Pub Date : 2024-09-10DOI: 10.1097/phh.0000000000002049
Tori L Cowger,Nicholas B Link,Justin D Hart,Madeline T Sharp,Shoba Nair,Ruchita Balasubramanian,Soroush Moallef,Jarvis Chen,William P Hanage,Loni Philip Tabb,Kathryn T Hall,Bisola O Ojikutu,Nancy Krieger,Mary T Bassett
CONTEXTMonitoring neighborhood-level SARS-CoV-2 wastewater concentrations can help guide public health interventions and provide early warning ahead of lagging COVID-19 clinical indicators. To date, however, U.S. Centers for Disease Control and Prevention's (CDC) National Wastewater Surveillance System (NWSS) has provided methodology solely for communicating national and state-level "wastewater viral activity levels."PROGRAMIn October 2022, the Boston Public Health Commission (BPHC) began routinely sampling wastewater at 11 neighborhood sites to better understand COVID-19 epidemiology and inequities across neighborhoods, which vary widely in sociodemographic and socioeconomic characteristics. We developed equity-centered methods to routinely report interpretable and actionable descriptions of COVID-19 wastewater levels, trends, and neighborhood-level inequities.APPROACH AND IMPLEMENTATIONTo produce these data visualizations, spanning October 2022 to December 2023, we followed four general steps: (1) smoothing raw values; (2) classifying current COVID-19 wastewater levels; (3) classifying current trends; and (4) reporting and visualizing results.EVALUATIONCOVID-19 wastewater levels corresponded well with lagged COVID-19 hospitalizations and deaths over time, with "Very High" wastewater levels coinciding with winter surges. When citywide COVID-19 levels were at the highest and lowest points, levels and trends tended to be consistent across sites. In contrast, when citywide levels were moderate, neighborhood levels and trends were more variable, revealing inequities across neighborhoods, emphasizing the importance of neighborhood-level results. Applying CDC/NWSS state-level methodology to neighborhood sites resulted in vastly different neighborhood-specific wastewater cut points for "High" or "Low," obscured inequities between neighborhoods, and systematically underestimated COVID-19 levels during surge periods in neighborhoods with the highest COVID-19 morbidity and mortality.DISCUSSIONOur methods offer an approach that other local jurisdictions can use for routinely monitoring, comparing, and communicating neighborhood-level wastewater levels, trends, and inequities. Applying CDC/NWSS methodology at the neighborhood-level can obscure and perpetuate COVID-19 inequities. We recommend jurisdictions adopt equity-focused approaches in neighborhood-level wastewater surveillance for valid community comparisons.
{"title":"Visualizing Neighborhood COVID-19 Levels, Trends, and Inequities in Wastewater: An Equity-Centered Approach and Comparison to CDC Methods.","authors":"Tori L Cowger,Nicholas B Link,Justin D Hart,Madeline T Sharp,Shoba Nair,Ruchita Balasubramanian,Soroush Moallef,Jarvis Chen,William P Hanage,Loni Philip Tabb,Kathryn T Hall,Bisola O Ojikutu,Nancy Krieger,Mary T Bassett","doi":"10.1097/phh.0000000000002049","DOIUrl":"https://doi.org/10.1097/phh.0000000000002049","url":null,"abstract":"CONTEXTMonitoring neighborhood-level SARS-CoV-2 wastewater concentrations can help guide public health interventions and provide early warning ahead of lagging COVID-19 clinical indicators. To date, however, U.S. Centers for Disease Control and Prevention's (CDC) National Wastewater Surveillance System (NWSS) has provided methodology solely for communicating national and state-level \"wastewater viral activity levels.\"PROGRAMIn October 2022, the Boston Public Health Commission (BPHC) began routinely sampling wastewater at 11 neighborhood sites to better understand COVID-19 epidemiology and inequities across neighborhoods, which vary widely in sociodemographic and socioeconomic characteristics. We developed equity-centered methods to routinely report interpretable and actionable descriptions of COVID-19 wastewater levels, trends, and neighborhood-level inequities.APPROACH AND IMPLEMENTATIONTo produce these data visualizations, spanning October 2022 to December 2023, we followed four general steps: (1) smoothing raw values; (2) classifying current COVID-19 wastewater levels; (3) classifying current trends; and (4) reporting and visualizing results.EVALUATIONCOVID-19 wastewater levels corresponded well with lagged COVID-19 hospitalizations and deaths over time, with \"Very High\" wastewater levels coinciding with winter surges. When citywide COVID-19 levels were at the highest and lowest points, levels and trends tended to be consistent across sites. In contrast, when citywide levels were moderate, neighborhood levels and trends were more variable, revealing inequities across neighborhoods, emphasizing the importance of neighborhood-level results. Applying CDC/NWSS state-level methodology to neighborhood sites resulted in vastly different neighborhood-specific wastewater cut points for \"High\" or \"Low,\" obscured inequities between neighborhoods, and systematically underestimated COVID-19 levels during surge periods in neighborhoods with the highest COVID-19 morbidity and mortality.DISCUSSIONOur methods offer an approach that other local jurisdictions can use for routinely monitoring, comparing, and communicating neighborhood-level wastewater levels, trends, and inequities. Applying CDC/NWSS methodology at the neighborhood-level can obscure and perpetuate COVID-19 inequities. We recommend jurisdictions adopt equity-focused approaches in neighborhood-level wastewater surveillance for valid community comparisons.","PeriodicalId":520109,"journal":{"name":"Journal of Public Health Management & Practice","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1097/phh.0000000000002053
Wendy Ellis,Kristen Hayes,Esmeralda Salas,Stephanie A Bultema,Tahlia Gousse,Kuan-Lung Daniel Chen
CONTEXTResilience Catalysts (RC) in Public Health provides local health departments (LHDs) with a process and technical assistance (TA) to operationalize the Community Health Strategist (CHS) role, foster equity, and support community resilience through policy, practice, and program change across multiple sectors.OBJECTIVESThis evaluation sought to (1) identify essential elements of the RC process and TA that help LHDs address the systemic drivers of adversity and inequity, and (2) expand understanding of RC's preliminary impact and inform implications for theory, practice, and funding in the post-COVID context.DESIGNThe mixed-methods evaluation incorporated online surveys and semi-structured interviews. Key themes and takeaways were identified using framework analysis, constant comparison analysis, and descriptive statistics.SETTINGThe evaluation was conducted in 12 cities and counties across the United States, including California, Colorado, Florida, Iowa, Kentucky, Maryland, Massachusetts, New Jersey, North Carolina, Ohio, Tennessee, and Washington.PARTICIPANTSSurvey participants consisted of 29 representatives of 11 RC sites. Interview participants included 33 individuals: 19 representatives of 9 RC sites and 14 individuals representing RC TA providers and funders.MAIN OUTCOME MEASURESThe evaluation measured outcomes related to collaborative engagement, addressing inequity, systems change, knowledge change, ability to work within a local political and community context, sustainability, and scalability.RESULTSEvaluation results demonstrate outcomes related to community engagement, expansion of system-level thinking, advancing health and racial equity, clarity and understanding of RC process, building LHD and partners' capacity and skills needed to embody the CHS role.CONCLUSIONSThe RC process prepared LHDs to operationalize the CHS role by providing the knowledge, skills, and capacities needed to understand root causes of adversity and inequity, address structural racism as a public health issue, and develop collaborative plans for addressing root causes.
CONTEXTResilience Catalysts (RC) in Public Health (LHDs) 为地方卫生部门（LHDs）提供流程和技术援助（TA），以落实社区卫生战略家（CHS）的角色，促进公平，并通过跨多个部门的政策、实践和计划变革来支持社区复原力。该评估旨在：（1）确定 RC 流程和技术援助的基本要素，以帮助地方保健发展机构解决逆境和不平等的系统性驱动因素；（2）扩大对 RC 初步影响的理解，并为后 COVID 环境下的理论、实践和资金提供信息。采用框架分析法、恒定比较分析法和描述性统计法确定了关键主题和收获。地点评估在美国的 12 个城市和县进行，包括加利福尼亚州、科罗拉多州、佛罗里达州、爱荷华州、肯塔基州、马里兰州、马萨诸塞州、新泽西州、北卡罗来纳州、俄亥俄州、田纳西州和华盛顿州。访谈参与者包括 33 人：主要结果测量评估测量了与合作参与、解决不公平问题、系统变革、知识变革、在当地政治和社区背景下工作的能力、可持续性和可扩展性有关的结果。结果评估结果显示了与社区参与、扩展系统级思维、促进健康和种族公平、明确和理解 RC 流程、建设 LHD 和合作伙伴体现 CHS 角色所需的能力和技能相关的成果。结论RC 流程通过提供理解逆境和不公平的根本原因所需的知识、技能和能力，解决作为公共卫生问题的结构性种族主义，并制定解决根本原因的合作计划，为 LHD 履行 CHS 角色做好了准备。
{"title":"Addressing Systemic Inequities: An Evaluation of the Resilience Catalysts in Public Health Program.","authors":"Wendy Ellis,Kristen Hayes,Esmeralda Salas,Stephanie A Bultema,Tahlia Gousse,Kuan-Lung Daniel Chen","doi":"10.1097/phh.0000000000002053","DOIUrl":"https://doi.org/10.1097/phh.0000000000002053","url":null,"abstract":"CONTEXTResilience Catalysts (RC) in Public Health provides local health departments (LHDs) with a process and technical assistance (TA) to operationalize the Community Health Strategist (CHS) role, foster equity, and support community resilience through policy, practice, and program change across multiple sectors.OBJECTIVESThis evaluation sought to (1) identify essential elements of the RC process and TA that help LHDs address the systemic drivers of adversity and inequity, and (2) expand understanding of RC's preliminary impact and inform implications for theory, practice, and funding in the post-COVID context.DESIGNThe mixed-methods evaluation incorporated online surveys and semi-structured interviews. Key themes and takeaways were identified using framework analysis, constant comparison analysis, and descriptive statistics.SETTINGThe evaluation was conducted in 12 cities and counties across the United States, including California, Colorado, Florida, Iowa, Kentucky, Maryland, Massachusetts, New Jersey, North Carolina, Ohio, Tennessee, and Washington.PARTICIPANTSSurvey participants consisted of 29 representatives of 11 RC sites. Interview participants included 33 individuals: 19 representatives of 9 RC sites and 14 individuals representing RC TA providers and funders.MAIN OUTCOME MEASURESThe evaluation measured outcomes related to collaborative engagement, addressing inequity, systems change, knowledge change, ability to work within a local political and community context, sustainability, and scalability.RESULTSEvaluation results demonstrate outcomes related to community engagement, expansion of system-level thinking, advancing health and racial equity, clarity and understanding of RC process, building LHD and partners' capacity and skills needed to embody the CHS role.CONCLUSIONSThe RC process prepared LHDs to operationalize the CHS role by providing the knowledge, skills, and capacities needed to understand root causes of adversity and inequity, address structural racism as a public health issue, and develop collaborative plans for addressing root causes.","PeriodicalId":520109,"journal":{"name":"Journal of Public Health Management & Practice","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1097/phh.0000000000002056
Kristi Bentler,Lexie Barber,Anna K Lintelmann,Darcia M Dierking,Abby C Meyer,Ashley Comer,Jennifer Hauser
CONTEXTDespite the undeniable success of newborn screening (NBS), numerous barriers exist regarding long-term follow-up (LTFU) of children with conditions included in NBS. Furthermore, there is a focus on condition-specific follow-up with no national guidelines for standard quality measures collected by state public health LTFU programs.PROGRAMMinnesota Department of Health (MDH) Longitudinal Follow-up for NBS.IMPLEMENTATIONA state public health LTFU for NBS quality improvement (QI) project was carried out with collaboration between MDH project team members and a QI Steering Team who provided clinical, public health, education, caregiver, and community perspectives and expertise to MDH. Relevant measures were selected from existing data elements, and additional measures were developed based on exchange between MDH project team and the QI Steering Team. Potential data sources were explored and prioritized. Processes for querying existing data sources such as death records were refined, new sources such as electronic health records and paper/PDF health records were established, and data collection was piloted. The Minnesota Electronic Disease Surveillance System was modified, and an electronic data form was created to promote consistent data abstraction from sources. Throughout the project, progress was evaluated and shared. At project conclusion, MDH project team and the QI Steering Team reviewed project outcomes and approaches to evolve the project into ongoing surveillance.EVALUATIONFive common public health LTFU measures were determined. Overall, 77% of attempted measures were successfully collected. Primary and secondary data sources were adopted. In addition, collected data resulted in 7% of cases that were closed to further public health LTFU, often related to a move out of state.DISCUSSIONThis project established the feasibility of state public health LTFU surveillance of outcomes and health care use by collecting a common data set applicable across NBS conditions.
内容尽管新生儿筛查（NBS）取得了不可否认的成功，但在对 NBS 所含病症的儿童进行长期随访（LTFU）方面仍存在许多障碍。项目明尼苏达州卫生部（MDH）的新生儿筛查纵向随访项目（Longitudinal Follow-up for NBS）在 MDH 项目组成员和 QI 指导小组的合作下开展了州公共卫生新生儿筛查纵向随访质量改进（QI）项目，QI 指导小组为 MDH 提供了临床、公共卫生、教育、护理人员和社区方面的观点和专业知识。从现有的数据元素中选择了相关的衡量标准，并根据 MDH 项目小组和 QI 指导小组之间的交流制定了其他衡量标准。对潜在的数据源进行了探索和优先排序。完善了现有数据源（如死亡记录）的查询流程，建立了新的数据源（如电子健康记录和纸质/PDF 健康记录），并对数据收集进行了试点。对明尼苏达州电子疾病监测系统进行了修改，并创建了电子数据表，以促进从数据源中提取一致的数据。在整个项目过程中，对进展情况进行了评估和共享。在项目结束时，明尼苏达州卫生部项目小组和 QI 指导小组对项目成果和方法进行了审查，以便将该项目发展为持续监测项目。总体而言，成功收集了 77% 的尝试措施。采用了一级和二级数据来源。此外，收集到的数据还导致 7% 的病例因进一步的公共卫生 LTFU 而结案，这些病例通常与迁出本州有关。讨论该项目通过收集适用于各种 NBS 条件的通用数据集，确定了对结果和医疗保健使用情况进行州公共卫生 LTFU 监测的可行性。
{"title":"Using Quality Improvement to Expand and Align State Public Health Long-Term Follow-up Data Collection Across Newborn Screening Conditions.","authors":"Kristi Bentler,Lexie Barber,Anna K Lintelmann,Darcia M Dierking,Abby C Meyer,Ashley Comer,Jennifer Hauser","doi":"10.1097/phh.0000000000002056","DOIUrl":"https://doi.org/10.1097/phh.0000000000002056","url":null,"abstract":"CONTEXTDespite the undeniable success of newborn screening (NBS), numerous barriers exist regarding long-term follow-up (LTFU) of children with conditions included in NBS. Furthermore, there is a focus on condition-specific follow-up with no national guidelines for standard quality measures collected by state public health LTFU programs.PROGRAMMinnesota Department of Health (MDH) Longitudinal Follow-up for NBS.IMPLEMENTATIONA state public health LTFU for NBS quality improvement (QI) project was carried out with collaboration between MDH project team members and a QI Steering Team who provided clinical, public health, education, caregiver, and community perspectives and expertise to MDH. Relevant measures were selected from existing data elements, and additional measures were developed based on exchange between MDH project team and the QI Steering Team. Potential data sources were explored and prioritized. Processes for querying existing data sources such as death records were refined, new sources such as electronic health records and paper/PDF health records were established, and data collection was piloted. The Minnesota Electronic Disease Surveillance System was modified, and an electronic data form was created to promote consistent data abstraction from sources. Throughout the project, progress was evaluated and shared. At project conclusion, MDH project team and the QI Steering Team reviewed project outcomes and approaches to evolve the project into ongoing surveillance.EVALUATIONFive common public health LTFU measures were determined. Overall, 77% of attempted measures were successfully collected. Primary and secondary data sources were adopted. In addition, collected data resulted in 7% of cases that were closed to further public health LTFU, often related to a move out of state.DISCUSSIONThis project established the feasibility of state public health LTFU surveillance of outcomes and health care use by collecting a common data set applicable across NBS conditions.","PeriodicalId":520109,"journal":{"name":"Journal of Public Health Management & Practice","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1097/phh.0000000000002062
Matthew Fifolt,Peg Allen,Andrew Crenshaw,Paul C Erwin,Britt Lang,Amy Belflower Thomas,Ross C Brownson
CONTEXTThis article focuses on 4 small local health departments (LHDs) that were in the process of seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022.OBJECTIVEThe objective of this study was to explore the experiences of 4 small LHDs related to Quality Improvement (QI) and Performance Management (PM) in their pursuit of PHAB reaccreditation or Pathways Recognition.DESIGNA team of researchers conducted 22 qualitative interviews with health department leaders and staff. Findings relative to QI/PM represent an embedded case study since they were part of a larger investigation.SETTINGThe research team conducted interviews remotely with health departments located in the West and Midwest.PARTICIPANTSParticipants included adults at least 18 years old and employed in 1 of 4 health departments.MAIN OUTCOME MEASURESEmergent themes from this qualitative investigation included using QI/PM tracking systems, building staff buy-in for QI/PM, integrating QI/PM into daily work, and advice for other health departments regarding QI/PM.RESULTSParticipants suggested that tracking systems helped them manage QI/PM processes. Staff buy-in for QI/PM was strengthened by building a sense of ownership of the process and connecting improvement processes to outcomes. Health departments integrated QI/PM into daily work by leadership modeling and communicating expectations. Advice for other health departments included finding a QI system that was easy to follow and recognizing the role of QI/PM in improving performance to better support the wellbeing of the community.CONCLUSIONSQI/PM are important tools for health department effectiveness. Participants affirmed that the primary purposes of QI/PM are to enhance internal processes and improve community health outcomes. Study findings demonstrate how 4 small health departments integrated QI/PM into their public health practice.
{"title":"Using National Public Health Accreditation to Explore Quality Improvement and Performance Management in Small Local Health Departments.","authors":"Matthew Fifolt,Peg Allen,Andrew Crenshaw,Paul C Erwin,Britt Lang,Amy Belflower Thomas,Ross C Brownson","doi":"10.1097/phh.0000000000002062","DOIUrl":"https://doi.org/10.1097/phh.0000000000002062","url":null,"abstract":"CONTEXTThis article focuses on 4 small local health departments (LHDs) that were in the process of seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022.OBJECTIVEThe objective of this study was to explore the experiences of 4 small LHDs related to Quality Improvement (QI) and Performance Management (PM) in their pursuit of PHAB reaccreditation or Pathways Recognition.DESIGNA team of researchers conducted 22 qualitative interviews with health department leaders and staff. Findings relative to QI/PM represent an embedded case study since they were part of a larger investigation.SETTINGThe research team conducted interviews remotely with health departments located in the West and Midwest.PARTICIPANTSParticipants included adults at least 18 years old and employed in 1 of 4 health departments.MAIN OUTCOME MEASURESEmergent themes from this qualitative investigation included using QI/PM tracking systems, building staff buy-in for QI/PM, integrating QI/PM into daily work, and advice for other health departments regarding QI/PM.RESULTSParticipants suggested that tracking systems helped them manage QI/PM processes. Staff buy-in for QI/PM was strengthened by building a sense of ownership of the process and connecting improvement processes to outcomes. Health departments integrated QI/PM into daily work by leadership modeling and communicating expectations. Advice for other health departments included finding a QI system that was easy to follow and recognizing the role of QI/PM in improving performance to better support the wellbeing of the community.CONCLUSIONSQI/PM are important tools for health department effectiveness. Participants affirmed that the primary purposes of QI/PM are to enhance internal processes and improve community health outcomes. Study findings demonstrate how 4 small health departments integrated QI/PM into their public health practice.","PeriodicalId":520109,"journal":{"name":"Journal of Public Health Management & Practice","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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