Journal of Public Health Management and Practice最新文献

Introduction: Since the occurrence of the COVID-19 pandemic, there has been significant interest in the public health workforce and its development. Substantial emphasis has been placed on the competencies needed for the development of the workforce. As important as this work on competencies is to a competent public health workforce, the certification of public health professionals and the maintenance of their skills and knowledge is of equal importance. The National Board of Public Health Examiners (NBPHE), along with other organizations, plays a key role in this process. Based on the National Board of Public Health Examiner's 2022 JTA, this study investigates the specific tasks that are performed by the public health workforce in each of 10 domains, their criticality and frequency, and the relationship of their criticality to their frequency.

Methods: Using data from the National Board of Public Health Examiners (NBPHE) job task analysis (JTA), the criticality and frequency of tasks and their relationship were investigated through tabular analysis.

Results: Ten tasks were identified as the most critical, focused on the domains of communication, leadership, resource and program management, and law and ethics. The 10 most frequent tasks were the same as the most critical tasks in 8 instances. When the criticality of all tasks was related to their frequency, 12 tasks were found to have high criticality and high frequency, 17 tasks had low criticality and low frequency, and 74 tasks had high criticality and low frequency. In our data, no low criticality tasks were performed frequently.

Discussion: Results are discussed for their relevance to education in public health and practitioner development. A key takeaway is that workforce tasks and competencies appear to provide two different and important ways to analyze workforce activity in future research.

Indiana state government partnered with researchers to develop a real-time dashboard that brings together multiple data sources to provide state and county-level measures around overdose touchpoints, which are settings that people engaged with prior to fatal overdose. Exploration of the dashboard reveals multiple opportunities for overdose prevention and highlights its use as a tool to monitor strategies in reducing overdose deaths.

Context: Facility policies, practices, and culture contribute to inequities in maternal outcomes. In New York State (NYS), Black birthing people are 4 to 5 times more likely to experience maternal mortality than White birthing people.

Objectives: Understanding the racial, ethnic, linguistic, and gender equity policies at NYS birthing facilities can identify areas of improvement to impact care and outcomes.

Design: The design was a cross-sectional study.

Setting: The setting was NYS birthing facilities, which included hospitals and birthing centers.

Participants: Facility leadership completed self-reported surveys from December 2020 through June 2021.

Main outcome measure: Facility equity data were obtained across 4 domains: (1) organizational commitment to equity, (2) staff equity training and evaluation, (3) leadership and staff composition, and (4) patient data, voice, and influence.

Results: Over half of NYS birthing facilities documented a public commitment to equity in their mission, but only 15% had a written equity plan with processes for monitoring progress. Less than one-third of facilities stated that staff from underrepresented racial, ethnic, and language, gender (REaLG) groups were proportionally represented in leadership and management positions. About half of the facilities reported their staff composition reflects their patient population, but only a quarter analyzed staff REaLG demographics to serve diverse patients. Twenty-eight percent of facilities assess diversity in their board of directors, facility leadership, medical leadership, medical staff, and administrative staff. One-third required staff implicit bias training; 17% collected and used data on patient satisfaction regarding racial equity; and 12% engaged affected communities.

Conclusions: Facilities differed in their implementation of policies and practices that support equitable care. Survey data provide facilities with specific areas of improvement to focus their efforts. Equity assessments are an important step for facilities to evaluate their policies and practices and for statewide institutions to develop programming.

Few short-term training programs exist for persons with limited experience or training in public health to support public health initiatives. We describe a public health training designed by the Pennsylvania (PA) Training Center for Health Equity for the PA Community Health Organizer (CHO) program. The CHO program was created to address the immediate needs of underserved communities and promote lasting health equity during the pandemic. CHOs are professionals who promote community action and align efforts with local organizations to build sustainable public health infrastructure and apply evidence-based practices to program policy, planning, and development. The training content, delivered by Project Extension for Community Healthcare Outcomes (ECHO) in 12 monthly sessions, focused upon foundational public health concepts in a novel community case study approach. The ECHO All Teach, All Learn training model was successful in providing relevant public health information to this new workforce, and the pre-/post-training evaluation demonstrated a positive increase in knowledge across all domains.

Context: Chronic hepatitis B (CHB), caused by hepatitis B virus (HBV), is a risk factor for cirrhosis. The management of HBV-related cirrhosis is challenging, with guidelines recommending treatment initiation and regular monitoring for those affected.

Objective: Our study characterized Kaiser Permanente Southern California patients with HBV-related cirrhosis and assessed whether they received recommended laboratory testing and imaging monitoring.

Design: Retrospective cohort study.

Setting and participants: We identified KPSC members aged ≥18 years with CHB (defined by 2, consecutive positive hepatitis B surface antigens ≥6 months apart) from 2008 to 2019. Of these patients, we further identified patients with potential HBV-related cirrhosis through ICD-10 code diagnosis, adjudicated via chart review.

Main outcome measures: Age, race/ethnicity, laboratory tests (eg, alanine aminotransferase [ALT]), and hepatocellular carcinoma (HCC) screening (based on standard screening recommendations via imaging) were described in those with HBV-related cirrhosis versus those without.

Results: Among patients with CHB, we identified 65 patients with HBV-related cirrhosis over ~8 years. Diabetes was the most common comorbidity and was approximately 3 times more prevalent among patients with cirrhosis compared to patients without cirrhosis (21.5% vs. 7.1%). Of the 65 patients with cirrhosis, 72.3% (N = 47) received treatment. Generally, we observed that liver function tests (eg, ALT) were completed frequently in this population, with patients completing a median of 10 (6, 16) tests/year. All patients with cirrhosis had ≥1 ALT completed over the study period, and almost all cirrhotic patients (N = 64; 98.5%) had ≥1 HBV DNA test. However, the proportion of yearly imaging visits completed varied across the study years, between 64.0% in 2012 and 87.5% in 2009; overall, 35% (N = 23) completed annual imaging.

Conclusions: Our findings suggest that among patients with HBV-related cirrhosis, at the patient-level, completed imaging orders for HCC screening were sub-optimal. However, we observed adequate disease management practices through frequent liver function tests, linkage to specialty care, image ordering, and shared EHR between KPSC providers.

A qualitative study was conducted using semi-structured interviews leaders in community-based organizations, health care, and local public health to understand organizational perspectives of collaboration for health equity and identify opportunities to improve collaboration. Twelve leaders were interviewed from March through May 2023 in Kent County, Michigan. All leaders saw collaboration as valuable for advancing health equity. Key themes that affected collaboration and could be a facilitator or barrier to advancing health equity in the community were inclusion, power, relationships, resources, and organizational traits. Leaders articulated the following factors as those that support collaboration for health equity: authentic inclusion, shared decision-making, taking time to foster trusting relationships, adequate resources to support the infrastructure needed for collaborations, organizational flexibility, and individual commitment. Building partnerships with these facilitators in mind may result in more robust, sustainable, and resilient collaboratives.

Context: Rural America faces a dual challenge with a higher prevalence of diabetes mellitus (hereafter, diabetes) and diabetes-related mortality. Diabetes self-management education (DSME) can improve glucose control and reduce adverse effects of diabetes, but certified DSME programs remain disproportionately limited in rural counties than in urban counties.

Objective: The goal of this study is to examine the proportion of urban and rural adults who report having received DSME using a nationwide, 29-state survey while considering the potential consequences of lower service availability.

Design: This cross-sectional study used data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS). Residence was defined as urban (metropolitan county) vs rural (non-metropolitan county). Logistic regression, incorporated survey weights, was used to determine the odds of having received DSME by residence.

Setting: BRFSS is a nationally representative survey, and this study included participants from 29 states that were distributed throughout all regions of the United States.

Participants: The study sample consisted of 28,179 adults who reported having diabetes, lived in one of the states that administered the diabetes module in 2019, and answered all relevant questions.

Main outcome measures: The main outcome measure was whether a participant had ever received DSME. Participants were considered to have received DSME if they self-reported having ever taken a class on how to manage diabetes themselves.

Results: Overall, 54.5% of participants reported having received DSME; proportionately fewer rural residents (50.4%, ±1.1%) than urban residents (55.5%, ±1.0%) reported DSME. Rural disparities persisted after adjusting for demographic, enabling, and need factors (Adjusted Odds Ratio  = 0.79; CI, 0.71-0.89). By sociodemographic factors, Hispanic persons vs non-Hispanic White persons and single vs married/coupled individuals were less likely to report DSME receipt (both 0.76 [0.62-0.94]).

Conclusions: Ongoing national efforts addressing rural disparities in diabetes-related complications should target individuals most at risk for missing current diabetes educational programming and design appropriate interventions.