Geographic Variation in the Delivery of High-Value Public Health Services: Exploring Causes and Consequences

OBJECTIVES: A growing body of evidence indicates that the delivery of public health activities varies widely across states and communities, creating missed opportunities for prevention as well as inequities in health protection. Measures of quality in public health are needed to guide public health improvement initiatives and to support research on the comparative effectiveness of alternative public health strategies. The Multi-network Practices and Outcomes Variation Examination Study (MPROVE), uses the infrastructure of six Public Health Practice-Based Research Networks (PBRNs) across the U.S. to develop and validate a “starter set” of measures and to analyze geographic variation delivery across diverse public health settings.

STUDY DESIGN: We conducted: (1) a review of existing data sources available within the six PBRNs to identify common measurement capabilities; (2) an expert panel process modeled after the RAND/UCLA Appropriateness Method to specify candidate quality measures based on the HHS Framework using the best available scientific evidence combined with the collective judgment of experts; and (3) collection and analysis of data to explore causes and consequences of variation in the delivery of public health services across local public health settings that participate in the six public health PBRNs.  The study population includes approximately 210 local public health settings in six states that participate in one of six public health PBRNs.

RESULTS: The volume and intensity of public health delivery varies by a factor of 2-3 across local settings, even after adjusting for population size and health status. Chronic disease prevention services exhibit the highest variability in volume and intensity across settings.

CONCLUSIONS: A mixed-method approach to measurement development allows explicit trade-offs to be made among feasibility, practice relevance, validity and reliability, and expected health impact.  Carefully developed quality measures can enable research on the comparative effectiveness of public health services and systems and ultimately drive health-improving advances in practice.

Learning Areas:

Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Assess economies of scale and scope in the delivery of public health services. Evaluate the influence of workforce characteristics, financial resources, and community needs and risks on the volume and intensity of public health services delivered in local communties.

Keyword(s): Economic Analysis, Public Health Infrastructure

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I direct the National Coordinating Center for Public Health Services & Systems Research and lead studies on the organization and financing of public health services.
Any relevant financial relationships? No

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.

Back to: 4131.0: Improving the social and economic value of public health strategies through practice-based research networks