The Association of Changes in Local Health Department Resources With Changes in State-Level Health Outcomes

Center for Public Health, University of Tennessee, Knoxville, TN 37996, USA.
American Journal of Public Health (Impact Factor: 4.23). 04/2011; 101(4):609-15. DOI: 10.2105/AJPH.2009.177451
Source: PubMed

ABSTRACT We explored the association between changes in local health department (LHD) resource levels with changes in health outcomes via a retrospective cohort study. We measured changes in expenditures and staffing reported by LHDs on the 1997 and 2005 National Association of County and City Health Officials surveys and assessed changes in state-level health outcomes with the America's Health Rankings reports for those years. We used pairwise correlation and multivariate regression to analyze the association of changes in LHD resources with changes in health outcomes. Increases in LHD expenditures were significantly associated with decreases in infectious disease morbidity at the state level (P = .037), and increases in staffing were significantly associated with decreases in cardiovascular disease mortality (P = .014), controlling for other factors.

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    ABSTRACT: Introduction Tuberculosis (TB) requires at least six months of multidrug treatment and necessitates monitoring for response to treatment. Historically, public health departments (HDs) have cared for most TB patients in the United States. The Affordable Care Act (ACA) provides coverage for uninsured persons and may increase the proportion of TB patients cared for by private medical providers and other providers outside HDs (PMPs). We sought to determine whether there were differences in care provided by HDs and PMPs to inform public health planning under the ACA. Methods We conducted a retrospective, cross-sectional analysis of California TB registry data. We included adult TB patients with culture-positive, pulmonary TB reported in California during 2007–2011. We examined trends, described case characteristics, and created multivariate models measuring two standards of TB care in PMP- and HD-managed patients: documented culture conversion within 60 days, and use of directly observed therapy (DOT). Results The proportion of PMP-managed TB patients increased during 2007–2011 (p = 0.002). On univariable analysis (N = 4,606), older age, white, black or Asian/Pacific Islander race, and birth in the United States were significantly associated with PMP care (p<0.05). Younger age, Hispanic ethnicity, homelessness, drug or alcohol use, and cavitary and/or smear-positive TB disease, were associated with HD care. Multivariable analysis showed PMP care was associated with lack of documented culture conversion (adjusted relative risk [aRR] = 1.37, confidence interval [CI] 1.25–1.51) and lack of DOT (aRR = 8.56, CI 6.59–11.1). Conclusion While HDs cared for TB cases with more social and clinical complexities, patients under PMP care were less likely to receive DOT and have documented culture conversion. This indicates a need for close collaboration between PMPs and HDs to ensure that optimal care is provided to all TB patients and TB transmission is halted. Strategies to enhance collaboration between HDs and PMPs should be included in ACA implementation.
    PLoS ONE 10/2014; 9(10):e110645. DOI:10.1371/journal.pone.0110645 · 3.53 Impact Factor
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    ABSTRACT: The current study was interested in analyzing the Florida Department of Health’s overall success and effectiveness across the State’s counties given the financial performance data to facilitate further development of a solution that will have bearing on the performance of the organization. It was necessary for the current study to examine both quantitative and qualitative factors that have influenced the performance rate of counties across the State of Florida. Employing data published by the Florida Department of Health and other relevant external datasets, which will include data queries and state and county profiles, the current study was able to predict and find the correlation between where the Florida Department of Health is targeting their budgeted money and what effect this had on outcome vital health indicators. The purpose of the current study was to assist the Florida Department of Health in: targeting their efforts and recourses to areas that were currently not operating as efficiently and determining the effectiveness of services as nothing in the given data connects directly to actual outcomes for the population. The current study hypothesized that there was a relationship between the given administrative data as well as the data from Florida Charts regarding resident health and birth rates. As discussed, the Florida Department of Health has the potential to increase their productivity and output if they can determine what makes the top performers so much more productive than their average and bottom performers.
    Stetson Showcase 2014, Deland, FL; 04/2014
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    ABSTRACT: Background State and local public health department infrastructure in the U.S. was impacted by the 2008 economic recession. The nature and impact of these staffing changes have not been well characterized, especially for the part-time public health workforce. Purpose To estimate the number of part-time workers in state and local health departments (LHDs) and examine the correlates of change in the part-time LHD workforce between 2008 and 2013. Methods We used workforce data from the 2008 and 2013 National Association of County and City Health Officials (n=1,543) and Association of State and Territorial Health Officials (n=24) profiles. We employed a Monte Carlo simulation to estimate the possible and plausible proportion of the workforce that was part-time, over various assumptions. Next, we employed a multinomial regression assessing correlates of the change in staffing composition among LHDs, including jurisdiction and organizational characteristics, as well measures of community involvement. Results Nationally representative estimates suggest that the local public health workforce decreased from 191,000 to 168,000 between 2008 and 2013. During that period, the part-time workforce decreased from 25% to 20% of those totals. At the state level, part-time workers accounted for less than 10% of the total workforce among responding states in 2013. Smaller and multi-county jurisdictions employed relatively more part-time workers. Conclusions This is the first study to create national estimates regarding the size of the part-time public health workforce and estimate those changes over time. A relatively small proportion of the public health workforce is part-time and may be decreasing.

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