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Abstract #161235
Audio (mp3) recordingJohn B. Wayne, PhD, College of Public Health, Univ of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #820, Little Rock, AR 72205-7199, (501)526-6604, jwayne@uams.edu, Glen Mays, PhD, MPH, Dept. of Health Policy & Management, College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, #820, Little Rock, AR 72205, Paul K. Halverson, DrPH, MHSA, Division of Health and College of Public Health, Arkansas DHHS and Univ. of AR for Medical Sciences, PO Box 1437, Slot H-39, Little Rock, AR 72203-1437, and Andrea Ridgway, MS, RD, LD, CDE, Division of Health, Arkansas DHHS, P.O. Box 1437, Slot H21, Little Rock, AR 72203-1437.
The CDC has spearheaded a national partnership initiative to develop public health performance standards (PHPS) in an effort to strengthen public health practice, systems-based performance, and public health infrastructure. This paper reports some of the results of the assessment in Arkansas. METHODOLOGY: Steering Committees were established to guide the assessment process. Staff received training in use of the NPHPSP "Local Assessment Instrument," and representatives of the "broadly defined public health system" were invited to participate. Participants (1931 statewide) assessed their local public health system against each of ten performance standards and each of thirty-one components included in the standards. Assessment responses were generated through a consensus process in meetings conducted during Jan-Mar 2006. Final scoring of responses was based on an algorithm developed by CDC. Arkansas' scores were compared with national norms from a database of existing local users of the instruments. There have been anecdotal reports that small jurisdictions have been reluctant to use the standards (and to engage in the accreditation movement) for fear they will be disadvantaged by them. Thus, the Arkansas responses were stratified by OMB geographic designations so that the results for Metropolitan, Micropolitan, and Rural areas could be compared. RESULTS: The average population was: 72,626 in 21 counties classified as Metropolitan, 31,440 in 23 Micropolitan counties, and 16,175 in 36 rural counties. Overall, Arkansas' local public health systems exceeded national norms for all 10 PHPS. Further, 81.3% of the state's 75 counties "Met" or "Substantially Met" the PHPS. However, contrary to some expectations, we didn't see large rural-urban disparities in performance. On average rural counties met or substantially met a greater number of standards (7.17) then their Micropolitan (7.11) and Metropolitan (6.90) counterparts [chisquare, p<0.05]. Similarly, on average rural counties "met or substantially met' a greater number of components of the standards (21.81) then their Micropolitan (21.22) and Metropolitan (21.14) counterparts [p, ns]. This trend is partially explained by the number of public health employees per 10,000 population (Metropolitan-5.36, Micropolitan-9.56, Rural-11.32). However, these "average results" mask differences that will be presented. The highest performance levels occurred in Standard-2: Diagnose and investigate health problems (93); Standard-6: Enforce laws and regulations (79), and Standard-3: Inform and educate (78). CONCLUSIONS: Arkansas' data demonstrate the usefulness of the PHPS in guiding improvement activities. The Urban/Rural comparisons show that performance reflects resource allocation and comparable performance in rural and urban areas. Possible reasons for this outcome will be suggested.
Learning Objectives: Participants will be able to
- Articulate the importance of the National Public Health Performance Standards Program;
- Identify factors that influence performance differences between rural and urban areas in one state;
- Describe the implementation process and discuss the advantages of participating in the entire National Public Health Performance Standards Program.
Keywords: Rural Health, Performance Measurement
Presenting author's disclosure statement:
Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.
The 135th APHA Annual Meeting & Exposition (November 3-7, 2007) of APHA