger implications of these findings suggest that the way people conceptualize complex systems varies tremendously, and that this has fundamental importance for understanding how to improve such systems

The Resilient Local Health Department: Attributes of Survival During the Economic Crisis

The purpose of this research is to explore the attributes of local health departments (LHDs) which have survived the recent economic crises without loss of staff. A retrospective cohort study is being conducted, using the 2005 and 2010 Profile of Local Health Departments datasets from the National Association of County and City Health Officials. LHDs which responded to both surveys and which provided data on full-time equivalents (FTEs) and expenditures are included for analysis. LHDs are categorized as resilient or non-resilient based on whether the LHD gained or did not lose FTEs between 2005 and 2010 (“resilient LHD”) vs. those LHDs which experienced a loss of FTEs (“non-resilient LHD”). Resilient vs. non-resilient LHDs are compared across a range of LHD characteristics, including jurisdictional population size, expenditures, tenure of the LHD director, and presence of a governing Board of Health. Resilient LHDs (n=625) experienced an increase in the median number of FTEs from 15.8 in 2005 to 20 in 2010, while non-resilient LHDs (n=589) experienced a decline from a median of 33 to 25 FTEs. Expenditures per capita for resilient LHDs increased from a median of $35.29 to a median of$44.16, while expenditures per capita for non-resilient LHDs rose only slightly from $40.60 to$41.52.Compared to non-resilient LHDs, resilient LHDs tended to have somewhat smaller jurisdictional populations (median of 35,825 vs. median of 48,896 (z=4.374, p=0.000)) and to have a governing Board of Health in 2005 (chi-square 8.52, p=0.004) and in 2010 (chi-square=6.29, p=0.012). There were no differences in the tenure of the LHD director comparing resilient vs. non-resilient LHDs. Investigators will be conducting additional analyses, specifically exploring the differences in LHD context (local unemployment rate, poverty rate, population density, etc), sources of revenues, and array of LHD services and activities. A second set of comparisons will be made between LHDs in the lowest and the highest quintiles of percent change in FTEs between 2005 and 2010. The goal of these analyses will be to identify potential modifiable factors that may protect LHDs from subsequent negative economic conditions

Answering the Call to Integrate: Simple Strategies from Public Health and Healthcare Executives in One Urban County

Background: As the Affordable Care Act transforms the practice of both public health and health care, it also provides opportunity for both to become more closely linked through improved integration and collaboration. Yet, while public health agencies are increasingly called to work with healthcare partners to address population health needs, both public health leaders and their healthcare counterparts may not be well equipped to answer that call. Although recent studies have begun exploring the collaborative strategies and capacity of public health system partners, there is still much to learn. The purpose of this study was to identify, through the perspective of senior public health and healthcare leaders, actionable strategies that might facilitate better integration or linkages between public health and healthcare organizations. Methods: Through semi-structured key informant interviews with senior healthcare and public health executives in one urban county, strategies were identified that public health and healthcare leaders might use to more effectively link population health programs and activities. Data were collected in 2013–2014; analysis was conducted in 2014. Results: Identified strategies include: focusing on targeted issues with shared interest; leveraging payers and business partners to expand support for integrated efforts; training and retraining the workforce for interdisciplinary, population health work; and developing and supporting a strong, neutral convening agency. Implications: As they employ these strategies to structure collaborative efforts, public health and healthcare leaders may improve linkages around population health programs and activities

Measures of Highly Functioning Health Coalitions: Corollaries for an Effective Public Health System

In Tennessee, health coalitions provide guidance in conducting community assessments, health improvement plans and policies and delivering of health and human services, which are considered core functions of public health. In fact, it has been postulated that these coalitions may serve as the organizational embodiment of the local public health system (LPHS). This study identifies functional characteristics of 63 Tennessee County Health Councils (CHCs), advisory councils to local and regional governmental public health agencies on broad issues of health, that contribute to its ability to operate as the primary advising entity of the LPHS. Exploratory factor analysis was conducted on 20 questions serving as proxy measures of functional characteristics. Eight functional characteristics related to structure, operations and leadership were identified. These characteristics are essential in further developing and tracking capacity and performance of health coalitions serving as an advisory and possibly decision making entity of the LPHS. This study also lays the groundwork to explore how to link coalition function with performance in order to determine characteristics that are most strongly associated with optimal performance and population health

The Resilient Local Health Department: Surviving the 2008 Economic Crisis

Research Objective: The purpose of this study was to identify potential modifiable factors that can protect local health departments from job losses and budget cuts during periods of economic stress. Study Design: This was a retrospective cohort study which used data from census surveys of local health departments (LHDs) which were conducted in 2005 and 2010 by the National Association of County and City Health Officials. The 2005 survey data served as the source of independent variables, which were grouped around domains of organization, revenue, and services. The outcome of interest - resiliency of the LHD - represented financial resiliency for maintaining budgets in the face of the recession, and was based on the ratio of observed-to-predicted expenditures per capita for 2010. Control variables included several measures known to influence both LHD performance and health outcomes, including jurisdictional population, poverty, race, education, age distribution, and health insurance status. An ordered logistic regression was used to model the dependent variable with three attributes - resilient, variously resilient, and non-resilient - with independent and control variables as described above. Population Studied: Data from 987 local health departments comprised the final dataset for analysis. Principal Findings: LHDs above the 95% confidence interval for the mean observed-to-predicted expenditures per capita ratio for 2010 (n=338) were defined as resilient; those within the 95% confidence interval (n=85) were defined as variously resilient; and LHDs below the 95% confidence interval (n=564) were defined as non-resilient. In the final ordered logistic regression model, there were significant differences across the three categories of resiliency for presence of a board of health and a board of health without hire/fire authority; percentage of revenues from Medicaid, Medicare, and federal pass-through funding; number of services categorized as screening, treatment, and population services; and community characteristics including percentage of African-Americans, percentage of the population greater than 65 years, and the percentage of uninsured persons. Marginal effects estimates from the ordered logit model indicate that an agency\u27s probability of being resilient increased by 9% for agencies governed by a board of health, compared to agencies without a board (p Conclusion: Local health departments which successfully weathered the economic recession of 2008 were more likely to have had a board of health (but without the authority to hire/fire), have a greater diversity of funding sources (relative to local sources only), and provide a larger number of treatment and population services compared to LHDs which experienced significant losses in funding by 2010. Implications for Policy, Delivery or Practice: Since advocacy for LHDs (through a board of health), revenue mix, and array of services may all be modifiable and adaptable characteristics, the findings suggest possible means for LHDs to attain resiliency in the face of future economic crises

The Resilient Local Health Department: Surviving the 2008 Economic Crisis

The purpose of this study was to identify potential modifiable factors that can protect local health departments (LHDs) from job losses and budget cuts during periods of economic stress. This was a retrospective cohort study based on the 2005 and 2010 surveys of LHDs conducted by the National Association of County and City Health Officials. The outcome of interest – resiliency of the LHD – represented financial resiliency for maintaining budgets during the 2008 recession, and was based on the ratio of observed-to-predicted expenditures per capita for 2010. LHDs which successfully weathered the economic recession of 2008 represented smaller populations and were better resourced in 2005, were less likely to have had a board of health with the authority to hire/fire, and were less likely to be dependent on local resources compared to LHDs which experienced significant losses in funding by 2010. These results varied by size of the jurisdictional population