Background – Many barriers exist for clinicians when applying the principals of evidence-based medicine in everyday practice, which can lead to wide variations in care. The Center for Evidence-Based Practice (EBP) at the Medical University of South Carolina (MUSC) was established to support clinicians’ ability to provide high quality, evidence-based care. The goal of the Center is to improve the care delivered at MUSC through the creation of evidence-based order sets and guidelines for clinicians. This process involves working with inter-professional teams to identify questions of interest, collaborating with medical librarians to systematically review pertinent literature, using the GRADE approach to appraise evidence, and facilitating the development of clinical practice recommendations to drive the creation of evidence-based order sets and guidelines.

Methods - Advancements in health care management have prompted MUSC to adopt the Patient Centered Medical Homes model in MUSC’s Primary Care Clinics to better understand and replicate best practices within total population health. To assist with this, the Center is expanding its reach to include the support of evidence-based care for total population health, in all phases, with a focus on lowering total medical expenditures for Charleston metro area residents.

Results – The primary outcomes are the development and evaluation of evidence-based guidelines for care across the health spectrum, with a focus on primary and secondary prevention, for use in ambulatory care.

Conclusions – This framework has proven useful in the delivery of comprehensive, coordinated, evidence-based care across the clinical spectrum for inpatients at MUSC, and the expansion to total population health will substantially magnify its reach.

Saint Mary’s Health Clinic (SMHC) was established in 2005 as a free clinic offering low-income vulnerable adults a basic primary care medical home. Through strengthening an academic/health care delivery partnership, in 2012 SMHC began developing into an interprofessional collaborative (IPC) practice model; this required several expansions, including adding health educators and social workers as well as creating an interprofessional team culture, developing student patient advocacy teams focused on social determinants of health, and obtaining specialist physician consultants and monitoring patient outcomes.

 The setting is a community hospital sponsored free clinic working collaboratively with a state supported university and serving low-income, vulnerable clients. The practice moved from a traditional primary care practice to an IPC practice through expanding and then developing and participating in a series of team workshops. To gauge effectiveness of changes and to monitor progress, we collected extensive baseline data on patients’ clinical indicators and continued to collect these data annually for three years. We also assessed interprofessional team readiness and developed quality improvement subgroups. We revised original intervention plans as outcomes and processes indicated a need.

 Preliminary findings revealed clinically significant changes in diabetes and hypertension patient outcomes, increased staff satisfaction and enhanced interprofessional competencies. While only one clinical indicator reached statistical significance, i.e., LDL readings among patients with diabetes (p=.04) many processes improved, including the percent of patients failing to keep appointments (by 22%).

 After only 2 ½ years, an interprofessional primary care team has been developed that includes students as patient advocates and links to physician specialists. The interprofessional team has been able to assist complex, high need patients to improve their health and quality of life. We highlight lessons learned from: helping low-income, vulnerable populations manage chronic disease, developing a unique interprofessional collaborative model, incorporating students as  advocates and overcoming challenges with university-practice collaboration.

North Dakota local public health units (LPHU) have been exploring ways to overcome financial and staff capacity barriers so they can better deliver the Ten Essential Services and be in a position to achieve Public Health Accreditation Board (PHAB) accreditation. The SE Central Regional Network of North Dakota, comprising seven LPHUs, established a goal to improve financial and performance efficiency by reviewing their budget and services delivered, and then established a performance management system to carry out the prescribed changes.

The gap analysis was a two-year process that included financial and qualitative assessment. Financial assessment was done by cost-benefit analysis of public health services delivered and PHUND$ analysis of institutional financial efficiency. Cost-benefit analysis ranked 23 services provided by cost per beneficiary. PHUND$ analysis determined that the LPHU’s administrative expenditures were only 13.78%, and total operating margin 2%. Qualitative assessment was done through the administration of a survey of LPHU employees, county health board members, and community-based partners. Among the many findings was the extent to which public perception of public health as free compromises financial sustainability. This was followed by the development of a performance management system that will be used to guide on-going future development.

This presentation will describe the process by which the gap analysis was performed, with the recommendation that LPHUs in rural counties consider undertaking a systematic review of their work processes in order to redesign the process of delivering the essential public health services.

background: Community based participatory research (CBPR) involves community members in the research and program development process, building the capacity of the community to draw on its social capitol to address multifaceted problems. Recruiting community members to participate in CBPR projects can be daunting due to the lack of training or skills the community has in public health research terminology and theory. CBPR is advantageous for Mississippi's communities due to its social determinants of health contributing to health disparities. objective: The development of a partnership among academic institutes, health organizations, and the health department to develop and implement a 16 week training program on public health and research. methods: A steering committee was established from academic institutes and health organizations of the Jackson Metro Area and the state health department. The steering committee provided recommendations for the community advisory board (CAB), refined the syllabus, recruited participants, and participated as faculty members. Faculty members were selected from the universities and experts of public health in Mississippi. The CAB consisted of professionals who provide a direct service to the community. results: Eighteen faculty members, seven CAB members, and six steering community members collaborated together, a total of 14 academic institutes, health care organizations, and community organizations. Twenty-seven community members participated in the program; twenty-five graduated from the 16 week curriculum. discussion/conclusion:Preparing the community for CBPR requires a collaborative effort from a multitude of professions. These partnerships can last longer than the scope of the project, benefiting both the community and the organizations.

As part of accreditation readiness, local public health departments (LHDs) are required to complete several planning processes with multiple partners and diverse stakeholders. Gaining authentic input from local public health system, hospital, academic and community partners is a key ingredient in conducting a thorough Community Health Assessment, Community Health Improvement Plan and a departmental strategic plan.  Meaningful community engagement is also important to more general public health system improvement efforts.

This session will identify and describe group facilitation processes that have been successfully used in several states and LHDs to gain authentic input from partners and constituents across the country. Information will be shared about the philosophy, purpose and methods related to this type of facilitation. Examples of the results of participatory group facilitation processes and of how results were used will be discussed.

By the end of this session, participants will be able to:

Explain the theory supporting participatory group facilitation methods

Identify participatory facilitation methods that support authentic community input

Differentiate which facilitation methods are best suited for different purposes

Describe how other LHDs have used participatory facilitation methods to advance their agendas while assuring meaningful community involvement.

This session will be illuminating for anyone responsible for carrying out accreditation readiness activities with a focus on Community Health Improvement Processes, as well as those who seek stronger, reliable ways to engage partners in providing input. Information from this session may be applied in additional public health arenas, including Health in All Policies planning and Laboratory System Improvement efforts.

Background: Previous research has demonstrated that there is not clear awareness or understanding of public health laws and how they can be used as effective tools to improve workforce performance and population health. The purpose of the study was to collect and code state and local laws that govern public health practice in Nebraska and use the data to evaluate the impact on performance and changes in health behaviors.

Methods: Nebraska laws that govern public health practice were collected through searches of LexisNexis and Westlaw, as well as consultation with experienced public health staff and lawyers. Laws were coded in LawAtlas and a publicly available interactive website was created. The legal data was then merged with longitudinal performance and surveillance data and analyzed using time series regressions.

Findings:  A total of 18 legal datasets were created ranging from alcohol, tobacco and other drugs, chronic injury and disease to health professions licensure, structure and governance and vital statistics. By merging the legal datasets with data information on health department performance, such as clean indoor air enforcement, and health behaviors, such as tobacco use, we were able to evaluate laws at the level of provisions rather than just dichotomous measures of the law and evaluate the impact.

Conclusions: The project could be a first step towards helping public health practitioners and researchers better evaluate the impact of law on the delivery of public health services and population health, as well as consider amendments to current laws in response to the existing evidence base.

Historically hospitals, public health departments, and county and city management have limited, if any, interaction because of the perceived nature of their own disparate areas of focus and responsibility. However, in an effort to create “healthy communities” or “accountable care communities” these agencies are recognizing the need for developing effective working relationships with one another. Nationally, there has been some indication of community service organizations working collaboratively to create healthier communities.  However, these efforts are still episodic and disjointed in nature; they lack the systematic, coordinated processes and strategic management required to sustain effective and efficient primary, secondary and tertiary prevention and intervention needed to create and maintain healthy communities.

The Community Translational Research Institute (CTRI), Jurupa Valley Diabetes Free Riverside (DeFeR) Demonstration and Feasibility Assessment Project, brings together the Riverside County Public Health Department, local hospitals, and City and County management along with community leaders and academic institutions to strengthen their infrastructure as a whole, and achieve integrated, multi-sectorial effectiveness in addressing the obesity epidemic among the adults and children residing in Jurupa Valley, California.  Preliminary analyses of data have ignited a greater sense of urgency for prevention measures, 33% of the 139 adults screened have been diagnosed as pre-diabetics.  The importance of community input for promoting healthy nutrition and increasing physical activity is at the forefront of this endeavor; a cadre of health professionals armed with the tools needed to reverse this epidemic and improve better health outcomes for the underserved population of Jurupa Valley, California.

Fragmentation of services continues to be a major barrier in healthcare and public health, which has sparked the need academic-clinical partnerships.  These partnerships create a ‘shared space’ for administrators, clinicians, and researchers to discuss the impact of organizational and Affordable Care Act (ACA) policies. Case study research was conducted describing the development of an alliance between IU Health Bloomington, the largest health care system in Southern Indiana, and the Indiana University Bloomington School of Public Health. Three participatory models aligning with the partners’ strategic areas were developed to reduce health insurance barriers, improve utilization of hospital-based community health services, and reduce disparities among seniors.  Within a two year period, the Alliance has engaged over 40 administrators, clinicians, community organizations, researchers, and undergraduate and graduate students.  The impact of this partnership has resulted in the increase of referrals to Medical Nutrition Therapy to support patients with chronic conditions that are amendable to nutrition intervention; recruitment of participants ages 65 and older to prevent falls, and analyses of healthcare and services datasets to identify barriers for uninsured patients to enrolling in health insurance plans. The Alliance will determine how to best utilize the findings from this partnership and translated to practical applications and the development of policies that enhance population health and well-being.  Additional impact of the project includes:  identifying barriers and facilitators to research in the model; developing mutually important outcomes to guide research; and improving communication across clinical academic lines.  This partnership can serve as a system-based participatory model for other Schools of Public Health and healthcare systems to consider towards enhancing their community engagement activities.

An innovative collaboration between a community based project, LoWellness, a health assessment survey created for distribution in Lowell, Michigan and Grand Valley State University public health students.

Lowell is a small rural community about 20 miles east of Grand Rapids, Michigan with limited resources for health services and care. Community leaders sought to determine the health needs of their community through distribution of the LoWellness survey in hopes to increase services, access and overall health locally with the results in the future.  

The organization sought out the assistance of graduate students to work on the development of the survey, implementation, evaluation, and data analysis. A strong partnership and experiential learning experience for students was derived from this partnership.

This presentation will explain the survey development process, while highlighting the need, desirability, barriers, and challenges of a community organization and university partnership. Disseminating the outcomes of the survey will provide a platform for discussion and future steps for development of programs and services to meet the demand of disparities in the Lowell community.

background:

The National Health Expenditure Accounts (NHEA) public health activity estimate is frequently used as an estimate of the nation’s governmental public health expenditures. However, it has been posited that actual public health spending is lower than the NHEA estimates. 

research objective: Re-code Census of Government state agency expenditure data to assess the accuracy of the NHEA Public Health Activity estimate.

study design: We dual-coded state agency expenditure data to ascertain 1) whether the expenditure record was recognized as public health under the Foundational Public Health Services (FPHS) model and 2) if it was characterized as a public health expenditure, to determine the type of spending. We compared spending by state, year, type, and examined drivers of non public health spending. 

population studied: Expenditure data from all U.S. State government agencies, FY2000-FY2012.

principal findings:

Coding revealed approximately 1.05 million state agency budget line items in the FPHS public health definition ($202 billion), and 682,445 items not public health ($253 billion) FY2000-2012. Leading non-public health categories included Behavioral health, Human Services, Health Care Financing, and Environmental Protection. Our refined estimates suggest that less than half of the Census public health activities are actually public health, suggesting NHEA’s estimates of Public Health Activity spending might be significantly larger than actuals.

conclusions and implications: Findings suggest that governmental public health spending might be significantly lower than current estimates. This has implications as to approaches, investments, and partnerships that might be needed to secure and sustain a FPHS public health model.