Health Departments: Do rural urban characteristics really matter? - PowerPoint PPT Presentation

Public Health Performances of Local Health Departments: Do rural urban characteristics really matter? Lava Timsina*, MPH; Glen P. Mays, PhD; Cezar B. Mamaril, PhD; Rachel A. Hogg, DrPH; Richard C. Ingram, DrPH *PhD student, Graduate Research Assistant University of Kentucky AcademyHealth: Annual Research Meeting, 2016 Boston, MA 06/27/2016

Acknowledgements Systems for Action is a National Program Office of the Robert Wood Johnson Foundation and a collaborative effort of the Center for Public Health Systems and Services Research in the College of Public Health, and the Center for Poverty Research in the Gatton College of Business and Economics, administered by the University of Kentucky, Lexington, KY. • Directors/Administrators from participating Local Health Departments • Robert Wood Johnson Foundation

Overview • Highlight differences in public health performances using measures of multi-sectoral delivery systems between rural and urban health departments. • Discuss conclusions and potential strategies to address challenges

Rationale • The differences in rural-urban local health departments – a function of population size, – state and local public health statutes, and – Local availability of entities that help in delivery of public health services • Examined Public health performances – by population sizes (especially in large size jurisdictions) and not by rural-urban differences using a nationally representative data

Objectives • To examine the variations in public health performances using measures of multi- sectoral delivery system between rural and urban communities

Conceptual Framework Rural Urban Differences in Multi-Sectoral PH Delivery System (Micro level) Variation in Structural Capacity: Information Resources Organizational resources Physical Resources Macro Context defining Human Resources rural/urban differences: Fiscal Resources Mission/ 1. Demographic Purpose 2. Economic contexts 3. Socio-cultural values -Variation in Disparities and preferences for PH priority health in Access to products issues & Utilization 4. Demand and need for Difference in scale of health PH activities and and scope of PH services products based on service delivery: communities health Activities, indicators Effectiveness, LHD’s 5. Coordination & contribution Information

Variables Rural and Urban Differences Macro Level - Population density (demographic); - Hospital beds per capita (demand); - % of non-white population (demographic); - Unemployment rate Composite measures of (economic); Scale & Scope of PH - Total un-insurance rate (need); performances: Availability, - % of population with at least 4 Effectiveness, LHD’s years of college education Contribution (Social) Structural Capacity at System Level - Jurisdiction has board of health - Type of jurisdiction; - Jurisdiction resides in centralized state; - FTE per capita

Methods • Data: – Cross-sectional – National Longitudinal Survey of Local Public Health System (2014) • Large size jurisdiction ( a cohort from 1998) • Small size jurisdiction (sampled in 2014) • Survey administration: – LHD’s administrators, directors, or other top executives – Self administered, Online survey with multiple follow-ups • Sampling – Large size jurisdiction = 497 (complete enumeration in 1998) – Small size jurisdiction = 556 (stratified random sampling in 2014) • Response rate – Responded: 525 – 2014: 57% (large sized jurisdiction), 43% (small sized jurisdiction) • Data Linkages: – NACCHO 2013 – Area Health Resource File 2013-2014

Statistical Analysis • Separate Multivariable regression model for each of the 3 public health performances composite scores: availability, effectiveness, LHD’s contributions

Results Metropolitan Status: % in Sample Metropolitan Status: % responded 66.48 70 70 63.62 60 60 51.72 50.17 49.83 48.28 50 50 36.38 40 40 33.52 30 30 20 20 10 10 0 0 Unweighted Weighted Unweighted Weighted Non-metropolitan LHDs Metropolitan LHDs Non-metropolitan LHDs Metropolitan LHDs

Availability Effectiveness LHD's contribution Public Health Activity Non- Non- Non- Metro p-value Metro p-value Metro p-value metro metro metro # 1Community needs assessment 84.9% 82.5% 0.4799 76.3% 72.9% 0.1204 57.0% 58.6% 0.5058 2Behavioral risk factor survey 64.9% 56.8% 0.0748 69.3% 61.5% 0.0041 34.0% 30.0% 0.253 3Adverse health events investigation 99.7% 97.7% 0.0887 87.5% 82.6% 0.0008 78.1% 77.2% 0.5891 4Public health laboratory services 94.5% 92.1% 0.3199 80.1% 76.2% 0.0429 40.3% 41.2% 0.7728 5Analysis of health determinants & resources 70.2% 61.9% 0.0632 66.4% 68.5% 0.3692 54.8% 55.4% 0.8474 6Analysis of preventive services use 35.8% 27.7% 0.0618 58.7% 59.4% 0.856 43.3% 41.7% 0.7271 7Communication network of health organizations 83.5% 78.9% 0.2064 69.6% 63.0% 0.0014 53.5% 52.9% 0.7927 8Inform elected officials about health issues 82.9% 67.4% 0.0002 63.3% 58.7% 0.0713 68.3% 68.8% 0.8353 9Prioritization of community health needs 81.3% 73.9% 0.0599 73.3% 68.7% 0.0575 57.8% 58.8% 0.6585 10Implementation of health initiatives in priority areas 81.8% 70.9% 0.0068 61.4% 59.6% 0.4276 49.5% 54.1% 0.0368 11Community participation in health planning 64.2% 59.7% 0.3141 68.2% 62.0% 0.0158 57.4% 55.2% 0.4026 12Resource allocation planning 41.8% 32.6% 0.0381 50.2% 51.8% 0.6566 53.4% 54.0% 0.8738 13Resource deployment consistent with plan 56.0% 44.3% 0.0122 50.9% 51.3% 0.8992 51.6% 50.7% 0.7609 14LHD organizational assessment 50.4% 41.6% 0.0579 72.5% 71.5% 0.7272 85.9% 83.3% 0.368 15Provision/linkage to needed health services 49.6% 46.2% 0.476 58.5% 53.2% 0.0595 48.6% 50.0% 0.6451 16Evaluation of public health services 35.7% 30.8% 0.2642 55.9% 58.7% 0.4297 65.9% 63.2% 0.5456 17Monitor/improve program processes and outcomes 47.0% 29.3% 0.0001 57.4% 59.0% 0.6396 70.7% 64.5% 0.1666 18Health information provision to the public 79.9% 76.0% 0.3142 62.2% 58.6% 0.1249 62.6% 58.6% 0.1104 19Health information provision to the media 83.8% 79.4% 0.2306 71.0% 64.6% 0.0036 66.0% 64.6% 0.5171 20Implementation of mandated PH activities 92.1% 93.7% 0.518 -- -- -- -- -- -- Overall average - all activities 65.7% 58.6% 0.0005 67.3% 64.2% 0.0073 57.6% 57.7% 0.9662

Results: Multivariable regression (Reduced Model) coefficient estimates (y-axis) of public health performances using measures of multi-sectoral delivery system from 2014 National Longitudinal Survey of Local Public Health Systems 4 Availability of PH activities P<0.05 3.5 P<0.01 3 2.5 2 1.5 1 0.5 0 Metropolitan area Jurisdiction has board of health City County Other Jurisdiction is in Centralized state Population density, 100,000s Public health FTE staff per capita, % of population aged 65+ years Total Uninsurance rate -0.5 10,000s (log) Note: Figure presents coefficients from reduced model. Each of these model controlled for having BOH, Jurisdiction type, Jurisdiction in centralized state, population density, FTE staff per capita, Unemployment rate, Hospital beds (log), % non-white, % 65+ years age, Uninsurance rate, % with at least 4+ years of college education. Only those control variables whose p-value was <0.10 were included in the model

Results: Multivariable regression (Reduced Model) coefficient estimates (y-axis) of public health performances using measures of multi-sectoral delivery system from 2014 National Longitudinal Survey of Local Public Health Systems 2 Perceived effectiveness of PH activities P<0.05 P<0.01 1.5 1 0.5 0 Metropolitan area Jurisdiction has board of health City County Other Jurisdiction is in Centralized state Population density, 100,000s -0.5

Results: Multivariable regression (Reduced Model) coefficient estimates (y-axis) of public health performances using measures of multi-sectoral delivery system from 2014 National Longitudinal Survey of Local Public Health Systems 0.1 LHD's contribution in PH activities P<0.05 P<0.01 0.08 0.06 0.04 0.02 0 Metropolitan area Jurisdiction has board of health City County Other Jurisdiction is in Centralized state Public health FTE staff per capita, 10,000s % of population unemployed -0.02 -0.04 (log)

Discussion & Conclusion • Differ in public health practice and infrastructure • Resource limitation - the primary challenge • Less flexible and less adaptive service delivery models • Strengthening capacity in resource allocation planning and resource deployment consistent with the plan

Discussion & Conclusion • The disparities in rural local health director’s perceived effectiveness raises concerns about the shortcomings in the rural areas. • Elected officials and public media need to be strongly informed about the healthcare concerns in rural communities. • Capacity in enhancing the monitoring of program processes and outcomes needs to be strengthened to improve public health performances.

Discussion & Conclusion • Health initiatives addressing priority areas • Effective communication network created by local health departments and community agencies • Active community coalition and participation in health planning