Karen Hartfield, MPHAcademic Partnership Coordinator

Public Health – Seattle & King County

Develop sustainable infrastructure Identify practice questions of interest to

LHJs, State DOH and Academic Partners Identify and seek funds to answer practice

questions Translate research findings into practice

through proactive dissemination

Nine regional LHJs w/PHSKC acting as leadNine regional LHJs w/PHSKC acting as lead WA State DOHWA State DOH University of Washington School of NursingUniversity of Washington School of Nursing University of Washington School of Public University of Washington School of Public

Health - NW Center for Public Health Health - NW Center for Public Health PracticePractice

Washington State Association of Local Public Washington State Association of Local Public Health OfficialsHealth Officials

Access to the academic literature and cutting edge models, measures, and methods.

Ability to conduct more complex research projects, such as cost benefit analyses

Provide the evidence base that what we are doing is effective (or not!)

Help us make our case to legislators and funders.

Identify Executive Committee Develop charter Learn about network member’s interests

and skills Hold kick-off retreat to establish research

priorities Identify and apply for funds for research

priorities Conduct research projects/disseminate

findings

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

PH Systems Development andOrganization

PH Best Practices -Communicable Disease

PH Best Practices - ChronicDisease Prevention

PH Best Practices -Environmental Health

PH Best Practices - HealthPromotion

PH Best Practices - HealthCommunication

Impact of Public Health Policyon Health Outcomes

Impact of CommunityOrganizing on Public Health

PH Laws and Regulations

Addressing Health InequitiesAmong Underserved

Impact of funding losses on services and outcomes

The role of community in public health service provision

Effectiveness of public health interventions Measurement of health outcomes Emergency preparation communication Childhood obesity intervention

effectiveness

H1N1 Funding Loss: The Unfortunate Natural

Experiment Variation in Communicable Disease

Investigation Practices

PurposePurpose◦ Identify variation in LHJ preparedness & response activitiesIdentify variation in LHJ preparedness & response activities◦ Articulate lessons learned for future flu pandemic/PH Articulate lessons learned for future flu pandemic/PH

emergency emergency ◦ Pilot evaluation methodology for other PH emergency Pilot evaluation methodology for other PH emergency

planning & responseplanning & response effortsefforts

MethodsMethods◦ Four telephone surveys of 15 LHJs (9/09 – 5/10)Four telephone surveys of 15 LHJs (9/09 – 5/10)◦ Two online surveys (10, 2009)Two online surveys (10, 2009)◦ Timely results disseminationTimely results dissemination

Most LHJs were unable to estimate vaccine coverage in ACIP target groups

Access to timely, accurate reports on vaccine coverage is critical to inform decisions about target group prioritization, vaccine allocation and other vaccine strategies

A timely and efficient statewide vaccine reporting system is needed

Partnerships with community stakeholders facilitated public messaging, outreach, and vaccine provision to ACIP target groups

LHJs should establish and maintain ongoing relationships & channels of communication with stakeholders as a part of ongoing routine public health activities

◦ A stronger statewide health emergency response A stronger statewide health emergency response structure would improve communication & structure would improve communication & coordination among DOH and LHJs coordination among DOH and LHJs

◦ In collaboration with LHJs, WA DOH should In collaboration with LHJs, WA DOH should consider designing a process to develop common consider designing a process to develop common standardized guidelines around:standardized guidelines around: Prioritization of vaccine target groupsPrioritization of vaccine target groups Vaccine management & allocationVaccine management & allocation Tracking vaccine coverageTracking vaccine coverage

0 5 10 15

Collaborations with hospitals

Community-based organizations

Exisiting communicationchannels

Health care provider networks

Vaccines For Childreninfrastructure

Collaborations with schools

Incident Command training

Mass vaccination drills/practice

Number of LHJs

Not helpfulSomewhat helpfulVery helpful

How are decisions to cut programs made? Are funding decisions evidence-based? Are there empirical tools that can be used to

make tough decisions? Can we improve quality of public health services

by using objective decision-making tools and criteria?

1. Describe the variation in cuts in response to the current dramatic fiscal conditions forcing LHD service and system changes in WA.

2. Identify factors that influence the adoption, implementation and maintenance of evidence based public health practices during a fiscal crisis

3. Identify commonalities in decisions made across public health settings based on racial, ethnic and socioeconomic composition of the populations served.

A mixed method approach that includes an examination of existing local data and the collection of key informant interview data.

Data sources include: WA State Activities and Services Inventory, WSALPHO data, and NACCHO Profile data

Identify ways to increase the adoption and implementation of evidence based practices for disease prevention and reducing disparities.

Identify efficient and consistent strategies for evidence based decision-making in the face of budgetary crises.

Study completed in August 2011

Descriptive study of variation in approaches to CD investigation

Online survey using SPSS web-based survey application

Collection of LHJ protocols Possible precursor to determining best

practices and protocols

Animal bite reporting and PEP Pertussis and criteria for PEP Salmonella and food worker policy Hepatitis C criteria for investigation Food borne outbreak and criteria for EH

inspections West Nile Virus surveillance

Multi-site PBRN study Examine health outcomes related to variation in PH

practice to determine “what works” on a national level.

Compare effectiveness of various approaches to LHD practice

Use findings to improve the quality of LHD practice and health outcomes in vulnerable populations

 

Articulating value of PHSSR to LHJs and academics

Finding principal investigators Funding infrastructure in a time of

diminished resources Difficulty of real time assessment Organizing network meetings

Enthusiastic network of academic and public health practice partners

Local and national recognition that descriptive and inferential research can improve quality of public health practice

Improved capacity to conduct PHSSR Some increase in funding opportunities

(RWJ)

Dr. Betty Bekemeier, University of Washington School of Nursing

Dr. Jeffrey Duchin, Public Health – Seattle & King County

Dr. Hanne Thiede, Public Health – Seattle & King County

Dr. David Fleming, Public Health – Seattle & King County

The Washington Public Health Practice-Based Research Network

Robin Pendley MPH, CPHAngela T. Dearinger MD, MPH, FAAPKentucky Public Health Research Network (K-PHReN)

Kentucky Public Health Research Network 17 LHD members

53/120 KY counties Kentucky Public Health Association Kentucky Department of Public Health University of Kentucky

College of Public Health Center for Clinical & Translational Science

10% of KY adults have diabetes 9th in nation

6th leading cause of death in KY 40% of KY adults have pre- diabetes 2002 estimates of indirect and direct

costs of DM $2.9 billion

Evaluate the extent to which organizational QI strategies influence the adoption and implementation of evidence- based interventions identified in the Community Guide to Preventive Services Sufficient evidence to recommend that

Diabetes Self- Management Education (DSME) be provided to adults with Type II DM in community gathering places

Six LHD (all K-PHReN members) 2 single county LHDs 4 district LHDs (6-10 counties)

Adults with Type II Diabetes Goals

Diabetes Self Management Education (DSME)

Behavior change support

Overall purpose: Test whether evidence- based strategies lead to systems changes and process improvements within health departments

Method: Facilitate DCOE in design and implementation of a QI project to improve the delivery of existing DSME services

Utilize methods for systems change including: Assess readiness for systems level change Assess current practice Establish process for improved service delivery Evaluation of new system for service delivery

LHD designated as a DCOE (6) QI Champion

Contact person Coordinate team meetings Provide pre/ post intervention data

QI Team DCOE staff/ DSME educators 4-6 members

UK Office of Research Engagement for Advancing Community Health (REACH)

Previous training in QI facilitation AHRQ Putting Prevention into Practice IHI QI Collaborative Embracing Quality in Local Public Health:

Michigan’s QI Guidebook Applied qualitative methodology Regulatory compliance in QI research

Previous projects Primary Care practice- DM management, cancer

screening (through primary care PBRN)

Enrollment visit Consent Project Overview

Three ½ day facilitation sessions Monthly At each DCOE site

Weekly communication with QI teams Individual project periods

6-9 months Data collection & Evaluation

Session One Readiness for Change

(Modified) Assessment of Chronic Illness Care Version 3.5 (RWJF) Assessment of current practice Overview of QI methods/ tools Specific focus on PDSA Specific focus on evaluation Also introduce: RCA, Cause/ Effect diagram, Logic

models, Flow mapping Brainstorming Tailor training to QI team needs/ preferences

Sessions 2 & 3 Facilitate PDSA Guide

modifications to QI project plan

Provide additional QI training as needed

Between sessions Weekly contact

Phone Email

Include all study participants Discuss early successes and challenges

After 1st & 2nd facilitation session Tele-video

Assumption-Improved outcomes not short termExternal Factors-Previous QI experience, organizational climate

1. Assess effectiveness of systems- based QI methods Process improvement

Adoption/ Implementation of QI activities Systems level change

Organizational climate Behavior change

Knowledge of and comfort with QI Utilization of pre/post surveys, post- session

evaluations, direct observation, interviews

2. Assess impact on DCOE capacity # enrolled in DCOE # receiving DSME # completing DSME # referrals and referral sources Care Coordination efforts with PCP Service delivery changes:

Method, location, content, timing, duration, frequency, language translation availability

DM rates DM related factors rates (physical activity, diet) Utilization of pre/post intervention capacity measures

Nancy Winterbauer, PhDNancy Winterbauer, PhDDuval County Health Department & Duval County Health Department &

•University of Florida University of Florida

FL-PHPBRN background◦ Organizational structure◦ Strengths

QI implementation: Transformational change◦ Qualitative results◦ Notes and observations

Transformation, diffusion and readiness

PHPBR to drive QI

Network Development/Academic

Health Departments

FL-PHPBRNSteering Committee

Research

Florida Center for PHPBR

SoutheastWest Central

Emerald Coast

Central Southwest AlachuaNortheast

Subcommittees

FACHO Regional Consortia

Academic CHD

Other CHDs

Regional University Affiliates and Other

Partners

Regional network illustrated for the FACHO Southwest

Region

Health Informatics

MarionLevy

DixieAlachua

Columbia

Hamilton

Gilchrist

Bay

Walton

Gulf

Liberty

JacksonOkaloosa

Santa Rosa

Calhoun

Escambia Holmes

Washington

Taylor

Leon Madison

Wakulla

Jefferson

Suwannee

FranklinLafayette

Gadsden

Clay

DuvalBaker

Nassau

Flagler

St. Johns

Polk

Lake

Volusia

Highlands

Putnam

Manatee

Sumter

Sarasota

Hernando

Union

Seminole

Bradford

Collier

LeeHendry

Glades

De Soto

Okeechobee

Charlotte

Osceola

Orange

Brevard

Martin

St. Lucie

Indian River

Pasco

Citrus

Hardee

HillsboroughPinellas

Dade

Palm Beach

Broward

Monroe

NovaUniversity

FL Agricultual and

Mechanical University

University of Miami

University South FL

FL International University

University of West FL

University ofNorth FL

University of Florida

Southeast Florida ConsortiumWest Central Florida AllianceCentral Florida CoalitionSouthwest Florida AssociationCounties with Multiple AffiliationsNortheast Florida ConsortiumAlachua ConsortiumNon-Affiliated Counties Emerald Coast Consortium

N

FACHO Regions, March 2010

Background: FL-PHPBRN Organizational Structure

67 county health departments Strong SACHO

◦ Communication◦ Relationships

Strong academic partners◦ Academic health

departments Health Information

Technology

Evaluating Quality Improvement Approaches to Improve Immunizations in Jacksonville, FL ◦ RWJF-funded, June 15 2009 – June 14 2011;◦ PIs: Wlliam Livingood, PhD; Radwan Sabbagh, MD◦ Initial implementation (1st six months)

Social marketing Customer satisfaction Employee satisfaction

PDCAPDCA

Agency-Wide Agency-Wide Philosophical Philosophical

ShiftShift

Staff Staff External External Locus of Locus of ControlControl

PositivePositiveResultsResults

Leadership Leadership CommitmenCommitmen

t t

Implement Implement ChangeChange

Staff Staff Internal Internal Locus of Locus of ControlControl

Staff Staff CapacityCapacity

OrganizatioOrganizational Valuingnal Valuing

Staff Staff EngagementEngagement

Change valence Change efficacy

◦ Task demands◦ Resource availability◦ Situational factors

Contextual factors Outcomes

◦ Implementation◦ qi : QI

Weiner, Implementation Science, 2009, 4:67

Nancy Winterbauer, PhDDirector, Florida Center for Public Health

Practice-Based ResearchNancy_Winterbauer@doh.state.fl.us

904-253-2056