Public Health Services & Activities Tracking (PHAST):

1. Public Health Services & Activities Tracking (PHAST): A multi-state Study of the National Network of PH PBRNs October 17, 2011 Vancouver, WA Betty Bekemeier, PhD, MPH, RN School of Nursing University of Washington, Seattle PBRN PHAST Study | A project funded by RWJF –Nurse Faculty Scholars

2. Outline • PHAST: what? • PHAST: why? • PHAST: whom? • PHAST: how? • PHAST: so what? • PHAST: when?

3. PHAST: What?

4. PHAST Study: Purpose • Establish data repository for comparing effectiveness of local PH efforts • Provide evidence for PH programs & characteristics most effective in reducing disparities & improving population health • What works? For what populations? Under what conditions? PBRN PHAST Study | A project funded by RWJF –Nurse Faculty Scholars

5. PHAST: Why?

6. Local Health Departments (LHD)… • Lack evidence & data for service-related decision-making • Are in “pivotal positions” to address health disparities • Provide services that “vary tremendously” Mays et al., 2009; Tilson & Berkowitz, 2006 PBRN PHAST Study | A project funded by RWJF –Nurse Faculty Scholars

7. Unnecessary variation in LHD services implies “wasteful, harmful, and inequitable” inefficiencies. Mays & Smith, 2009

8. Financial Crises are bad for the public’s health…especially for vulnerable populations. Freudenberg et al., 2006; Stuckler et al., 2009

9. PHAST: Whom?

10. Public Health Practice-based Research Networks • For expanding the volume & quality of research for evidence‐based PH decision‐making • Bringing PH agencies & researchers together to • identify practice-based questions, • design & implement relevant studies, & • translate findings rapidly into practice

11. PHAST State PBRN Partners

12. WA PBRN Whom? • DOH • LHJs • Activities & Services Inventory Committee • Colleagues & Friends ….critical to the process of assessing the • Data, Findings, Application Wennberg, 2010

13. PHAST: How?

14. Methods • Combine & coordinate similar research interests of National Network of PBRNS • Identify common data elements across states • Link multi-state data into an expandable repository for comparing practice variation & outcomes over time • Analyze data for practice variation & related proximal health outcomes • 5) Conduct studies & evaluate processes relative to the long-term potential of the repository & collaboration PBRN PHAST Study | A project funded by RWJF –Nurse Faculty Scholars

15. Retrospective Service Data Initial activity determined… • What common data elements exist? • What data show detail in service volume, reach, type, quality? • What data can be matched to proximal health outcomes? • How accessible are the data? • How far back do data go? PBRN PHAST Study | A project funded by RWJF –Nurse Faculty Scholars

16. Data Base Infrastructure Partnership established… • UW Center for Studies in Demography & Ecology (CSDE) • Creating expandable data-base infrastructure • With a potential for something like The Dartmouth Atlas of Health Care • http://www.dartmouthatlas.org/

17. Data Specifications • LHD Services • MCH, EH, CD control • Provided directly • Per LHD • Time frame • Yearly: 2005-present • Source • County/LHD level data • Easily retrievable at the State

18. Types of Data (for now) • Activities and services: MCH, EH, & CD Control • Volume of service delivered, # of clients served • Expenditures • $$ spent per year per LHD per service domain area • Human resources • # of FTEs engaged in a type of service/LHD/year

19. Activities & Services EXAMPLE: Domains with commonly existing data: • Maternal/Child Health Example: WIC • Clients—# of unduplicated WIC clients served/LHD/year 2005-2009. PBRN PHAST Study | A project funded by RWJF –Nurse Faculty Scholars

20. Activities & Services EXAMPLE: Domains with commonly existing data: • Environmental Health Example: Food Safety • # of permanent food service establishments permitted/LHD/year 2005-2009.

21. Activities & Services EXAMPLE: Domains with commonly existing data: • CD Control Example: Immunizations • # of local providers receiving vaccine by LHD staff through state immunization program/LHD/year 2005-2009.

22. E.g. Model for examining MCH Service Outcomes

23. Figure: Change in per capita MCH Expenditures among LHDs in WA State

24. What questions would you like asked for/with practice?

25. PHAST: So what?

26. General Implications • Practice: • Establishment of an evidence-base for decision-making regarding PH service/system delivery models • Better, more useful research with practice involvement • Policy: • Guidance for policy decisions • Fostering interest in & accountability around LHD services, data collection • Research: • A structure for further research • Monitor outcomes from budget cuts PBRN PHAST Study | A project funded by RWJF –Nurse Faculty Scholars

27. Practice-based Research Implications • PBRN members are critical to success • Have relationships with key “data owners” • Bring willingness & interest in locating/providing data • Finding “astonishing” amounts of LHD service data already exists • High interest in data quality & research due to: • Budget crisis • Accreditation • CDC Infrastructure grants

28. PHAST: When?

29. Next Steps • Preliminary Research • Additional Funding • Identifying more Research Questions • Translating Research to Practice • Addressing Challenges

30. Preliminary Research • WIC • How does WIC service by LHDs vary & change over time? • Urban areas keeping better pace with “need” • MCH • Are MCH-related expenditures by LHJs be predicted by “need”?

31. Increasing Funding • More Studies • Track the “natural experiment” of budget cuts • Different LHD services • LHD budget, funding, revenue issues • Translation or utilization of findings • More Infrastructure

32. Other Study Questions?.....e.g.’s • Do changes in revenue sources impact services & outcomes? • What is an effective frequency for restaurant inspections? • What happens when LHDs no longer provide Dental Services? STD clinics? • How can we compare changes in Chronic Disease Prevention activities by LHDs? • How can we start to measure attributes of services such as reach & quality?

33. Research Translation • How to best apply/use findings? • How can this improve practice? Outcomes?

34. Public Health Services & Activities Tracking (PHAST): • A multi-state Study of the National Network of PH PBRNs PBRN PHAST Study | A project funded by RWJF –Nurse Faculty Scholars