University of KentuckyUKnowledge

Health Management and Policy Presentations Health Management and Policy

4-17-2012

Using State and Local Health Survey Data toAdvance PHSSRGlen P. MaysUniversity of Kentucky, glen.mays@cuanschutz.edu

Right click to open a feedback form in a new tab to let us know how this document benefits you.

Follow this and additional works at: https://uknowledge.uky.edu/hsm_present

Part of the Econometrics Commons, Health and Medical Administration Commons, HealthEconomics Commons, Health Policy Commons, Health Services Administration Commons, andthe Health Services Research Commons

This Presentation is brought to you for free and open access by the Health Management and Policy at UKnowledge. It has been accepted for inclusionin Health Management and Policy Presentations by an authorized administrator of UKnowledge. For more information, please contactUKnowledge@lsv.uky.edu.

Repository CitationMays, Glen P., "Using State and Local Health Survey Data to Advance PHSSR" (2012). Health Management and Policy Presentations.57.https://uknowledge.uky.edu/hsm_present/57

http://uknowledge.uky.edu/?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttp://uknowledge.uky.edu/?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttps://uknowledge.uky.edu?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttps://uknowledge.uky.edu/hsm_present?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttps://uknowledge.uky.edu/hsm?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttps://uky.az1.qualtrics.com/jfe/form/SV_9mq8fx2GnONRfz7https://uknowledge.uky.edu/hsm_present?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttp://network.bepress.com/hgg/discipline/342?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttp://network.bepress.com/hgg/discipline/663?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttp://network.bepress.com/hgg/discipline/1085?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttp://network.bepress.com/hgg/discipline/1085?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttp://network.bepress.com/hgg/discipline/395?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttp://network.bepress.com/hgg/discipline/747?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttp://network.bepress.com/hgg/discipline/816?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPageshttps://uknowledge.uky.edu/hsm_present/57?utm_source=uknowledge.uky.edu%2Fhsm_present%2F57&utm_medium=PDF&utm_campaign=PDFCoverPagesmailto:UKnowledge@lsv.uky.edu

Using State and Local

Health Survey Data

to Advance PHSSR

Glen P. Mays, PhD, MPH

University of Kentucky

Keeneland Conference on Public Health Services & Systems Research • Lexington, KY • 17 April 2012

Missed opportunities in public health

delivery

Large segments of the populations at risk are not covered by evidence-based public health practices:

Smoking cessation

Aspirin use

Influenza vaccination

Hypertension control

Nutrition and physical activity programming

HIV prevention

Family planning

Substance abuse prevention

Interpersonal violence prevention

Maternal and infant home visiting for high-risk populations

Fundamental empirical questions

Which programs, interventions, policies, delivery systems

(mechanisms)….

Work best (outcomes)…

In which institutional & community settings (contexts)…

And why (causal pathways, active ingredients)?

Pawson and Tilley 1997

PHSSR’s place in the continuum

Intervention

Research

What works – proof of efficacy

Controlled trials

Guide to Community Preventive Services

Services/Systems

Research

How to organize, implement and sustain in the real-world

– Reach

– Quality/Effectiveness

– Cost/Efficiency

– Equity/Disparities

Impact on population health

Comparative effectiveness & efficiency

Developmental path for PHSSR

Descriptive

Inferential

Translational

Measuring practice & performance

Detecting variation in practice

Examining determinants of variation – Organization – Law & policy

– Financing – Information

– Workforce – Preference

Determining consequences of variation

– Health outcomes – Medical care use – Economic outcomes – Disparities

Testing strategies to reduce harmful,

wasteful, & inequitable variation

in practice and outcomes

The Need for Health Survey Data

in Advancing PHSSR

Descriptive

Inferential

Translational

How are public health services & systems

distributed in relation to population health

needs? Reach to populations at risk

Appropriateness of services

Responsiveness to community preferences

Inequities in delivery

Do communities with more/better systems

and services experience superior health?

Adoption of evidence-based practices

Slater et al. 2007

http://www.ajpm-online.net/current

Variation in Local Public Health Spending

0

5%

1

0%

1

5%

Fra

ctio

n o

f A

ge

ncie

s

$0 $50 $100 $150 $200

Expenditures per capita, 2008

Gini = 0.472 “Local spending varies

by a factor of 13

between the top 20%

and bottom 20% of

communities, even after

adjusting for differences

in demographics, SES,

and service mix.”

Mays et al. 2009

Examining value: prospects for medical care

cost savings

Mays et al. 2009

Variation in System

Composition & Structure

0%

10%

20%

30%

40%

50%

60%

Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 6 Cluster 7

% o

f S

yste

ms

1998

2006

Differentiation High High High Mod Mod Low Low

Integration High High Low Mod Mod Low Mod

Centrality Mod Low High High Low High Low

Comprehensive Conventional Limited Mays et al. 2009

Comprehensive Limited Conventional Regression-adjusted means control for population size, density, age composition, poverty status, racial

composition, and physician supply

Comparing practice effectiveness

across PH system types

Mays et al. Milbank Quarterly 2010.

Public Health System Change and Population Health

Fixed-effects models control for population size, density, age composition, poverty status, racial

composition, and physician supply

Infant Deaths/1000 Live Births

-6.0

-4.0

-2.0

0.0

2.0

4.0

6.0

8.0

Cluster 3 Clusters 4-5 Cluster 6 Cluster 7

0.0

2.0

4.0

6.0

8.0

10.0

Cluster 3 Clusters 4-5 Cluster 6 Cluster 7

-2.0

-1.0

0.0

1.0

2.0

Cluster 3 Clusters 4-5 Cluster 6 Cluster 7

0.0

1.0

2.0

3.0

4.0

Cluster 3 Clusters 4-5 Cluster 6 Cluster 7

-0.1

0.0

0.1

0.2

0.3

0.4

Cluster 3 Clusters 4-5 Cluster 6 Cluster 7

Cancer deaths/100,000 population Heart Disease Deaths/100,000

Influenza Deaths/100,000 Infectious Disease Deaths/100,000

Difference-in-Differences

Estimates

(Reference: Clusters 1-2)

Infant Deaths/1000 Births

Conclusions: moving the field forward

Local and state health survey data can get us inside the “black box” of public health agencies and systems

Agencies &

Systems

Funding

Human capital

Policy & legal

authority

Health &

economic

outcomes Population

needs & risks

Service

delivery

Public Health

System

Public Health Agency

Legal authority

Participation

incentives

Intergovernmental

relationships

Strategic

Decisions

Breadth of

organizations

Leadership

Needs

Perceptions

Preferences

Risks Population &

Environment

Distribution

of effort

Scope of

services

Staffing levels

& mix

Governing

structure Funding levels

& mix

Division of

responsibility

Nature & intensity

of relationships

Scope of

activity

Compatibility

of missions Resources &

expertise

Resources

Threats

Outputs and Outcomes

Scale of

operations

Decision Support •Accreditation

•Performance measures

•Practice guidelines

Reach

Effectiveness

Timeliness

Efficiency

Equity

Adherence to EBPs

Dealing with complex systems

University of KentuckyUKnowledge4-17-2012

Using State and Local Health Survey Data to Advance PHSSRGlen P. MaysRepository Citation

UNC Clinical Scholars Program Lecture