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Mudzengi DL, Chomutare H, Nagudi J, Ntshiqa T, Davis JL, Charalambous S, Velen K. Using mHealth Technologies for Case Finding in Tuberculosis and Other Infectious Diseases in Africa: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e53211. [PMID: 39186366 PMCID: PMC11384173 DOI: 10.2196/53211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/04/2024] [Accepted: 06/05/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies are increasingly used in contact tracing and case finding, enhancing and replacing traditional methods for managing infectious diseases such as Ebola, tuberculosis, COVID-19, and HIV. However, the variations in their development approaches, implementation scopes, and effectiveness introduce uncertainty regarding their potential to improve public health outcomes. OBJECTIVE We conducted this systematic review to explore how mHealth technologies are developed, implemented, and evaluated. We aimed to deepen our understanding of mHealth's role in contact tracing, enhancing both the implementation and overall health outcomes. METHODS We searched and reviewed studies conducted in Africa focusing on tuberculosis, Ebola, HIV, and COVID-19 and published between 1990 and 2023 using the PubMed, Scopus, Web of Science, and Google Scholar databases. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review, synthesize, and report the findings from articles that met our criteria. RESULTS We identified 11,943 articles, but only 19 (0.16%) met our criteria, revealing a large gap in technologies specifically aimed at case finding and contact tracing of infectious diseases. These technologies addressed a broad spectrum of diseases, with a predominant focus on Ebola and tuberculosis. The type of technologies used ranged from mobile data collection platforms and smartphone apps to advanced geographic information systems (GISs) and bidirectional communication systems. Technologies deployed in programmatic settings, often developed using design thinking frameworks, were backed by significant funding and often deployed at a large scale but frequently lacked rigorous evaluations. In contrast, technologies used in research settings, although providing more detailed evaluation of both technical performance and health outcomes, were constrained by scale and insufficient funding. These challenges not only prevented these technologies from being tested on a wider scale but also hindered their ability to provide actionable and generalizable insights that could inform public health policies effectively. CONCLUSIONS Overall, this review underscored a need for organized development approaches and comprehensive evaluations. A significant gap exists between the expansive deployment of mHealth technologies in programmatic settings, which are typically well funded and rigorously developed, and the more robust evaluations necessary to ascertain their effectiveness. Future research should consider integrating the robust evaluations often found in research settings with the scale and developmental rigor of programmatic implementations. By embedding advanced research methodologies within programmatic frameworks at the design thinking stage, mHealth technologies can potentially become technically viable and effectively meet specific contact tracing health outcomes to inform policy effectively.
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Affiliation(s)
- Don Lawrence Mudzengi
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Thobani Ntshiqa
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - J Lucian Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Connecticut, CT, United States
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Neri DT, da Costa Miranda AL, Botelho EP, Valois RC, Dias GAR, Parente AT, da Cunha Araújo E, Ferreira GRON. Hospitalizations for congenital syphilis in children under one year old in the state of Pará, Brazilian Amazon: ecological study. BMC Pediatr 2023; 23:581. [PMID: 37986154 PMCID: PMC10658822 DOI: 10.1186/s12887-023-04409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The high incidence of congenital syphilis shows flaws in the resolution of primary health care, being a predictor of greater use of hospital services, whose regional differences in access to health actions and services may be reflected in health inequalities. OBJECTIVE to investigate hospitalizations due to congenital syphilis in children under one year of age, in the state of Pará, Brazilian Amazon. METHODS an ecological study was carried out, using hospitalization, lethality and mortality rates related to congenital syphilis in children under one year of age. Temporal analysis and mapping of hospitalization flows were carried out using Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5. RESULTS A total of 6,487 hospitalizations were recorded. For the ten years of the study period (2009 to 2018), the lethality rate showed a decreasing trend of - 13.5% (p = 0.01). The crude hospitalization rate showed an increasing trend of 12.8% (p < 0.000. The regression analysis demonstrated that there was a change point in the trend with a significant growth of 12.8% until 2016 (p = 0.0006). In the mortality rate the trend was stable (p = 0.56). The analysis of hospitalization care flows made it possible to identify that most hospitalizations due to congenital syphilis occurred in the municipalities of residence, but 1,378 (21.2%) had to move. Two large care gaps were highlighted in Metropolitan health regions II and III, belonging to macroregion II. The hospitalizations of residents of these regions were carried out by the assistance networks of Belém (capital) and Marituba, both of which are part of Metropolitana I. Residents of macroregions III and IV had the greatest distances traveled to access hospital care. CONCLUSIONS The increase in the rate of hospitalizations with an increasing trend demonstrates the impact that syphilis still causes in Brazil, not being resolved even after national government interventions in primary health care, but there was a decreasing trend in the fatality rate. The results demonstrate a heterogeneous organization of health care networks in the state's health regions and macroregions.
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Affiliation(s)
- Débora Talitha Neri
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Amanda Loyse da Costa Miranda
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Eliã Pinheiro Botelho
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | | | - Geyse Aline Rodrigues Dias
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Andressa Tavares Parente
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Eliete da Cunha Araújo
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
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Carman AL, Gatton K, Hogg-Graham R. Assessment of Kentucky's Local Health Department Cross-Jurisdictional Sharing: Strategy for Maximizing Efficiency. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E808-E814. [PMID: 36037519 PMCID: PMC9555585 DOI: 10.1097/phh.0000000000001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to examine patterns of cross-jurisdictional sharing across the 61 local public health jurisdictions (LHJs) in Kentucky. The opportunities to reduce the cost-of-service delivery for Kentucky's LHJs via cross-jurisdictional sharing present a mechanism to address financial instability across the state by achieving economies of scale, especially among smaller jurisdictions. DESIGN A cross-sectional study design was used to examine patterns of cross-jurisdictional sharing across the 61 LHJs in Kentucky. The survey tool utilized was designed by the Center for Sharing Public Health Services, an initiative managed by the Kansas Health Institute with support from the Robert Wood Johnson Foundation. RESULTS Seventy-two percent of the 61 LHJs in Kentucky responded to the survey. The majority of responding jurisdictions sharing services were rural, single-county jurisdictions, utilizing service-related informal sharing arrangements. The majority of health departments, when asked to identify which programmatic areas shared service arrangements were focused in, listed those services requiring intensive staff training such as Health Access Nurturing Development Services (HANDS) and epidemiology. Of particular interest were the services most infrequently shared such as communicable disease screening and treatment. CONCLUSIONS This study suggests that, pre-COVID-19, a core group of primarily rural, single-county Kentucky local health departments has experience with cross-jurisdictional sharing. Among this group, engagement in informal arrangements was the form of cross-jurisdictional sharing predominantly used, with few jurisdictions reporting shared functions with joint oversight. When considering the potential benefits and efficiencies that cross-jurisdictional sharing can provide to public health departments and their communities, for some, COVID-19 may have been a catalyst to engage in sharing across health department jurisdictional lines.
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Affiliation(s)
- Angela L. Carman
- Health, Behavior & Society Department (Dr Carman) and Health, Management & Policy Department (Dr Hogg-Graham), College of Public Health, University of Kentucky (Ms Gatton), Lexington, Kentucky
| | - Kelsey Gatton
- Health, Behavior & Society Department (Dr Carman) and Health, Management & Policy Department (Dr Hogg-Graham), College of Public Health, University of Kentucky (Ms Gatton), Lexington, Kentucky
| | - Rachel Hogg-Graham
- Health, Behavior & Society Department (Dr Carman) and Health, Management & Policy Department (Dr Hogg-Graham), College of Public Health, University of Kentucky (Ms Gatton), Lexington, Kentucky
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Orr JM, Leider JP, Singh S, Balio CP, Yeager VA, Bekemeier B, McCullough JM, Resnick B. Regarding Investment in a Healthier Future: Impact of the 2012 Institute of Medicine Finance Report. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E316-E323. [PMID: 32956294 DOI: 10.1097/phh.0000000000001209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Governments at all levels work to ensure a healthy public, yet financing, organization, and delivery of public health services differ across the United States. A 2012 Institute of Medicine Finance report provided a series of recommendations to ensure a high-performing and adequately funded public health infrastructure. OBJECTIVES This review examines the influence of the Finance report's 10 recommendations on public health policy and practice. DESIGN This review utilized peer-reviewed and gray literature published since 2012. ELIGIBILITY CRITERIA Documents that address at least one of the Finance report's 10 recommendations and contain information on either official actions taken in response to the Finance report or evidence of the report's influence on the practice community. RESULTS Of 2394 unique documents found, a total of 56 documents met the eligibility criteria. Review of these 56 documents indicated that the most substantial activity related to the recommendations was focused on the "minimum package of public health services" concept and establishment of a uniform chart of accounts. DISCUSSION Progress has been mixed on the Finance report recommendations. Improved tracking and auditing of public health activity appears to be advancing, yet financial benchmarks remain unmet. Challenges remain in determining actual investment in public health and equitable resource allocation approaches. State and local health department use of cost estimation methodology and a uniform chart of accounts tool has contributed to an increase in understanding and improvement in public health spending. CONCLUSIONS The Finance report has served as a strong impetus for advocating for an increased investment in governmental public health. Efforts are bolstered by informed public health practitioners and stakeholders but often stymied by policy makers who must balance complex competing issues and priorities. Although many successes have occurred, further work is needed toward improving investment in the nation's public health.
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Affiliation(s)
- Jason M Orr
- Kansas Health Institute, Topeka, Kansas (Mr Orr); Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan (Dr Singh); Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Ms Balio and Dr Yeager); Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington (Dr Bekemeier); School for the Science of Health Care Delivery, Arizona State University, Phoenix, Arizona (Dr McCullough); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Resnick)
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Pollock JR, Moore ML, Hogan JS, Haglin JM, Brinkman JC, Doan MK, Chhabra A. Orthopaedic Group Practice Size Is Increasing. Arthrosc Sports Med Rehabil 2021; 3:e1937-e1944. [PMID: 34977651 PMCID: PMC8689279 DOI: 10.1016/j.asmr.2021.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/20/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To analyze recent trends in orthopaedic surgery consolidation and quantify these changes temporally and geographically from 2012 to 2020. METHODS We performed a retrospective cross-sectional analysis of orthopaedic surgeon practice size in the United States using 2012 and 2020 data obtained from the Physician Compare database. RESULTS Although we observed an increase from 21,216 unique orthopaedic surgeons in 2012 to 21,553 in 2020 (1.6% increase), the number of practices experienced a large decrease from 7,299 practices in 2012 to 5,829 in 2020 (20.1% decrease). The proportion of orthopaedic surgeons working in solo practices decreased from 13.2% (2,790) in 2012 to 7.4% (1,595) in 2020, and the proportion of orthopaedic surgeons working in groups sized 2 to 24 decreased from 35.3% (7,482) in 2012 to 22.2% (4,775) in 2020. In contrast, groups sized 25 to 99 have grown from 20.7% (4,387) of all orthopaedic surgeons to 23.4% (5,048) in 2020. Groups sized 100 to 499 have increased from 16.9% (3,593) in 2012 to 24.1% (5,190) in 2020, whereas groups sized 500 or greater have grown from 14% (2,964) in 2012 to 22.9% (4,945) in 2020. The number of unique group practices showed a significant decrease in the number of solo groups, which comprised 43.8% (3,200) of the total number of individual practices in 2012, decreasing to 32% (1,886) in 2020. All other groups increased in number and proportionally from 2012 to 2020. CONCLUSIONS This study shows that over the period from 2012 to 2020, there has been a substantial trend of orthopaedic surgeons shifting to increasing practice sizes, potentially indicating that more orthopaedic surgeons are working for large health care organizations rather than small independent practices. CLINICAL RELEVANCE The impact of these changes should be examined to determine large-scale effects on patient care, payment models, access, and outcomes, along with physician compensation, lifestyle, and satisfaction.
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Affiliation(s)
- Jordan R. Pollock
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | - M. Lane Moore
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | - Jacob S. Hogan
- Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Jack M. Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | | | - Matthew K. Doan
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
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Singh SR, Leider JP, Orcena JE. The Cost of Providing the Foundational Public Health Services in Ohio. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:492-500. [PMID: 32956296 DOI: 10.1097/phh.0000000000001233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine levels of expenditure and needed investment in public health at the local level in the state of Ohio pre-COVID-19. DESIGN Using detailed financial reporting from fiscal year (FY) 2018 from Ohio's local health departments (LHDs), we characterize spending by Foundational Public Health Services (FPHS). We also constructed estimates of the gap in public health spending in the state using self-reported gaps in service provision and a microsimulation approach. Data were collected between January and June 2019 and analyzed between June and September 2019. PARTICIPANTS Eighty-four of the 113 LHDs in the state of Ohio covering a population of almost 9 million Ohioans. RESULTS In FY2018, Ohio LHDs spent an average of $37 per capita on protecting and promoting the public's health. Approximately one-third of this investment supported the Foundational Areas (communicable disease control; chronic disease and injury prevention; environmental public health; maternal, child, and family health; and access to and linkages with health care). Another third supported the Foundational Capabilities, that is, the crosscutting skills and capacities needed to support all LHD activities. The remaining third supported programs and activities that are responsive to local needs and vary from community to community. To fully meet identified LHD needs in the state pre-COVID-19, Ohio would require an additional annual investment of $20 per capita on top of the current $37 spent per capita, or approximately $240 million for the state. CONCLUSIONS A better understanding of the cost and value of public health services can educate policy makers so that they can make informed trade-offs when balancing health care, public health, and social services investments. The current environment of COVID-19 may dramatically increase need, making understanding and growing public health investment critical.
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Affiliation(s)
- Simone R Singh
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan (Dr Singh); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); and Union County Health Department, Marysville, Ohio (Dr Orcena)
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Shah GH, Corso L, Sotnikov S, Leep CJ. Impact of Local Boards of Health on Local Health Department Accreditation, Community Health Assessment, Community Health Improvement Planning, and Strategic Planning. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:423-430. [PMID: 31348156 DOI: 10.1097/phh.0000000000000847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Local health departments (LHDs) are increasingly using national standards to meet the challenges presented by the complex environments in which these agencies operate. Local boards of health (LBoHs) might play an instrumental role in improving LHDs' engagement in activities to meet these standards. OBJECTIVES To assess the impact of LBoH performance of governance functions on LHDs having a current (completed within 5 years) community health assessment (CHA), community health improvement plan (CHIP), strategic plan, and level of engagement in the Public Health Accreditation Board (PHAB) accreditation program. METHODS Binary and multinomial logistic regression models were used to analyze linked data from 329 LHDs participating in both the 2015 Local Board of Health Survey and the 2016 National Profile of LHDs Survey. RESULTS Higher performance of LBoH governance functions, measured by an overall scale of LBoH taxonomy consisting of 60 items, had a significant positive effect on LHDs having completed CHA (P < .001), CHIP (P = .01), and strategic plan (P < .001). LHDs operating in communities with a higher score on the overall scale of LBoH taxonomy had significantly higher odds (P = .03) of having higher level of participation in the PHAB national voluntary accreditation program-that is, being accredited, having submitted application for accreditation, or being in the e-PHAB system (eg, by submitting a letter of intent). CONCLUSIONS LBoHs serve as governance bodies for roughly 71% of LHDs and can play a significant role in encouraging LHDs' participation in these practices. That positive influence of LBoHs can be seen more clearly if the complexity and richness of LBoH governance functions and other characteristics are measured appropriately. The study findings suggest that LBoHs are a significant component of the public health system in the United States, having positive influence on LHDs having a CHA, CHIP, strategic plan, and participation in accreditation.
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Affiliation(s)
- Gulzar H Shah
- Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Corso and Dr Sotnikov); and National Association of County & City Health Officials, Washington, District of Columbia (Ms Leep)
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Hoornbeek J, Morris M, Libbey P, Pezzino G. Consolidating Local Health Departments in the United States: Challenges, Evidence, and Thoughts for the Future. Public Health Rep 2019; 134:103-108. [PMID: 30794755 DOI: 10.1177/0033354919829054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- John Hoornbeek
- 1 Center for Public Policy and Health, College of Public Health, Kent State University, Kent, OH, USA.,2 College of Public Health, Kent State University, Kent, OH, USA
| | - Michael Morris
- 3 Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Patrick Libbey
- 4 Center for Sharing Public Health Services, Topeka, KS, USA
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Good Things in Small Packages? Evaluating an Economy of Scale Approach to Behavioral Health Promotion in Rural America. J 2018. [DOI: 10.3390/j1010006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rural American youth exhibit pronounced health disparities. This study enlists insights from an economy of scale paradigm to determine the relative effects of serving smaller versus larger client groups in an assembly-style school-based behavioral health promotion program. Evaluation results are reported from a three-year intervention delivered to eighth-grade and tenth-grade rural Mississippi students from 2012 to 2015. The program, I Got U: Healthy Life Choices for Teens, coupled a day-long intensive immersion in youth risk prevention and mental health promotion with school-based information dissemination. Results reveal robust effectiveness in program years 1 and 2, during which caps of 175 attendees per event were imposed. Salutary results were no longer evident during year 3, when larger venues were used to serve over three times the number of students per event. This program teaches valuable lessons about the potential for diminishing returns yielded by an economy of scale approach to implementation.
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Humphries DL, Hyde J, Hahn E, Atherly A, O'Keefe E, Wilkinson G, Eckhouse S, Huleatt S, Wong S, Kertanis J. Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost. Front Public Health 2018; 6:115. [PMID: 29755964 PMCID: PMC5932147 DOI: 10.3389/fpubh.2018.00115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background Forty one percent of local health departments in the U.S. serve jurisdictions with populations of 25,000 or less. Researchers, policymakers, and advocates have long questioned how to strengthen public health systems in smaller municipalities. Cross-jurisdictional sharing may increase quality of service, access to resources, and efficiency of resource use. Objective To characterize perceived strengths and challenges of independent and comprehensive sharing approaches, and to assess cost, quality, and breadth of services provided by independent and sharing health departments in Connecticut (CT) and Massachusetts (MA). Methods We interviewed local health directors or their designees from 15 comprehensive resource-sharing jurisdictions and 54 single-municipality jurisdictions in CT and MA using a semi-structured interview. Quantitative data were drawn from closed-ended questions in the semi-structured interviews; municipal demographic data were drawn from the American Community Survey and other public sources. Qualitative data were drawn from open-ended questions in the semi-structured interviews. Results The findings from this multistate study highlight advantages and disadvantages of two common public health service delivery models – independent and shared. Shared service jurisdictions provided more community health programs and services, and invested significantly more ($120 per thousand (1K) population vs. $69.5/1K population) on healthy food access activities. Sharing departments had more indicators of higher quality food safety inspections (FSIs), and there was a non-linear relationship between cost per FSI and number of FSI. Minimum cost per FSI was reached above the total number of FSI conducted by all but four of the jurisdictions sampled. Independent jurisdictions perceived their governing bodies to have greater understanding of the roles and responsibilities of local public health, while shared service jurisdictions had fewer staff per 1,000 population. Implications There are trade-offs with sharing and remaining independent. Independent health departments serving small jurisdictions have limited resources but strong local knowledge. Multi-municipality departments have more resources but require more time and investment in governance and decision-making. When making decisions about the right service delivery model for a given municipality, careful consideration should be given to local culture and values. Some economies of scale may be achieved through resource sharing for municipalities <25,000 population.
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Affiliation(s)
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs, Bedford, MA, United States
| | - Ethan Hahn
- Yale School of Public Health, New Haven, CT, United States
| | - Adam Atherly
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, IL, United States.,Center for Health Services Research, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Elaine O'Keefe
- Yale School of Public Health, New Haven, CT, United States
| | | | - Seth Eckhouse
- Boston University School of Public Health, Boston, MA, United States
| | - Steve Huleatt
- West Hartford-Bloomfield Health District, Bloomfield, CT, United States
| | - Samuel Wong
- Framingham Health Department, Framingham, MA, United States
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Cost Analysis of Prevention Research Centers: Instrument Development. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 24:440-443. [PMID: 29227417 DOI: 10.1097/phh.0000000000000706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The 2014-2019 Prevention Research Centers (PRC) Program Funding Opportunity Announcement stated that "all applicants will be expected to collaborate with CDC to collect data to be able to perform cost analysis." For the first time in the 30-year history of the PRC Program, a cost indicator was included in the PRC Program Evaluation and a cost analysis (CA) instrument developed. The PRC-CA instrument systematically collects data on the cost of the PRC core research project to eventually answer the CDC PRC Program Evaluation question: "To what extent do investments in PRCs support the scalability, sustainability, and effectiveness of the outcomes resulting from community-engaged efforts to improve public health?" The objective of this article is to briefly describe the development of the PRC-CA instrument. Data obtained from the PRC-CA instrument can be used to generate cost summaries to inform decision making within the PRC Program and each individual PRC.
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Singh SR, Winterbauer NL, Tucker A, Harrison LM. Exploring Costing Methods for Environmental Health Services in North Carolina. Public Health Rep 2016; 132:37-40. [PMID: 28005479 DOI: 10.1177/0033354916679985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
All local health departments in North Carolina are mandated to provide a defined set of environmental health services, yet few have the tools to understand the costs incurred in delivering these services. The objectives of this study were to (1) derive cost estimates for 2 commonly provided environmental health services-food and lodging inspections and on-site water services-and (2) explore factors that drive variations in costs, focusing on the roles of economies of scale and scope. Using data from 15 local health departments in North Carolina, we found that costs varied substantially. A bivariate analysis found evidence of economies of scale: higher volumes of services were associated with lower costs per service. Providing a greater scope of services, however, was not consistently associated with reduced costs. In-depth cost data provide public health officials with key information when deciding how to best serve their communities.
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Affiliation(s)
- Simone R Singh
- 1 Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Winterbauer
- 2 Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ashley Tucker
- 2 Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Shah GH, Badana ANS, Robb C, Livingood WC. Cross-Jurisdictional Resource Sharing in Changing Public Health Landscape: Contributory Factors and Theoretical Explanations. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22:110-9. [PMID: 26808685 DOI: 10.1097/phh.0000000000000368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Local health departments (LHDs) are striving to meet public health needs within their jurisdictions, amidst fiscal restraints and complex dynamic environment. Resource sharing across jurisdictions is a critical opportunity for LHDs to continue to enhance effectiveness and increase efficiency. PURPOSE This research examines the extent of cross-jurisdictional resource sharing among LHDs, the programmatic areas and organizational functions for which LHDs share resources, and LHD characteristics associated with resource sharing. METHODS Data from the National Association of County & City Health Officials' 2013 National Profile of LHDs were used. Descriptive statistics and multinomial logistic regression were performed for the 5 implementation-oriented outcome variables of interest, with 3 levels of implementation. RESULTS More than 54% of LHDs shared resources such as funding, staff, or equipment with 1 or more other LHDs on a continuous, recurring basis. Results from the multinomial regression analysis indicate that economies of scale (population size and metropolitan status) had significant positive influences (at P ≤ .05) on resource sharing. Engagement in accreditation, community health assessment, community health improvement planning, quality improvement, and use of the Community Guide were associated with lower levels of engagement in resource sharing. Doctoral degree of the top executive and having 1 or more local boards of health carried a positive influence on resource sharing. CONCLUSIONS Cross-jurisdictional resource sharing is a viable and commonly used process to overcome the challenges of new and emerging public health problems within the constraints of restricted budgets. LHDs, particularly smaller LHDs with limited resources, should consider increased resource sharing to address emerging challenges.
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Affiliation(s)
- Gulzar H Shah
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro (Drs Shah and Robb and Mr Badana); and Center for Health Equity and Quality Research, UF College of Medicine-Jacksonville, Florida (Dr Livingood)
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