Delivering data for decision-making in Washington: An academic/practice partnership Examining state and local spending and services

Background: Tremendous unnecessary variation exists across local health departments, challenging the performance of public health systems and leaving populations potentially underserved. Through partnerships with practitioners and Public Health Practice-Based Research Networks (PBRN), the Public Health Activities and Services Tracking (PHAST) study is providing a comprehensive, accessible database for answering practice-based research questions. To date, PHAST has been examining these questions with states having particularly detailed, annual data regarding their local health departments' spending and services. Washington (WA) State's public health leaders have been early and prominent partners with PHAST, making use of this infrastructure to examine state-wide data and facilitate discussions, planning, and decision-making.

Methods: We compiled unique, annual LHD financial data from 1993 to 2010, to examine trends over time and differences among WA's 35 LHDs and in relation to LHD characteristics, lines of service provided, and local demographics. Specific visual displays of data were created in partnership with researchers and practitioners to maximize relevance and accessibility for practice leaders.

Results: Preliminary findings show per capita, inflation-adjusted changes over time per LHD in total revenue and changes in percent of revenue from various major funding sources—with 2010 generally among the lowest budget year for WA LHDs. Two primary clusters exist among WA's LHDs, including those spending $25-50 per capita and those spending much more. Further analyses will examine trends in relation to service delivery and health outcomes. LHD leaders are using these displays of data to facilitate state-wide discussions for development of a long-term strategy for predictable and appropriate public health funding.

Conclusions: Existing detailed data, never previously accessible to practitioners for decision-making, can become a meaningful planning tool. Practice-relevant questions examined in partnership with researchers can support effective health policy and data-driven decision-making, providing opportunities for improvement in local public health performance.