Informing Policy. Improving Health. State-specific adoption and diffusion of the Foundational Public Health Services within the United States: A systematic literature review Public Health Systems Group Meeting • 4/15/2016 Anne Burke Kansas Health Institute
Overview n Background n Purpose of study n Data and methodology n Results § FPHS initiation and stage of adoption § FPHS models § FPHS definition methodologies § Foundational capabilities § Foundational areas n Discussion/conclusions
Background n Paving the way for the FPHS § Core functions of public health (1988) § Ten Essential Public Health Services (1994) § PHAB standards (2011) n Articulating the FPHS § IOM 2012: For the Public’s Health § RESOLVE framework n Nationwide framework?
Purpose of Literature Review n To assess the current body of knowledge regarding the FPHS and its implementation in states in order to evaluate knowledge gaps and inform efforts to implement the FPHS in Kansas and other states
Data and Methods n January-February 2016 n Conducted according to PRISMA (Moher et al. 2009) n Scientific literature n Gray literature
Methods Identification Records identified through Additional records identified database searching through other sources (n = 38; one state) (n = 20; fourteen states) Records after duplicates removed (n = 55) Screening Records excluded Records screened (n = 33) (n = 55) Did not address the FPHS Full-text articles excluded Full-text documents (n = 2) Eligibility assessed for eligibility (n = 22) Were not specific to one state Reference list search Documents meeting Additional documents inclusion criteria included (n = 1) (n = 20) Included Documents included in qualitative synthesis (n = 21)
Results n Peer reviewed literature: one article for one state n Gray literature: 20 documents for 14 states n States with intention to adopt: CT, OK, MO, KS, IA n States with defined FPHS: WA, ND, KY, WV n States with adopted FPHS: OH, CO, NC, TX, OR
FPHS Initiation n States with n States with n States with articulation adoption intention (2002-2015) (2012-2014) (2014-2015) N=4 N=5 N=5 20% 25% 75% 80% 100% Public health Legislature Public health Legislature Public health Legislature
FPHS Models n Modification or adoption of RESOLVE framework: § OR, WA, ND n Adoption of prior framework (10 Essential Services, PHAB): § TX, NC n Development of original framework: § OH, KY, WV, CO
Defining the FPHS n Washington: § Extent to which services are population-based § Extent to which other organizations do the services § Whether or not the service is mandated n Oregon: § Statutory requirements § Governance structures § Financing at the state and local levels § Health system transformation implementation § Social determinants of health § Other states approaches to governmental public health services (Washington)
Defining the FPHS, cont’d. n Ohio: § Defined current status of health system • Reviewed LHD information • State-level regulatory scan • Online survey of AOHC members § Stakeholder considerations • Key informant interviews • Literature review § Consensus • Consensus-building meetings
Defining the FPHS, cont’d. n Kentucky: § University of Kentucky’s cost-estimation instruments § National FPHS definitions § Other state’s approaches to defining the FPHS (Ohio) § State statutes § Current public health system operations n Colorado: § Developed by a taskforce of health departments leaders including stakeholder input n West Virginia: § Other state’s approaches to defining the FPHS (Ohio)
A minimum package, by another other name… n FPHS=Core public health services n FA=Basic programs; core, basic, essential services
Foundational Capabilities n Articulated by eight states § Assessment and business competencies (8/8 states; 100%) § Communication (7/8 states; 87.5%) § Emergency preparedness, community partnership development, policy development and support (6/8 states; 75%)
Assessment n Most common: § Data collection/analytics § Data response/report preparation § CHA n Less common: § Access to lab services n Additional: § Program evaluation § HIE interface
Emergency Preparedness n Less common: n No states included all in RESOLVE § Emergency Support Function 8 framework § Communication n Most common: § COOP § Developing and § Investigation of threats rehearsing strategies § Emergency health and plans orders § NIMS § 24/7 notification n No states: § LRN § Promoting readiness
Communications n Most common: § Strategy based on risks, behaviors and prevention n Less common: § Media/public relations § Health education/promotion, interventions* n Additional: § Health literacy § Marketing, branding, and social media
Community Partnership Development n Most common: § Create/maintain partnerships § CHIP n Less common: § Select/coordinate/articulate roles n Additional: none
Policy Development and Support n Most common: § Working with partners to enact policies n Less common: § Cost/benefit analysis n Additional: § Public health administrative rules/regulations § Policy evaluation
Business Competencies n Most common: n Additional: § QA/QI § Evidence-based practices § Leadership § Accreditation § IT § Strategic planning § HR § Fiscal management § Legal services n Less common: § Facilities and operations § Health equity § Strategic planning
Foundational Areas n Articulated by nine states § Communicable disease control, chronic disease and injury prevention*, environmental health (9/9 states; 100%) § Access/linkage to clinical care (8/9 states; 88.9%) § MCH (7/9 states; 77.8%)
Communicable Disease Control n Most common: n Less common: § Receiving lab reports, § Providing information conducting investigations, § Identifying assets and responding to § Notification services outbreaks § TB treatment n Additional: § Coordinating other § Community-based programs prevention § Contact tracing § Vaccination/immunization § Quarantine authority § Disease reporting § Provider education § Screening
Chronic Disease and Injury Prevention n Frequently named n Less common: “Prevention and § Identifying assets Health Promotion” § Coordinating other programs n Most common: n Additional: § Providing § Cancer, suicide, information injury, diabetes, § Reducing tobacco teen pregnancy, § Obesity prevention STI prevention § Oral health promotion
Environmental Public Health n Most common: n Additional: § Testing, inspections, § Laboratory testing and oversight § School/childcare/ correctional facility inspections n Less common: § Nuisance abatement § Providing information § Promoting recycling/reuse § Identifying assets § Childhood lead case § Identifying public health management threats § Protection from radiation exposure § Sustainability § Coordinating other services
Maternal/Child/Family Health n Most common: None n Less common: § Providing information § Newborn screening, § Promoting information to optimize development § Identifying assets § Coordinating other programs n Additional: § Protection of critical states of development § Infant mortality/preterm birth prevention § EPSDT outreach
Access/Linkage to Clinical Care n Most common: None n Additional: § State-level health system n Less common: planning § Providing information § Assessing and supporting § Monitoring and licensing access to care healthcare § Health workers as facilities/providers facilitator of care § Identifying assets § Interventions to barriers § Coordinating other to care programs § Linkage to coverage § Grief counseling § Purchase/distribution of biological and therapeutic products
Additional Areas n Vital records § Assure a system of vital records § Provide certified birth/death certificates n Mental/behavioral health n Substance abuse prevention n Clinical services and programs n Patient safety and market oversight
Discussion n Various n Definition methods mechanisms: and KS § Initiation n FPHS models § Definition § All states modified RESOLVE n States with FPHS § Complementary to, fully articulated: but distinct from: § Began earlier • PHAB n States with FPHS • 10 Essential Services adopted: § Importance of defining the § More likely to begin minimum package within the legislature
Discussion, cont’d. n Increasing FPHS awareness § 42% of health department leaders unfamiliar with FPHS (Leider et al. 2015) § Lack of FPHS presence in peer-reviewed literature n Tailoring the FPHS § What is defined as “truly necessary” differ from RESOLVE’s FPHS and by location (Leider et al. 2015) § Minimum package should be tailored to unique circumstances (Bobadilla et al. 1994) • Burden of disease • Cost-effectiveness of interventions
Discussion, cont’d. n Commonalities in areas and capabilities overall § Assessment: “Nobody else in the community can do” (Leider et al. 2015) § Communicable disease control, chronic disease and injury prevention, EH • All identified as “truly necessary” (Leider et al. 2015)
Discussion, cont’d. n Differences in cross-cutting skills and capacities § Clinical services • Immunizations § Family planning
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