Public Health Services And Systems Research Research Articles

Rebuilding public health on more than thoughts and prayers.

Sweeping reviews will be conducted once the COVID-19 pandemic concludes to support public health system strengthening. Unfortunately, these reviews will find what past reviews on public health in Canada have found: limited evidence on the organization, financing, and delivery of public health services. This is due to inattention to the field of public health services and systems research (PHSSR) in Canada. To avoid this pandemic becoming “just another public health crisis,” PHSSR must be prioritized by public health and health service research associations, funders, and scholars.

Filling the Gaps in Data and Methods for Public Health Services and Systems Research (PHSSR)

Introduction: The goal of aligning the delivery of public health and medical care services so as to achieve population-wide improvements in health status is not new. Yet the urgency to achieve greater alignment has increased as the prevalence of costly and preventable diseases and injuries grows, and as incentives for health care system redesign take hold through Affordable Care Act implementation. The science of public health services and systems research (PHSSR) can leverage this opportunity for change by bringing data together from public health and health care systems to support a holistic and integrated learning health system that maximizes the value of new data streams.Issue Overview: This joint issue of eGEMs and Frontiers in PHSSR displays the viewpoints of diverse authors to enhance the types and sources of data that are available to understand and improve population health, and to integrate these data where possible. Four primary themes emerge from the papers: (1) the vision and strategy needed to support the role of data and methods in advancing population health in the United States; (2) the need to improve the infrastructure required to understand public health financing and organization; (3) the importance of making early, meaningful use of health information technology (IT) to achieve these goals; and (4) the need for new approaches and partners to improve measurement strategies and assess population health.Next Steps and Considerations for the Field: eGEMs and Frontiers in PHSSR hope that, over time, this literature will continue to grow, identifying opportunities for multidisciplinary teams to work with communities and address common priorities that fill in existing information gaps such as those identified in the special issue.

Transforming public health systems: using data to drive organizational capacity for quality improvement and efficiency.

Introduction:This paper examines the organization, services, and priorities of public health agencies and their capacity to be learning public health systems (LPHS). An LPHS uses data to measure population health and health risks and to evaluate its services and programs, and then integrates its own research with advances in scientific knowledge to innovate and improve its efficiency and effectiveness.Public Health Agencies and Impact for LPHS:Public health agencies’ (PHA) organizational characteristics vary across states, as does their funding per capita. Variations in organization, services provided, and expenditures per capita may reflect variations in community needs or may be associated with unmet needs. The status of legal statutes defining responsibilities and authorities and their relationships to other public and private agencies also vary. Little information is available on the efficiency and effectiveness of state and local PHAs, in part due to a lack of information infrastructure to capture uniform data on services provided. There are almost no data on the relationship of quality of services, staff performance, and resources to population health outcomes. By building a capacity to collect and analyze data on population health within and across communities, and by becoming a continuous learning PHA, the allocation of resources can more closely match population health needs and improve health outcomes. Accreditation of every PHA is an important first step toward becoming a learning PHA.Conclusions:Public Health Services and Systems Research (PHSSR) is beginning to shed light on some of these issues, particularly by investigating variation across PHAs. As this emerging discipline grows, there is a need to enhance the collection and use of data in support of building organized, effective, and efficient LPHSs with the PHA capacity to continually improve the public’s health.

Public Health Systems and Services Research: Building the Evidence Base to Improve Public Health Practice

Public health services and systems research (PHSSR) is the American designation for a field that uses a number of research disciplines and perspectives to examine the organization of public health systems, how they are financed, how they deliver public health services, the quality and costs of services they deliver, and the impact of variations in all these areas on population health; it is closely related to health services research (HSR), and uses many of the same methods as HSR. This article traces the developmental path of PHSSR, identifies organizations that have been critical in its growth, provides examples of PHSSR that demonstrate the potential it has to improve public health practice, and discusses the future of PHSSR and the use of PHSSR to influence public policy. While there have been sporadic attempts to examine the public health system in the United States since the early 20th century, PHSSR has only been a formally recognized area of scientific inquiry since the early 2000s. PHSSR has experienced rapid growth, and evolved from mainly descriptive research to inferential research, and towards yielding results that suggest causation rather that correlation. While PHSSR as a field shows great promise to improve public health practice, in order for it to fulfill that promise it is vital that PHSSR produce results that are of use to the practice and policy making communities.

Learning by Doing for Public Health Improvement

All too often, the knowledge gained through learning-by-doing in public health fails to be fully harvested and disseminated because of missed opportunities to carefully study the experiences and innovations occurring in practice. The field of public health services and systems research (PHSSR) has emerged to capitalize on these opportunities before they are missed. This article is available in Frontiers in Public Health Services and Systems Research: http://uknowledge.uky.edu/frontiersinphssr/ vol2/iss1/1 he public health profession has long been a bastion for innovation and experimentation, often driven by economic and epidemiological necessities. All too often, however, the knowledge gained through “learning by doing” in public health fails to be fully harvested and disseminated because of missed opportunities to carefully study the experiences and innovations occurring in practice. The field of public health services and systems research (PHSSR) has emerged to capitalize on these opportunities before they are missed. The central objective of Frontiers is to help share the resulting knowledge as broadly and rapidly as possible across the public health enterprise. With the new year of 2013, we open Volume 2 of Frontiers with some important new studies and also some innovations in the journal’s operations, reflecting our own learning by doing. First, the innovations in scholarship. Our first issue of 2013 includes an important and very timely new study by Harold Schmidt at the University of Pennsylvania that examines the acceptability of wellness incentive programs used in the workplace. He finds that reward-based incentives are favored by the public over penalty-based ones by a factor of four, and that the acceptable size of penalty-based programs is quite small. These findings come on the heels of the federal government’s release of proposed new rules governing the design of workplace wellness programs under the Affordable Care Act. Also in this first issue of the year, Georgetown University’s Sara Rosenbaum and colleagues offer a comparative analysis of federal and state community benefit reporting systems for tax-exempt hospitals. The authors find that most state programs lack the specificity and clarity that is contained in the new federal requirements created under the Affordable Care Act, particularly regarding how community benefit is defined, categorized and reported. Together, these studies offer new insight into the roles that key private-sector stakeholders can and will play in transforming the American public health system. Other new studies in this issue examine social media adoption among public health agencies, public health roles within systems of care for children with special health care needs, and models of dissemination and implementation in public health. Next, our innovations in dissemination. Our first six months of learning to operate the Frontiers journal have taught us that a major bottleneck in the production of a peer-reviewed journal is the peer-reviewed part of the equation. Securing sufficient numbers of willing and qualified reviewers to read and comment on Frontiers submissions on a rapid-cycle schedule is challenging. For journal’s quick turn-around model to work, not only must its authors be brief, timely and to-the-point in their contributions, but the journal’s peer-reviewers must also follow suit. To address this issue, we are providing much more targeted and tailored instructions to reviewers on how to conduct a rapidcycle assessment of Frontiers submissions, and we are continuing to expand our reviewer pool. Additionally, we are pleased to announce that beginning with this issue, Frontiers is moving to a rolling publication schedule for articles. This will allow us to release articles individually as soon as they complete the production cycle, rather than waiting for a full issue to be complete. This will allow new knowledge to reach our stakeholders in practice, policy, and research even faster than before. We are excited about these improvements to the journal, and we hope they will add to the utility that Frontiers offers its readership as an engine for the open science movement in public health. T 3 Mays: Learning by Doing Published by UKnowledge, 2013

Public Health: Back to the Future

Public Health: Back to the Future

Advancing the Science of Delivery

Advancing the Science of Delivery

Defining Organizational Capacity for Public Health Services and Systems Research

More than a decade has passed since a conceptual framework was introduced to guide public health services and systems research (PHSSR) and elucidate the relationships associated with system performance. Since then, research has primarily focused on performance, standards, and key processes, with less emphasis on identification of measures or methods. Capacity lies at one end of the conceptual framework, although little emphasis has been placed on measuring and defining "capacity" of the public health system. This is striking, given organizational capacity is a critical determinant of performance and is necessary for understanding systematic effectiveness, sustainability, or generalizability. As a nascent field, PHSSR needs to develop a definition of organizational capacity and elucidate its relationship within a research framework. Evidence must be developed on the temporal and causal relationships between capacity, process/performance, and outcomes. The purpose of this article was to review research frameworks and capacity measures in various disciplines to expand the existing PHSSR conceptual framework.

A National Research Agenda for Public Health Services and Systems

The field of public health services and systems research (PHSSR) has emerged over the past decade to produce the evidence needed to address critical uncertainties about how best to organize, finance, and deliver effective public health strategies to all Americans. To advance these efforts, a national PHSSR research agenda–setting process was used to identify a broad inventory of information needs and uncertainties that public health stakeholders face in the domains of public health workforce, public health system structure and performance, public health financing, and public health information and technology. This paper presents the results of an expert review process used to transform the identified information needs into a concise set of research questions that can be pursued through new scientific inquiry in PHSSR.Established research frameworks were used to specify the contexts, mechanisms of action, and outcomes within the public health system that require further study. A total of 72 research questions were developed from the 113 original items in the PHSSR inventory of information needs. The questions include both persistent problems and newly emerging needs in public health practice and policy. The resulting research agenda provides a starting point for mobilizing the public health scientific enterprise around contemporary, high-priority uncertainties identified by broad cross sections of public health stakeholders. Regular updates to this agenda will be required to achieve continuous improvements in both the science and practice of public health.

New Public Health Services and Systems Research Agenda: Directions for the Next Decade

For years we have known the value of assessing the delivery and effectiveness of individual clinical services and how factors such as structure, organization, and finance influence the quality and quantity of clinical care. There is a comparable field in public health called public health services and systems research (PHSSR) that studies system-level factors and their association to public health delivery and the health of populations. Mays and colleagues1 have defined public health services and systems research as a field of study that examines the organization, finance, and delivery of public health services in communities and the impact of these services on public health.

Mapping the Multidisciplinary Field of Public Health Services and Systems Research

Public health services and systems research (PHSSR) is the field of study charged with evaluating the public health system. PHSSR currently lacks a clear identity integrating the many theories, approaches, and disciplines contributing to the field. Experts in PHSSR were consulted to identify 11 key published PHSSR studies. With these articles as a starting point, a newly developed citation data collection system was used to collect a sample of 2986 documents connected to the key articles through citation linkages. Data were collected in October 2009. Citation network methods and latent position cluster modeling were used to examine the network of documents. A subset of 108 documents comprising the backbone of the network was identified through main-path analysis. Four unique clusters were identified within the main path. The core cluster consisted of older articles focused on local health department activities, partnerships, and effectiveness. The three non-core clusters focused on public health law, behavioral interventions, and national performance standards. Although all non-core clusters cited the core, there was little crosstalk among the non-core clusters, a pattern consistent with multidisciplinary fields. PHSSR appears to be a multidisciplinary field with research happening in silos across different research areas. Developing transdisciplinary research connections across PHSSR is necessary to meet national PHSSR goals.

Evolution of Coauthorship in Public Health Services and Systems Research

Public health services and systems research (PHSSR) focuses on the structure, organization, and legal basis of domestic public health activities and their effect on population health. An accurate description of the field is needed to empower funding agencies and other stakeholders to coordinate PHSSR activities and to foster the development of the field. The purpose of the study is to characterize the emerging community of researchers engaged in PHSSR. This study (1) describes dynamics of this growing community and (2) identifies research themes, subgroups within the field, and collaboration among groups. Coauthorship network visualization of selected research publications in the MEDLINE bibliographic database between 1988 and May 2010. PHSSR has emerged gradually with noticeable growth after 1994 and after 2004. The network of PHSSR research has a core-periphery structure. The core includes highly collaborative researchers focusing on topics pertaining directly to PHSSR, such as workforce, quality improvement and performance, law, and information infrastructure. The periphery consists of groups publishing either on general health services research topics or on epidemiologic and clinical topics. Although a nucleus group of productive and engaged individuals participate in PHSSR, most also publish broadly on health services research and population health. This trend suggests that this emerging field cannot yet support a singular focus on PHSSR. Lack of funding sources and defined career paths likely contribute to this pattern. An overview of collaboration in PHSSR is an important step in advancing a coordinated research agenda and attracting sustainable funding streams for this field.

Public Health Services and Systems Research: Entering Adolescence?

In this issue of the American Journal of Preventive Medicine, three sentinel articles are published that examine the growth and development of the field of public health services and systems research (PHSSR).1–3 Rather than focusing on the outcome of the research, the primary focus of these articles is the development and maturation, or lack thereof, of this new discipline. PHSSR is defined as: a multidisciplinary field of study that recognizes and investigates system-level properties and outcomes that result from the dynamic interactions among various components of the public health system and how those interactions affect organizations, communities, environments, and population health status.

Growth of a Scientific Community of Practice: Public Health Services and Systems Research

Public health services and systems research (PHSSR) is an emerging discipline that examines the organization, financing, and delivery of public health services. The objective of this descriptive study is to provide insight into the discipline's growth by examining the researchers, practitioners, and policymakers who are engaged in PHSSR and their expertise, sources of funding, collaboration patterns, productivity, and challenges. A 27-item online survey was conducted and analyzed in 2010. It targeted 2067 individuals who had participated in PHSSR groups, meetings, and events since 2004. The response rate was 41%. Descriptive statistics characterized demographics, expertise and mentoring, funding, publication, and collaboration. Half of the community members became involved in 2004 or after. More than 40% of the community collaborates in some form. Challenges include knowledge distribution, an agenda to secure ongoing funding, and translating research evidence to public health practice. A clear resource for the community is a nucleus of productive and engaged members who foster its growth.

Commentary: Partnership for the Future of Public Health Services and Systems Research

For the Robert Wood Johnson Foundation, this edition of HSR is the end of the beginning for Public Health Services and Systems Research (PHSSR). HSR is the premier health services research journal in the nation, and to have top quality research on PHSSR published in this prestigious journal demonstrates that PHSSR is a bona fide research field that stands ready to answer important research and practice questions. In the pages that follow, the reader will discover that good scholarship can be brought to bear on how best to organize, manage, finance, and administer public health systems and services.