The Status of PHSSR in the United States May 26, 2011 PHSSR THINK - - PowerPoint PPT Presentation

The Status of PHSSR in the United States

May 26, 2011 PHSSR THINK TANK Montreal Canada

• F. Douglas Scutchfield, MD

Peter P. Bosomworth Professorship of Health Services Research and Policy and Director University of Kentucky National Coordinating Center for Public Health Systems & Services Research

What is PHSSR?

A field of inquiry examining the organization, financing, and delivery of public health services at local, state and national levels, and the impactof these activities on population health.

Mays, G. P., Halverson, P. K., & Scutchfield, F. D. (2003). Behind the curve? What we know and need to learn from public health systems research. J Public Health Management and Practice, 9(3), 179-182.

Macro context Social, Political, Economic forces operating in the overall society (e.g. National economy) Extent of Demand and need for public health services within the population Social values and preferences for products of public health systems (e.g. clean water) External forces such as: Medical delivery systems, Technological advances, Nature of federal-state-local relationships Local Public Health System PHS Mission and Purpose Goals and how they are to be implemented Performance of the core functions of assessment, policy development, and assurance Capacity System Inputs: Workforce Facilities Technology Organizational relationships Funding Processes Essential Public Health Services Outputs Programs and Services consistent with mandates and community priorities Process Outcomes Improved

• rganizational

performance Improved program performance Community Health Outcomes Improved Health Practices, Environment, Life Styles Improved Morbidity and Mortality Rates

Improved Health Status

Early Steps In Establishing PHSSR

• Data

–HSRR Listing , Bibliographic citations –Data Harmonization

• Researchers

–Mini-grants

• Venues and opportunities for net working

–Keeneland Conference

–AcademyHealth PHSR Special Interest Group

• Funding for research

–RWJ/NNPHI

• Linkage of practice to research and translation

–PBRNs –Communication/website/Social networking

Developmental Path for PHSSR

Descriptive Inferential Translational

Measuring practice & performance Detecting variation in practice Examining determinants of variation

– Organization – Law & policy – Financing – Information – Workforce – Preference

Determining consequences of variation

– Health outcomes – Medical care use – Economic outcomes – Disparities

Testing strategies to reduce harmful, unnecessary, & inequitable variation in practice and outcomes

Key Literature in PHSSR in the US

Mays, G. P., Halverson, P. K., & Scutchfield, F. D. (2003). Behind the curve? What we know and need to learn from public health systems

• research. J Public Health Management and

Practice, 9(3), 179-182.

• Argues for a renewed focus on how the public

health system interacts with the contextual factors that influence health

Key Literature in PHSSR in the US

Mays, G. P., McHugh, M. C., Shim, K., Perry, N., Lenaway, D., Halverson, P. K., et al. (2006). Institutional and economic determinants of public health system performance. [Article]. American Journal of Public Health, 96(3), 523-531. Scutchfield, F. D., Knight, E. A., Kelly, A. V., Bhandari, M. W., & Vasilescu, I. P. (2004). Local public health agency capacity and its relationship to public health system performance. J Public Health Management and Practice, 10(3), 204-215.

• Both examine impact of variation in both financial and

agency capacity variables on system performance

Key Literature in PHSSR in the US

Scutchfield, F. D., Marks, J. S., Perez, D. J., & Mays, G. P. (2007). Public health services and systems research. American Journal of Preventive Medicine, 33(2), 169-171

• Calls for renewed emphasis on developing and

adapting research methods/techniques suitable for examining the public health system

RWJ/CDC National PHSSR Research Agenda Setting

• Several PHSSR research agendas exist

– Out of date and/or too specific

• Broad process involving as many constituents as

possible

• Started in Fall 2010
• The Atlanta Ice Storm of January 2011
• Webinars on topical areas
• Projected Conclusion in September 2011
• Still in Process
• Available on the Publichealthsystems.org website mid

June

Setting the PHSSR Agenda

Step One: Comprehensive systematic literature review, including targeted reviews in four areas:

– Public health workforce – Organization/structure – Technology/data methods – Quality improvement

Setting the PHSSR Agenda

Step Two: White papers distributed to key practice and research partners

– Systematic literature reviews, contained key findings of those reviews, and unexamined areas

• f critical research

– Through review of RWJ funded research literature

• f PHSSR research through early 2010

Setting the PHSSR Agenda

Step Three: Webinars with subject matter experts in the four areas covered by the targeted systematic reviews Workforce Finance Data and Methods Structure and Organization

– Facilitated discussions to develop and then discuss key areas of research/research questions that have utility to the practice community

Setting the PHSSR Agenda

Step Four: Vetting with research and practice community: Keeneland Conference, AcademyHealth PHSR IG, NACCHO annual meeting etc. (ongoing)

– Submit input from larger group of public health researchers and practitioners

Setting the PHSSR Agenda

Step Five: Online comment period (pending)

– Will be available on key organizations intranet, as well as internet for community at large www.publichealthsystems.org – Give entire PHSSR/public health community

• pportunity to comment on/shape research

agenda – Social media

Setting the PHSSR Agenda

Step Six: Publication (pending)

– Widespread dissemination; AJPM supplement – Use of the web and social media resources – Utility and value to PHSSR researchers – Sets the stage for funding of research and development of research resources

Setting the PHSSR Agenda

Step Seven: Back to step one (constant)

– Research agenda should be forward thinking, trying to advance the field – In order for research agenda to be relevant, it must reflect the state of the art in research – Becomes quickly outdated – Needs to evolve

National Coordinating Center for PHSSR

• RWJF Funded Coordinating center for PHSSR work
• Awarded Competitively to UK
• Five Pillars

–Education of Researchers ($1M) –Education of Practitioners to use research ($1M) –Increased base of Funding for Research ($1.5M) –Increased current grant funding for research ($2.4M and $2.5M) –Technical Assistance, communication, dissemination, utilization and visibility of PHSSR($3.4M)

NCC Charge

• To create a unified, coherent agenda for PHSSR
• To synthesize, translate and disseminate results of current and past

investments in PHSSR by RWJF and other funders

• To increase the number of researchers in the field with the appropriate

skills to conduct quality work

• To strengthen the ability of practitioners to interpret and apply PHSSR

findings

• To increase the relevance of PHSSR findings to practitioners
• To increase the number of practitioners who are engaged in PHSSR
• To increase the number of policy-makers who are aware of PHSSR
• To increase the number of funders committed to PHSSR
• To inform public health policy and practice, which will lead to better

health outcomes for all Americans

What have we learned

• Funding is key, Willie Sutton principle applies

in the academy, if you fund it they will come

• Transitioning a researcher from an existing

comfortable research area to a new one is hard, it is easier to grow new ones

• With practitioners, if you build it they won’t

come, you have to go to them

• Things that work in HSR in general also work

in PHSSR, like typology, QI, accreditation

What have we learned

• Questions from practice are always more interesting
• With many players and organizations in PH,

coordination is herding cats

• We don’t get no respect and what we do is hard to

explain

• We need new data, particularly financial data and

longitudinal data

• How do we get interest from Feds other than CDC, like

NIH’s CTSA and AHRQ Comparative Effectiveness and HIT work

• We need to use new and more robust methodology for
• ur efforts

That’s All Folks

Questions?

For more information contact:

• F. Douglas Scutchfield

scutch@uky.edu

121 Washington Avenue, Suite 212 Lexington, KY 40517 859-257-5678

www.publichealthsystems.org