Public Health System Research Methods & Informatics

SESSION AUDIO:
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MODERATORS:
Katherine F. Papa, M.P.H.

PANELISTS:

Jonathan Keeling, M.S.

Development of a Water Fluoridation Information Portal as a Knowledge Management Proof of Concept in the Domain of PH Law

Co-Investigators: J. Merrill, RN, M.P.H., D.N.Sc., K. Gebbie, Dr.P.H., RN, K. McCarty, J.D., M.P.H., S. Kahn, M.S.

Develop a web portal of community water fluoridation information as a proof of concept for knowledge management of public health law using informatics techniques. Community water fluoridation specific materials were gathered by a legal expert via an exhaustive search.  These include 75 instances of national and state case law, 72 instances of state and local legislation, 1 state ballot, 5 state bills, 55 journal articles related to both fluoridation science and policy implications, 119 national or state organizations, and 18 government publications. The data sources were analyzed and a fluoridation specific terminology containing 92 unique tags representing concepts across all data types was created using expert opinion and consensus.  The Drupal content management system was used to create the web portal. Currently the domain of PH law lacks in proper knowledge management and informatics solutions.  This site was built as a proof of concept and succeeded in mapping disparate sources of information to each other through concept tagging using a topic specific terminology.  This allows researchers, practitioners, and policy-makers to obtain knowledge and derive relationships through a concept-oriented approach.  A demo of the portal and its features will follow the presentation. Although this terminology is specific to community water fluoridation, it demonstrates the usefulness of knowledge management for the entire domain of PH law.  Future work includes the development of an ontology for PH law.  This would improve on the terminology implementation by formally mapping the relationships between concepts and legislation, which would allow for more sophisticated types of analyses such as comparative research between states and automatic identification of gaps in the law.  This proof of concept and future more sophisticated knowledge management solutions provide a practical resource for PH law research and development. 

Gulzar Shah, Ph.D., M.S., M.Stat.

The State of Informatics in Local Health Departments: Findings from a NACCHO Needs Assessment Survey

Co-Investigator: A. Matheson, M.P.H.

In order to ascertain the state of public health informatics in local health departments (LHDs), the National Association of County and City Health Officials (NACCHO) conducted an informatics needs assessment.  The needs assessment consisted of two components: a quantitative survey that covered a wide variety of informatics-related topics, and a series of focus groups.  This presentation will focus on the results from the survey, and in particular the questions relating to informatics infrastructure and workforce capacity. Building on questions from previous surveys, including the Profile study, NACCHO sampled about a quarter of the 2800 LHDs (n=724) throughout the country, stratified for population served by that LHD.  Respondents used a web-based survey tool to enter their answers.  A response rate of approximately 33% was achieved, with higher rates among LHDs that serve larger populations. Results showed that LHDs have low levels of information systems use.  For example, of the LHDs that provide primary health care through clinics, almost half rely solely on paper records and a majority of the remainder uses a mix of paper and electronic systems.  A lack of funding was identified as one of the major barriers to implementing information systems, along with a lack of time or resources able to be diverted for implementation. This is a unique time for health information technology, with large-scale investment resulting from the stimulus legislation.  As it currently stands, a significant proportion of this investment will need to be directed towards LHDs in order for them to fully take advantage of HIT, or else they will fall behind the broader healthcare industry.  The findings from the survey will be used to advocate for LHDs at a national level and to guide NACCHO’s informatics programs.

Kate Beatty, M.P.H.

Understanding the Role of Public Health Systems and Services Research in Public Health: A Citation Network Analysis

Co-Investigator: J.K. Harris, M.A., Ph.D.

Public health systems and service research (PHSSR) is a multidisciplinary field including research from a range of theoretical and methodological perspectives. PHSSR focuses on the performance of complex public health systems and how characteristics and structures of these systems influence health outcomes. Given the complexity of public health systems and their role in protecting the public health, there is interest in better understanding how PHSSR connects with other fields and fits into the larger context of public health. To examine these connections, we collected publications stemming from 11 key PHSSR articles identified by experts in the field. Using the Citation Network Analyzer, the key articles (seeds) were utilized as a starting point to collect a list of 20% of the articles that cite the seeds, 20% of the articles that cite this first generation sample, and 20% of articles that cite the second-generation sample. This unique data collection strategy produced a network of publications connected in one, two, or three steps from these initial articles. We used citation network analysis to examine the resulting network. The network included 2,986 unique documents with 2,283 unique authors published between 1993 and 2009. Using traversal weights to identify those articles most critical to the development of the network, we identified a main path of 108 key articles. This main path revealed a core set of PHSSR articles with three branches off the core showing connection between PHSSR and other research areas. Specifically, PHSSR research was linked to public health law; work in translation of research to practice, and a group of systems thinking, transdisciplinarity, and team science manuscripts. Taking advantage of these connections has the potential to allow PHSSR researchers to fill gaps and broaden topics covered and approaches used to examine and strengthen the public health system.

Travis Worth, B.S.

A Simulation Model of Local Public Health Response to Pertussis Events

Co-Investigators: J. Johnson, B.S., J. Maillard, Ph.D., A. Meyer, Ph.D., E. Samoff, Ph.D., J. Taheri, Ph.D., R. Uzsoy, Ph.D.

Public health systems and services research offers a unique opportunity to explore important public health problems through new tools and multi-disciplinary collaboration.  The objective of this research is to apply a novel modeling strategy from systems engineering to study the role of the North Carolina PHIN (Public Health Information Network) alerting systems.  Using simulated data, we present a Monte-Carlo estimation model of a hypothesized response to a pertussis event in a local North Carolina health department.  We take a thorough view of the heterogeneity surrounding public health actions during the event and test different variance estimates throughout the model.  Our analysis begins with the detection of an individual patient and follows with confirmation of the case by physician, laboratory results, contact tracing, and medication of contacts by local health departments. We explicitly focus on the information transfer between actors involved with identifying and controlling an outbreak.  Through our model, we can examine the effect of different alerting strategies on the number of secondary infections prevented, and present best and worse case scenarios.  The model also allows us to prescriptively examine the effect of time delays associated with physical resources such as laboratories and public health personnel, as well as the information transmission of lab results and diagnoses.  By combining public health expertise with advanced systems engineering techniques we can identify the most effective strategies for resource allocation and information transfer.