Journal of Public Health Management and Practice最新文献

Context: International Classification of Diseases (ICD) codes are used for billing but also for surveillance for injuries such as traumatic brain injuries (TBI). While specificity is possible in the ICD-10-CM scheme, use of the code for unspecified injury of head (SO9.9) remains high.

Objectives: This process evaluation sought to understand medical ICD-10-CM coding behaviors for TBI in emergency department (ED) settings.

Design: Semi-structured interviews explored the processes that facilitate or hinder ED physicians from selecting specific ICD codes for TBI and potential points of intervention for increased coding specificity and reducing the use of unspecified codes.

Setting: Video interviews were conducted with a nationwide sample in the United States.

Participants: A purposive snowball sampling strategy was used to recruit 26 ED physicians with experience diagnosing TBI.

Intervention: Semi-structured interviews identified factors related to the selection of specific ICD codes for head injury.

Main outcome measure: Thematic analysis of transcribed data.

Results: Four main themes emerged from the data: the impact of training and expertise, factors related to diagnosis, unclear connections with medical coders, and actionable recommendations. Interviews underscored the context surrounding "unspecified" codes for TBI, including demands from patient care, time pressures, issues around how a diagnosis may impact patient management decisions, and considerations related to mapping within the electronic medical record (EMR) where options may default to an unspecified code.

Conclusions: Findings from this analysis indicate that ED providers may benefit from more robust training on how documentation can better support ICD-10-CM coding for this type of trauma. Revised EMR structures could support efficient coding specificity and clarity.

This study explored how structural empowerment and systems thinking enabled public health nutritionists to adapt to complex environments. Interviews with 14 dietitian-prepared nutritionists from state governmental public health agencies elucidated 3 key themes: leveraging relationships was essential to exercising structural empowerment and systems thinking; accessing resources and support were priorities in supporting public health nutrition initiatives; and addressing gaps in formal training, specific to systems thinking, enabled adaptability to work in public health settings. The findings highlight the need for broader examinations into strengthening access to organizational power structures; integrating systems thinking into public health operations; and sustaining professional development for the public health workforce, especially with limited resources. Enhancing access to organizational power structures and applying systems thinking can empower the public health workforce to better adapt to challenges by building relationships, accessing resources and support, and making informed decisions that positively impact population health.

Objectives: To propose a framework for adoption of privacy-preserving record linkage (PPRL) for public health applications.

Methods: Twelve interviews with subject matter experts (SMEs) were conducted virtually and coded using an inductive approach. A collaborative session was conducted with SMEs to identify key steps in the PPRL project lifecycle which informed development of a PPRL implementation checklist.

Results: This framework has 2 decision-making levels: the organization level and the project or program level. Organization-level considerations include PPRL governance, the optimal choice among approved PPRL solutions, the need for longitudinal linkages, the potential issue of vendor lock-in, and costs. Program-level considerations include characteristics of the PPRL use case, linkage quality and accuracy, data privacy and use, security thresholds, compatibility with data owners' data architecture, and trade-offs between open-source and commercial PPRL solutions. A PPRL implementation checklist was developed to guide public health practitioners considering PPRL for data linkage.

Conclusions: The framework may be considered by public health entities to guide adoption and implementation of PPRL in public health research and surveillance. Public health experts may refer to this framework and the PPRL implementation checklist when determining the appropriateness of PPRL for specific use cases and implementation planning.

Context: Multisector community partnerships play a pivotal role in public health strategy for understanding and addressing social determinants of health (SDOH) and promoting health equity. The work of these partnerships is well aligned with building community resilience.

Program: The Year 2 Improving Social Determinants of Health-Getting Further Faster (GFF) retrospective evaluation was designed to gather practice-based evidence that can inform future community-driven partnerships to improve chronic disease outcomes and advance health equity by addressing social determinants of health (SDOH).

Implementation: This paper sought to determine how the efforts of multisector community partnerships could also support community resilience. Guided by CDC's Framework for Program Evaluation in Public Health and health equity principles, the GFF evaluation engaged 14 Multisector Community Partnerships to better understand how their SDOH interventions contribute to community changes that improve chronic diseases and advance health equity. Data collection included qualitative discussions along with additional quantitative analyses of SDOH outcomes, costs, and prevention impacts. This paper focuses on insights gathered from qualitative discussions (2 virtual 60-minute discussions with members of each of the 14 Partnerships) around community resilience.

Evaluation: Results from qualitative discussions demonstrate how Partnerships' SDOH efforts created parallel opportunities for nurturing community resilience. For example, Partnerships engaged community members in the design and implementation of SDOH interventions in ways that nurtured a sense of belonging and empowerment to shape their community. To further build community resilience, Partnerships mentioned the importance of sustained and flexible funding, help building stronger partnerships, and a shared goal to build resilience and engage community members.

Discussion: Findings indicate that community partnerships working to address SDOH can drive reciprocal improvements in community resilience-contributions that are critical for advancing health equity. Partnerships suggested that health departments may have opportunities to enhance community resilience through their role as funder, facilitator, and convener.

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: Most major urban areas in the US, including Seattle and King County, have a long-standing lack of public restrooms, handwashing stations, and drinking water, presenting public health risks.

Objective: To aid decision-makers in expanding access, we review available information regarding successful hygiene programs in urban settings to identify shared characteristics and costs.

Design: We reviewed 10 journal articles, 49 news articles, and 54 pieces of gray literature including reports, white papers, and online resources describing real-world hygiene, sanitation, and drinking water programs in US and global urban settings. We selected programs in 8 cities and applied a thematic analysis to identify shared success factors. We also summarized costs where available.

Settings: Calgary (Canada), Denver (Colorado), London (United Kingdom), Los Angeles (California), Portland (Oregon), San Francisco (California), Seattle (Washington), and Vancouver (Canada).

Results: Successful programs usually provide frequent cleaning and maintenance, are designed and operated to discourage crime and misuse, leverage existing infrastructure, and include mobile solutions. Cities can expect an initial cost of at least $133 000 per toilet and annual operating costs of at least $100 000 per toilet.

Conclusions: By employing proven solutions and bringing them to scale over time, cities can promote health while improving quality of life and facilitating movement through public spaces for all. Costs should be understood in the context of expenses such as sidewalk cleaning and human waste removal that are necessitated by a lack of restrooms.

In the past decade, depression has become more visible in the public conversation; depression has also become bound in national divides. We sought to assess (1) whether positive screen for depression is associated with political party affiliation and (2) whether use of mental health care varies by political affiliation. Positive screen for depression did not differ significantly for Republicans versus Democrats in Spring 2023. However, Republicans were less likely to have received treatment for their mental health in the past 12 months. Depression is a bipartisan issue, and improving access to mental health care could be a priority that unites political groups during the upcoming election season.

Context: Representation of racial and ethnic minority groups and sexual and gender minority groups is limited on public health data dashboards. The small size of these populations leads to data being aggregated or suppressed to produce stable estimations and preserve individuals' information privacy. This might, however, limit the usefulness of the represented data for identifying individuals' risk factors and allocating services.

Objective: To explore public health practitioners' concerns about underrepresented populations on public health data dashboards that emerged during a usability evaluation study.

Participants: 20 public health practitioners from New York State, US.

Setting: Virtual Zoom meetings were conducted to monitor the participants' use of a public health dashboard and ask about their experience using it. The collected data, in the form of researchers' notes and audio transcripts, were analyzed using the thematic analysis approach.

Results: Participants were very concerned about the underrepresentation of sexual and gender minority groups and racial and ethnic minority groups on public health data dashboards. Four themes emerged regarding the consequences of the underrepresentation: (1) misinterpretation of risk for underrepresented groups, (2) exacerbating the mistrust between underrepresented populations and the government, (3) a potential disservice to underserved populations if the data is used as the basis for allocating resources, and (4) and unknown impact for the individuals whose demographic information is unknown.

Conclusions: We propose considerations for displaying underrepresented populations on public health data dashboards to improve the utility of the represented data.