State-specific adoption and diffusion of the Foundational Public - - PowerPoint PPT Presentation

State-specific adoption and diffusion

• f the Foundational Public Health

Services within the United States: A systematic literature review

Public Health Systems Group Meeting • 4/15/2016

Anne Burke Kansas Health Institute

Informing Policy. Improving Health.

Overview

n Background n Purpose of study n Data and methodology n Results

§ FPHS initiation and stage of adoption § FPHS models § FPHS definition methodologies § Foundational capabilities § Foundational areas

n Discussion/conclusions

Background

n Paving the way for the FPHS

§ Core functions of public health (1988) § Ten Essential Public Health Services (1994) § PHAB standards (2011)

n Articulating the FPHS

§ IOM 2012: For the Public’s Health § RESOLVE framework

n Nationwide framework?

Purpose of Literature Review

n To assess the current body of

knowledge regarding the FPHS and its implementation in states in order to evaluate knowledge gaps and inform efforts to implement the FPHS in Kansas and other states

Data and Methods

n January-February 2016 n Conducted according to PRISMA

(Moher et al. 2009)

n Scientific literature n Gray literature

Records identified through database searching (n = 38; one state) Screening Included Eligibility Identification Additional records identified through other sources (n = 20; fourteen states) Records after duplicates removed (n = 55) Records screened (n = 55) Records excluded (n = 33) Did not address the FPHS Full-text documents assessed for eligibility (n = 22) Full-text articles excluded (n = 2) Were not specific to one state Documents meeting inclusion criteria (n = 20) Additional documents included (n = 1) Reference list search Documents included in qualitative synthesis (n = 21)

Methods

Results

n Peer reviewed literature: one article for one

state

n Gray literature: 20 documents for 14 states n States with intention to adopt: CT, OK, MO,

KS, IA

n States with defined FPHS: WA, ND, KY,

WV

n States with adopted FPHS: OH, CO, NC,

TX, OR

FPHS Initiation

n States with

articulation (2002-2015)

N=4

n States with

intention (2014-2015)

N=5

75% 25%

Public health Legislature

100%

Public health Legislature

n States with

adoption (2012-2014)

N=5

20% 80%

Public health Legislature

FPHS Models

n Modification or adoption

• f RESOLVE framework:

§ OR, WA, ND

n Adoption of prior

framework (10 Essential Services, PHAB):

§ TX, NC

n Development of original

framework:

§ OH, KY, WV, CO

Defining the FPHS

n Washington:

§ Extent to which services are population-based § Extent to which other organizations do the services § Whether or not the service is mandated

n Oregon:

§ Statutory requirements § Governance structures § Financing at the state and local levels § Health system transformation implementation § Social determinants of health § Other states approaches to governmental public health services (Washington)

Defining the FPHS, cont’d.

n Ohio:

§ Defined current status of health system

• Reviewed LHD information
• State-level regulatory scan
• Online survey of AOHC members

§ Stakeholder considerations

• Key informant interviews
• Literature review

§ Consensus

• Consensus-building meetings

Defining the FPHS, cont’d.

n Kentucky:

§ University of Kentucky’s cost-estimation instruments § National FPHS definitions § Other state’s approaches to defining the FPHS (Ohio) § State statutes § Current public health system operations

n Colorado:

§ Developed by a taskforce of health departments leaders including stakeholder input

n West Virginia:

§ Other state’s approaches to defining the FPHS (Ohio)

A minimum package, by another other name…

n FPHS=Core public health services n FA=Basic programs; core, basic,

essential services

Foundational Capabilities

n Articulated by eight states

§ Assessment and business competencies (8/8 states; 100%) § Communication (7/8 states; 87.5%) § Emergency preparedness, community partnership development, policy development and support (6/8 states; 75%)

Assessment

n Most common:

§ Data collection/analytics § Data response/report preparation § CHA

n Less common:

§ Access to lab services

n Additional:

§ Program evaluation § HIE interface

Emergency Preparedness

n No states included

all in RESOLVE framework

n Most common:

§ Developing and rehearsing strategies and plans § NIMS

n Less common:

§ Emergency Support Function 8

§ Communication § COOP § Investigation of threats § Emergency health

• rders

§ 24/7 notification

n No states:

§ LRN § Promoting readiness

Communications

n Most common:

§ Strategy based on risks, behaviors and prevention

n Less common:

§ Media/public relations § Health education/promotion, interventions*

n Additional:

§ Health literacy § Marketing, branding, and social media

Community Partnership Development

n Most common:

§ Create/maintain partnerships § CHIP

n Less common:

§ Select/coordinate/articulate roles

n Additional: none

Policy Development and Support

n Most common:

§ Working with partners to enact policies

n Less common:

§ Cost/benefit analysis

n Additional:

§ Public health administrative rules/regulations § Policy evaluation

Business Competencies

n Most common:

§ QA/QI § Leadership § IT § HR § Fiscal management § Legal services

n Less common:

§ Facilities and

• perations

§ Health equity § Strategic planning

n Additional:

§ Evidence-based practices § Accreditation § Strategic planning

Foundational Areas

n Articulated by nine states

§ Communicable disease control, chronic disease and injury prevention*, environmental health (9/9 states; 100%) § Access/linkage to clinical care (8/9 states; 88.9%) § MCH (7/9 states; 77.8%)

Communicable Disease Control

n Most common:

§ Receiving lab reports, conducting investigations, and responding to

• utbreaks

n Additional:

§ Community-based prevention § Vaccination/immunization § Quarantine authority § Disease reporting § Provider education § Screening

n Less common:

§ Providing information § Identifying assets § Notification services § TB treatment § Coordinating other programs § Contact tracing

Chronic Disease and Injury Prevention

n Frequently named

“Prevention and Health Promotion”

n Most common:

§ Providing information § Reducing tobacco § Obesity prevention

n Less common:

§ Identifying assets § Coordinating other programs

n Additional:

§ Cancer, suicide, injury, diabetes, teen pregnancy, STI prevention § Oral health promotion

Environmental Public Health

n Most common:

§ Testing, inspections, and oversight

n Less common:

§ Providing information § Identifying assets § Identifying public health threats § Protection from radiation exposure § Sustainability § Coordinating other services

n Additional:

§ Laboratory testing § School/childcare/ correctional facility inspections § Nuisance abatement § Promoting recycling/reuse § Childhood lead case management

Maternal/Child/Family Health

n Most common: None n Less common:

§ Providing information § Newborn screening, § Promoting information to optimize development § Identifying assets § Coordinating other programs

n Additional:

§ Protection of critical states of development § Infant mortality/preterm birth prevention § EPSDT outreach

Access/Linkage to Clinical Care

n Most common: None n Less common:

§ Providing information § Monitoring and licensing healthcare facilities/providers § Identifying assets § Coordinating other programs

n Additional:

§ State-level health system planning § Assessing and supporting access to care § Health workers as facilitator of care § Interventions to barriers to care § Linkage to coverage § Grief counseling § Purchase/distribution of biological and therapeutic products

Additional Areas

n Vital records

§ Assure a system of vital records § Provide certified birth/death certificates

n Mental/behavioral health n Substance abuse prevention n Clinical services and programs n Patient safety and market oversight

Discussion

n Various

mechanisms:

§ Initiation § Definition n States with FPHS

fully articulated:

§ Began earlier

n States with FPHS

adopted:

§ More likely to begin within the legislature

n Definition methods

and KS

n FPHS models

§ All states modified RESOLVE § Complementary to, but distinct from:

• PHAB
• 10 Essential Services

§ Importance of defining the minimum package

Discussion, cont’d.

n Increasing FPHS awareness

§ 42% of health department leaders unfamiliar with FPHS (Leider et al. 2015) § Lack of FPHS presence in peer-reviewed literature

n Tailoring the FPHS

§ What is defined as “truly necessary” differ from RESOLVE’s FPHS and by location (Leider et al. 2015) § Minimum package should be tailored to unique circumstances (Bobadilla et al. 1994)

• Burden of disease
• Cost-effectiveness of interventions

Discussion, cont’d.

n Commonalities in areas and

capabilities overall

§ Assessment: “Nobody else in the community can do” (Leider et al. 2015) § Communicable disease control, chronic disease and injury prevention, EH

• All identified as “truly necessary” (Leider et
• al. 2015)

Discussion, cont’d.

n Differences in cross-cutting skills and

capacities

§ Clinical services

• Immunizations

§ Family planning

Conclusions

n FPHS definition and adoption has occurred

and continues to occur within the United States

n Methodology of initiation and definition can

guide other states

n General commonalities in areas and

capabilities overall

n Differences in cross-cutting skills and

capacities and additional areas

n Importance of tailoring the FPHS to state’s

local context

References

n

Bobadilla, J.-L., Cowley, P., Musgrove, P., Saxenian, H. (1994). Design, content and financing of an essential national package of health services. Bulletin of the World Health Organization 72(4): 653-662.

n

Committee on Public Health Strategies to Improve Health, Institute of Medicine (2012). For the Public’s Health: Investing in a Healthier Future. Washington, DC: National Academies Press.

n

Leider, J.P., Juliano, C., Castrucci, B.C., Beitsche, L.M., Dilley, A., Nelson, R., Kaiman, S., Sprague, J.P. (2015). Practitioner perspectives on foundational capabilities. Journal

• f Public Health Management and Practice 21(4): 325-335.

n

Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097.

n

NACCHO (2012a). Statement of policy: Provision of clinical services by local health

• departments. Washington, DC: NACCHO.

n

NACCHO (2012b). Statement of policy: Minimum package of public health services. Washington, DC: NACCHO.

n

Public Health Leadership Forum. (2014). Defining and constituting foundational “Capabilities” and “Areas.” Version 1.Washington DC: RESOLVE.

Questions?

Thank you! Anne Burke, MS Analyst Kansas Health Institute 785-233-5443 aburke@khi.org