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Madsen ER, Schaffer K, Hare Bork R, Yeager VA. On-the-Job Learning: Bright Spots of Governmental Public Health Employee Reflections on the COVID-19 Response. J Public Health Manag Pract 2024; 30:372-376. [PMID: 38489538 DOI: 10.1097/phh.0000000000001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
This article is one of 3 research briefs that highlight valuable experiences and opportunities that can be thought of as "bright spots" of the governmental public health workforce's pandemic response. Using PH WINS 2021 data, we qualitatively examined responses to an open-ended survey question about workforce experiences during the pandemic response. On-the-job learning was emphasized as a critical component of employees' experiences. Seven "on-the-job learning" subthemes were identified among 91 responses. Findings indicate that the pandemic facilitated opportunities for on-the-job learning for various skills and workplace activities. Public health employees were appreciative of the opportunity to gain new technical and practical skills including communicating with the public and to experience new roles and responsibilities. Respondents reported other related benefits including career growth and leadership opportunities. Highlighting these unexpected benefits of the COVID-19 pandemic is important for employee morale and continued workforce development planning.
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Affiliation(s)
- Emilie R Madsen
- Author Affiliations: Department of Communication Studies, Indiana University School of Liberal Arts, Indianapolis, Indiana (Ms Madsen); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer and Dr Hare Bork); and Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana (Dr Yeager)
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Madsen ER, Schaffer K, Hare Bork R, Yeager VA. Teamwork and Collaboration: Bright Spots of Governmental Public Health Employee Reflections on the COVID-19 Response. J Public Health Manag Pract 2024; 30:377-383. [PMID: 38489536 DOI: 10.1097/phh.0000000000001882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
The public health emergency response following the outbreak of COVID-19 necessitated greater internal public health agency teamwork and external collaboration. Building on previous research, this article is the third of 3 research briefs that highlight "bright spots" or valuable experiences and opportunities from the COVID-19 response. Using PH WINS 2021 data, we qualitatively examined responses to a question about pandemic workforce experiences. Teamwork and collaboration were emphasized as a critical component of employees' experiences. Across 260 responses, 7 subthemes emerged, generally commemorating the ways that the response effort and employees were supported by teamwork and collaboration. Findings highlight the value of ongoing cross-division teamwork within agencies, the role of leaders in teamwork, and that lessons from teamwork/collaboration experiences can inform organizational system improvements. Maintaining and expanding on improved external collaboration and partnerships should be prioritized for preparing for future emergency events and serving public health communities on a daily basis.
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Affiliation(s)
- Emilie R Madsen
- Author Affiliations: Department of Communication Studies, Indiana University School of Liberal Arts, Indianapolis, Indiana (Ms Madsen); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer and Dr Hare Bork); and Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana (Dr Yeager)
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Madsen ER, Schaffer K, Hare Bork R, Yeager VA. Leadership: Bright Spots of Governmental Public Health Employee Reflections on the COVID-19 Response. J Public Health Manag Pract 2024; 30:367-371. [PMID: 38489533 DOI: 10.1097/phh.0000000000001881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
The protracted nature of the COVID-19 pandemic demanded extraordinary efforts and innovation from public health agencies and their leaders. This is the first of 3 research briefs that highlight valuable experiences and opportunities that can be thought of as "bright spots" of the public health workforce's pandemic response. Using Public Health Workforce Interests and Needs Survey 2021 data, we qualitatively examined responses to an open-ended question about pandemic workforce experiences. Leadership was emphasized as a critical component of employees' experiences during the response, and 7 "leadership" subthemes were identified among 157 responses. Findings illustrate the importance of leaders prioritizing safe and supportive environments for employees. Respondents also highlighted the importance of leaders fostering teamwork alongside employees and advocating for and demonstrating appreciation for employees. In addition, effective leadership communication was reported to be motivational and alleviate uncertainty during crisis situations. Focusing on these leadership skills and competencies may aid the workforce during future emergency response events.
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Affiliation(s)
- Emilie R Madsen
- Author Affiliations: Department of Communication Studies, School of Liberal Arts, Indiana University, Indianapolis, Indiana (Ms Madsen); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); Research and Impact, de Beaumont Foundation, Bethesda, Maryland (Dr Hare Bork); and Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana (Dr Yeager)
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Burns A, Menachemi N, Mazurenko O, Salyers MP, Yeager VA. State Policies Associated with Availability of Mobile Crisis Teams. Adm Policy Ment Health 2024:10.1007/s10488-024-01368-0. [PMID: 38498103 DOI: 10.1007/s10488-024-01368-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 03/20/2024]
Abstract
Mobile crisis teams are comprised of multidisciplinary mental health professionals that respond to mental health crisis calls in community settings. This study identified counties with mobile crisis teams and examined state policies associated with mobile crisis teams. Descriptive statistics and geographic information system software were used to quantify and map counties with mobile crisis teams in the United States. Relationships between state policies and mobile crisis teams were examined using an adjusted logistic regression model, controlling for county characteristics and accounting for clustering by state. Approximately 40% (n = 1,245) of all counties in the US have at least one mobile crisis team. Counties in states with legislation in place to fund the 988 Suicide and Crisis Lifeline were more likely to have a mobile crisis team (Adjusted Odds Ratio (AOR): 2.0; Confidence Interval (CI): 1.23-3.26), whereas counties in states with 1115 waivers restricting Medicaid benefits were less likely to have a mobile crisis team (AOR: 0.43; CI: 0.21-0.86). Additionally, counties with the largest population were more likely to have a mobile crisis team (AOR: 2.20; CI:1.43-3.38) than counties with the smallest population. Having a mobile crisis teams was positively associated with legislation to fund 988. Legislation that encourages expansion of existing crisis care services, specifically funding aimed at mobile crisis teams, may help increase availability of services for people who are experiencing a mental health crisis in the community.
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Affiliation(s)
- Ashlyn Burns
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
| | - Nir Menachemi
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Olena Mazurenko
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University School of Science, Indianapolis, IN, USA
| | - Valerie A Yeager
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
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Yeager VA, Silverman RD, Halverson PK. Laws Governing State Health Official Appointments: A Legal and Historical Review. J Public Health Manag Pract 2024; 30:267-273. [PMID: 38032841 DOI: 10.1097/phh.0000000000001855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE The current study presents the legal epidemiological review of State Health Official (SHO) appointment laws, including the evolution of educational and experience requirements of SHOs over time. Findings can inform the discussion about state laws and the substantive, multidisciplinary qualifications essential to successfully leading state public health agencies in the 21st century. METHODS Standard policy surveillance methods were used to collect and assess the statutes governing SHO appointment and eligibility from all 50 states and the District of Columbia between 1995 and 2020. RESULTS SHOs are most frequently appointed by their jurisdiction's Health Secretary (n = 17), followed by Governor nominations with legislative approval (n = 15), and 13 states where the Governor is the sole SHO appointing authority. While a large majority of jurisdictions require certain professional and/or educational minimum qualifications to serve as an SHO, 11 states have no professional or experiential minimum qualifications. The most common minimum requirement found was possessing a medical degree, which is required in 22 jurisdictions (including Washington, District of Columbia). Twelve of these states require the physician to have additional education or experience, such as the possession of experience in public health (n = 5), experience in both public health and management (n = 3), or holding an additional health-related degree (n = 2). Four states added a medical degree as a requirement for SHOs over the last 25 years, while 5 states removed their medical degree requirement. CONCLUSIONS States should reassess their eligibility requirements for SHO service in light of the advancement and demands of public health leadership in the 21st century, as many states continue to look to those with medical training as the primary source for such leadership.
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Affiliation(s)
- Valerie A Yeager
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Yeager and Halverson); and Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, Pennsylvania (Dr Silverman)
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Mills CA, Yeager VA, Unroe KT, Holmes A, Blackburn J. The impact of rural general hospital closures on communities-A systematic review of the literature. J Rural Health 2024; 40:238-248. [PMID: 37985431 DOI: 10.1111/jrh.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/30/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE To compile the literature on the effects of rural hospital closures on the community and summarize the evidence, specifically the health and economic impacts, and identify gaps for future research. METHODS A systematic review of the relevant peer-reviewed literature, published from January 2005 through December 2021, included in the EMBASE, CINAHL, PubMed, EconLit, and Business Source Complete databases, as well as "gray" literature published during the same time period. A total of 21 articles were identified for inclusion. FINDINGS Over 90% of the included studies were published in the last 8 years, with nearly three-fourths published in the last 4 years. The most common outcomes studied were economic outcomes and employment (76%), emergent, and non-emergent transportation, which includes transport miles and travel time (42.8%), access to and supply of health care providers (38%), and quality of patient outcomes (19%). Eighty-nine percent of the studies that examined economic impacts found unfavorable results, including decreased income, population, and community economic growth, and increased poverty. Between 11 and 15.7 additional minutes were required to transport patients to the nearest emergency facility after closures. A lack of consistency in measures and definition of rurality challenges comparability across studies. CONCLUSIONS The comprehensive impact of rural hospital closures on communities has not been well studied. Research shows predominantly negative economic outcomes as well as increased time and distance required to access health care services. Additional research and consistency in the outcome measures and definition of rurality is needed to characterize the downstream impact of rural hospital closures.
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Affiliation(s)
- Carol A Mills
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Valerie A Yeager
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana, USA
| | - Kathleen T Unroe
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Ann Holmes
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana, USA
| | - Justin Blackburn
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana, USA
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Yeager VA, Gutta J, Kutschera L, Stelzner SM. Perceived Value of the Inclusion of Parent-to-Parent Support in Case Conferences and Care Planning for Children With Special Healthcare Needs. Adv Health Care Manag 2024; 22:211-229. [PMID: 38262017 DOI: 10.1108/s1474-823120240000022010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
This chapter qualitatively explored the impact of including parent liaisons (i.e., parents with lived experience caring for a child with complex needs, who support other caregivers in navigating child and family needs) in a case conferencing model for children with complex medical/social needs. Case conferences are used to address fragmented care, shared decision-making, and set patient-centered goals. Seventeen semi-structured interviews were conducted with clinicians and parent liaisons to assess the involvement of parent liaisons in case conferencing. Two main themes included benefits of parent liaison involvement (10 subthemes) and challenges to parent liaison involvement (5 subthemes). Clinicians reported that liaison participation and support of patients reduced stress for clinicians as well as family members. Challenges to liaison involvement included clinical team/parent liaison communication delays, which were further exacerbated by the COVID-19 pandemic. Parent liaison involvement in case conferences is perceived to be beneficial to children with complex needs, their families, and the clinical team. Integration of liaisons ensures the familial perspective is included in clinical goal setting.
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Affiliation(s)
- Valerie A Yeager
- a Indiana University Richard M. Fairbanks School of Public Health, USA
| | - Jyotsna Gutta
- a Indiana University Richard M. Fairbanks School of Public Health, USA
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Yeager VA, Hilts KE, Dearth S, Sanner L, McNamee C, Duszynski T. Conducting a Comprehensive Assessment of the Public Health Workforce: Lessons Learned and Opportunities for the Future. J Public Health Manag Pract 2024; 30:66-71. [PMID: 37831629 PMCID: PMC10664795 DOI: 10.1097/phh.0000000000001816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Indiana was one of the earliest states to conduct a comprehensive public health workforce assessment in preparation for the use of federal funds for infrastructure strengthening. Experiences from this assessment provide insights that may be useful to other public health agencies and partners. This brief summarizes key lessons and highlights opportunities for improved workforce assessments. For example, the lack of standardized job titles within local health departments (LHDs) can be mitigated by collecting the top 3 job tasks employees engage in daily and reassigning standardized titles based on nationally collected workforce data. This facilitates comparisons across LHD employees nationally. In addition, many employees felt their job tasks did not align well with the Foundational Public Health Services (FPHS) areas and capabilities, which contributed to the likely overestimation of effort. Further consideration of how to better align and/or integrate FPHS assessment within current practice is needed in addition to improved ways of assessing efforts toward FPHS.
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Affiliation(s)
- Valerie A. Yeager
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Katy Ellis Hilts
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Shandy Dearth
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Lindsey Sanner
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Cassidy McNamee
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Thomas Duszynski
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
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Yeager VA, Burns A, Singh SR, Cronin CE, Franz B. Evaluation of Community Benefit Activities Among Nonprofit Hospitals, 2018-2021. J Public Health Manag Pract 2023; 29:E231-E236. [PMID: 37499100 DOI: 10.1097/phh.0000000000001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE This study examined approaches that nonprofit hospitals use to evaluate community benefit activities in the Community Health Needs Assessment/Implementation Plan (CHNA/IP) process. DESIGN Content analysis of CHNAs/IPs completed between 2018 and 2021 from a 20% stratified random sample (n = 503) of US nonprofit hospitals. MAIN OUTCOME MEASURES A coding sheet was used to record details about the evaluation content reported by hospitals in their CHNAs/IPs. Evaluation was coded into 4 categories: (1) no mention of evaluation; (2) description of evaluation without reporting any measures; (3) reporting reach (number of people served) only; and (4) reporting social/health outcomes. For logistic regression analyses, categories 1 and 2 were grouped together into "no evaluation measures" and categories 3 and 4 were grouped into "evaluation measures" for binary comparison. Multinomial logistic regression was also used to individually examine categories 3 and 4 compared with no evaluation measures. RESULTS While a majority of nonprofit hospitals (71.4%, n = 359) mentioned evaluation in their CHNAs, almost half (49.7%, n = 250) did not report any evaluation measures. Among the 50.3% (n = 253) of hospitals that reported evaluation measures, 67.2% (n = 170) only reported reach. Fewer than 1 in 5 hospitals (16.5%, n = 83) reported social/health outcomes. Hospitals that hired a consultant (adjusted odds ratio [AOR] = 1.61; 95% confidence interval [CI], 1.08-2.43) and system members (AOR = 1.76; 95% CI, 1.12-2.75) had higher odds of reporting evaluation measures. Using hospitals that reported no measures as the base category, system members (AOR = 7.71; 95% CI, 2.97-20.00) also had significantly higher odds of reporting social/health outcomes, while rural locations had lower odds (AOR = 0.43; 95% CI, 0.20-0.94). CONCLUSIONS Although hospitals are required to evaluate the impact of actions taken to address the health needs identified in their CHNAs, few hospitals are reporting social/health outcomes of such activities. This represents a missed opportunity, as health/social outcomes could be used to inform the allocation of resources to maximize community benefits and the expansion of successful community initiatives.
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Affiliation(s)
- Valerie A Yeager
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana (Dr Yeager and Ms Burns); School of Public Health, University of Michigan, Ann Arbor, Michigan (Dr Singh); and College of Health Sciences and Professions (Dr Cronin) and Heritage College of Osteopathic Medicine (Dr Franz), Ohio University, Athens, Ohio
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Yeager VA, Burns AB, Lang B, Kronstadt J, Hughes MJ, Gutta J, Kirkland C, Orr J, Leider JP. What Are Public Health Agencies Planning for Workforce Development? A Content Analysis of Workforce Development Plans of Accredited Public Health Departments. J Public Health Manag Pract 2023; 29:762-774. [PMID: 37646511 PMCID: PMC10549878 DOI: 10.1097/phh.0000000000001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Recruiting and retaining public health employees and ensuring they have the skills necessary to respond are vital for meeting public health needs. As the first study examining health department (HD) workforce development plans (WDPs), this study presents gaps and strategies identified in WDPs across 201 accredited HDs (168 initial/33 reaccreditation plans). DESIGN This cross-sectional study employed qualitative review and content analysis of WDPs submitted to the Public Health Accreditation Board (PHAB) between March 2016 and November 2021. MAIN OUTCOME MEASURES Eight overarching workforce themes were examined: planning/coordination, leadership, organizational culture, workplace supports/retention, recruitment, planning for departmental training, delivery of departmental training, and partnership/engagement. Within each theme, related subthemes were identified. Coders indicated whether the WDP (1) identified the subtheme as a gap; (2) stated an intent to address the subtheme; and/or (3) identified a strategy for addressing the subtheme. RESULTS The most common gaps identified included prepare workforce for community engagement/partnership (34.3%, n = 69), followed by resource/fund training (24.9%, n = 50). The subtheme that had the most instances of an identified strategy to address it was assess training needs (84.1%, n = 169), followed by foster quality improvement (QI) culture/provide QI training (63.2%, n = 127). While both of these strategies were common among the majority of HDs, those subthemes were rarely identified as a gap. Secondary findings indicate that increase recruitment diversity/recruit from a more diverse applicant pool was rarely identified as a gap (6.0%, n = 12) and rarely had an identified strategy for addressing the subtheme (9.0%, n = 18). CONCLUSION While HDs recognized many workforce gaps, HDs did not always propose a strategy for addressing them within the WDP. Conversely, some WDPs proposed strategies for subthemes that did not reflect recognized gaps. Such discrepancies between identified gaps and strategies in WDPs may suggest areas where HDs could use additional support and guidance.
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Affiliation(s)
- Valerie A. Yeager
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager and Mss Burns and Gutta); Public Health Accreditation Board, Alexandria, Virginia (Mx Lang and Ms Kronstadt); St. David's School of Nursing at Texas State University, Round Rock, Texas (Dr Hughes); and Center for Public Health Systems, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Drs Kirkland and Leider and Mr Orr)
| | - Ashlyn B. Burns
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager and Mss Burns and Gutta); Public Health Accreditation Board, Alexandria, Virginia (Mx Lang and Ms Kronstadt); St. David's School of Nursing at Texas State University, Round Rock, Texas (Dr Hughes); and Center for Public Health Systems, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Drs Kirkland and Leider and Mr Orr)
| | - Britt Lang
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager and Mss Burns and Gutta); Public Health Accreditation Board, Alexandria, Virginia (Mx Lang and Ms Kronstadt); St. David's School of Nursing at Texas State University, Round Rock, Texas (Dr Hughes); and Center for Public Health Systems, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Drs Kirkland and Leider and Mr Orr)
| | - Jessica Kronstadt
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager and Mss Burns and Gutta); Public Health Accreditation Board, Alexandria, Virginia (Mx Lang and Ms Kronstadt); St. David's School of Nursing at Texas State University, Round Rock, Texas (Dr Hughes); and Center for Public Health Systems, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Drs Kirkland and Leider and Mr Orr)
| | - Monica J. Hughes
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager and Mss Burns and Gutta); Public Health Accreditation Board, Alexandria, Virginia (Mx Lang and Ms Kronstadt); St. David's School of Nursing at Texas State University, Round Rock, Texas (Dr Hughes); and Center for Public Health Systems, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Drs Kirkland and Leider and Mr Orr)
| | - Jyotsna Gutta
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager and Mss Burns and Gutta); Public Health Accreditation Board, Alexandria, Virginia (Mx Lang and Ms Kronstadt); St. David's School of Nursing at Texas State University, Round Rock, Texas (Dr Hughes); and Center for Public Health Systems, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Drs Kirkland and Leider and Mr Orr)
| | - Chelsey Kirkland
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager and Mss Burns and Gutta); Public Health Accreditation Board, Alexandria, Virginia (Mx Lang and Ms Kronstadt); St. David's School of Nursing at Texas State University, Round Rock, Texas (Dr Hughes); and Center for Public Health Systems, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Drs Kirkland and Leider and Mr Orr)
| | - Jason Orr
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager and Mss Burns and Gutta); Public Health Accreditation Board, Alexandria, Virginia (Mx Lang and Ms Kronstadt); St. David's School of Nursing at Texas State University, Round Rock, Texas (Dr Hughes); and Center for Public Health Systems, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Drs Kirkland and Leider and Mr Orr)
| | - Jonathon P. Leider
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager and Mss Burns and Gutta); Public Health Accreditation Board, Alexandria, Virginia (Mx Lang and Ms Kronstadt); St. David's School of Nursing at Texas State University, Round Rock, Texas (Dr Hughes); and Center for Public Health Systems, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Drs Kirkland and Leider and Mr Orr)
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Burns A, Gutta J, Kooreman H, Spitznagle M, Yeager VA. Strategic use of tobacco treatment specialists as an innovation for tobacco cessation health systems change within health care organizations. Health Care Manage Rev 2023; 48:323-333. [PMID: 37615942 DOI: 10.1097/hmr.0000000000000380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Tobacco screening interventions have demonstrated effectiveness at improving population health, yet many people who want to quit using tobacco lack access to professional assistance. One way to address this gap is to train members of the clinical team as tobacco treatment specialists (TTSs). PURPOSE The purpose of this study was to understand how TTSs have been used across a variety of health care organizations implementing health systems change for tobacco treatment and examine the sustainability of TTSs as a health systems change innovation for tobacco cessation. METHODOLOGY This study used qualitative interviews ( n = 25) to identify themes related to implementing TTSs as a health systems change innovation and examined these themes within the constructs of the theory of innovation implementation. RESULTS Insights about implementing TTSs as an innovation primarily aligned with four theoretical constructs: implementation policies and practices, implementation climate, innovation-values fit, and implementation effectiveness. Specific themes were perceived to facilitate the sustainability of TTSs including team-based TTS efforts, widespread awareness of TTS roles, leadership buy-in, and recognized value of TTS services. Barriers to sustainability included inadequate resources (e.g., time and staff), lack of tracking outcomes, inappropriate referrals, and lack of reimbursement. PRACTICE IMPLICATIONS Health care organizations planning to implement health systems change for tobacco cessation can encourage committed use of TTSs as an innovation by considering the insights provided in this study. These primarily related to five overarching implementation considerations: staff selection and training, tracking and dissemination of impacts, adequate resources, referrals and workflow, and billing and reimbursement.
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Burns A, Menachemi N, Yeager VA, Vest JR, Mazurenko O. Adoption of Best Practices in Behavioral Health Crisis Care by Mental Health Treatment Facilities. Psychiatr Serv 2023; 74:929-935. [PMID: 36872894 PMCID: PMC10565906 DOI: 10.1176/appi.ps.20220427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The authors aimed to examine adoption of behavioral health crisis care (BHCC) services included in the Substance Abuse and Mental Health Services Administration's (SAMHSA's) best practices guidelines. METHODS Secondary data from SAMHSA's Behavioral Health Treatment Services Locator in 2022 were used. BHCC best practices were measured on a summated scale capturing whether a mental health treatment facility (N=9,385) adopted BHCC best practices, including provision of these services to all age groups: emergency psychiatric walk-in services, crisis intervention teams, onsite stabilization, mobile or offsite crisis responses, suicide prevention, and peer support. Descriptive statistics were used to examine organizational characteristics (such as facility operation, type, geographic area, license, and payment methods) of mental health treatment facilities nationwide, and a map was created to show locations of best practices BHCC facilities. Logistic regressions were performed to identify facilities' organizational characteristics associated with adopting BHCC best practices. RESULTS Only 6.0% (N=564) of mental health treatment facilities fully adopted BHCC best practices. Suicide prevention was the most common BHCC service, offered by 69.8% (N=6,554) of the facilities. A mobile or offsite crisis response service was the least common, adopted by 22.4% (N=2,101). Higher odds of adopting BHCC best practices were significantly associated with public ownership (adjusted OR [AOR]=1.95), accepting self-pay (AOR=3.18), accepting Medicare (AOR=2.68), and receiving any grant funding (AOR=2.45). CONCLUSIONS Despite SAMHSA guidelines recommending comprehensive BHCC services, a fraction of facilities have fully adopted BHCC best practices. Efforts are needed to facilitate widespread uptake of BHCC best practices nationwide.
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Affiliation(s)
- Ashlyn Burns
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Nir Menachemi
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Valerie A Yeager
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Joshua R. Vest
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis
| | - Olena Mazurenko
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
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Leider JP, Yeager VA, Kirkland C, Krasna H, Hare Bork R, Resnick B. The State of the US Public Health Workforce: Ongoing Challenges and Future Directions. Annu Rev Public Health 2023; 44:323-341. [PMID: 36692395 DOI: 10.1146/annurev-publhealth-071421-032830] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Between the 2009 Great Recession and the onset of the COVID-19 pandemic, the US state and local governmental public health workforce lost 40,000 jobs. Tens of thousands of workers also left during the pandemic and continue to leave. As governmental health departments are now receiving multimillion-dollar, temporary federal investments to replenish their workforce, this review synthesizes the evidence regarding major challenges that preceded the pandemic and remain now. These include the lack of the field's ability to readily enumerate and define the governmental public health workforce as well as challenges with the recruitment and retention of public health workers. This review finds that many workforce-related challenges identified more than 20 years ago persist in the field today. Thus, it is critical that we look back to be able to then move forward to successfully rebuild the workforce and assure adequate capacity to protect the public's health and respond to public health emergencies. Expected final online publication date for the Annual Review of Public Health, Volume 44 is April 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Jonathon P Leider
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Valerie A Yeager
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Chelsey Kirkland
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Heather Krasna
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Beth Resnick
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Yeager VA, Madsen ER, Schaffer K. Qualitative Insights From Governmental Public Health Employees About Experiences Serving During the COVID-19 Pandemic, PH WINS 2021. J Public Health Manag Pract 2023; 29:S73-S86. [PMID: 36223502 PMCID: PMC10573089 DOI: 10.1097/phh.0000000000001644] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of the current study was to examine governmental public health employee experiences during the COVID-19 pandemic. DESIGN AND SETTING A total of 5169 responses to a PH WINS 2021 open-ended question were qualitatively coded. The question asked employees to share their experiences during the COVID-19 response. The 15 most common themes are discussed. PARTICIPANTS Responses from governmental public health employees in state health agencies (SHAs), big cities (Big City Health Coalition or BCHC agencies), and local health departments (LHDs) across all 50 states were included. RESULTS The most frequently identified theme was pride in public health work and/or the mission of public health (20.8%), followed by leadership (17.2%), burnout or feeling overwhelmed (14%), communication (11.7%), and overtime/extra work (9.7%). Among the top 15 themes identified, comments about pride in public health work and/or the mission of public health (95.9%), teamwork (81.5%), and telework (61%) were predominantly positive. Co-occurring themes for responses that expressed pride in public health work and/or the mission of public health were often countered with explanations of why respondents remain frustrated, including feeling burned out or overwhelmed , disappointment with the community's sense of responsibility or trust in science , and feeling unappreciated either by the community or their agency. All of these co-occurring themes were predominantly negative. CONCLUSIONS Employees are proud to work in public health and value teamwork but often felt overworked and unappreciated during the COVID-19 pandemic. Reviewing existing emergency preparedness protocols in the context of lessons learned during the COVID-19 pandemic and listening to employees' experiences with teleworking and task sharing may better prepare agencies for future challenges. Creating channels for clear communication during a period of changing information and guidelines may help employees feel more prepared and valued during an emergency response.
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Affiliation(s)
- Valerie A. Yeager
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); Department of Communication Studies, IUPUI School of Liberal Arts, Indianapolis, Indiana (Ms Madsen); and de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer)
| | - Emilie R. Madsen
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); Department of Communication Studies, IUPUI School of Liberal Arts, Indianapolis, Indiana (Ms Madsen); and de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer)
| | - Kay Schaffer
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); Department of Communication Studies, IUPUI School of Liberal Arts, Indianapolis, Indiana (Ms Madsen); and de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer)
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Leider JP, Shah GH, Yeager VA, Yin J, Madamala K. Turnover, COVID-19, and Reasons for Leaving and Staying Within Governmental Public Health. J Public Health Manag Pract 2023; 29:S54-S63. [PMID: 36223500 PMCID: PMC10573096 DOI: 10.1097/phh.0000000000001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Public health workforce recruitment and retention continue to challenge public health agencies. This study aims to describe the trends in intention to leave and retire and analyze factors associated with intentions to leave and intentions to stay. DESIGN Using national-level data from the 2017 and 2021 Public Health Workforce Interests and Needs Surveys, bivariate analyses of intent to leave were conducted using a Rao-Scott adjusted chi-square and multivariate analysis using logistic regression models. RESULTS In 2021, 20% of employees planned to retire and 30% were considering leaving. In contrast, 23% of employees planned to retire and 28% considered leaving in 2017. The factors associated with intentions to leave included job dissatisfaction, with adjusted odds ratio (AOR) of 3.8 (95% CI, 3.52-4.22) for individuals who were very dissatisfied or dissatisfied. Odds of intending to leave were significantly high for employees with pay dissatisfaction (AOR = 1.83; 95% CI, 1.59-2.11), those younger than 36 years (AOR = 1.58; 95% CI, 1.44-1.73) or 65+ years of age (AOR = 2.80; 95% CI, 2.36-3.33), those with a graduate degree (AOR = 1.14; 95% CI, 1.03-1.26), those hired for COVID-19 response (AOR = 1.74; 95% CI, 1.49-2.03), and for the BIPOC (Black, Indigenous, and people of color) (vs White) staff (AOR = 1.07; 95% CI, 1.01-1.15). The leading reasons for employees' intention to stay included benefits such as retirement, job stability, flexibility (eg, flex hours/telework), and satisfaction with one's supervisor. CONCLUSIONS Given the cost of employee recruitment, training, and retention of competent employees, government public health agencies need to address factors such as job satisfaction, job skill development, and other predictors of employee retention and turnover. IMPLICATIONS Public health agencies may consider activities for improving retention by prioritizing improvements in the work environment, job and pay satisfaction, and understanding the needs of subgroups of employees such as those in younger and older age groups, those with cultural differences, and those with skills that are highly sought-after by other industries.
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Affiliation(s)
- Jonathon P. Leider
- University of Minnesota School of Public Health (SPH) and SPH Center for Public Health Systems (CPHS), Minneapolis, Minnesota (Dr Leider); Departments of Health Policy and Community Health (Dr Shah) and Biostatistics, Epidemiology, and Environmental Health Sciences (Dr Yin), Jiann-Ping Hsu College of Public Health Georgia Southern University, Statesboro, Georgia; Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); and Oregon Health Authority, Public Health Division and Multnomah County Health Department, Portland, Oregon (Dr Madamala)
| | - Gulzar H. Shah
- University of Minnesota School of Public Health (SPH) and SPH Center for Public Health Systems (CPHS), Minneapolis, Minnesota (Dr Leider); Departments of Health Policy and Community Health (Dr Shah) and Biostatistics, Epidemiology, and Environmental Health Sciences (Dr Yin), Jiann-Ping Hsu College of Public Health Georgia Southern University, Statesboro, Georgia; Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); and Oregon Health Authority, Public Health Division and Multnomah County Health Department, Portland, Oregon (Dr Madamala)
| | - Valerie A. Yeager
- University of Minnesota School of Public Health (SPH) and SPH Center for Public Health Systems (CPHS), Minneapolis, Minnesota (Dr Leider); Departments of Health Policy and Community Health (Dr Shah) and Biostatistics, Epidemiology, and Environmental Health Sciences (Dr Yin), Jiann-Ping Hsu College of Public Health Georgia Southern University, Statesboro, Georgia; Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); and Oregon Health Authority, Public Health Division and Multnomah County Health Department, Portland, Oregon (Dr Madamala)
| | - Jingjing Yin
- University of Minnesota School of Public Health (SPH) and SPH Center for Public Health Systems (CPHS), Minneapolis, Minnesota (Dr Leider); Departments of Health Policy and Community Health (Dr Shah) and Biostatistics, Epidemiology, and Environmental Health Sciences (Dr Yin), Jiann-Ping Hsu College of Public Health Georgia Southern University, Statesboro, Georgia; Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); and Oregon Health Authority, Public Health Division and Multnomah County Health Department, Portland, Oregon (Dr Madamala)
| | - Kusuma Madamala
- University of Minnesota School of Public Health (SPH) and SPH Center for Public Health Systems (CPHS), Minneapolis, Minnesota (Dr Leider); Departments of Health Policy and Community Health (Dr Shah) and Biostatistics, Epidemiology, and Environmental Health Sciences (Dr Yin), Jiann-Ping Hsu College of Public Health Georgia Southern University, Statesboro, Georgia; Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); and Oregon Health Authority, Public Health Division and Multnomah County Health Department, Portland, Oregon (Dr Madamala)
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Mills CA, Tran Y, Yeager VA, Unroe KT, Holmes A, Blackburn J. Perceptions of Nurses Delivering Nursing Home Virtual Care Support: A Qualitative Pilot Study. Gerontol Geriatr Med 2023; 9:23337214231163438. [PMID: 36968120 PMCID: PMC10037723 DOI: 10.1177/23337214231163438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/29/2023] Open
Abstract
Avoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive and require dedicated clinical staff, although nursing homes are chronically understaffed. The OPTIMISTIC project was one of seven programs selected by CMS as "enhanced care & coordination providers" and was implemented from 2012 to 2020. This qualitative study explores the perceptions of the nurses that piloted a virtual care support project developed to expand the program's reach through telehealth, and specifically considered how nurses perceived the effectiveness of this program. Relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of the implementation of virtual care support programs within nursing homes.
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Affiliation(s)
- Carol A. Mills
- The Pennsylvania State University,
Department of Health Policy and Administration, University Park, USA
| | - Yvette Tran
- Indiana University, Richard M.
Fairbanks School of Public Health at IUPUI, Indianapolis, USA
| | - Valerie A. Yeager
- Indiana University, Richard M.
Fairbanks School of Public Health at IUPUI, Indianapolis, USA
| | - Kathleen T. Unroe
- Indiana University School of Medicine,
Department of Medicine, Division of General Internal Medicine and Geriatrics,
Indianapolis, USA
| | - Ann Holmes
- Indiana University, Richard M.
Fairbanks School of Public Health at IUPUI, Indianapolis, USA
| | - Justin Blackburn
- Indiana University, Richard M.
Fairbanks School of Public Health at IUPUI, Indianapolis, USA
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17
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Franz B, Cronin CE, Yeager VA, Burns A, Singh SR. Overview of the Most Commonly Identified Public Health Needs and Strategies in a Nationally Representative Sample of Nonprofit Hospitals. Med Care Res Rev 2022; 80:342-351. [PMID: 36377207 DOI: 10.1177/10775587221135365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nonprofit hospitals have been required to conduct Community Health Needs Assessments and develop implementation strategies for almost a decade, yet little is known about this process on the national level. Using a nationally representative dataset of 2019 to 2021 nonprofit hospital community benefit reports, we assessed patterns in hospital identification of community health needs and investments in corresponding programs. The five most common needs identified by hospitals were mental health (identified by 87% of hospitals), substance use (76%), access (73%), social determinants of health (69%), and chronic disease (67%). The five most common needs addressed were: mental health (87%), access (81%), substance use (77%), chronic disease (72%), and obesity (71%). Institutional and community-level factors were associated with whether hospitals identified and addressed health needs. Hospitals often addressed needs that they did not identify, particularly related to the provision of medical services—which has important implications for population health improvement.
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18
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Yeager VA, Balio CP, Chudgar RB, Hare Bork R, Beitsch LM. Estimating Public Health Workforce Efforts Toward Foundational Public Health Services. J Public Health Manag Pract 2022; 28:393-398. [PMID: 34939602 DOI: 10.1097/phh.0000000000001452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The Foundational Public Health Services (FPHS) include a core set of activities that every health department should be able to provide in order to ensure that each resident has access to foundational services that protect and preserve health. Estimates of the public health workforce necessary to provide the FPHS are needed. OBJECTIVE This study assessed the potential use of an FPHS calculator to assess health department workforce needs. DESIGN AND SETTING Qualitative interviews were conducted via Zoom in December 2020-January 2021. PARTICIPANTS Seventeen state and local public health leaders. MAIN OUTCOME MEASURES Qualitative insights into the potential use of an FPHS calculator. RESULTS Almost all participants expressed that a reliable estimate would help them justify requests for new staff and that a calculator based on the FPHS would help organizations to critically assess whether they are meeting the needs of their communities and the core expectations of public health. Although participants expected that a tool to calculate full-time equivalent needs by the FPHS would be helpful, some participants expressed concerns in regard to using the tool, given ongoing workforce issues such as recruitment challenges, hiring freezes, and funding restrictions. An anticipated positive consequence of using this tool was that it may lead to cross-training the workforce and result in more diverse expertise and skills among existing workers. The other unintended consequences were that an FPHS calculator would require a substantial amount of time assessing the current FPHS efforts of existing staff and the results of the FPHS gap estimate could become the bar rather than the minimum needed. CONCLUSIONS The current public and political focus on public health infrastructure as a result of the COVID-19 pandemic has created a window of opportunity to create change. An FPHS-based staffing tool may help transform public health and initiate a new era.
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Affiliation(s)
- Valerie A Yeager
- Department of Health Policy and Management, IU Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); Center for Rural Health Research, East Tennessee State University College of Public Health, Johnson City, Tennessee (Dr Balio); Public Health National Center Innovation, Public Health Accreditation Board, Alexandria, Virginia (Ms Chudgar); de Beaumont Foundation, Bethesda, Maryland (Dr Hare Bork); and Florida State University College of Medicine, Tallahassee, Florida (Dr Beitsch)
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19
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Yeager VA. The Politicization of Public Health and the Impact on Health Officials and the Workforce: Charting a Path Forward. Am J Public Health 2022; 112:734-735. [PMID: 35417216 PMCID: PMC9010922 DOI: 10.2105/ajph.2022.306744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Valerie A Yeager
- Valerie A. Yeager with the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis
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20
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Hilts KE, Yeager VA, Kooreman H, Smith R, Busching B, Spitznagle M. Public Health and Health Care Partnerships for Improved Tobacco Cessation. J Public Health Manag Pract 2022; 28:E404-E412. [PMID: 34347652 PMCID: PMC8807793 DOI: 10.1097/phh.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Tobacco use remains a leading cause of preventable death and disease. While most tobacco users are interested in quitting, few receive professional assistance. PROGRAM This state health department-led project leveraged partnerships to build capacity and support 9 health care organizations in implementing system-level initiatives to improve delivery of tobacco cessation. IMPLEMENTATION Participating organizations' initiatives targeted 3 focus areas: implementing best practices for tobacco cessation; quality improvement; and utilization of the electronic health record. EVALUATION A qualitative study was conducted to examine facilitators and barriers to tobacco cession systems change among participating health care organizations. Common barriers included time constraints, staffing issues, and organizational structure. These factors often differed by organization type (eg, large vs small). Facilitators included leadership buy-in, organizational priority, technical assistance, teams/teamwork, and IT support. DISCUSSION Initial findings suggest that this type of partnership model can be leveraged to gain organizational support, build capacity, address key barriers, and ensure that systems change strategies align with best practices for tobacco cessation across a diverse set of health care organizations. Findings presented in this report provide insights for other public health and health care organizations looking to implement similar initiatives.
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Affiliation(s)
- Katy Ellis Hilts
- Center for Health Policy, Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Hilts and Yeager and Mr Kooreman); and Tobacco Prevention and Cessation Commission, Indiana Department of Health, Indianapolis, Indiana (Mss Smith and Spitznagle and Mr Busching)
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21
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Yeager VA, Taylor HL, Menachemi N, Haut DP, Halverson PK, Vest JR. Primary Care Case Conferences to Mitigate Social Determinants of Health: A Case Study from One FQHC System. Am J Accountable Care 2021; 9:12-19. [PMID: 37283888 PMCID: PMC10241440 DOI: 10.37765/ajac.2021.88802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- Valerie A Yeager
- Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy and Management, 1050 Wishard Blvd, RG 5136, Indianapolis, IN, 46220
| | - Heather L Taylor
- Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy and Management, 1050 Wishard Blvd, Indianapolis, IN, 46220
| | - Nir Menachemi
- Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy and Management, 1050 Wishard Blvd, Indianapolis, IN, 46220
| | - Dawn P Haut
- Eskenazi Health Center, 720 Eskenazi Avenue, Indianapolis, IN, 46220
| | - Paul K Halverson
- Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy and Management, 1050 Wishard Blvd, Indianapolis, IN, 46220
| | - Joshua R Vest
- Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy and Management, 1050 Wishard Blvd, Indianapolis, IN, 46220
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22
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Balio CP, Blackburn J, Yeager VA, Simon KI, Menachemi N. Many States Were Able To Expand Medicaid Without Increasing Administrative Spending. Health Aff (Millwood) 2021; 40:1740-1748. [PMID: 34724415 DOI: 10.1377/hlthaff.2020.01695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.
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Affiliation(s)
- Casey P Balio
- Casey P. Balio is a research assistant professor at the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, in Johnson City, Tennessee. She was a doctoral candidate at the Indiana University Richard M. Fairbanks School of Public Health, in Indianapolis, Indiana, at the time this article was written
| | - Justin Blackburn
- Justin Blackburn is an associate professor in the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health
| | - Valerie A Yeager
- Valerie A. Yeager is an associate professor in the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health
| | - Kosali I Simon
- Kosali I. Simon is the Herman B. Wells Endowed Professor at the Paul H. O'Neill School of Public and Environmental Affairs and associate vice provost for health sciences, Indiana University, in Bloomington, Indiana
| | - Nir Menachemi
- Nir Menachemi is the Fairbanks Endowed Chair, a professor, and head of the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, and a scientist at the Regenstrief Institute, in Indianapolis, Indiana
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Abstract
OBJECTIVES To examine the role of a formal public health degree as it relates to core competency needs among governmental public health employees. DESIGN This cross-sectional study utilizes the 2017 Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate relationships were analyzed by conducting χ tests of respondents' supervisory level and reported skill gaps. Multivariate logistic regressions of reported skill gaps were performed holding gender, age, race/ethnicity, highest degree attained, current employer, role type, tenure in current agency, and public health certificate attainment constant. SETTING Nationally representative sample of government public health employees. PARTICIPANTS A total of 30 276 governmental public health employees. MAIN OUTCOME MEASURE Self-reported competency skills gaps. RESULTS Among nonsupervisors, those with a public health degree had significantly lower odds of reporting a competency gap for 8 of the 21 skills assessed. Among supervisors/managers, those who had a formal public health degree had significantly lower odds of reporting a competency gap in 3 of the 22 skills assessed. Having a degree in public health was not significantly related to an executive's likelihood of reporting a skill gap across any of the 22 skills assessed. Regardless of supervisory level, having a public health degree was not associated with a reduced likelihood of reporting skill gaps in effective communication, budgeting and financial management, or change management competency domains. CONCLUSIONS Possessing a formal public health degree appears to have greater value for skills required at the nonsupervisor and supervisor/manager levels than for skills needed at the executive level. Future work should focus on longitudinal evaluations of skill gaps reported among the public health workforce as changes in public health curricula may shift over time in response to newly revised accreditation standards. In addition, public health education should increase emphasis on communication, budgeting, systems thinking, and other management skills among their graduates.
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Affiliation(s)
- Heather L Taylor
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana
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Yeager VA, Beitsch LM, Johnson SM, Halverson PK. Public Health Graduates and Employment in Governmental Public Health: Factors That Facilitate and Deter Working in This Setting. J Public Health Manag Pract 2021; 27:4-11. [PMID: 31688733 DOI: 10.1097/phh.0000000000001052] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Previous surveys of public health graduates examine where they work; however, little is known about public health graduates' employment decisions or the factors that facilitate interest or deter interest in working in governmental public health settings. The purpose of the current pilot study was to build on the information previously collected in graduate surveys by expanding questions to undergraduates and asking about decisions and factors that influence choices of employment. METHODS A pilot survey of graduates of public health programs was conducted. Respondents provided information about their degree programs, year of graduation, and current employment. Questions asked where they applied for jobs, factors they considered, experiences with the application processes, and so forth. Descriptive statistics were calculated using frequencies and proportions. Open-ended responses were qualitatively reviewed and general themes were extracted. RESULTS Employment preferences were ranked the highest for not-for-profit organizations (ranked first among 21 of 62, 33.9%), followed by governmental public health agencies (ranked first among 18 of 62, 29.0%). Among master of public health graduates, 54.7% sought employment within this setting, although only 17.0% of those employed full time at the time of the survey were employed within a governmental public health agency. Job security (84.7%), competitive benefits (82.2%), identifying with the mission of the organization (82.2%), and opportunities for training/continuing education (80.6%) were the most influential, positive factors garnering interest in working in governmental public health. Factors that were the biggest deterrents included the ability to innovate (19.2%), competitive salary (17.8%), and autonomy/employee empowerment (15.3%). CONCLUSIONS Approximately half of the respondents applied for a job within governmental public health in anticipation of or since graduating. However, only a quarter of employed respondents are currently working within governmental public health, suggesting a missed opportunity for recruiting the other quarter who applied and were interested in governmental positions.
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Affiliation(s)
- Valerie A Yeager
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Yeager and Halverson and Ms Johnson); and Florida State University College of Medicine, Tallahassee, Florida (Dr Beitsch)
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Yeager VA, Leider JP, Saari CK, Kronstadt J. Supporting Increased Local Health Department Accreditation: Qualitative Insights From Accredited Small Local Health Departments. J Public Health Manag Pract 2021; 27:508-512. [PMID: 32956291 DOI: 10.1097/phh.0000000000001251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accredited health departments now cover 80% of the US population. A relatively modest proportion of these are small local health departments (LHDs), serving fewer than 50 000 people. Despite comprising more than half of all health departments, only 2% of small LHDs are accredited. This brief report is a qualitative inquiry into the enablers of accreditation for small LHDs. We interviewed health department and accreditation leaders from 9 accredited small local LHDs. Interviews were transcribed, verified, and coded by 2 coders. We found that dedicated funding, prework, clear expectations, and peer examples were strong enablers of accreditation for these groups. Additional resources specific to small LHDs may be necessary to expedite application processes and encourage greater uptake from this group.
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Affiliation(s)
- Valerie A Yeager
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); and Public Health Accreditation Board, Alexandria, Virginia (Mss Saari and Kronstadt)
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Vest JR, Blackburn J, Yeager VA, Haut DP, Halverson PK. Primary Care-Based Case Conferences and Reductions in Health Care Utilization. J Health Care Poor Underserved 2021; 32:1288-1300. [PMID: 34421031 DOI: 10.1353/hpu.2021.0132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Case conferences are collaborative, interdisciplinary team meetings that facilitate consensus on individual patients' health management plans, coordinate services, and initiate referrals. This approach is well-suited to address the social needs and risks of complex patients. Evidence of this approach in primary care settings to change patient outcomes is limited. A panel of 976 patients from an urban, federally qualified health center were included in case conferences. Fixed-effects regression models estimated the effect of case conferences on admissions, emergency department (ED) visits, and missed outpatient appointments. Case conferencing was associated with a 6% reduction in the probability that the patient would have an ED visit in a given month and a 5% lower probability of an inpatient admission. The probability of missed primary care appointments increased. Case conferences are a potential strategy to address the multiple issues facing complex patients.
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Hilts KE, Blackburn J, Gibson PJ, Yeager VA, Halverson PK, Menachemi N. Impact of Medicaid expansion on smoking prevalence and quit attempts among those newly eligible, 2011-2019. Tob Prev Cessat 2021; 7:16. [PMID: 34414341 PMCID: PMC8336658 DOI: 10.18332/tpc/139812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/24/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Low-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses. This study assessed the long-term impact of increased coverage for tobacco cessation through Medicaid expansion on past-year quit attempts and prevalence of cigarette smoking. METHODS Using data from CDC's annual Behavioral Risk Factor Surveillance System 2011-2019, we conducted difference-in-difference regression analyses to compare changes in smoking prevalence and past-year quit attempts in expansion states versus non-expansion states. Our sample included non-pregnant adults (18-64 years old) without dependent children with incomes at or below 100% of the Federal Poverty Level (FPL). RESULTS Regression analyses indicate that Medicaid expansion was associated with reduced smoking prevalence in the first two years post-expansion (β=-0.019, p=0.04), but that this effect was not maintained at longer follow-up periods (β=-0.006, p=0.49). Results of regression analyses also suggest that Medicaid expansion does not significantly impact quit attempts in the short-term (β=-0.013, p=0.52) or at longer term follow-up (β=-0.026, p=0.08). CONCLUSIONS Expanded coverage for tobacco cessation services through Medicaid alone may not be enough to increase quit-attempts or sustain a reduction in overall prevalence of smoking in newly eligible populations over time. Medicaid programs should consider additional strategies, such as public education campaigns and removal of barriers, to support cessation among enrollees.
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Affiliation(s)
- Katy Ellis Hilts
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - Justin Blackburn
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - P Joseph Gibson
- Marion County Public Health Department, Indianapolis, United States
| | - Valerie A Yeager
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - Paul K Halverson
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - Nir Menachemi
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
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Walker DM, Yeager VA, Lawrence J, McAlearney AS. Identifying Opportunities to Strengthen the Public Health Informatics Infrastructure: Exploring Hospitals' Challenges with Data Exchange. Milbank Q 2021; 99:393-425. [PMID: 33783863 DOI: 10.1111/1468-0009.12511] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Policy Points Even though most hospitals have the technological ability to exchange data with public health agencies, the majority continue to experience challenges. Most challenges are attributable to the general resources of public health agencies, although workforce limitations, technology issues such as a lack of data standards, and policy uncertainty around reporting requirements also remain prominent issues. Ongoing funding to support the adoption of technology and strengthen the development of the health informatics workforce, combined with revising the promotion of the interoperability scoring approach, will likely help improve the exchange of electronic data between hospitals and public health agencies. CONTEXT The novel coronavirus 2019 (COVID-19) pandemic has highlighted significant barriers in the exchange of essential information between hospitals and local public health agencies. Thus it remains important to clarify the specific issues that hospitals may face in reporting to public health agencies to inform focused approaches to improve the information exchange for the current pandemic as well as ongoing public health activities and population health management. METHODS This study uses cross-sectional data of acute-care, nonfederal hospitals from the 2017 American Hospital Association Annual Survey and Information Technology supplement. Guided by the technology-organization-environment framework, we coded the responses to a question regarding the challenges that hospitals face in submitting data to public health agencies by using content analysis according to the type of challenge (i.e., technology, organization, or environment), responsible entity (i.e., hospital, public health agency, vendor, multiple), and the specific issue described. We used multivariable logistic and multinomial regression to identify characteristics of hospitals associated with experiencing the types of challenges. FINDINGS Our findings show that of the 2,794 hospitals in our analysis, 1,696 (61%) reported experiencing at least one challenge in reporting health data to a public health agency. Organizational issues were the most frequently reported type of challenge, noted by 1,455 hospitals. The most common specific issue, reported by 1,117 hospitals, was the general resources of public health agencies. An advanced EHR system and participation in a health information exchange both decreased the likelihood of not reporting experiencing a challenge and increased the likelihood of reporting an organizational challenge. CONCLUSIONS Our findings inform policy recommendations such as improving data standards, increasing funding for public health agencies to improve their technological capabilities, offering workforce training programs, and increasing clarity of policy specifications and reporting. These approaches can improve the exchange of information between hospitals and public health agencies.
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Affiliation(s)
- Daniel M Walker
- College of Medicine, The Ohio State University.,Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University
| | - Valerie A Yeager
- Richard M. Fairbanks School of Public Health, Indiana University
| | - John Lawrence
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University
| | - Ann Scheck McAlearney
- College of Medicine, The Ohio State University.,Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University
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Leider JP, Kronstadt J, Yeager VA, Hall K, Saari CK, Alford A, Freeman LT, Kuehnert P. Application for Public Health Accreditation Among US Local Health Departments in 2013 to 2019: Impact of Service and Activity Mix. Am J Public Health 2021; 111:301-308. [PMID: 33351657 PMCID: PMC7811080 DOI: 10.2105/ajph.2020.306007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives. To examine correlates of applying for accreditation among small local health departments (LHDs) in the United States through 2019.Methods. We used administrative data from the Public Health Accreditation Board (PHAB) and 2013, 2016, and 2019 Profile data from the National Association of County and City Health Officials to examine correlates of applying for PHAB accreditation. We fit a latent class analysis (LCA) to characterize LHDs by service mix and size. We made bivariate comparisons using the t test and Pearson χ2.Results. By the end of 2019, 126 small LHDs had applied for accreditation (8%). When we compared reasons for not pursuing accreditation, we observed a difference by size for perceptions that standards exceeded LHD capacity (47% for small vs 22% for midsized [P < .001] and 0% for large [P < .001]).Conclusions. Greater funding support, considering differing standards by LHD size, and recognition that service mix might affect practicality of accreditation are all relevant considerations in attempting to increase uptake of accreditation for small LHDs.Public Health Implications. Overall, small LHDs represented about 60% of all LHDs that had not yet applied to PHAB.
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Affiliation(s)
- Jonathon P. Leider
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Jessica Kronstadt
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Valerie A. Yeager
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Kellie Hall
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Chelsey K. Saari
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Aaron Alford
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Lori Tremmel Freeman
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Paul Kuehnert
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
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Vest JR, Blackburn J, Yeager VA. Challenges in Translating National and State Reopening Plans Into Local Reopening Policies During the COVID-19 Pandemic. Public Health Rep 2020; 136:127-131. [PMID: 33290170 DOI: 10.1177/0033354920971721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Joshua R Vest
- 124006 Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health-Indianapolis, Indianapolis, IN, USA.,Regenstrief Institute, Center for Biomedical Informatics, Indianapolis, IN, USA
| | - Justin Blackburn
- 124006 Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health-Indianapolis, Indianapolis, IN, USA
| | - Valerie A Yeager
- 124006 Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health-Indianapolis, Indianapolis, IN, USA
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Abstract
CONTEXT As public health needs and priorities evolve, maintaining a trained public health workforce is critical to the success of public health efforts. Researchers have examined training needs in various contexts and subpopulations, but a nationally representative study of what motivates public health workers to seek out training has yet to be conducted. By understanding these motivations, public health agencies and policy makers can appeal to worker motivations in both training programs and organizational incentives. OBJECTIVE The purpose of this article was to describe overall training motivations and identify patterns of training motivations among public health workers. This study also explored whether or not training needs differ across prevalent motivational patterns. DESIGN AND PARTICIPANTS Using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), the study used latent class analysis (LCA) to identify motivational patterns and logistic regression to analyze associations with training needs. RESULTS The most prominent motivation to seek training was personal growth (82.7% of respondents). LCA identified 4 motivational classes of public health workers: those motivated by organizational pressure and requirements (31.8%), those motivated indiscriminately by all factors (28.4%), those motivated primarily by personal growth (21.7%), and those motivated by organizational accommodations and supports (18.2%). Motivational class was not associated with indicating training needs in any of 8 training domains, nor was it associated with indicating any training need in any domain. CONCLUSIONS Public health agencies should consider the different motivational classes present in the public health workforce. In particular, motivational classes that represent organizational choices suggest that public health agencies should both motivate workers with organizational requirements and pressure from managers and offer institutional support via paid travel and covered time for training.
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Affiliation(s)
- Nate C Apathy
- Health Policy & Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
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Wisniewski JM, Jacinto C, Yeager VA, Castrucci B, Chapple-McGruder T, Gould E. Opportunities to Improve Employee Satisfaction Within State and Local Public Health Agencies. J Public Health Manag Pract 2020; 25:440-447. [PMID: 31348158 DOI: 10.1097/phh.0000000000000857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Public health agencies will likely struggle to staff at necessary levels, given ongoing workforce shortages, the potential for mass retirement, and expanding responsibility. Although the majority of public health workers are satisfied with their jobs overall, it is critical to understand the degree to which they are satisfied and identify factors that contribute to any dissatisfaction that occurs. OBJECTIVE This study identified opportunities for public health agencies to improve work environments and, in turn, improve employee satisfaction and retention. DESIGN Using data from the 2014 Public Health Workforce Interest and Needs Survey, we analyze responses to the survey question, "If you wish, you may provide comments below about your level of job satisfaction." The 2966 responses (2389 from state and 542 from local public health agencies) that indicated a negative disposition were examined to understand employee dissatisfaction. SETTING The survey was administered to a representative sample of state health departments and convenience samples of local health departments. PARTICIPANTS Responses from employees of state and local health departments are considered. MAIN OUTCOME MEASURES The most frequently occurring themes overall were identified. In addition, responses describing weaknesses in organizational support (specifically training, communication, workload, and innovation) were summarized. RESULTS The most frequently occurring themes were as follows: (1) salary, specifically in relation to the merit system, performance evaluation, and workload; (2) job security with emphasis on funding, organizational transformation, and politics/government; and (3) career development related to the merit system, performance evaluation, and management. Respondents also reported opportunities in the areas of training, communication, workload, and innovation to improve satisfaction levels. CONCLUSIONS These findings serve as a call to action for leaders in health departments as well as national public health leaders to remedy the concerns raised in their responses. Some of the solutions are within the realm of public health agency leadership, but some may fall within the realm of governors and public health leaders at the federal level. It is important to share these findings so that appropriate decision makers can address public health workforce retention and recruitment issues in the interest of retaining valuable employees.
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Affiliation(s)
- Janna M Wisniewski
- Department of Global Health Management and Policy, Tulane University, New Orleans, Louisiana (Dr Wisniewski); Department of Health Policy and Management, IU Fairbanks School of Public Health, Indianapolis, Indiana (Mr Jacinto and Dr Yeager); de Beaumont Foundation, Bethesda, Maryland (Mr Castrucci and Dr Chapple-McGruder); and Association of State and Territorial Health Officials, Washington, District of Columbia (Dr Gould)
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Yeager VA, Wisniewski JM, Chapple-McGruder T, Castrucci BC, Gould E. Public Health Workforce Self-Identified Training Needs by Jurisdiction and Job Type. J Public Health Manag Pract 2020; 25:181-190. [PMID: 29933265 PMCID: PMC6519872 DOI: 10.1097/phh.0000000000000830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Ensuring adequate and appropriate training of the workforce is a crucial priority for governmental public health. This is particularly important, given the diverse backgrounds of the public health workforce; the vast majority (approximately 83%) do not have formal training in public health, and those that do have formal training in public health have limited training in management and other essential organizational skills. OBJECTIVE The purpose of this article is to identify training needs among public health workers in specific job types and settings. DESIGN AND PARTICIPANTS This cross section study used 2014 data from the Public Health Workforce Interests and Needs Survey. Qualitative analyses were used to code open-ended responses to questions about training needs. Needs are stratified across job types and jurisdiction. RESULTS Eight main themes or skill areas were identified with the largest proportion indicating a need for management/leadership skills (28.2%). The second most frequent need was communication skills (21.3%). Across the 9 job types examined, general management skills were either the first or second training need for 7 job types. Among individuals who already have leadership/management positions, budgeting was the most common training need. CONCLUSIONS Findings from this study can inform targeted strategies to address training needs for specific types of employees. Such strategies can influence the efficiency and effectiveness of public health efforts and employee satisfaction. As new public health frameworks-like Public Health 3.0 and the Chief Health Strategist-are advanced nationally, it is necessary to ensure that the workforce has the skills and abilities to implement these frameworks.
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Affiliation(s)
- Valerie A Yeager
- Department of Health Policy and Management, IU Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); Department of Global Health Management and Policy, Tulane University, New Orleans, Louisiana (Dr Wisniewski); de Beaumont Foundation, Bethesda, Maryland (Dr Chapple-McGruder and Mr Castrucci); and ASTHO, Washington, District of Columbia (Dr Gould)
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Affiliation(s)
- Paul Campbell Erwin
- Paul Campbell Erwin is an AJPH associate editor and is with the School of Public Health, University of Alabama at Birmingham. Angela J. Beck is with the University of Michigan School of Public Health, Ann Arbor. Valerie A. Yeager is with the Richard M. Fairbanks School of Public Health, Indiana University-Purdue University, Indianapolis. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Angela J Beck
- Paul Campbell Erwin is an AJPH associate editor and is with the School of Public Health, University of Alabama at Birmingham. Angela J. Beck is with the University of Michigan School of Public Health, Ann Arbor. Valerie A. Yeager is with the Richard M. Fairbanks School of Public Health, Indiana University-Purdue University, Indianapolis. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Valerie A Yeager
- Paul Campbell Erwin is an AJPH associate editor and is with the School of Public Health, University of Alabama at Birmingham. Angela J. Beck is with the University of Michigan School of Public Health, Ann Arbor. Valerie A. Yeager is with the Richard M. Fairbanks School of Public Health, Indiana University-Purdue University, Indianapolis. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Jonathon P Leider
- Paul Campbell Erwin is an AJPH associate editor and is with the School of Public Health, University of Alabama at Birmingham. Angela J. Beck is with the University of Michigan School of Public Health, Ann Arbor. Valerie A. Yeager is with the Richard M. Fairbanks School of Public Health, Indiana University-Purdue University, Indianapolis. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
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Beitsch LM, Yeager VA, Leider JP, Erwin PC. Mass Exodus of State Health Department Deputies and Senior Management Threatens Institutional Stability. Am J Public Health 2019; 109:681-683. [PMID: 30969838 DOI: 10.2105/ajph.2019.305005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Leslie M Beitsch
- Leslie M. Beitsch is with the Center on Medicine and Public Health at Florida State University College of Medicine, Tallahassee. Valerie A. Yeager is with the Department of Health Policy and Management at Indiana University Fairbanks School of Public Health, Indianapolis. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Paul Campbell Erwin is an AJPH associate editor and was with the Department of Public Health, University of Tennessee, Knoxville, when this editorial was written
| | - Valerie A Yeager
- Leslie M. Beitsch is with the Center on Medicine and Public Health at Florida State University College of Medicine, Tallahassee. Valerie A. Yeager is with the Department of Health Policy and Management at Indiana University Fairbanks School of Public Health, Indianapolis. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Paul Campbell Erwin is an AJPH associate editor and was with the Department of Public Health, University of Tennessee, Knoxville, when this editorial was written
| | - Jonathon P Leider
- Leslie M. Beitsch is with the Center on Medicine and Public Health at Florida State University College of Medicine, Tallahassee. Valerie A. Yeager is with the Department of Health Policy and Management at Indiana University Fairbanks School of Public Health, Indianapolis. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Paul Campbell Erwin is an AJPH associate editor and was with the Department of Public Health, University of Tennessee, Knoxville, when this editorial was written
| | - Paul Campbell Erwin
- Leslie M. Beitsch is with the Center on Medicine and Public Health at Florida State University College of Medicine, Tallahassee. Valerie A. Yeager is with the Department of Health Policy and Management at Indiana University Fairbanks School of Public Health, Indianapolis. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Paul Campbell Erwin is an AJPH associate editor and was with the Department of Public Health, University of Tennessee, Knoxville, when this editorial was written
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Yeager VA, Leider JP. The Role of Salary in Recruiting Employees in State and Local Governmental Public Health: PH WINS 2017. Am J Public Health 2019; 109:683-685. [PMID: 30969835 DOI: 10.2105/ajph.2019.305008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Valerie A Yeager
- Valerie A. Yeager is with the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis. Jonathon P. Leider is with the University of Minnesota School of Public Health, Division of Health Policy and Management, Minneapolis
| | - Jonathon P Leider
- Valerie A. Yeager is with the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis. Jonathon P. Leider is with the University of Minnesota School of Public Health, Division of Health Policy and Management, Minneapolis
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Wisniewski JM, Diana ML, Yeager VA, Hotchkiss DR. Comparison of objective measures and patients' perceptions of quality of services in government health facilities in the Democratic Republic of Congo. Int J Qual Health Care 2018; 30:472-479. [PMID: 29617833 PMCID: PMC6047449 DOI: 10.1093/intqhc/mzy052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/14/2018] [Indexed: 12/18/2022] Open
Abstract
Objective Examine the relationship between patients’ perceptions of quality and the objective level of quality at government health facilities, and determine whether the pre-existing attitudes and beliefs of patients regarding health services interfere with their ability to accurately assess quality of care. Design Cross-sectional, visit-level analysis. Setting Three regions (Nord-Ubangi, Kasai/Kasai-Central and Maniema/Tshopo) of the Democratic Republic of Congo. Participants Data related to the inpatient and outpatient visits to government health facilities made by all household members who were included in the survey was used for the analysis. Data were collected from patients and the facilities they visited. Main Outcome Measures Patients’ perceptions of the level of quality related to availability of drugs and equipment; patient-centeredness and safety serve compared with objective measures of quality. Results Objective measures and patient perceptions of the drug supply were positively associated (β = 0.16, 95% CI = 0.03, 0.28) and of safety were negatively associated (β = −0.12, 95% CI = −0.23, −0.01). Several environmental factors including facility type, region and rural/peri-urban setting were found to be significantly associated with respondents’ perceptions of quality across multiple outcomes. Conclusions Overall, patients are not particularly accurate in their assessments of quality because their perceptions are impacted by their expectations and prior experience. Future research should examine whether improving patients’ knowledge of what they should expect from health services, and the transparency of the facility’s quality data can be a strategy for improving the accuracy of patients’ assessments of the quality of the health services, particularly in low-resourced settings.
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Affiliation(s)
- Janna M Wisniewski
- Department of Global Health Management and Policy, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Mark L Diana
- Department of Global Health Management and Policy, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Valerie A Yeager
- Department of Health Management and Policy, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - David R Hotchkiss
- Department of Global Community Health and Behavioral Sciences, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Ellis Hilts K, Xia J, Yeager VA, Ferdinand AO, Menachemi N. Market characteristics associated with community health assessments by local health departments. Public Health 2018; 162:118-125. [PMID: 30029173 DOI: 10.1016/j.puhe.2018.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/18/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Community health assessments (CHAs) have been promoted as a strategy for population health. This study uses the resource dependence theory (RDT) to examine how external market characteristics are associated with CHAs conducted by local health departments (LHDs) and subsequent partnering with hospitals for CHAs in the United States. STUDY DESIGN The RDT was used to guide the conceptualization of the market in the context of local public health. RDT emphasizes that organizations are not in control of all the resources they need and, to some extent, must rely on the external environment to provide those necessary resources. Binary measures were used to examine whether LHDs conducted CHAs and whether they did so in partnership with a local hospital. Independent variables were identified to measure the RDT constructs of munificence (resource availability in the environment), complexity (level of heterogeneity), and dynamism (level of environmental turbulence). METHODS Bivariate (Chi-squared and t-tests) and multivariate (logistic regression) cross-sectional analyses were conducted using secondary data from the National Association of County and City Health Officials 2013 Profile Survey, the 2013 County Health Rankings data set, and the Health Resources and Services Administration's Area Health Resource File. RESULTS Two of three variables measuring munificence were positively associated with having conducted a CHA; one variable was also related to doing so in conjunction with a local hospital. One measure of market complexity was negatively associated with having conducted a CHA. No measure of dynamism was related to the dependent variables. CONCLUSIONS Study results provide partial support for the use of RDT in understanding the relationship between market factors and LHDs' activities around CHAs. Local hospitals as partners and other market factors should be considered by LHDs when conducting CHAs. Findings from this work will be of interest to public health practitioners, policy-makers, and researchers interested in public health and population health improvement.
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Affiliation(s)
- K Ellis Hilts
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA.
| | - J Xia
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
| | - V A Yeager
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
| | | | - N Menachemi
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
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Yeager VA, Beitsch LM, Hasbrouck L. A Mismatch Between the Educational Pipeline and Public Health Workforce: Can It Be Reconciled? Public Health Rep 2018; 131:507-9. [PMID: 27252573 DOI: 10.1177/003335491613100318] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Valerie A Yeager
- Valerie Yeager is an Assistant Professor at the Tulane University School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, Louisiana. Leslie Beitsch is Chair of the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida. LaMar Hasbrouck is Executive Director of the National Association of County and City Health Officials, Washington, D.C
| | - Leslie M Beitsch
- Valerie Yeager is an Assistant Professor at the Tulane University School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, Louisiana. Leslie Beitsch is Chair of the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida. LaMar Hasbrouck is Executive Director of the National Association of County and City Health Officials, Washington, D.C
| | - LaMar Hasbrouck
- Valerie Yeager is an Assistant Professor at the Tulane University School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, Louisiana. Leslie Beitsch is Chair of the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida. LaMar Hasbrouck is Executive Director of the National Association of County and City Health Officials, Washington, D.C
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Abstract
OBJECTIVE Given challenges to recruiting nurses to public health and the growth in national policies focused on population health, it is crucial that public health agencies develop strategies to sustain this important group of employees. The objective of this study was to examine factors that influence nurses' decisions to work in public health agencies. METHODS This cross-sectional study examined perspectives of nurses who worked in state and local public health departments and responded to the 2010 Council on Linkages Between Academia and Public Health Practice's survey of public health workers. We calculated the mean rating of each recruitment and retention factor for nurses and non-nurses separately and compared differences by using t tests. We then used multivariate regression analysis to examine differences in ratings by role (ie, nurse or non-nurse). RESULTS After controlling for personal and organizational characteristics, the influence of 5 recruitment factors was significantly stronger among nurses than among non-nurses: flexibility of work schedule ( P < .001), autonomy/employee empowerment ( P < .001), ability to innovate ( P = .002), specific duties and responsibilities ( P = .005), and identifying with the mission of the organization ( P = .02). The influence of 5 retention factors was stronger among nurses than among non-nurses : autonomy/employee empowerment ( P < .001), flexibility of work schedule ( P < .001), specific duties and responsibilities ( P < .001), opportunities for training/continuing education ( P = .03), and ability to innovate ( P = .008). CONCLUSIONS Some factors that influence nurses to begin and remain working in local governmental public health agencies, such as flexible schedules and employee autonomy, are factors that governmental public health agencies can design into positions and highlight when recruiting from health care organizations, private industry, and academia.
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Affiliation(s)
- Valerie A Yeager
- 1 Department of Global Health Management and Policy, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Janna M Wisniewski
- 1 Department of Global Health Management and Policy, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Hurst D, Sharpe S, Yeager VA. Administrative Preparedness Strategies: Expediting Procurement and Contracting Cycle Times During an Emergency. Public Health Rep 2017; 132:294-297. [PMID: 28394699 DOI: 10.1177/0033354917698131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We assessed whether administrative preparedness processes that were intended to expedite the acquisition of goods and services during a public health emergency affect estimated procurement and contracting cycle times. We obtained data from 2014-2015 applications to the Hospital Preparedness Program and Public Health Emergency Preparedness (HPP-PHEP) cooperative agreements. We compared the estimated procurement and contracting cycle times of 61 HPP-PHEP awardees that did and did not have certain administrative processes in place. Certain processes, such as statutes allowing for procuring and contracting on the open market, had an effect on reducing the estimated cycle times for obtaining goods and services. Other processes, such as cooperative purchasing agreements, also had an effect on estimated procurement time. For example, awardees with statutes that permitted them to obtain goods and services in the open market had an average procurement cycle time of 6 days; those without such statutes had a cycle time of 17 days ( P = .04). PHEP awardees should consider adopting these or similar processes in an effort to reduce cycle times.
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Affiliation(s)
- David Hurst
- 1 Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharon Sharpe
- 1 Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Valerie A Yeager
- 2 Department of Global Health Management and Policy, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Abstract
The Internal Revenue Service (IRS) recently introduced tax code revisions requiring stricter oversight of community benefit activities (CBAs) conducted by tax-exempt, not-for-profit hospitals. We examine the impact of this tax requirement on CBAs among these hospitals relative to for-profit and government hospitals that were not subject to the new policy. We employed a quasi-experimental, difference-in-difference study design using a longitudinal observational approach and used secondary data collected by the American Hospital Association (years 2006-2010 including 20,538 hospital year observations). Findings show a significant increase in the reporting of 7 of the 13 CBAs among tax-exempt, not-for-profit hospitals compared with other hospitals after the policy change. Examples include partnering to conduct community health assessments ( b = 0.035, p = .002) and using capacity assessments to identify unmet community health needs ( b = 0.041, p = .001). Recent tax revisions are associated with increases in reported CBAs among tax-exempt, not-for-profit hospitals. As the debate continues regarding tax exemption status for not-for-profit hospitals, policy makers should expand efforts for enhanced accountability.
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Affiliation(s)
- Valerie A Yeager
- 1 Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Alva O Ferdinand
- 2 Texas A&M University School of Public Health, College Station, TX, USA
| | - Nir Menachemi
- 3 Richard M. Fairbanks School of Public Health at Indiana University, Indianapolis, IN, USA
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Abstract
This study examines the relationship between clinical quality of care and physician productivity in the public sector clinical setting. This longitudinal study takes place in Jefferson County, Alabama using data from six public sector clinics. Data representing 21 physicians across 13 consecutive quarters representing 44,765 person observations were analyzed. Four variables were selected to represent quality of care for this pediatric patient population; two of which pertained to antibiotic use and two pertained to asthma care. Findings from multivariate analyses examining each quality of care measure and controlling for other visit and practice characteristics indicate that three of the four quality measures were significantly related to productivity. Specifically, the percent of asthma patients with documented asthma severity classification was negatively related to physician productivity (ß = -.24, p = .04), although the magnitude of this relationship was small. The percent of asthma patients prescribed an inhaled corticosteroid who also had a severity classification was negatively related to physician productivity (ß = -.23, p = .03) and the percent of patients prescribed oral antibiotics was marginally negatively related to physician productivity (ß = -.09, p = .09). In general, findings suggest that a relationship exists between quality of healthcare and physician productivity. Future research should continue to examine this relationship across other disciplines and healthcare settings.
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Zhang Y, Yeager VA, Hou S. The Impact of Community-Based Supports and Services on Quality of Life Among the Elderly in China: A Longitudinal Study. J Appl Gerontol 2016; 37:1244-1269. [PMID: 27496140 DOI: 10.1177/0733464816661945] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Community-based supports and services (CBSS) have been developing rapidly in China as a new way of satisfying the needs of elderly people. However, it is not clear how pervasive these services are or whether the availability of CBSS impacts quality of life. This study examines trends in CBSS and the impact of the perceived CBSS availability on self-reported quality of life among the elderly in China. We found a significant increase in perceived CBSS availability from 2005 to 2011, but the perceived availability of CBSS varies by the type of CBSS. Multivariate analyses show that home medical visits (β = .181, p = .03), psychological support (β = .332, p = .02), social and recreation activities (β = .231, p = .02), and legal consulting services (β = .271, p = .02) were each significantly associated with a good quality of life. Results from this study provide insight that can inform CBSS strategies and the development of new services for the elderly in China.
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Goldsby TU, George BJ, Yeager VA, Sen BP, Ferdinand A, Sims DMT, Manzella B, Cockrell Skinner A, Allison DB, Menachemi N. Urban Park Development and Pediatric Obesity Rates: A Quasi-Experiment Using Electronic Health Record Data. Int J Environ Res Public Health 2016; 13:411. [PMID: 27070635 PMCID: PMC4847073 DOI: 10.3390/ijerph13040411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Childhood obesity affects ~20% of children in the United States. Environmental influences, such as parks, are linked with increased physical activity (PA). OBJECTIVE To examine whether changes in Body Mass Index (BMI) z-score were associated with construction of a new park. METHODS A quasi-experimental design was used to determine whether living in proximity of a park was associated with a reduction in BMI z-score. Children were selected from health clinics within an 11 mile radius of the park. A repeated-measure ANOVA was employed for analysis of the relationship between exposure (new park) and BMI z-score. RESULTS Participants were 1443 (median age 10.3 range (2-17.9 years), BMI: z-score 0.84 ± 1.09) African American (77.4%) adolescents. Change in BMI z-score was not statistically different for children living at different distances from the park after controlling for age, gender, race, ethnicity, or payer type (p = 0.4482). We did observe a small 0.03 increase in BMI z-score from pre- to post-park (p = 0.0007). There was a significant positive association between child's baseline age and BMI z-score (p < 0.001). CONCLUSIONS This study found proximity to a park was not associated with reductions in BMI z-score. Additional efforts to understand the complex relationship between park proximity, access, and PA are warranted.
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Affiliation(s)
- TaShauna U Goldsby
- Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Brandon J George
- Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Valerie A Yeager
- Department of Global Health Management and Policy, Tulane University, New Orleans, LA 70112, USA.
| | - Bisakha P Sen
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Alva Ferdinand
- Department of Health Policy and Management, Texas A&M Health Science Center, College Station, TX 77843, USA.
| | - Devon M T Sims
- Scientific Technologies Corporation, Scottsdale, AZ 85258, USA.
| | - Bryn Manzella
- Jefferson County Department of Health, Birmingham, AL 35233, USA.
| | - Asheley Cockrell Skinner
- Division of General Internal Medicine, The Duke Clinical Research Institute, Duke University, Durham, NC 27705, USA.
| | - David B Allison
- Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Nir Menachemi
- Department Health Policy and Management, Indiana University, Indianapolis, IN 46202, USA.
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Wisniewski JM, Yeager VA, Diana ML, Hotchkiss DR. Exploring the barriers to rigorous monitoring and evaluation of health systems strengthening activities: qualitative evidence from international development partners. Int J Health Plann Manage 2016; 31:e302-e311. [PMID: 26927839 DOI: 10.1002/hpm.2339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/15/2016] [Accepted: 01/22/2016] [Indexed: 11/08/2022] Open
Abstract
The number of health systems strengthening (HSS) programs has increased in the last decade. However, a limited number of studies providing robust evidence for the value and impact of these programs are available. This study aims to identify knowledge gaps and challenges that impede rigorous monitoring and evaluation (M&E) of HSS, and to ascertain the extent to which these efforts are informed by existing technical guidance. Interviews were conducted with HSS advisors at United States Agency for International Development-funded missions as well as senior M&E advisors at implementing partner and multilateral organizations. Findings showed that mission staff do not use existing technical resources, either because they do not know about them or do not find them useful. Barriers to rigorous M&E included a lack suitable of indicators, data limitations, difficulty in demonstrating an impact on health, and insufficient funding and resources. Consensus and collaboration between international health partners and local governments may mitigate these challenges. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Janna M Wisniewski
- Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Valerie A Yeager
- Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mark L Diana
- Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - David R Hotchkiss
- Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
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Yeager VA, Bertrand J. Putting Management Capacity Building at the Forefront of Health Systems Strengthening: Comment on "Management Matters: A Leverage Point for Health Systems Strengthening in Global Health". Int J Health Policy Manag 2015; 5:129-31. [PMID: 26927402 DOI: 10.15171/ijhpm.2015.195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/25/2015] [Indexed: 11/09/2022] Open
Abstract
The current limited focus on management in global health activities is highly problematic given the amounts of financial and human resources that are pouring into health system strengthening interventions and the complexity of clinical operations across settings. By ensuring that public health and healthcare practitioners in domestic and international settings receive management training in their educational programs and that we build management capacity among individuals already in the health workforce, we can begin to prepare for more effective health systems strengthening efforts. Rigorous evaluation of health systems strengthening and the impact of management capacity building is crucial to building evidence for the field.
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Affiliation(s)
- Valerie A Yeager
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jane Bertrand
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Yeager VA, Wisniewski JM, Amos K, Bialek R. What Matters in Recruiting Public Health Employees: Considerations for Filling Workforce Gaps. Am J Public Health 2015; 105:e33-6. [PMID: 26469672 DOI: 10.2105/ajph.2015.302805] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We examined factors that influence the decision to join the public health workforce. In this cross-sectional study, we used 2010 secondary data representing 6939 public health workers. Factors influencing the decision to take jobs in public health were significantly associated with specific previous employment settings. Respondents generally rated organizational factors as more influential than personal factors in terms of their decision to work in governmental public health. Leaders should consider tailoring recruitment efforts to maximize job uptake and enhance the potential for long-term retention.
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Affiliation(s)
- Valerie A Yeager
- Valerie A. Yeager and Janna M. Wisniewski are with Tulane School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, LA. Kathleen Amos and Ron Bialek are with Public Health Foundation, Washington, DC
| | - Janna M Wisniewski
- Valerie A. Yeager and Janna M. Wisniewski are with Tulane School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, LA. Kathleen Amos and Ron Bialek are with Public Health Foundation, Washington, DC
| | - Kathleen Amos
- Valerie A. Yeager and Janna M. Wisniewski are with Tulane School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, LA. Kathleen Amos and Ron Bialek are with Public Health Foundation, Washington, DC
| | - Ron Bialek
- Valerie A. Yeager and Janna M. Wisniewski are with Tulane School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, LA. Kathleen Amos and Ron Bialek are with Public Health Foundation, Washington, DC
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Yeager VA, Zhang Y, Diana ML. Analyzing Determinants of Hospitals’ Accountable Care Organizations Participation. Med Care Res Rev 2015; 72:687-706. [DOI: 10.1177/1077558715592295] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/28/2015] [Indexed: 11/16/2022]
Abstract
Accountable care organizations (ACOs) are rapidly being implemented across the United States, but little is known about what environmental and organizational factors are associated with hospital participation in ACOs. Using resource dependency theory, this study examines external environmental characteristics and organizational characteristics that relate to hospital participation in Medicare ACOs. Results indicate hospitals operating in more munificent environments (as measured by income per capita: β = 0.00002, p < .05) and more competitive environments (as measured by Health Maintenance Organization penetration: β = 1.86, p < .01) are more likely to participate in ACOs. Organizational characteristics including hospital ownership, health care system membership, electronic health records implementation, hospital type, percentage of Medicaid inpatient discharge, and number of nursing home beds per 1,000 population over 65 are also related to ACO participation. Should the anticipated benefits of ACOs be realized, findings from this study can guide strategies to encourage hospitals that have not gotten involved in ACOs.
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Affiliation(s)
- Valerie A. Yeager
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Yongkang Zhang
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Mark L. Diana
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Yeager VA, Ferdinand AO, Beitsch LM, Menachemi N. Local Public Health Department Characteristics Associated With Likelihood to Participate in National Accreditation. Am J Public Health 2015; 105:1653-9. [PMID: 26066930 DOI: 10.2105/ajph.2014.302503] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined factors associated with completing, initiating, or intending to pursue voluntary national accreditation among local health departments (LHDs). METHODS We examined National Association of County and City Health Officials 2010 and 2013 profile data in a pooled cross-sectional design with bivariate and multivariable regression analyses. We conducted individual multivariable models with interest in accreditation and likely to accredit as outcome variables, comparing changes between 2010 and 2013. RESULTS LHDs with formal quality improvement programs are significantly more likely to have initiated or completed the accreditation process (odds ratio [OR] = 7.99; confidence interval [CI] = 1.79, 35.60), to be likely to accredit (OR = 2.41; CI = 1.65, 3.50), or to report an interest in accreditation (OR = 2.32; CI = 1.67, 3.20). Interest was lower among LHDs in 2013 than in 2010 (OR = 0.56; CI = 0.41, 0.77); however, there was no difference regarding being likely to accredit. LHDs with a high number of full-time equivalent employees were more likely to indicate being likely to accredit or interest in accreditation. CONCLUSIONS Quality improvement may facilitate the accreditation process or be a proxy measure for an unmeasurable LHD attribute that predicts accreditation.
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Affiliation(s)
- Valerie A Yeager
- Valerie A. Yeager is with the Tulane School of Public Health and Tropical Medicine, New Orleans, LA. Alva O. Ferdinand is with the Texas A&M Health Science Center and School of Public Health, College Station, TX. Leslie M. Beitsch is with the Florida State University College of Medicine, Tallahassee. Nir Menachemi is with the University of Alabama, Birmingham School of Public Health, Birmingham
| | - Alva O Ferdinand
- Valerie A. Yeager is with the Tulane School of Public Health and Tropical Medicine, New Orleans, LA. Alva O. Ferdinand is with the Texas A&M Health Science Center and School of Public Health, College Station, TX. Leslie M. Beitsch is with the Florida State University College of Medicine, Tallahassee. Nir Menachemi is with the University of Alabama, Birmingham School of Public Health, Birmingham
| | - Leslie M Beitsch
- Valerie A. Yeager is with the Tulane School of Public Health and Tropical Medicine, New Orleans, LA. Alva O. Ferdinand is with the Texas A&M Health Science Center and School of Public Health, College Station, TX. Leslie M. Beitsch is with the Florida State University College of Medicine, Tallahassee. Nir Menachemi is with the University of Alabama, Birmingham School of Public Health, Birmingham
| | - Nir Menachemi
- Valerie A. Yeager is with the Tulane School of Public Health and Tropical Medicine, New Orleans, LA. Alva O. Ferdinand is with the Texas A&M Health Science Center and School of Public Health, College Station, TX. Leslie M. Beitsch is with the Florida State University College of Medicine, Tallahassee. Nir Menachemi is with the University of Alabama, Birmingham School of Public Health, Birmingham
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