2013 phssr keeneland conference full program

7/28/2019 2013 PHSSR Keeneland Conference Full Program

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121 Washington Avenue Suite 212 Lexington, Kentucky 40536

Tel. 859. 257. 5678 Fax 859. 257. 3748 www.publichealthsystems.org

Hyatt Regency Lexington &

Lexington Convention Center Lexington, Kentucky

20132013APRIL 8-1

www.keenelandconference


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121 Washington Avenue Suite 212 Lexington, Kentucky 40536

Tel. 859. 257. 5678 Fax 859. 257. 3748 www.publichealthsystems.org


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General InfoPublic Health Se

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TABLE OF CONTENTSWelcome ................................................. 1Sponsor & Contents .............................. 2Hotel Inormation .................................3General Inormation ..............................5

Keynote Speakers ...................................7 Paul L. Kuehnert, M.S., R.N. William L. Roper, M.D., M.P.H. Joe V. Selby, M.D., M.P.H.

AgendaMonday (04.08.13) ......................11uesday (04.09.13) .......................11Wednesday (04.10.13) .................12Tursday (04.11.13) .....................13

Plenary Sessions and Roundtable ........15Concurrent Sessions

Session I .........................................23Session II ........................................39Session III ......................................55Session IV ......................................71

Poster Sessions ......................................87

The 2013 Keeneland Conference onPblic Health Services & Systems Resear

made possible with spport from theRobert Wood Johnson Fondation

The Robert Wood Johnson Foundation (RWJF) anpartners have committed signicant unding to urthe eld o Public Health Services & Systems Rese(PHSSR). Under the Foundations direction, the NatiCoordinating Center or PHSSR continues to buildevidence base, expand the research capacity, encouragetranslation o research into practice and expand the unsources available to the community.

The Goals of this Conference: Connect public health researchers, public health

practitioners, and policy-makers and provide a orum orthem to exchange ideas about new research areas; meet nentrants to the discipline; and learn about data sources amethods

Foster collaboration among scientists, practitioners andpolicy-makers with common research agendas

Highlight the work o junior PHSS researchers andencourage and support their mentors

Recognize the recipients o PHSSR grantees, theirresearch eorts, and encourage mentoring o the newawardees

Introduce several exciting developments indicative o thegrowth o the eld o PHSSR

Engage in a vital discussion o the uture o the PHSSR

research evidence and its role in practice, research and po Focus on examples o successul translation o research to

the eld, both in practice and in policy


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Genera2013 KEENELAND

CONFERENCE

HYATT REGENCY LEXINGTON

GENERAL INFORMATION

Check-in and Check-out Check-in: 3 p.m. Check-out: Noon Express Check-in Express Check-out

Parking Complimentary on-site self-parking Valet parking: $20 per day

Airport Shuttle Free shuttle service to and from the

Bluegrass Airport

AADDDDRREESSSS::HHyyaatttt RReeggeennccyy LLeexxiinnggttoonn

440011 WWeesstt HHiigghh SSttrreeeettLLeexxiinnggttoonn,, KKYY 4400550077TTeell:: (88559) 22553-11223344FFaaxx:: (88559) 2554-77443300

Amenities Hyatt Grand Beds iHome stereo w/ iPod docks Indoor heated pool Outdoor sun deck The shops at Lexington Center 24 hour StayFitTM gym

Internet AccessLocations & Connectivity

Public Areas Wireless free for hotel guests

Guest Rooms

Wireless is $9.99 per 24-hour period.


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LEXINGTON CONVENTION CENTER

ADDRESS:Lexington Convention Center430 West Vine StreetLexington, KY 40507Tel: (88559) 233-4567www.lexingtoncenter.com

Level 3


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Genera2013 KEENELAND

CONFERENCE

ContactsVikki Y. Franklin 859.230.8052Rebecca Brown 859.437.0034

Kara Richardson 859.327.2825

Meeting VeneLexington Convention Center430 W. Vine St.Lexington, KY 40507(859) 233-4567

HotelsHyatt Regency Lexington401 W. High St.

Lexington, KY 40507(859) 253-1234

Hilton Lexington/Downtown369 W. Vine St.Lexington, KY 40507(859) 231-9000

Conference Registration/Information Desk Hors

Monday, April 87:30 a.m.-4 p.m. Hyatt Regency Lexington Lobby

Tesday, April 9-Wednesday, April 107:30 a.m.-5 p.m. Thoroughbred Preunction Entrance(Convention Center)

Thrsday, April 117:30 a.m.-11 a.m. Thoroughbred Preunction Entrance(Convention Center)

Exhibitors TableLocated next to the registration table in the ThoroughbredPreunction Entrance o the Convention Center, anexhibitors table is available or conerence attendees toplace materials and other resources to share with otherattendees.

Airport & TransportationLexingtons Blue Grass Airport, a 10-minute drivdowntown, is located near Keeneland Race Cou

surrounded by horse arms creating one o Ammost beautiul air approaches. A number o carcompanies have airport locations.

In the downtown area, many attractions, restand shops are within walking distance o the LexConvention Center and major hotels. All o the busurrounding Triangle Park in the heart o downtoconnected by pedways. An intra-city bus system (L859-253-4636 or www.lextran.com) and t(859-231-8294 or 859-381-1010) provide con

transportation. Colt, Lexingtons new downtownsystem, is a ree and easy way to get around.

Ble Grass Airportwww.bluegrassairport.comIno: (859) 425-31144000 Terminal Dr.Lexington, KY 40510

Transportation from Ble Grass AirportTaxi: Approximately $18City limousine: Approximately $9 per person

Hyatt TransportationFor Hyatt Regency Lexington guests, courtesy caris available to and rom the Hyatt on a complimbasis rom 6 a.m. to midnight daily. A courtesy pavailable near the baggage claim area. Return timbe arranged through the Hyatts guest departmenhotel. A blue or grey van bearing the insignia oRegency Lexington provides service to the hotel.


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Lexington Visitors InformationVisit www.visitlex.com to view the virtual VisitorPlanning Guide online, or download the ree epub or a

phone or ereader. Or stop by our conerence registration/inormation table to pick up a copy.

Speaker Presentations& Other Conference MaterialsFull conerence materials, including speaker bios andpresentations, will be available on our website,

www.keenelandconference.org

Meeting EvalationShortly ater our conerence concludes, you will receivea survey asking or eedback about the 2013 KeenelandConerence. We ask that you please take a ew minutes tocomplete the survey to provide us valuable eedback, andwe thank you in advance.Link: http://bit.ly/keeneland2013

Social MediaTell the rest o the world whats happening at the KeenelandConerence! Please use the hashtag #PHSSRKC13 whenposting on Twitter.

ParkingMore than 10,000 parking spaces are available within a10-minute walk o the Lexington Center. All surroundingparking lots and garages oer spaces or guests withdisabilities. Additional details and directions can be oundon the Convention Centers website, www.visitlex.com.

FreeThe Lexington Center parking lot on Manchester Streetis open on non-arena event days and is ree to attendees.

HorlyThe Lexington Center parking lot on High Street is openon non-arena event days or $7.00 all day, or $1.00 orthe rst hal-hour, and $0.75 or each hal hour ater.Three hours ree parking are available with merchantvalidation in the Shops at Lexington Center (purchasenecessary). On arena event days, ees vary.

Keeneland Race Corse Information

Lexington Room

Located on the 4th foor and overlooking the racthe Lexington and Kentucky rooms oer non-smbuet dining in a business ormal setting.

Dress CodeNo denim o any color, shorts or athletic attire.Gentlemen - coat and tie are required.Ladies - skirts, dresses, dress slacks, or capris are reAny dressy shoes.

Men

Keeneland oers amous corned bee, roast chicken entree, vegetables du jour, potato du joubar, dessert, iced tea and coee. Alcoholic bevjuice and sot drinks are not included.

Arrival TimeGuests must arrive by 1:15 p.m. on the day oreservation or their table will be resold and tickbe invalid. Room opens at 11 a.m. The buet is arom 11:30 - 3:00 p.m.

TransportationBoth buses will be located at the High Street entrthe Lexington Convention Center.

Bus ABus A will leave the Lexington Convention Ce11:30 am. The rst stop will be at the Bluegrass AAttendees can check their bags and get their bpasses. The bus will leave the airport and goKeeneland by 12:15 p.m. At 3 p.m., the bus wi

Keeneland and go back to the airport.NOTE: Bus A will NOT return to the hConvention Center.

Bus BBus B will leave the Lexington Convention Ce11:30 a.m. The bus will go directly to Keenelashould arrive by noon. At 4 p.m., the bus wiKeeneland and return to the Hyatt.


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Keynote Sp2013 KEENELANDCONFERENCE

KuEHNERT

Pal L. Kehnert, D.N.P., R.N.

Senior Program Ofcer and Team Director, Public HealthRobert Wood Johnson Foundation

Paul Kuehnert is a senior program ocer and the team director or thePublic Health team. Coming o age in the 1960s with parents who wereaith community-based activists or peace and justice, it wasnt that bigo a surprise to anyone in his amily when Paul decided to fout gendernorms and become a nurse. What started as a bit o a dare and a way tomake ends meet transormed into a vocation when he became a publichealth nurse early in his career. Serving children and parents in St. Louis

Head Start Program ignited his passion or community-ocused health promotion and advocapassion that just wont quit.

As an executive leader or the past 20 years, Paul has led both governmental and communityorganizations in order to help people lead healthier lives. In the late 1980s he was a ounder anCEO o Community Response, Inc., one o the Chicago areas largest housing, nutrition andservice providers or people living with HIV/AIDS. He moved to Maine in 1999 and served in thhealth department, leading the development o a regional public health system, and becoming ddirector o the department in 2005. Most recently Paul was the county health ocer and exedirector or health in Kane County, Ill., a metro Chicago county o 515,000, where he initiated a

Making Kane County Fit or Kids, a public-private partnership to reverse the epidemic o chilobesity.

Paul is a pediatric nurse practitioner and holds a master o science degree in public health nursingthe University o Illinois at Chicago. He was named a Robert Wood Johnson Foundation ExeNurse Fellow in 2004.


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Keynote SpeakersPublic Health Se

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ROPER

William L. Roper, M.D., M.P.H.

Chie Executive OfcerUNC Health Care System

William L. Roper is Dean o the School o Medicine, Vice Chancelloror Medical Aairs and Chie Executive Ocer o the UNC HealthCare System at the University o North Carolina at Chapel Hill. Healso is Proessor o Pediatrics in the School o Medicine and Proessor oHealth Policy and Administration in the School o Public Health.

From 1997 until March 2004, Dr. Roper was Dean o the School o Public Health at UNC.

joining UNC in 1997, Dr. Roper was senior vice president o Prudential HealthCare. He Prudential in 1993 as president o the Prudential Center or Health Care Research.

Beore coming to Prudential, Dr. Roper was director o the Centers or Disease Control and Prev(CDC), served on the senior White House sta, and was administrator o the Health Care Fina

Administration. Earlier, he was a White House Fellow.

He received his M.D. rom the University o Alabama School o Medicine, and his M.P.H. roUniversity o Alabama at Birmingham School o Public Health. He completed his residency in pedat the University o Colorado Medical Center.

Dr. Roper is a member o the Institute o Medicine o the National Academy o Sciences. Hmember o the board o directors o DaVita, Inc., a member o the board o directors o Medco HSolutions, Inc., a member o the Scientic Management Review Board o the NIH, a member board o directors o the Partnership or a Healthier America, and chairman o the board o directhe National Quality Forum.


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Keynote Sp2013 KEENELANDCONFERENCE

SELBY

Joe V. Selby, M.D., M.P.H.

Executive DirectorPatient-Centered Outcomes Research Institute (PCORI)

Joe Selby is the rst Executive Director o the Patient-CenteredOutcomes Research Institute (PCORI). A amily physician, clinicalepidemiologist and health services researcher, Dr. Selby has more than35 years o experience in patient care, research and administration.He is responsible or identiying strategic issues and opportunities orPCORI and implementing and administering programs authorized bythe PCORI Board o Governors.

Dr. Selby joined PCORI rom Kaiser Permanente, Northern Caliornia, where he was Directhe Division o Research or 13 years and oversaw a department o more than 50 investigato500 research sta working on more than 250 ongoing studies. He was with Kaiser Permanente years. An accomplished researcher, Dr. Selby has authored more than 200 peer-reviewed articlcontinues to conduct research, primarily in the areas o diabetes outcomes and quality improveHis publications cover a spectrum o topics, including eectiveness studies o colorectal cancer scrstrategies; treatment eectiveness, population management and disparities in diabetes mellitus; pcare delivery and quality measurement.

Dr. Selby was elected to membership in the Institute o Medicine in 2009 and was a member Agency or Healthcare Research and Quality study section or Health Care Quality and Eectirom 1999-2003. A native o Fulton, Missouri, Dr. Selby received his medical degree rom NorthwUniversity and his masters in public health rom the University o Caliornia, Berkeley. He commissioned ocer in the Public Health Service rom 1976-1983 and received the CommisOcers Award in 1981.


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A2013 KEENELANDCONFERENCE

Monday, april 8, 2013

7:30 am to 4 pm Public Health PBRN Grantee MeetingBreakout Sessions rom 1 to 3 pm

Hyatt Regency Lobby LevelRegency Ballroom

4 to 6 pm PHSSR Grantee Networking Reception Hyatt Regency Lower Level AKentucky

uesday, april 9, 2013

7:30 to 8:30 am PHSSR Grantees Breakast Junior Investigators Mentored Research Scientist Development Awardees Brown Scholars

Hyatt Regency Lobby LevelRegency Ballroom 1

7:30 to 8:30 am Public Health PBRN Grantees Breakast Hyatt Regency Lobby LevelRegency Ballroom 2 & 3

7:30 to 8:30 am NNPHI Grantees Breakast Hyatt Regency Lower Level A Kentucky

9 to 11 am PHSSR Grantee Workshop:ranslation and DisseminationOpen to all PHSSR, PBRN, & NNPHI Grantees

Hyatt Regency Lobby LevelRegency Ballroom 1, 2 & 3

10:00 to 11:30 am PHSSR National Advisory Committee Meeting Hyatt Regency Lower Level AKentucky

12 to 1:30 pm Opening Lunch:p l. Kht, d.n.p., rneam Director and Senior Program OfcerRobert Wood Johnson Foundation

Lexington Convention CenterBluegrass Ballroom 2

2 to 3:15 pm Concurrent Scientic SessionsSee page 23 or ull details1A-Workorce I1B-Consolidation1C-Finance1D-Partnerships1E-echnology & Data I

Lexington Convention Center

Toroughbred 1 Toroughbred 2 Toroughbred 3 Toroughbred 5 & 6 Toroughbred 7 & 8

3:45 to 4:45 pm Washington UpdateSee page 15 or ull details


5:30 to 6:30 pm Poster Session A

See page 87 or ull details


Toroughbred Preunction Area

6 to 7 pm Networking Reception Lexington Convention CenterToroughbred Preunction Area

7 to 9 pm Dinner:J V. sb, M.d., M.p.H.Executive DirectorPatient-Centered Outcomes Research Institute (PCORI)



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Agenda Public Health Se& Systems Res

Wednesday, april 10, 2013

7:30 to 8:30 am Breakast-Roundtable SessionSee page 16 or list o topics


9 to 10:15 am Concurrent Scientic SessionsSee page 39 or ull details2A-Preparedness2B-ranslation I2C-Organization2D-Quality Improvement I2E-echnology & Data II



10:45 am to 12 pm Concurrent Scientic SessionsSee page 55 or ull details3A-echnology & Data III3B-Workorce II3C-ranslation II

3D-Quality Improvement II3E-Social Network Analysis



12:30 to 1:30 pm Lunch:Wm l. r, M.d., M.p.H.CEOUNC Health Care System


2 to 3:15 pm Concurrent Scientic SessionsSee page 71 or ull details4A-Accreditation4B-Workorce III4C-Food Saety

4D-Disparities4E-echnology & Data IV


Toroughbred 1 Toroughbred 2 Toroughbred 3

Toroughbred 5 & 6 Toroughbred 7 & 8

3:45 to 4:45 pm A Formative Evaluation o PHSSRSee page 19 or ull details


5:30 to 6:30 pm Poster Session BSee page 89 or ull details

Lexington Convention CenterToroughbred Preunction Area

6 to 7 pm Networking Reception Lexington Convention CenterToroughbred Preunction Area

7 to 10 pm Dine-A-Round Lexington Various Local Restaurants


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A2013 KEENELANDCONFERENCE

Hursday, april 11, 2013

7:30 to 8:30 am Breakast or All Attendees Lexington Convention CenterToroughbred 1, 2 & 3

9 to 10:30 am Closing Session on ranslation and DisseminationSee page 20 or ull details

Lexington Convention CenterToroughbred 1, 2 & 3

11 am to 4 pm Historic Keeneland Race Course Outing Buses will be outside o the High Street Entrance Lexington Convention Center.


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Plenary Se2013 KEENELANDCONFERENCE

uesday, april 9, 20133:45 o 4:45 pM

Washington Update: PHSSR and Policy ranslation Bluegrass BallrooFind out the inside scoop on whats happening inside the Beltway - rom sequestration to the Aordable Care Act and how itand indirectly aects PHSSR rom those who know. AcademyHealth is the National Coordinating Center or PHSSRs paWashington. Te moderator and panelists will share their insight regarding issues to watch on the ederal level.

Moderaor

l sm, M.B., B.Ch., M.p.H.President and CEOAcademyHealth

paneliss

p J, M.d., M.B.a.Executive DirectorAssociation o State and erritorial Health Ocials (ASHO)

ASHO is the national nonprot organization representing public health agencies in the United States, the U.S. erritories,District o Columbia, and over 100,000 public health proessionals these agencies employ. ASHO members, the chie healtho these jurisdictions, ormulate and inuence sound public health policy and ensure excellence in state-based public health ASHOs primary unction is to track, evaluate, and advise members on the impact and ormation o public or private healtthat may aect them and to provide them with guidance and technical assistance on improving the nations health.

J lv, ph.d.

Executive Directorrust or Americas Health (FAH)

FAH is a non-prot, non-partisan organization dedicated to saving lives by protecting the health o every community and to make disease prevention a national priority. By ocusing on prevention, protection, and communities, FAH is leading themake disease prevention a national priority, rom Capitol Hill to Main Street.

rbt ptk, M.p.H.Executive DirectorNational Association o County and City Health Ocials (NACCHO)

NACCHOs vision is health, equity, and security or all people in their communities through public health policies and NACCHOs mission is to be a leader, partner, catalyst, and voice or local health departments in order to ensure the conditi

promote health and equity, combat disease, and improve the quality and length o all lives.


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RoundtablesPublic Health Se

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Wednesday, april 10, 20137:30 o 8:30 aM

Breakast Roundtables Bluegrass Ballroo1: ogztLisa Lang, M.P.P., Head, National Inormation Center on Health Services Research, and Assistant Director, HealthServices Research InormationNational Library o Medicine, National Institutes o Health Additional presenters:

Karen Dahlen, M.L.S. Paul C. Erwin, M.D., Dr.P.H. Paul Halverson, M.D., M.H.S.A., FACHE

2. Finance

Patrick Bernet, Ph.D., Associate Proessor o Healthcare FinanceFlorida Atlantic University College o Business Additional presenters:

Simone R. Singh, Ph.D. Jonathon Leider, Ph.D.

3: Technology & DataEduardo Simoes, M.D., Chair, University o Missouri School o Medicine Department o Health Management andInormatics; National Advisory Committee or PHSSR Member

Additional presenters: Susan Cahn, M.P.H., M.A. Roland Gamache, Ph.D., M.B.A. Brian Dixon, Ph.D., M.P.A.

4: GovernanceAnne Drabczyk, Ph.D., M.A., Chie Executive OcerNational Association o Local Boards o Health

Additional presenters: Anne Drabczyk, Ph.D., M.A. Scott Hays, Ph.D. Elizabeth Harper, M.P.H.

5: Reducing Health DisparitiesFrancisco Sy, M.D., Dr.P.H., Director o Extramural Activities and Scientic ProgramsNational Institute on Minority Health and Health Disparities, National Institutes o Health

6: PARTNER Network Analysis ToolDanielle Varda, Ph.D., Assistant ProessorSchool o Public Aairs, University o Colorado Denver; secondary appointment in the Colorado School o Public Department o Health Systems, Management, and Policy


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Round2013 KEENELAND

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7: State and Local Health SurveysA.J. Scheitler, M.Ed., Coordinator o Stakeholder Relations andCoordinator o the National Network o State and Local Health SurveysUCLA Center or Health Policy Research

8: Sharing Public Health ServicesGianranco Pezzino, M.D., M.P.H., Co-DirectorCenter or Sharing Public Health services, Kansas Health Institute

9: Conducting PHSSR Translation with Health Departments and PracticeRoss Brownson, Ph.D., Co-DirectorPrevention Research Center, Washington University and St. Louis UniversityPublic Health PBRN National Advisory Committee Member

10: Research Translation or Policy-MakersLisa Simpson, M.B., B.Ch., M.P.H., President and CEO, and Kate Papa, M.P.H., Director

AcademyHealth

11: Enhancing the Prole SurveyCarolyn Leep, M.S., M.P.H., Senior Director o Research and EvaluationNational Association o County & City Health Ocials

12: Brainstorming With PracademicsRobert Pestronk, M.P.H., Executive DirectorNational Association o County & City Health OcialsPublic Health PBRN National Advisory Committee Member

13: Measuring Health Equity

Katie Sellers, Dr.P.H., CPH, Senior Director, Survey Research, Association o State and Territorial Health Ocials

14: Public Health Laboratory Data or PHSSREric Blank, Dr.P.H., Senior Director, Public Health Systems, andDeborah Kim, M.P.H., Director, Institutional ResearchAssociation o Public Health Laboratories

15: Opportunities or Integration o PHSSR & PHLRScott Burris, J.D., DirectorNational Advisory Committee or PHSSR MemberJennier Ibrahim, Ph.D., M.P.H., Associate DirectorPublic Health Law Research program

16: Core Competencies or Public HealthKathleen Amos, MLIS, Project ManagerCouncil on Linkages Between Academia and Public Health Practice, Public Health Foundation

17: PHSSR & AccreditationJessica Kronstadt, M.P.P., Director o Research and EvaluationPublic Health Accreditation Board


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RoundtablesPublic Health Se

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18: Injury PreventionLinda Degutis, Dr.P.H., MSN, DirectorNational Center or Injury Prevention and Control, Centers or Disease Control and Prevention

19: Measuring Capacity o a Membership NetworkBrittany Bickord, M.P.H., and Sarah McKasson, M.P.H., Evaluation CoordinatorsNational Network o Public Health Institutes


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Wednesday, april 10, 20133:45 o 4:45 pM

A Formative Evaluation o PHSSR Bluegrass BallrooResearchers rom the Urban Institute present results rom their assessment o RWJFs portolio o PHSSR projects commby the Foundation. Data sources include an environmental scan o published and unpublished materials; surveys o publipractitioners, public health PBRN network partners, and PHSSR grantees; site visits to PBRNs; and key inormant interviews.and recommendations will be sought rom the audience.

paneliss

r r. Bvbjg, J.d.Bovbjerg is a Senior Fellow in the Health Policy Center o the Urban Institute in Washington, DC. He has acquired an combination o research and practical skills during a long career in health policy, including many RWJF projects, numerous eva

and many case studies. His specialties include public and private health insurance and reorm, public health and workorce isuninsured and the health care saety net, and administrative and legal issues in health care, such as liability and patient saetyOther current projects than the PHSSR work to be described at Keeneland include an assessment o opportunities or ComHealth Workers under health reorm and a case study o recent changes in medical proessional regulation in Washington stand Hatrys close collaboration began with a 1990s project on nursing regulation, and they recently co-authored ManagDelivering Perormance, or theJournal o Nursing Regulation. Bovbjerg also lead-authored What Directions or Public Healtthe Aordable Care Act? and has served as a site-visit assessor or Harvards Innovations in Government Awards.

H p. Ht, M.s.Mr. Hatry is a Distinguished Fellow and Director o the Public Management Program at the Urban Institute in WashingtoHe pioneered tools or measuring program outcomes our decades ago and since then has worked on many public and privaprojects in perormance measurement, perormance management, and evaluation. Much o his work actively promotes a resuor local, state, and private nonprot organization sector. He has contributed to such national eorts as the International City/Management Associations comparative perormance measurement eort; the Governmental Accounting Standards BoardsEorts and Accomplishments eorts; the United Way o Americas work to bring outcome measurement into the nonproand the Legislating-or-Results initiative o the National Conerence o State Legislatures and the National League o Citiea member o the National Academy o Public Administration and the American Evaluation Association, and he received thWashington Evaluators Award as Evaluator o the Year and the 1985 Elmer B. Staats Award as the years outstanding contrimanagement science. He has also written two seminal books on outcome measurement and evaluation, both now in theireditions.


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Plenary SessionsPublic Health Se

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Hursday, april 11, 20139 o 10:30 aM

Closing Session: ranslation and Dissemination Toroughbred 1, 2One o the main goals o the Keeneland Conerence is to encourage the growth o Evidence-Based Public Health (EBPHthrough translation and dissemination o research into practice or practice-based research.

Moderaors

r Bw, ph.d.Prevention Research Center/Washington University and St. Louis UniversityPublic Health PBRN National Advisory Committee Member

p ew, M.d., d.p.H.University o ennessee

Co-Investigator o the National Coordinating Center or PHSSRDrs. Paul Erwin and Ross Brownson will co-moderate the closing session, with Dr. Brownson leading o with an overviewmulti-pronged LEAD-PH research project on EBPH, including early results. Te Robert Wood Johnson Foundation has unBrownson and his team at Washington University in St. Louis to explore evidence-based decision-making in local health depar

preseners

Practitioner: Beth Gyllstrom, Ph.D., M.P.H., Minnesota Department o HealthResearcher: Bill Riley, Ph.D., University o Minnesota

All Minnesota local health departments (LHDs) received unding in 2009 to implement policy, systems and environmental (PSEinterventions within their communities. Tis study examines actors at the LHD level that contribute to success in implementi

strategies. Te primary study hypothesis is that increased local public health capacity and perormance (as measured by authoritythe top local public health ocial, maturity o organizational quality improvement (QI), readiness or accreditation and participintervention-specic QI activities) improves LHD perormance on PSE strategies (ability to meet stated goals; depth o implemesustainability o strategies).Practitioner: Marie Flake, M.P.H., Washington State Department o HealthResearcher: Betty Bekemeier, Ph.D., M.P.H., RN, University o Washington

Trough partnerships with practitioners and Public Health Practice-Based Research Networks (PBRN), the Public Health Aand Services racking (PHAS) study is providing a comprehensive, accessible database or answering practice-based research quIn a Washington (WA) partnership, we compiled annual LHD nancial data rom 1993 to 2010, to examine trends over tidierences among Washingtons 35 LHDs and in relation to other local characteristics. Specic visual displays o data were collab

created between researchers and practitioners to maximize relevance and accessibility or practice leaders. Tese existing detaihave thus become a meaningul planning tool to support eective health policy and data-driven nancial planning.


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Practitioner: Chris Maylahn, M.P.H., New York State Department o HealthResearcher: Britney Johnson, M.P.H., Te State University o New York at Albany, School o Public Health

Integrated HIV/AIDS and SD Service Delivery in New York: A Natural Experiment: Te New York PBRN aims to iden

test valid and reliable measures o quality associated with delivery o HIV/AIDS and SD services by local public health agenthen use these measures as part o a natural experiment to evaluate the impact o a statewide initiative to integrate the delivery two service lines. Tis project will assess the impact o the integration process on sta attitudes and job satisaction, client awand utilization o services, and service quality based on adherence to evidence-based practices. Results o this study will yield vmeasures or assessing the quality o HIV and SD service delivery, as well as other eorts to integrate public health service pro

Practitioner: Colleen Bridger, Ph.D., Orange County Health Department, North CarolinaResearcher: Lisa Harrison, M.P.H., Vance District Health Department, North Carolina

Last year the North Carolina Institute o Medicine (NC IOM) established the ask Force on Implementing Evidence-Based Sin Public Health and completed their report in September 2012. Te ask Force was charged with developing recommendaassist public health proessionals in the identication and implementation o evidence-based strategies within their commu

improve population health. Dr. Bridger and Ms. Hill both served on the Steering Committee or this ask Group, and as locadepartment directors are now working to implement the recommendations described in the report. One o the recommendatioor local health department directors to select two evidence-based strategies or implementation, and this recommendation state-LHD agreement documents. Tus, we will hear rom the ront-lines on what may be the rst experience with codiyingor use in LHDs. View the report, (http://bit.ly/EBPH100912.).


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Concurrent Se2013 KEENELAND

CONFERENCE

SESSION 1A: Workorce I-uesday, April 9, 2013, rom 2 t

session 1-uesday, april 9, 2013 FroM 2 o 3:15 pM

SESSION 1A: Workorce I Room: Toroughbr

Mt: ag Cm, d.p.H., M.B.a.rch att puvt Ktck Cg pbc Hth

rbt a, d.p.H., M.p.H.

Using Expert Panels to Elicit Potential Indicators and Predictors o EBPH in Local Health Departments

Co-Investigators: Kay Lovelace, Ph.D., M.P.H.; Gulzar Shah, Ph.D.

Research Objective: o identiy appropriate indicators o local health department (LHD) use o Evidence-Based Public

(EBPH) strategies and actors that inuence their use.

Data Sets and Sources: ranscripts o interviews with 12 members o an expert panel representing researchers and pracworking in PHSSR and EBPH.

Study Design: Participants responded to a series o questions regarding: their denition o EBPH; ways to identiy and ause o EBPH strategies; and perceived barriers/enablers to the use o these strategies at the state and local levels.

Analysis: Content analysis perormed using QSR NVivo V. 9. Data matrices were created highlighting each particomments related to EBPH strategies and actors inuencing the use o EBPH strategies (including state level, locadepartment level and community level actors). Strategies were categorized based on denitions o EBPH used by partic

Principal Findings: wo basic denitions o EBPH emerged, with one reecting the use o data in decision-making pr

and the other reecting the adoption o scientically tested interventions. Factors at the state, local health departmcommunity levels that inuenced EBPH depended, in part, on the denition o EBPH used by participants.

Conclusion: LHD use o EBPH was inuenced by health ocer training and leadership, characteristics o the workotraining and technical assistance provided at the state and local levels. Familiarity with resources on tested interventions or one denition o EBPH. Community partnerships and competency in using data were key or others.

Implications or the Field o PHSSR: PHSSR and practice related to EBPH need to include precise denitions o termsmeaningul discussions regarding how to encourage the use o EBPH strategies.


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& Systems Res

SESSION 1A: Workorce I-uesday, April 9, 2013, rom 2 to 3:15 pm

Jtt Kwk, M.p.H., B.s., CHes

Cant Get No Satisaction: An Exploratory Review o the Local Public Health Workorce and Job Satisaca Predictor o Sustainability

Co-Investigators: None named.

Research Objective: Te purpose o this study is to examine job satisaction o the local Public Health Workorce in Milwaukee, Wisc., by analysis o multiple variables. Te study will answer two primary research questions: 1) whcomposition o the PHW in the target area; and 2) what variables signicantly impact job satisaction.

Data Sets and Sources: Primary data were obtained via utilization o the Job Satisaction Survey (JSS) (Spector, 1994). Tadministered JSS was disseminated via web/email to 145 adult, public health sta employed at LHDs in Milwaukee Coobtain JS indices per independent variable. Te JSS included 17 demographic and 36 job satisaction questions.

Study Design: Te ollowing assumptions were met or this exploratory, cross-sectional study o convenience: 145 adults .80) employed at LHDs in Milwaukee County completed a sel-administered survey online through email invite or har

mail anonymously in 2012. Te survey took less than 30 minutes to complete; no incentives were provided.

Analysis: Te survey was coded, and statistical sotware was used or analysis. Te signicance o the research was detby analysis o cross-tabulations, average mean JSS scores per variable, chi-square, one-way ANOVA(alpha.05), post hoc (amhanes) and eect size (adjusted R squared greater than .04). Te condence interval was 95 percent.

Principal Findings: Overall, JSS was not signicant or independent variables; however, our JSS subscales were signicantPHW. Te dierences were detected between administrators and PHNs or promotion; administrators and support sta or oconditions; PHNs and other proessional sta or coworkers and administrators and support sta or contingent rewards.

Conclusion: Job satisaction is a key variable that impacts employees daily regardless o title or role in the agency, whdemonstrated in the research. More research is needed to widen the rame o understanding o what constitutes average

subscales or the PHW locally, statewide and nationally.Implications or the Field o PHSSR: Te study suggests that JSS can be used to gather inormation about the PHW orresources (HR) and accreditation (PHAB) purposes. For HR: diversity, needs, proessional development and training. Fordomains 5- development o PH policies and plans; 8- maintenance o a competent PHW, and 11- maintenance o human re


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SESSION 1A: Workorce I-uesday, April 9, 2013, rom 2 t

C smth, M.p.a.

Factors Inuencing the Spread o Evidence-based Decision Making in Local Health Departments in the UStates

Co-Investigators: Robert Fields, B.S.; Kathleen Duggan M.P.H., M.S.; Rodrigo Reis, Ph.D., M.Sc.; Katie StamatakisM.P.H.; Paul Erwin, Dr.P.H., M.D.; Carolyn Leep, M.P.H., M.S.; Jenine Harris, Ph.D.; Ross Brownson, Ph.D.

Research Objective: o identiy the actors that inuence the spread (diusion) o Evidence-Based Decision Making (EBlocal health departments (LHDs) in the United States. Tese actors are based in part on Rogers Diusion o Innovation

Data Sets and Sources: Data were gathered rom a national survey about EBDM among LHDs. Te online survey was disto LHD directors and administrators (n = 517) (54% response rate). A section o questions (rened with cognitive and retesting) covered diusion attributes o LHDs and the decision-making process inuencing EBDM among LHDs.

Study Design: Cross-sectional

Analysis: We conducted Pearsons chi-square tests to analyze associations between characteristics o LHDs (e.g., govstructure) and diusion attributes (e.g., t with agency mission, ease o implementation). LHD characteristics were anarelation to 10 diusion attributes.

Principal Findings: In nine o 10 questions on diusion attributes, the majority o respondents reported barriers to EBDexample, 85% disagreed that implementing EBDM would involve minimal nancial cost. LHD characteristics associatdiusion attributes were population size served, governance structure o the LHD, and region o the country.

Conclusion: Characteristics o LHDs, specically size o population served, governance structure, and region o the cappear to inuence the use o EBDM. Tese results indicate that several key diusion properties need attention amongFuture analyses should use mixed-eects modeling methods.

Implications or the Field o PHSSR: Use o EBDM can help LHDs build competencies or accreditation, enhance e

and strengthen capacity to improve population health. Identiying and enhancing LHD characteristics that support ththe EBDM process can inuence the uptake o these practices.


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SESSION 1B: Consolidation-uesday, April 9, 2013, rom 2 to 3:15 pm

SESSION 1B: Consolidation Room: Toroughbr

Mt: Gc pzz, M.d., M.p.H.CdctCt shg pbc Hth svc

Jh Hbk, ph.d., M.p.a.

Insights and Issues Relating to Assessing the Impacts o Health Department Consolidation

Co-Investigators: Aimee Budnik, M.S.; egan Beechey, M.P.A.; Josh Filla, M.P.A.

Research Objective:o document perceived outcomes associated with the consolidation o health departments in Summit Ohio, one year ater its implementation. Te inormation presented can assist local public health systems in understandimpacts o consolidation and researchers in conducting evaluative studies o health department consolidation.

Data Sets and Sources: Te study team reviewed literature and documents on the Summit County health depconsolidation, interviewed public health stakeholders, and surveyed employees o the newly consolidated health departmtotal, eedback on the consolidation and its impacts was solicited rom about 300 individuals with knowledge and exprelating to the consolidation.

Study Design: Te study presents descriptive inormation on challenges in implementing the consolidation, the impactconsolidation, and variations in perceptions among stakeholders, managers, and employees. Te data collected are desilend insights on the process and impacts o consolidation and variations in perceptions o those involved in the process.

Analysis: Te data collected are analyzed qualitatively to identiy key challenges, and quantitatively to describe likely and variations in perceptions relating to these impacts. While the analyses completed to date are primarily descriptive, adstatistical analyses may be conducted to identiy predictors o support or consolidation across key audiences.

Principal Findings: Te consolidation saved $1.5 million during its rst year o implementation. While the study multiple perspectives, it generally suggested that baseline services had been maintained during the transition to a consodepartment, and that the consolidation holds the potential to improve public health services and capacities in the uture

Conclusion: Consolidating health departments is dicult, but Summit County has made progress in addressing operatiostrategic challenges, saving money, and re-examining strategies or public health services in the county. In addition, many contacted expressed optimism about the potential or uture improvements in public health capacities and services.

Implications or the Field o PHSSR: Te analyses presented oer helpul insights to other researchers undertaking eunderstand health department consolidation, as well as to practitioners who may be involved in considering or implemconsolidations. Te presentation will discuss the analytical processes undertaken by the project team and the challenges aswith its methodologies.


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SESSION 1B: Consolidation-uesday, April 9, 2013, rom 2 t

am Bk, M.s., B.s.

Presentation: Describing and Evaluating the Feasibility Assessment Process or Local Health DepartmentConsolidations

Co-Investigators: Ken Slenkovich, M.A.

Research Objective: Te purpose o the research was to evaluate the eectiveness o a methodology used to assess easiconsolidating multiple health districts into one organization or two communities in Ohio.

Data Sets and Sources: Te research team reviewed and evaluated the Feasibility Study Methodology rom two couOhio. Other data sources included the meeting minutes rom the task orce o one county; key inormant interviewsRetrospective Evaluation Report o another county; and survey data rom the task orce members.

Study Design: Te study design was a mixed methods approach including key inormant interviews, review o implementation documents, and survey o task orce members.

Analysis: Mixed methods approach to analysis was used to evaluate qualitative and quantitative data. Descriptive analysis and relationships were examined. Content analysis to identiy emerging themes rom meeting minutes and interviews was conduct

Principal Findings: o our knowledge, there is not a standard methodology to assess easibility or consolidating locahealth departments, and this methodology provides a starting point. Tere is a need or the measurement o other criticsuch as political will, capacity, readiness to change, and baseline data.

Conclusion: Tis methodology provides communities with tools to systematically determine the potential easibconsolidating multiple health districts into one. Te current eight critical areas need to be expanded to include meaassess organizational readiness to change specically grounded in theory (Diusion o Innovation), political climate and organizational data.

Implications or the Field o PHSSR: As the unds or providing public health services decrease, there is an increasin

to collaborate and nd ways to increase eciency. Potential consolidators could benet rom using a methodologycommunities can systematically assess the easibility o consolidating multiple health departments into one.

G nx, M.p.a., B.s.

From Evidence to Practice: How a Public Health District Utilized Data in its Organizational Decision-MBeore, During and Ater its Consolidation


Research Objective: Te purpose o the research was to describe how one public health district used data rom both its

Feasibility Study and a subsequent evaluation o its consolidations to aect change in the administration and the delpublic health services in the county.

Data Sets and Sources: Te research team utilized the Merger Feasibility Study Report, data rom SCPH, and survey dathe Retrospective Evaluation Report.

Study Design: Te design o the study was a process evaluation examining internal and external documents, data soureports.


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SESSION 1B: Consolidation-uesday, April 9, 2013, rom 2 to 3:15 pm

Analysis: A mixed methods approach to data analysis using qualitative and quantitative data. Financial analysis and qucontent analysis o job descriptions, organizational structures and Ohio public health law were completed. Internal and satisaction surveys were analyzed.

Principal Findings: Te Feasibility Study identied a proposed governing structure; scal requirements; person

programmatic disparities o the new organization; importance o obtaining community input; and sta participationprocess. Te retrospective analysis o the consolidation identied disparities in perceptions among the workorce. Te analysis identied a cost savings.

Conclusion: Te use o data can be inormative as well as a signicant catalyst or change. Te results rom the Feasibilitprovided evidence that was needed to successully move orward in a consolidation. Te data rom the Retrospective Evprovided areas or the leadership to ocus its attention.

Implications or the Field o PHSSR: Tere is a need or these types o collaborations among public health deparacademic institutions, and political and community organizations to improve the public health system. Te use o dataan important part o organizational decision-making when public health departments are considering the need to conwithin communities.

Mch M, ph.d., M.p.H., C.p.H.

Consolidation in Ohio Local Public Health: Dierences in Expenditures, Stang & Service

Co-Investigators: Matthew Steanak, M.P.H.; John Hoornbeek, Ph.D.; Rohit Pradhan, Ph.D., M.P.A.; Joshua Filla, Sharla Smith M.P.H.

Research Objective: Te central objectives o this study are to develop evidence regarding the eect o consolidaexpenditures, workorce and services o local health departments (LHD) in Ohio and to deliver actionable and timely to inorm consolidation policy decisions both in Ohio and around the nation.

Data Sets and Sources: Data sources include Ohios Annual Financial Report (AFR) system and original data collectinterviews o stakeholders involved in LHD consolidation in Ohio since 2000. Financial, organizational and comcharacteristics will be incorporated rom the PHAS database, which has merged sources like NACCHOs Prole and Area Resource File.

Study Design: Tis study utilizes a mixed methods approach. Quantitative analyses will use a longitudinal design while quanalyses will utilize cross sectional semi-structured phone interviews with health commissioners and others who have partin LHD consolidations occurring since 2000.

Analysis: Inuence o consolidation on LHD expenditures and stang will be derived using two approaches: a diedierence model with matched control group and a second using Munkin and rivedis (2003) sel selection model. Dathe qualitative component o the study will be analyzed using thematic coding techniques.

Principal Findings: Preliminary ndings rom the analysis conducted on a partial sample o consolidations indicate thmay be some savings associated with consolidation, particularly in the area o administrative costs.

Conclusion: Forthcoming.

Implications or the Field o PHSSR: When completed, this study will provide evidence to inorm the consolidation dOhio and around the nation.


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SESSION 1C: Finance -uesday, April 9, 2013, rom 2 t

SESSION 1C: Finance Room: Toroughbr

Mt: ptck Bt, ph.d., M.B.a.act p Hthc FcF attc uvt

Btt Bkm, ph.d., M.p.H., M.s.n., rn

Local Health Department Expenditures on Maternal/Child Health Impact Health Outcomes: Findings FrPHAS and or Advancing Policy Discussions

Co-Investigators: Youngran Yang, Ph.D., M.P.H., RN; Michael Morris, Ph.D., M.P.H.; Matthew Dunbar, Ph.D.Grembowski, Ph.D., M.A.

Research Objective: In connection with the Public Health Activities and Service racking (PHAS) study and in collab

with Public Health Practice-Based Research Networks (PBRN), we examined annual maternal/child health (MCH) expeor 102 LHDs rom 2000-2010. Our purpose was to investigate the relationship between LHD expenditures on MCHand related health outcomes.

Data Sets and Sources: Unpublished annual LHD expenditures, obtained rom state health departments in Wasand Florida, represented nancial investments in three MCH service areas. Tese data were linked with county-levedemographic controls and MCH outcomes. Outcomes included no/late prenatal care rates, births to emales age 15-19, loweight, and inant mortality (IMR).

Study Design: We used a multivariate panel-time series design using robust standard errors to statistically estimate the associations between these MCH expenditures by LHDs and related outcomes over 11 years, while controlling or otherTree-year smoothed rates o each outcome variable were compared to the previous years expenditures.

Analysis: Tree-year smoothed rates o each outcome were compared to previous years expenditures and examined or relatto health, while controlling or other actors. Stratied analyses were conducted with jurisdictions categorized as poor (astates top one-third most impoverished counties) and non-poor (the two-thirds counties with lower poverty rates).

Principal Findings: Outcomes were consistently in the expected, benecial directions, but with the most signicant relatindicated in non-poor counties. Te strongest benecial relationships were indicated among the more targeted expendi.e. each program-specic expenditure (such as or WIC and Family Planning). Te least strong relationships existed withtotal LHD expenditures.

Conclusion: Relationships exist between an LHDs MCH expenditures and outcomes. Tis relationship appears stronger afuent communities where targeted MCH services may have more o an impact on populations that already have greateadvantages, versus where other unmeasured community actors impede the eect o these services in impoverished jurisd

Implications or the Field o PHSSR: Findings have policy implications suggesting that expenditures by LHDs on MCHservices do have a benecial relationship with important health indicators. Researchers using detailed, program-specic dproduce stronger, more ocused ndings or practice and policy decision-making.


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SESSION 1C: Finance -uesday, April 9, 2013, rom 2 to 3:15 pm

Bth rck, M.p.H.

Executives Reections on Success in Priority-Setting

Co-Investigators:J.P. Leider, Ph.D. (presenting); Beth Resnick M.P.H.; Jessica Young, M.S.

Research Objective: As part o the Setting Budgets and Priorities project, we sought to understand how state public healthsaw their successes and ailures during budget- and priority-setting. Tis presentation will report out the results o this pline o inquiry in this project.

Data Sets and Sources: 45 interviews and 207 survey responses rom state public health leaders

Study Design: Using a mixed-methods process, we rst interviewed 45 state health agency leaders around issues o rallocation. Next, we elded a complementary national survey to all state health agencies. We received 207 responseresponse rate).

Analysis: We transcribed, cleaned, and coded the interview data and open-ended question on the national survey. Major

were identied - one o which revolved around sel-identied success (and ailure) in budget- and priority-setting. Arelated theme was identied on how respondents would change the process, i they could.

Principal Findings: Respondents identied political acumen; good, sourced data; demonstrable results; established needsta; and organizational characteristics as drivers o success. Tirty-nine interviewees discussed changing priority-settinsaid they were satised with the process. Te remainder said they wanted: greater exibility, less political involvementdata, and a more systematic approach.

Conclusion: Sel-identied success is highly context-dependent. In these times o political scarcity, some respondents idany service growth as a win, where others viewed their success as relative to previous years and previous unding levels. inuence is clearly a primary challenge o priority-setting.

Implications or the Field o PHSSR: More characterization o political inuence on priority-setting at the state health

level is needed. Tese data also suggest that success is context-dependent, but that universally accessible tools (likepidemiological and comparative nancial data) may aid practitioners during times o higher scrutiny and budget scarci

Mch Mt, M.a., M.p.H.

Te State o the States: Public Health Financing in the U.S.

Co-Investigators: Amy Nevel, M.P.H.; Alana Knudson, Ph.D.; Ilana Dickman, M.P.H.

Research Objective: Te limitations o available public health nancing data aect the ability o public health practresearchers, and policy-makers to dene eective and ecient decision-making processes or resource allocations. T

explored how unding sources rom ederal, state, and local levels support the governmental public health system in theStates.

Data Sets and Sources: Quantitative revenue and expenditure data were collected through nancing templates thdeveloped based on the ASHO and NACCHO proles. Qualitative data were collected through semi-structured inwith public health system representatives such as health department program sta, state budget oce sta, and other comorganizations sta.

Study Design: Seven case studies were conducted with states diverse in their health department structure, services prgeography, size o population, and overall state and health department budgets. Te study included data collection tnancing templates and case studies, as well as a literature review and interviews with subject matter experts.


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SESSION 1C: Finance -uesday, April 9, 2013, rom 2 t

Analysis: Quantitative data collected through nancing templates were explored or key themes and trends across prograand localities. Qualitative data collected through semi-structured interviews were grouped by key theme.

Principal Findings: Study ndings noted variation in how state and local public health agencies report expenditures and respecically variations in inclusion and exclusion criteria, among other issues. Examples include challenges dening publi

and program areas; superagency structure issues; dening scal years and budgets; and distinguishing state money versuow-through.

Conclusion: With increased demands or accountability o public resources, budget constraints resulting rom theeconomic downturn, and shiting demands arising rom the passage o the Aordable Care Act, it is imperative ohealth stakeholders to understand and track nancing processes and allocations to acilitate well-inormed decision-makresource prioritization.

Implications or the Field o PHSSR: Tese issues have important implications: Limitations o currently available nancaect public health practitioners, researchers, and policy-makers as they dene eective and ecient decision-making por public health resource allocations. Consistent terminology and clearly dened categories can help ensure that publidata be easily compared across jurisdictions.

Mgg p, M.s.

Estimating the Impact o Public Health and Social Welare Investment on Population Health in the United


Research Objective: Tis study compares overall and program-specic public health investment and associated populatiooutcomes across local jurisdictions to estimate: (1) impact o high public health investment on population health; (2) imhigh social welare investment on population health; (3) impact o high investment in both policy areas on population h

Data Sets and Sources: Data provided by the National Association o County and City Health Ocials (NACCHO) will

in the cross-sectional component o the study, whereas data rom the Florida Public Health Administrative Data Colla(FADC) will be used or the longitudinal component.

Study Design: Te study consists o a longitudinal component, using data rom one state, Florida, to examine the inveoutcome relationship over the course o 10 years (2001-2011). A cross-sectional analysis perormed using 2010 NAnance data will be used to supplement the longitudinal study.

Analysis: Genetic matching will be used in the cross-sectional component o the study to compare spending and outcomacross jurisdictional boundaries. Multilevel modeling will be used to examine the longitudinal, program-specic daFlorida.

Principal Findings: Te analyses are orthcoming. Hypotheses: (1) Public health spending immediately aects commudisease outcomes; (2) Social spending has a positive, lagged eect on all-cause mortality (strongest or poorest); (3) High s

in both areas produces more desirable health outcomes than the sum o the eects o independent high spending.

Conclusion: Forthcoming.

Implications or the Field o PHSSR: Results o this research have the potential to inorm eorts to monitor the echanges in policy and unding in real-time. Research in this area is critical to ormulating a public nance policy agendin a strong understanding o its eects on health.


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SESSION 1D: Partnerships-uesday, April 9, 2013, rom 2 to 3:15 pm

SESSION 1D: Partnerships Room: Toroughbred 5

Mt: Cm nvz, M.d., M.p.H.Vc pt ext rt pvtv Mc avpbc Hth itttnt av Cmmtt pHssr Mmb

Km Mm, ph.d., M.p.H.

Shared Service Arrangements Among Local and ribal Health Departments in Wisconsin

Co-Investigators: Nancy Young, M.P.A.; Dustin Young, B.A.; Lieske Giese, M.S.P.H., B.A., RN; Dan Stier, J.DBrandenburg, M.B.A., M.P.A.; Susan Zahner, Dr.P.H., RN

Research Objective: Explore current and uture use o shared service arrangements as a management strategy to increase

to provide public health essential services in Wisconsin.

Data Sets and Sources: Select variables rom the 2010 Wisconsin Local Health Department survey were merged. Othsources included results rom a Board o Health governance analysis and the Wisconsin Department o Health Servicedata.

Study Design: Online cross-sectional survey o 99 local and tribal health departments in Wisconsin

Analysis: Ninety-one o 99 Wisconsin local and tribal health departments responded, yielding a 92% response rate. Deanalysis was perormed o current and uture shared service arrangements and the characteristics o the types o arrangand agreements in place.

Principal Findings: Seventy-one percent o respondents share services with one or more LHDs, with more requent arran

in programmatic areas than in departmental operations. Motivators include making better use o resources, providinservices, and responding to program requirements. Findings indicate arrangements accomplished what was intendeperceived gains in eciency and eectiveness.

Conclusion: Tere is widespread use o shared services among health departments in Wisconsin. Extensive qualitative cosuggest participant satisaction with what the arrangements have accomplished. Motivating actors in developing the arranand limited mention o expiration dates suggests continued study o how these arrangements may evolve.

Implications or the Field o PHSSR: Further examination o shared services as a potential mechanism to advanceeectiveness and eciency is needed. Potential research questions include: How do shared service arrangements chantime? What are emerging drivers? What evidence exists to support the perception o gains in eciency and eectiveness rrom shared services?

p s, M.p.H., M.s.

Strengthening Public Health Inormation Inrastructure through Collaborations: Lessons From BeaconCommunities



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SESSION 1E: echnology & Data I-uesday, April 9, 2013, rom 2 t

SESSION 1E: echnology & Data I Room: Toroughbred 7

Mt: Mch i, ph.d.Cc p th Cmmt Hth scc dv th schpbc Hthuvt Chcg

M J Bch, ph.d., rn

Te Status o LHD Inormation Systems: A Critical Need or Coordination to Inorm Meaningul HealthImprovement Initiatives

Co-Investigators:Jeanette Olsen, M.S.N., RN (presenting); Nancy J. Kreuser, Ph.D., M.S.N., RN

Research Objective: Te examination o inormation systems and standard terminologies among LHDs is critical or di

priority public health inormatics initiatives and interventions. A statewide study was conducted to identiy inormationand standard terminologies used to describe public health practices in LHDs, and explore LHD leaders perceptions o systems.

Data Sets and Sources: Adapted rom the 2010 Oregon Health Inormation echnology Oversight Councils survey oan electronic survey was disseminated to Wisconsin LHD health ocers/directors (N=88) in December 2012. Respon75% (n=66).

Study Design: Using a cross-sectional, descriptive design, the questionnaire was used to collect both quantitative and qudata: numbers and types o inormation systems utilized in local health departments and LHD stas perceptions o theirespectively.

Analysis: Descriptive statistics were used to analyze the number o systems in use, level o satisaction with current systeuse o standard terminologies to describe practices. Qualitative, thematic analysis was used to analyze narrative survey reregarding challenges, needs, priorities and plans.

Principal Findings: Eighty-ve systems were used by one or more LHDs; only our were used by 94-100% o departmenstandard terminologies were used: ICD9(25%), CP(14%), ICD10(8%), and OMAHA(8%). Deciencies and challeno system integration/intercommunication; need or outcomes data that captures public health work; and need or trainior user-riendly systems.

Conclusion: Findings indicate that there is a clear and urgent desire among LHDs or integration and coordination o inosystems, training and unding, so that they can provide state public health leaders with specic, meaningul data that canto guide inormatics initiatives and interventions and inuence state-level budget and policy decisions.

Implications or the Field o PHSSR: Tis study is aligned with the Public Health Inormation and echnology areNational Research Agenda or PHSSR. Specically, it contributes to the knowledge base needed to inorm initiatives to capabilities, to assess and monitor health outcomes, and improve communication technologies.


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SESSION 1E: echnology & Data I-uesday, April 9, 2013, rom 2 to 3:15 pm

H Jm, ph.d.

Implementing Health Inormation Exchange: Exchanging Immunization Data in Michigan


Research Objective: Te potential or Health Inormation Exchange (HIE) to improve population health outcoset by several sizable implementation challenges. Tis project assesses the implementation o the State HIE CooProgram through the lens o public health delivery. Preliminary ndings will be presented rom a targeted case studyimplementation in Michigan.

Data Sets and Sources: Te project utilizes original qualitative data: semi-structured interviews with key actors in sub-sstate-level HIOs in Michigan and two other comparator states. Te interview data are analyzed in conjunction with existand ederal surveys o HIOs, and a review o primary documents.

Study Design: Te Michigan case is part o a wider project supported by the RWJF PHSSR Mentored Research SDevelopment Award program. Te study is designed to use qualitative data to construct a dynamic simulation o HIE us

can inorm the process o incorporating public health-relevant data into HIE systems.

Analysis: Te project utilizes an iterative approach to data analysis and model verication. Interviews are conducted in twto allow re-assessment o model assumptions, together with more requent interactions with a group o key actors. Intranscripts are coded independently by two researchers and codes statistically compared or accuracy.

Principal Findings: Forthcoming.

Conclusion: Eective and sustainable HIE requires overcoming problems o organizational collaboration as well as technbarriers. Te bureaucratic organization o the state public health inrastructure has a signicant impact on the extent usage or public health purposes.

Implications or the Field o PHSSR: Te potential public health benets o HIE are not as prominently highlighted by

makers as the personal benets or patients o adopting EHRs, but they remain signicant. Tis project aims to contributunderstanding o how to create sustainable systems o health inormation exchange that support population health.

Jh r. Vt, ph.d., M.p.H.

Sharing Data Between Local Health Departments & State Health Agencies: Needs, Challenges andWorkarounds

Co-Investigators: L .Michele Issel, Ph.D., RN; Sean Lee; Julie Beth Heiniger

Research Objective: Problematically, public health practitioners work within a system and at local health departments

that may impose substantial barriers to the eective the use o inormation. Trough qualitative interviews, we sought claron how public health practitioners attempt to make eective use o public health data within this complex arrangement

Data Sets and Sources: We conducted interviews at an urban exas LHD, a rural Georgia LHD, and a medium-sized ciin Illinois. We interviewed a total o 12 public health practitioners working in the key practice areas o communicablecontrol (n=4), immunizations (n=4), and vital records (n=4).

Study Design: Data were collected through in-person interviews ollowing a semi-structured ormat with open-ended quInterviews covered job descriptions, daily activities, and the use and perceptions o both data and public health inorsystems (IS) in support o their work.


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SESSION 1E: echnology & Data I-uesday, April 9, 2013, rom 2 t

Analysis: Data analysis ollowed a general inductive approach. Independently, we read the transcripts and employed opento identiy tentative themes within the data.

Principal Findings: Interviews reported inecient activities like duplicate data entry; manually counting records; searchindividuals in multiple non-interoperable IS; or axing records even when a supposedly shared IS existed. Tis took employ

rom other activities or slowed data sharing between organizations. o ulll data needs, practitioners constructed workand make-work.

Conclusion: LHDs ace a challenge in both meeting the data needs o practitioners and turning data into inormation oLHDs do need to increase organizational capabilities around data management and rely less on paper records and orms

Implications or the Field o PHSSR: LHDS and SHAs must also work collaboratively to ensure their respectiveinteroperable and that policies are in place to ensure end user accessibility o data in shared IS.


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SESSION 2A: Preparedness-Wednesday, April 10, 2013, rom 9 to

session 2-Wednesday, april 10, 2013 FroM 9 o 10:15 aM

SESSION 2A: Preparedness Room: Toroughbr

Mt: J ibhm, ph.d., M.p.H.act dctpbc Hth lw rch pgm

M dv, d.p.H., M.s.p.H.

Creating a Preparedness Index, Easier Said Tan Done

Co-Investigators: Christine Bevc, Ph.D., M.A.; Anna Schenck, Ph.D.

Research Objective: Tis presentation will discuss the benets, limitations and implications associated with the use o prepa

measures indices. Previous composite measures oten assume equal variable weighting, discounting relationships among vSimple additive indices unduly penalize those organizations with ewer capacities, as well as those organizations that rgreater number o capacities.

Data Sets and Sources: Using longitudinal data collected by the LHD Preparedness Capacities Survey (P-CAS), this analexamine the preparedness capacities o 85 local public health agencies in North Carolina and a matched comparison g248 public health agencies.

Study Design: wo years o survey data will be used to examine changes in local preparedness capacities over time and the relationship among local characteristics and preparedness. esting various preparedness analysis methodologies willunderstand the impact that perormance measurement systems and tools can have on public health strategies.

Analysis: Data will be used to examine changes in local preparedness capacities over time and examine the relationship

local characteristics and preparedness. Detailed analysis o preparedness capacities will examine varying index methodolocalculations to illustrate dierences in preparedness levels and, subsequently, varying potential policy decisions.

Principal Findings: Results ound signicant dierences among calculations in multiple preparedness domains, insurveillance, communication, workorce, plans/protocols, and legal inrastructure.

Conclusion: Tese ndings will advance preparedness measurement or health departments to help track and perormance. Tese ndings translate more broadly to ongoing eorts to dene a Public Health Preparedness Index.

Implications or the Field o PHSSR: Tis presentation will help us to better understand the impact that perormance measusystems and perormance management tools can have on public health strategies delivered at local, state, and national levndings serve to advance the measurement and scoring methods and models or public health strategies.

l rtkw, J.d., ph.d., M.p.H., B.a.

ranslating Legal Research to Promote Preparedness Within Public Health Systems


Research Objective: Our rst objective was to analyze key legal issues that arise relative to mental and behavioral healthand shortly ater emergencies. Our second objective was to translate our legal analyses into concise tools or practitionthe public health system.


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Data Sets and Sources: Our set o translational tools was created using the ndings rom legal analyses conducted by ourteam. Te sources or our legal research included legislation, regulation, judicial opinions, and guidance documents roederal, state, and local governments.

Study Design: In consultation with a Project Advisory Group (PAG) consisting o lawyers, ethicists, and public health pract

we identied key legal topics to analyze (e.g., deployment o mental health proessionals in emergencies). For each legal researched, we drated an accompanying translational tool.

Analysis: We created a set o eight translational tools. Each tool was vetted by PAG members rom multiple disciplinmental health, law, preparedness), and revised to incorporate their eedback. Te tools are intended to promote empreparedness or mental and behavioral health within the public health system.

Principal Findings: Law has the potential to both enhance and obstruct emergency response and recovery eorts. Our transtools address this concern by providing inormation and recommendations in areas such as prescribing authority; liabhealth care proessionals; disability rights; and substance abuse treatment.

Conclusion: Some aspects o the legal environment relative to mental and behavioral health may pose challenges wit

public health system, especially during and ater emergencies. Trough our legal research, we identied and analyzed seveo importance to public health practitioners. Our translational tools oer brie analyses and recommendations.

Implications or the Field o PHSSR: Within the public health system, many proessionals have no legal training. We cset o translational tools regarding legal preparedness specically or these individuals. Te tools were vetted by a multidiscgroup, containing several members with no legal training. Te tools will be made available during the presentation.

Wm r, ph.d.

Leadership and its Eects on eam Perormance in Public Health Emergency Response

Co-Investigators: Gulzar Shah, Ph.D., M.S.; Paige Bowen, M.P.H.; Mickey Scullard, M.P.H.; Cheryl Petersen-Kroeber,

Research Objective: Research objectives are to: 1) assess eect o controller-led in situ simulation on emergency response o state health department; 2) study eects o training on team unction, dynamics, and communications among sta respor emergency operations at state health department; and 3) train public health teams or high reliability.

Data Sets and Sources: Tirty trials (one-hour unctional exercises) conducted in the state department operations cente16-month period (May 2010 to September 2011). Data gathered using in situ simulation methodology (recording, live vplayback analysis). Behavioral markers data collected using event set observational tool (24 recordings analyzed); decisiondata collected using decision taxonomy tool (22 recordings analyzed).

Study Design: Tis quasi-experimental intervention with time-series analysis and comparison group determined eectintervention on participants. Te study measured team perormance in public health preparedness context; examined imintervention to achieve high reliability in emergency operations center; and looked at the relationship among behavioral m

decision-making, and team perormance.

Analysis: Using a descriptive, longitudinal analysis, we examined the requency and distribution o behavioral markers to and describe: distinct phases o team ormation and reormation during incident response; patterns and distribution behaviors across phases; and the relationship among behavioral markers (non-technical skills), leaders, and team eectperormance.

Principal Findings: Data indicate that a leaders experience, training, expertise impacts team perormance positively o strong leader), as measured by trial scores. Converse is also true poor leader, negative impact. We iner that team bdependent on/associated with leader behavior, and identiable behaviors o leaders exist based on leadership skills.


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Conclusion: Our research shows that public health emergency response team perormance depends to a certain degree the leader is during the response/exercise. o eectively train and prepare response teams, it is essential to understand hotechnical skills, behavioral markers, and leadership interact and impact team perormance and high reliability.

Implications or the Field o PHSSR: Te intervention may be less important in improving response team perorman

the leader and his training and experience. No study o leaders at the micro-system level exists with respect to behavioral necessary to achieve high reliability in crisis settings. Our data and ndings provide insight into that process.

ezbth F Bjk, J.d., M.s.

Wait! Te Public Health System Looks Like Tat?


Research Objective: o determine whether public health agents are directed to unction as an interconnected, coordinaeective planning and response system or emergencies with public health consequences.

Data Sets and Sources: State laws and regulations directing emergency preparedness, response and recovery.

Study Design: Statutes and regulations in 11 states were identied and screened or relevancy. Numeric representationdierent categories were assigned to the legal text; data were created; and legal networks were presented in a visualizeNetwork analysis measured the inclusiveness, degree and strength o 26 discrete public health agents.

Analysis: Network analysis identied those agents with requently directed roles and responsibilities (inclusivenesscentral to the public health system (degree o connection); those agents that were underutilized; and agents with pairings (strength). Tese analyses allowed or inter-jurisdictional comparisons o how agents are legally directed.

Principal Findings: Agents with consistently high strength or all emergency types included administrative agencies andocials. Unexpectedly, agents with low strength included doctors, departments o agriculture and transportation, and h

Also surprising was that laws gave little directives to health care providers (community health centers, homes health aetc.).

Conclusion: Application o network methods and legal analysis allows planners and policy-makers to see, measure, aninter-state comparisons o legal directives among public health system agents. Consistency in those centrally importansuggests a need or redundancy to prevent inrastructure ailures. Outreach to underutlized agents should be considered

Implications or the Field o PHSSR: Cross-state dierences suggest that legal directives present in some states mconsidered to improve/enhance activities in states where they are absent. Planners and policy-makers can use the legal nmeasures to identiy areas or increased attention. More intensive study o the resulting legal implications needs to be m


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SESSION 2B: ranslation I Room: Toroughbr

Mt: p ew, M.d., d.p.H.Cpc ivtgtnt Ctg Ct pHssruvt

l Vrmck, M.p.H., M.s.W., B.s.

Are the Principles o Partnership or Community-Based Participatory Research Useul or Practice-BasedParticipatory Research?

Co-Investigators: Betty Bekemeier, Ph.D., M.P.A., RN; Anna Hoover, M.A.; Nancy Winterbauer, Ph.D., M.S.

Research Objective: Tis study examined Principles o Partnership or Community-Based Participatory Research (CB

the context o Public Health Practice-Based Research Networks (PH PBRNs). Objectives were to explore the relevancnine CBPR principles (Israel et al., 2003) to public health practice-based research partnerships and their potential to strpractice-academic partnerships.

Data Sets and Sources: An expert panel o PH PBRN leaders rom our states was convened. Data sources included Barbaand colleagues seminal works on CBPR (1998, 2003); historic documents rom the National Coordinating Center or and the authors experiences in CBPR, practice-based participatory research (PBPR), and PH PBRNs.

Study Design: Te study is grounded in various theories o participation, including theories o power, empowermecommunity participation. Te project was designed as an expert panel review and included panelists with substantial knand experience in public health practice, research, multi-stakeholder engagement, and PBPR.

Analysis: Analysis was based on iterative discussion and consensus decision-making, common participatory techniques.

Principal Findings: Te CBPR Principles o Practice are useul to PBPR both in terms o process (reections on principractice) and as strategies or partnership development and strengthening. Principles o equity, co-learning and capacity-bdissemination, and commitment emerged as particularly signicant to partnership development in PH PBRNs.

Conclusion: Results indicated that with the exibility inherent and intended in CBPR, the guidelines are generally uspartnership building in PH PBRNs. Additionally, the process o examining CBPR Principles o Partnership in the coPBPR proved enlightening by prompting deep consideration o requently taken-or-granted aspects o both CPBR and

Implications or the Field o PHSSR: Existing PH PBRNs wishing to strengthen their practice-academic partnershipsas individuals and coalitions interested in developing PH PBRNs, are likely to nd CBPR guidelines helpul in buildsustaining their networks. PH PBRN collaborators exploring the comparison as a group may nd the exploration itse

or strengthening their partnerships.

nc Wtb, ph.d., M.a., M.s.

Pracademics as Culture Brokers in Practice-Based Participatory Research

Co-Investigators: Carole Myers, Ph.D., RN

Research Objective: Study objectives were to: 1) describe roles and responsibilitiespracademics(individuals with publipractice and academic experience) are engaged in; and 2) describe the special insight pracademics bring to their roles in


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and academia, emphasizing tensions between practitioners and researchers, benets, and opportunities or interdiscbridges.

Data Sets and Sources: Data consist o qualitative interviews with individuals identied as pracademics. For the purposestudy, pracademics were dened as individuals with proessional experience in both academic and public health practice

Study Design: Recruitment began with six individuals known to the investigators to meet the study denition o a pracAt the conclusion o the qualitative interviews, participants identied additional individuals meeting the study denitioreerral). Purposive sampling ensured a reasonable mix o Public Health Practice-Based Research Network (PH PBRN) aPH PBRN respondents.

Analysis: We conducted a qualitative descriptive study using content analysis. Our initial coding scheme was inormedliterature and our own experience. Temes were identied based on repeated and close reading o transcripts. Rigor was enby participation o two investigators in qualitative data collection, coding and interpretation.

Principal Findings: Major themes included the recognition that public health academic researchers and practitioners inhdistinct cultural worlds. Dierences are apparent in the language, values, identity, and time-sensitivity o each group. Non

participants valued these relationships and oered a variety o suggestions or improving relationships between academpractitioners.

Conclusion: Public health practitioners and academics dier in a number o important ways that present challenges to pacademic research partnerships. However, recognition o these dierences, along with a commitment to actively opportunities to strengthen collaboration, will benet academic researchers, practitioners and public health practice.

Implications or the Field o PHSSR: A number o tensions exists between public health academic researchers and practIndividuals working in practice-based, public health services and systems research could enhance their work by recognizattending to these tensions by identiying opportunities to strengthen academic-practitioner relationships.

C r. M, ph.d., M.s.n., B.s., rn

Level o Community Engagement in Academic Health Departments

Co-Investigators: Margaret Knight, Ph.D., M.P.H.; Kathleen Amos, M.S.; Julie Grubaugh, M.P.H.; Charles Hamilton, D

Research Objective: Te project objective is to describe the level o engagement in academic health departments (AHperceived by each partner. Engagement involves the mutually benecial exchange o knowledge and resources in the copartnership and reciprocity and the ormation o relationships that inuence, shape, and promote success or both p(Carnegie Foundation).

Data Sets and Sources: Data are being collected rom a convenience sample o sel-identied partner dyads rom the memo the Academic Health Department (AHD) Learning Community. Each partner dyad consists o a primary representatthe practice and academic organization jointly involved in an AHD.

Study Design: Te survey tool that will be utilized is derived with permission rom the PARNER survey tool. Te subeen altered by changing the question language to reect the ocus on dyads. Questions were also added to assess the orbasis o each dyad and to collect additional demographic inormation.

Analysis: Descriptive statistics will be employed or quantitative responses. Open-ended, qualitative responses will be ausing conventional (inductive) content analysis. Conventional, or inductive, content analysis develops categories rom rather than rom the literature and is ideal when there is l

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