Paul K. Halverson, Dr.P.H., M.H.S.A., FACHE
Director and State Health Officer
Arkansas Department of Health
Glen P. Mays, Ph.D., M.P.H.
F. Douglas Scutchfield Endowed Professor
in Health Services and Systems Research
University of Kentucky College of Public Health
Public Health Practice-Based Research Networks National Coordinating Center
Halverson: Hello, and welcome to RE-ACT, the podcast supporting evidence-based practice for public health agencies. I am your host, Dr. Paul Halverson. Have you ever been faced with a situation when you had difficult decisions to make, not enough data to point toward the right answer or not enough time to fully develop the best question? If you are like me as a State Health Officer, that’s the world I live in every day. I’m not talking about making a decision on a drug choice or even the best way to implement a stop smoking program; those are tough issues, but fortunately those are the kinds of issues that are generally well researched and documented.
What I am referring to are the more operational and often strategic decisions; decisions for which there is very little existing research in a public health setting.
- What are the best productivity measures to use in measuring the output of a local public health unit?
- How do you measure the success of community health assessment activity?
- How much money per capita is really needed to operate an effective community based public health effort?
- What is the optimal size and configuration of an executive team?
- What does exemplary performance of a state or local health department look like? How will we know it when we get there?
- Or sadly, if I need to cut 5% from my budget, what is the best way to assure that we minimize the impact on our effectiveness while preserving the most jobs and increasing our organizational effectiveness?
One could say that it all depends on local conditions and circumstances, or we could see what an emerging group of excited and capable researcher and fellow practice partners have been doing to begin to wrestle with these issues.
Today we will begin our podcast with an introduction to some very promising work that is being done by an intriguing group of people who are pioneering the work of public health services and systems research whose goal it is to better inform those of us in the field how to best consider these tough issues.
The Public Health Practice-Based Research Networks, or PBRNs, are helping fill these gaps through a variety of research projects focused on the organization, financing, and delivery of public health services. With me today is Dr. Glen Mays, who is the director of the PBRN National Coordinating Center. Glen, what ARE Public Health Practice-Based Research Networks, and why is their work important for our audience?
Mays: The Public Health PBRN Program is a national program of the Robert Wood Johnson Foundation that brings together practitioners and academic researchers to investigate important questions from the field. The PBRN model has been used successfully in the healthcare industry for years, where they study medical care innovations and quality improvement strategies in clinical settings. In our public health networks, we look at issues like the comparative effectiveness, efficiency, and equity of public health strategies in real-world practice settings.
Halverson: So, tell me Glen how do these studies relate to public health practice?
Mays: These types of studies have real relevance for public health agencies since the results can inform decisions about how best to organize and where best to allocate limited fiscal resources during tight budgetary times. There are tough choices that many members of the RE-ACT audience face on a regular basis, and PBRN research results can help people weigh their options. PBRNs also help us evaluate new programs and quality improvement initiatives. Because our Networks span the nation geographically, we can look at the public health effects of changing local, state, and federal laws and policies. Finally – and importantly - by coordinating the efforts of our twenty-four member networks, we can help discover unnecessary, inefficient, and harmful variations in practice that reduce the effectiveness of the country’s public health enterprise. The information that we gather through our research can be very helpful to agencies making tough choices.
Halverson: Can you give us some examples of what PBRN research has already told us about real-world public health activities?
Mays: Certainly. During the height of the outbreak, we funded research into variations in public health response to and communication about H1N1. Our North Carolina PBRN found that accredited agencies did more activities and did them faster than non-accredited agencies. Just knowing about this finding could be very helpful for agencies that are struggling with decisions about voluntary accreditation. A number of ongoing studies are looking at the effects of regionalization and regionalization incentives on agency structure and service delivery. Meanwhile, our Colorado network has been looking at the effects of the Colorado Public Health Act of 2008 on local and state public health organization and activities. These are just a few of the many practitioner-researcher partnerships that are contributing to our knowledge base for what works best in public health.
Halverson: It sounds like the PBRNs are doing some really interesting research on the local and state levels, but do the networks ever collaborate to look at larger public health activities?
Mays: Absolutely! Right now, eight of our member networks are engaged in what we call the MPROVE study, which stands for Multi-Network Practice and Outcome Variation Examination. As a group, we have been working together to assemble a number of potential measures of public health service delivery related to three overarching topics: chronic disease prevention, communicable disease control, and environmental health. Through this study, we will be able to identify factors that influence geographic variation in health service delivery. We also are going to look at relationships between services and health outcomes to help identify opportunities for health improvement.
Halverson: In terms of a timeline, where are you and the networks in completing this study?
Mays: We have completed an initial, VERY extensive collection of potential measures. During the next month or so, we will evaluate these potential measures and select a much smaller set on which we want the study to focus. Then we get started collecting and analyzing the data related to those selected measures. About a year from now, I should be sitting right here with you again, talking about what we have discovered.
Halverson: Terrific. I will look forward to that. Where can our listeners learn more about the Public Health PBRNs?
Mays: They can visit our website at www.publichealthsystems.org/pbrn.
Halverson: Thank you, Glen. It seems clear that the PBRNs have a great deal to tell us about organization, financing, and delivery in public health. And that information can help practitioners around the country make decisions that are based in scientific evidence. Here at RE-ACT we look forward to bringing you the most recent research-related news from the PBRNs, as well as study outcomes from elsewhere in the public health systems and services field. I would like to again thank today’s guest, Dr. Glen Mays, director of the Public Health PBRN National Coordinating Center, for joining us. I look forward to talking more with you during future podcasts. I am Dr. Paul Halverson, and I thank you for joining this inaugural episode of RE-ACT.