Journal of Public Health Management and Practice最新文献

Correctional facilities serve as a key location to identify and treat those with HIV given high rates of HIV seen in justice-involved individuals; however, substantial barriers exist to accessing HIV care in the community upon release. In response to restricted in-person activities due to COVID-19, the County of Santa Clara (SCC) Jail launched a telephonic visits program in January 2021 to link justice-involved individuals diagnosed with HIV to community HIV care following release. Telephonic visits were conducted by social workers from SCC Public Health Department; these visits entailed conducting an HIV needs assessment, providing education, and offering support services. Following release, individuals were contacted by phone to assist with scheduling appointments, refilling medications, and transportation to clinic appointments. Telephonic visits offered a new opportunity to support HIV linkage to care; connecting with individuals prior to release from jail may mitigate barriers in receiving ongoing HIV care in the community.

Context: Medical-legal partnerships (MLPs) are innovative, promising models that integrate legal service providers and medical professionals to prevent, detect, and address legal, social, and economic needs arising from social inequities that may negatively impact health. The COVID-19 pandemic impacted health care systems across the United States. MLP workflows and legal services were also interrupted by COVID-19 infection prevention and control measures such as no-visitor policies, social distancing, and the cancellation of non-emergent or routine health care services.

Objective: We sought to describe the impact of COVID-19 on legal services provided by an MLP by exploring case types and services provided prior to the COVID-19 pandemic and during the pandemic.

Design: This is an examination of MLP services provided at a Midwestern academic medical center comparing data from three years prior to the pandemic (2017-2019) to three years during the pandemic (2020-2022).

Setting: The MLP is a collaboration between the University of Nebraska Medical Center/Nebraska Medicine (an academic medical center) and Legal Aid of Nebraska and Iowa Legal Aid (legal service providers).

Participants: Case data was drawn from individuals who were MLP patient-clients between 2017 and 2022.

Main outcome measures: The main outcome measures were the number of cases and categories and types of legal services provided by the MLP.

Results: Consistent across time, we found that on average 494 cases were closed each year. Consumer/finance cases decreased significantly from pre-COVID-19 to during the pandemic, while family cases increased significantly during the pandemic. Cases related to income maintenance increased across time.

Conclusions: Through the COVID-19 pandemic experience and understanding the case mix, MLPs and health care champions can be better prepared to understand some of the challenges that may occur and changes that may be necessary to better serve patient-clients during a public health emergency.

Purpose: To develop a set of social determinants of health (SDOH) measurements.

Problem: Despite burgeoning interest in addressing both SDOH and health-related social needs, the evidence on what works is limited due in part to the lack of standardized measures for evaluation.

Methods: In 2020, the Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) identified 5 SDOH domains related to chronic disease for future programmatic work. These included built environment, community connections to clinical care, tobacco-free policies, social connectedness, and food and nutrition security. Subsequently, NCCDPHP launched an effort to develop a set of SDOH measures for evaluating funded programs in these domains. The approach involved a literature scan and a rating process based on 5 criteria relevant to NCCDPHP's SDOH priorities. A complementary community review by 13 multisector community partnerships (MCPs) applied a real-world public health practice lens to measure development. MCPs' ratings were analyzed to create summary scores for each measure, and open-ended feedback was synthesized using rapid qualitative analysis.

Results: The internal workgroup identified 59 measures from the initial 200 measures. Feedback from the MCPs identified issues of relevancy and burden of measures. Their high scores narrowed the 59 measures to 22 covering all 5 domains. In response, CDC is honing the original measures review criteria to include community perspectives.

Conclusion: Public health measures development is often an academic pursuit. Engaging MCPs lends real-world credibility to the development of common SDOH measures.

As the COVID-19 pandemic progressed, reliable, accessible, and equitable community-based testing strategies were sought that did not flood already overburdened hospitals and emergency departments. In Hamilton County, Ohio, home to ~800 000 people across urban, suburban, and rural areas, we sought to develop and optimize an accessible, equitable county-wide COVID-19 testing program. Using Coronavirus Aid, Relief, and Economic Security Act funding, multidisciplinary, multiorganization partners created the test and protect program to deliver safe, reliable testing in neighborhoods and organizations needing it most. Our approach involved: (1) use of geospatial analytics to identify testing locations positioned to optimize access; (2) community engagement to ensure sites were in trusted places; and (3) tracking of data over time to facilitate ongoing improvement. Between August 2020 and December 2021, more than 65 000 tests were completed for nearly 46 000 individuals at community-based testing sites. These methods could have application beyond COVID-19 and our region.

Context: The first case of mpox was detected in the United States in a Laboratory Response Network (LRN) laboratory at the Massachusetts Department of Public Health on May 17, 2022. Through previous years of smallpox preparedness efforts by the United States government, testing capacity in LRN laboratories across the United States utilizing the FDA-cleared Centers for Disease Control and Prevention (CDC) Non-variola orthopoxvirus (NVO) test was approximately 6000 tests weekly across the nation prior to the mpox outbreak. By early June 2022, the LRN laboratories had capacity to perform up to 8000 tests per week. As the outbreak expanded, cases were identified in every United States state, peaking at ~3000 cases per week nationally in August 2022.

Objective: Although NVO testing capacity in LRN laboratories exceeded national mpox testing demand overall, LRN testing access in some areas was challenged and test expansion was necessary.

Participants: CDC engaged with partners and select commercial laboratories early to increase diagnostic testing access by allowing these commercial laboratories to utilize the NVO test.

Setting: The expansion of testing to commercial laboratories increased testing availability, capacity, and volume nationwide. This was the first time that CDC shared an FDA 510k-cleared molecular test with commercial laboratories to support a public health emergency.

Design: Extensive efforts were made to ensure the CDC NVO test was used appropriately in the private sector and that the transfer process met regulatory requirements.

Main outcome measures, results, conclusions: These novel methods to expand NVO testing to commercial laboratories increased national testing capacity to 80 000 mpox tests/week. Test volumes among these laboratories never exceeded this expanded capacity. The rapid increase in the nation's testing capacity, in conjunction and coordination with other public and private health efforts, helped to detect cases rapidly. These actions demonstrated the importance of highly functional and efficient public health and private sector partnerships for responding to public health emergencies.

Objective: Maintaining a skilled public health workforce is essential but challenging given high turnover and that few staff hold a public health degree. Situating workforce development within existing structures leverages the strengths of different organizations and can build relationships to address public health challenges and health equity. We implemented and evaluated an innovative, sustainable model to deliver an established evidence-based public health (EBPH) training collaboratively among Prevention Research Centers (PRC), local and state health departments, and Public Health Training Centers (PHTC).

Design: Quantitative data: quasi-experimental, 1-group pre-post. Qualitative data: cross-sectional. Data were collected between December 2021 and August 2022.

Setting: Four US sites, each a partnership between a PRC, local or state health department, and a PHTC.

Participants: Governmental public health staff and representatives from other organizations that implement public health programs in practice settings.

Main outcome measures: Course participants completed a pre- and postcourse survey self-rating 14 skills on a 5-point Likert scale. Differences were analyzed using mixed effects linear models. In-depth interviews (n = 15) were conducted with course faculty and partners to understand: (1) resources contributed, (2) barriers and facilitators, (3) benefits and challenges, and (4) resources needed to sustain this model. Interviews were transcribed verbatim, and a thematic analysis identified themes.

Results: Statistically significant increases in all skills were observed from pre- to postcourse (n = 241 at post, 90% response). The skills with the largest increases were understanding economic evaluation enough to inform decision-making (mean change = 1.22, standard error [SE] = 0.05) and developing an action plan (mean change = 1.07, SE = 0.07). Facilitators to delivering the course included having a shared goal of workforce development, existing course curricula, and dedicated funding for delivering the course.

Conclusions: Collaborative delivery of the EBPH training can ameliorate the effects of high staff turnover, strengthen academic-practice relationships, and promote population-wide health and health equity.

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.

The Centers for Disease Control and Prevention (CDC) responds to public health emergencies at various levels within its organization. Overtime, CDC's response capabilities have matured across the organization due to years of emergency management investment and experience across the agency. In 2019, CDC began to implement the Graduated Response Framework to formalize an approach for managing public health emergencies that recognizes its response capabilities and meets the evolving needs of the country. This brief report summarizes CDC's Graduated Response Framework structure, and how response management escalates and de-escalates according to resource needs and complexity.