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Evidence-Based Public Health Provided Through Local Health Departments: Importance of Academic-Practice Partnerships.

ABSTRACT: OBJECTIVES:To determine the extent to which US local health departments (LHDs) are engaged in evidence-based public health and whether this is influenced by the presence of an academic health department (AHD) partnership. METHODS:We surveyed a cross-sectional stratified random sample of 579 LHDs in 2017. We ascertained the extent of support for evidence-based decision-making and the use of evidence-based interventions in several chronic disease programs and whether the LHD participated in a formal, informal, or no AHD partnership. RESULTS:We received 376 valid responses (response rate 64.9%). There were 192 (51.6%) LHDs with a formal, 80 (21.6%) with an informal, and 99 (26.7%) with no AHD partnership. Participants with formal AHD partnerships reported higher perceived organizational supports for evidence-based decision-making and interventions compared with either informal or no AHD partnerships. The odds of providing 1 or more chronic disease evidence-based intervention were significantly higher in LHDs with formal AHD partnerships compared with LHDs with no AHD partnerships (adjusted odds ratio?=?2.3; 95% confidence interval?=?1.3, 4.0). CONCLUSIONS:Formal academic-practice partnerships can be important means for advancing evidence-based decision-making and for implementing evidence-based programs and policies.

SUBMITTER: Erwin PC

PROVIDER: S-EPMC6459662 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Evidence-Based Public Health Provided Through Local Health Departments: Importance of Academic-Practice Partnerships.

Erwin Paul Campbell PC Parks Renee G RG Mazzucca Stephanie S Allen Peg P Baker Elizabeth A EA Hu Hengrui H Davis-Joyce Johnnetta J Brownson Ross C RC

American journal of public health 20190321 5

<h4>Objectives</h4>To determine the extent to which US local health departments (LHDs) are engaged in evidence-based public health and whether this is influenced by the presence of an academic health department (AHD) partnership.<h4>Methods</h4>We surveyed a cross-sectional stratified random sample of 579 LHDs in 2017. We ascertained the extent of support for evidence-based decision-making and the use of evidence-based interventions in several chronic disease programs and whether the LHD partici ...[more]

PMID: 30896995

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Project description:BACKGROUND:Although public-private partnerships have become common in the health sector, the evidence supporting their effectiveness is limited, and when the products or services provided by the private partner are harmful to health inherent conflicts of interest may be difficult to overcome. The objective of this study is to appraise the evidence describing process or effectiveness of public-private partnerships (PPPs) that aim to promote population health, and analyse how characteristics such as independence or competing interests influence the results of their evaluation. METHODS:We carried out a systematic search of Medline and Web of Science to identify scientific reports evaluating the process or effectiveness of PPPs that aim to promote population health. Two reviewers applied inclusion criteria, extracted and evaluated study quality. We classified PPPs according to the health problem tackled, the independence of the evaluation, and the potential for competition between business interests of the private partner and health promotion activity undertaken. We classified the conclusions of the evaluation as positive (supportive/tentatively supportive) or negative (semi-critical/critical). RESULTS:We identified 36 studies evaluating 25 PPPs. Evaluations that were favourable to the use of PPPs in health promotion were more frequently classed as "not independent" and of poor quality. On the other hand, negative evaluations were more common when the PPP involved a private partner with a high potential for competition between the health promotion activity undertaken and their financial interests. PPPs that sought to prevent non-communicable diseases were more frequently negatively evaluated compared to PPPs tackling infectious disease or other types of health problem. Almost all of the evaluations evaluated process, with only 2 papers reporting quantitative health related outcomes. CONCLUSIONS:There is still a lack of sound evidence supporting the effectiveness of public-private partnerships in health promotion, and the evidence base is skewed by non-independent evaluations. Public health actors should abstain from engaging in agreements with industries whose business interests have a high potential for competition with the health promotion activity undertaken.

Project description:BackgroundPublic health resources are limited and best used for effective programs. This study explores associations of mis-implementation in public health (ending effective programs or continuing ineffective programs) with organizational supports for evidence-based decision making among U.S. local health departments.MethodsThe national U.S. sample for this cross-sectional study was stratified by local health department jurisdiction population size. One person was invited from each randomly selected local health department: the leader in chronic disease, or the director. Of 600 selected, 579 had valid email addresses; 376 completed the survey (64.9% response). Survey items assessed frequency of and reasons for mis-implementation. Participants indicated agreement with statements on organizational supports for evidence-based decision making (7-point Likert).ResultsThirty percent (30.0%) reported programs often or always ended that should have continued (inappropriate termination); organizational supports for evidence-based decision making were not associated with the frequency of programs ending. The main reason given for inappropriate termination was grant funding ended (86.0%). Fewer (16.4%) reported programs often or always continued that should have ended (inappropriate continuation). Higher perceived organizational supports for evidence-based decision making were associated with less frequent inappropriate continuation (odds ratio?=?0.86, 95% confidence interval 0.79, 0.94). All organizational support factors were negatively associated with inappropriate continuation. Top reasons were sustained funding (55.6%) and support from policymakers (34.0%).ConclusionsOrganizational supports for evidence-based decision making may help local health departments avoid continuing programs that should end. Creative mechanisms of support are needed to avoid inappropriate termination. Understanding what influences mis-implementation can help identify supports for de-implementation of ineffective programs so resources can go towards evidence-based programs.

Project description:IntroductionAdvanced practice providers (APP), including physicians' assistants and nurse practitioners, have been increasingly incorporated into emergency department (ED) staffing over the past decade. There is scant literature examining resource utilization and the cost benefit of having APPs in the ED. The objectives of this study were to compare resource utilization in EDs that use APPs in their staffing model with those that do not and to estimate costs associated with the utilized resources.MethodsIn this five-year retrospective secondary data analysis of the Emergency Department Benchmarking Alliance (EDBA), we compared resource utilization rates in EDs with and without APPs in non-academic EDs. Primary outcomes were hospital admission and use of computed tomography (CT), radiography, ultrasound, and magnetic resonance imaging (MRI). Costs were estimated using the 2014 physician fee schedule and inpatient payments from the Centers for Medicare and Medicaid Services. We measured outcomes as rates per 100 visits. Data were analyzed using a mixed linear model with repeated measures, adjusted for annual volume, patient acuity, and attending hours. We used the adjusted net difference to project utilization costs between the two groups per 1000 visits.ResultsOf the 1054 EDs included in this study, 79% employed APPs. Relative to EDs without APPs, EDs staffing APPs had higher resource utilization rates (use per 100 visits): 3.0 more admissions (95% confidence interval [CI], 2.0-4.1), 1.7 more CTs (95% CI, 0.2-3.1), 4.5 more radiographs (95% CI, 2.2-6.9), and 1.0 more ultrasound (95% CI, 0.3-1.7) but comparable MRI use 0.1 (95% CI, -0.2-0.3). Projected costs of these differences varied among the resource utilized. Compared to EDs without APPs, EDs with APPs were estimated to have 30.4 more admissions per 1000 visits, which could accrue $414,717 in utilization costs.ConclusionEDs staffing APPs were associated with modest increases in resource utilization as measured by admissions and imaging studies.

Project description:BACKGROUND:Previous research has reported that public-academic partnerships (PAPs) can effectively promote PAP leaders' use of research evidence in improving youth outcomes. However, the existing literature has not yet clarified whether and how PAP leaders' use of research evidence evolves along the PAP life cycle and whether PAP partners' concordant perceptions of usefulness of their PAP has an impact on PAP leaders' use of research evidence. Developing a conceptual framework that recognizes the PAP life cycle and empirically identifying contexts and mechanisms of PAPs that promote PAP leaders' use of research evidence from the PAP life cycle perspective are imperative to guide researchers and policymakers to successfully lead PAPs and foster policymakers' use of research evidence for improving youth outcomes. OBJECTIVE:Utilizing an integrated framework of organizational life cycle perspective, a social partnership perspective, and a realist evaluation, this study examines the extent to which PAP development and PAP leaders' use of research evidence can be characterized into life cycle stages and identifies PAP contexts and mechanisms that explain the progress of PAPs and PAP leaders' use of research evidence through life cycle stages. METHODS:Recruiting PAPs across the United States that aim to improve mental health and promote well-being of youth aged 12-25 years, the study conducts a document analysis and an online survey of PAPs to inform policymakers and academic researchers on the contexts and mechanisms to increase PAP sustainability and promote policymakers' use of research evidence in improving youth outcomes. RESULTS:Fifty-three PAPs that meet the recruitment criteria have been identified, and document review of PAPs and participant recruitment for the online survey of PAP experience have been conducted. CONCLUSIONS:This paper will help policymakers and researchers gain a deeper knowledge of the contexts and mechanisms for each PAP life cycle stage in order to optimize PAP leaders' use of research evidence in achieving positive youth outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/14382.

Dataset Information

Evidence-Based Public Health Provided Through Local Health Departments: Importance of Academic-Practice Partnerships.

Publications

Evidence-Based Public Health Provided Through Local Health Departments: Importance of Academic-Practice Partnerships.

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