Statewide Initiatives Research Articles

Does the Future Look Irrigated? Evaluating the Likelihood of Irrigation Adoption Within Alabama

Farmers have time and again adopted new methods or technologies. However, recent increases in global temperatures and occurrences of extreme weather events, call for an urgency to address and reduce the risks associated with climate change. Irrigation is a key adaptation that reduces crop heat stress and enhances agricultural production. Alabama is considered water-rich but lately has experienced increased rainfall variability and temperature extremes. Various state-wide initiatives to increase irrigation have been implemented, but adoption remains limited. Existing studies have explored factors in

The Impact of the Missouri School-Wide Positive Behavior Support (MO SW-PBS) on Disciplinary Exclusions

The negative outcomes of exclusionary discipline practices on children and youth are well established. Fortunately, for the past two decades, research has demonstrated that pro-active instructional approaches and building supportive class and school environments can effectively promote student social, emotional, and behavioral well-being, especially when evidence-based practices are placed within a problem-solving multitiered system of supports such as school-wide positive behavioral interventions and supports (SWPBIS). Recent work examining state-wide behavioral interventions and supports (PBIS) initiatives, which include professional development and technical assistance to school leadership teams, has clearly documented that educators can reduce problem behavior and thereby reduce the need or use for exclusionary discipline practices. This study extends that body of knowledge by examining Missouri’s SWPBIS initiative over time and across grade levels. Using an extant data base, schools implementing SWPBIS with fidelity were compared with nonimplementing schools over 11 school years. Results indicated that schools implementing SWPBIS with fidelity had statistically significant lower rates of exclusionary discipline practices at the primary, middle, and high school level. Results are discussed within the context of past state-wide SWPBIS initiatives.

Filling gaps - a case study in building advocacy capacity in the health promotion workforce.

Public health advocacy is a fundamental part of public health and health promotion practice. However, gaps exist in the provision of public health advocacy knowledge and skill acquisition both in the tertiary environment and within ongoing professional development programmes. The Goulburn Valley Public Health Unit partnered with the Public Health Advocacy Institute to build the skills of 49 public health and promotion professionals in their regions, to enable them to lead an advocacy project that aimed to promote state-wide initiatives. This involved a series of face-to-face skills-based public health advocacy workshops and post workshop e-mentoring. Results included the creation of locally relevant public health advocacy projects and a community of practice.

Variations in Management and Clinical Outcomes for Children With Diabetic Ketoacidosis in an Academic Pediatric Versus Community Emergency Department Setting.

Our objectives were to characterize variations from standardized, evidence-based guidelines in the management of pediatric patients with diabetic ketoacidosis (DKA) based on initial presentation to a tertiary pediatric emergency department (PED) versus a community emergency department (OSH) and compare clinical outcomes. We conducted a retrospective study on children 18 years and younger with DKA who presented to an OSH or PED over a 3-year period. Treatments monitored for variation included intravenous fluid management, insulin delivery, and sodium bicarbonate administrations. Clinical outcomes included time to anion gap correction and on insulin infusion, hypokalemia, hypoglycemia, rapid serum glucose decline, cerebral edema, mechanical ventilation, mortality, and time from initial presentation to hospital discharge. Children with DKA who presented to an OSH (n = 250) were more acidotic (pH 7.11 vs. 7.13, P = 0.001) and had larger anion gaps (28.8 vs. 25.5, P < 0.001) compared with children presenting to the PED (n = 237). The OSH patients were more likely to receive larger fluid boluses (>20 cc/kg or >1000 ml, 43% vs. 4%, P < 0.001), sodium bicarbonate (5% vs. 0%, P < 0.001), and intravenous bolus insulin (28% vs. 0%, P < 0.001). The OSH group were less likely to be started on maintenance intravenous fluids (70% vs. 99%, P < 0.001) or receive potassium in maintenance intravenous fluids (14% vs. 42%, P < 0.001). The OSH group had longer anion gap correction times (754 vs. 541 mins, P < 0.001), insulin infusion times (1018 vs. 854 min, P = 0.003), and times to hospital discharge (3358 vs. 3045 mins, P < 0.001). Incidence of hypokalemia, hypoglycemia, rapid glucose decline, cerebral edema, and deaths were similar between the 2 groups. Our study demonstrated significant variations in the initial management of pediatric DKA patients by OSH facilities that deviated from an evidence-based treatment pathway utilized by a PED. Statewide quality improvement initiatives could help improve the overall clinical care provided to pediatric DKA patients.

Abstract 811: Impact of Medicaid eligibility expansion to adults regardless of immigration status on health insurance access among Latina patients

Abstract Background: Disparities in the receipt of cancer screening and preventive services are strongly associated with health insurance status. Even after federal- and state-wide initiatives to boost access to health insurance such as the Patient Protection and Affordable Care Act (ACA) Medicaid Expansion to all individuals earning ≤138% of the federal poverty level (FPL) and nationwide individual health insurance marketplaces, Latino populations continue to have the highest uninsured rate of any racial or ethnic group in the US, with 17% of Latinos remaining uninsured compared to 5% of non-Hispanic white peers. In 2021, California and Oregon states amended their respective Medicaid program to expand eligibility to adults regardless of immigration status; which could reduce access disparities for patients from Latino communities. This study shows preliminary results of changes in health insurance status among Latina patients (who have multiple cancer prevention services recommended in middle age) receiving care in community health centers. Methods: A retrospective cohort study of Latina, non-Hispanic Black, and non-Hispanic white women ages 50-64 years receiving primary care from 382 community health clinics in California and Oregon. Using 2018, 2019, 2021, and 2022 electronic health record data, we estimated monthly rates of insured-type visits per 100 visits. We compared rates pre- and post-Medicaid eligibility expansion, both within and between race and ethnicity groups. Reported estimates were derived from generalized estimating equations Poisson regression, clustered on clinic, and adjusted for clinic-level demographics. Results: Of 41,960 patients, over half (53%) were Latina, most of whom (83%) preferred Spanish language communication. Latina patients had more uninsured visits pre-Medicaid eligibility expansion than did non-Hispanic Black and white patients (Rate: 27% versus 5% and 4%, respectively). All racial and ethnic groups experienced a decrease in uninsured visit rates, and this change was similar for all groups [Difference-in-difference Latina versus Black patients: 0.77 (95% CI 0.55, 10.7) and versus white patients: 1.02 (95% CI 0.89, 1.17)]. Overall rates of Medicaid-insured visits increased only for Latina patients [pre-to-post Relative Rate=1.06 (95% CI: 1.03-1.10)]. Both non-Hispanic Black and white patients experienced a drop in Medicaid-insured visits. Only Black patients experienced a significant decline in private-insured visits [pre-to-post RR=0.79 (95% CI: 0.70-0.89)]. Conclusion: These early results suggest an uptake of Medicaid-paid visits among Latina patients. This increase in healthcare coverage for Latina patients could significantly reduce disparities in access to primary care and especially in cancer preventive care. Citation Format: Nathalie Huguet, Jorge Kaufmann, Heather Holderness, Margaret Vieira, Gretchen Mertes, Jackilen Shannon, John Heintzman. Impact of Medicaid eligibility expansion to adults regardless of immigration status on health insurance access among Latina patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 811.

Abstract TP55: A Statewide Quality Improvement Project: Identifying Disparities in Dysphagia Screening for Stroke Patients

Objectives: One of the principal cornerstones of the Minnesota Department of Health’s Stroke Program is quality improvement. Minnesota Primary (PSC) and Comprehensive Stroke Center (CSC) hospitals have consistently demonstrated performance below the national benchmark (76%) for dysphagia screening. We formed a workgroup comprised of stroke coordinators from across the Minnesota Stroke System to stratify the data by race, ethnicity, and insurance status and collectively identify ways to improve dysphagia screening for stroke patients. Methods: In 2021, MN Stroke Registry data was analyzed for dysphagia screening performance and compliance. Data was stratified by race, ethnicity and insurance status to assess for variance in performance. Disparities by patient race/ethnicity and an overall underperformance on this measure in MN compared to hospitals nationwide was identified. Work group members developed an action plan to improve resources and increase dysphagia screening performance. Results: In Minnesota, Asian (63%) and African American (68%) stroke patients are less likely to be screened for dysphagia than stroke patients overall (76%). Patients on Medicaid were also slightly less likely to receive dysphagia screening. Statewide initiatives included: guidance on stratifying site-specific data; creation of Impaired Swallowing Education for medical providers accessible on YouTube, cultural considerations, and electronic health record best practices; facilitators and barriers were reported and shared. Conclusions: The overall percentage of dysphagia screening compliance has remained steady at 77%. Continuation of the QI project will focus on identifying group participants that are actively engaged and implementing programmatic changes to improve dysphagia screening and identify disparities within their organizations. Education was successfully disseminated to 136 hospitals across the Minnesota Stroke System with over 450 views on YouTube. The work group is exploring further development of data disaggregation standards, specific to the diverse and growing populations of Minnesota. This is a vital step to develop more effective strategies and interventions that directly address health disparities.

Community and Organizational Readiness to Adopt a Physical Activity Intervention in Micropolitan Settings.

Assessing community and organizational readiness is key to successfully implementing programs. The purpose of this study was to assess the baseline readiness of micropolitan communities to adopt an evidence-based physical activity (PA) intervention by exploring three dimensions: (1) attitudes and current efforts toward prevention, (2) community and organizational climate that facilitates (or impedes) change, and (3) capacity to implement change. Data were collected from community leaders in 14 communities through an online survey in June 2021 (n = 149). Data were analyzed in aggregate using descriptive statistics for multiple-choice responses and content analysis for open ended responses. One-way repeated analyses of variance were used to compare mean score differences. In reference to their attitudes prior to the pandemic, respondents said that addressing PA was "somewhat a priority" in their professional positions (M = 2.01, SD = 0.94), their organizations (M = 2.08, SD = 0.91), and their communities (M = 2.28, SD = 0.88). Current PA efforts included statewide initiatives, community sponsored events/clubs, and youth sports leagues. The community climate included both PA facilitators (mainly outdoor PA resources) and barriers (cost, lack of social services, and an unsupportive PA environment). Individual-level capacity (M = 2.94; SD = 1.21) to adopt a PA program was regarded lower than the community's capacity (M = 3.95; SD = 0.82), and perceptions of capacity at the community level improved even more if technical assistance (M = 3.96; SD = 0.84) or financial support (M = 4.12; SD = 0.80) were provided. Readiness varied by dimension, suggesting the need for tailored implementation supports including technical assistance and financial support.

Statewide Initiatives to Address Youth Suicide Prevention

Statewide Initiatives to Address Youth Suicide Prevention

Implementing contingency management for stimulant use in opioid treatment programs: protocol of a type III hybrid effectiveness-stepped-wedge trial

BackgroundContingency management (CM) is an evidence-based intervention for stimulant use and is highly effective in combination with medication for opioid use disorder. Yet, uptake of CM in opioid treatment programs that provide medication for opioid use disorder remains low. This paradox in which CM is one of the most effective interventions, yet one of the least available, represents one of the greatest research-to-practice gaps in the addiction health services field. Multi-level implementation strategies are needed to address barriers to CM implementation at both the provider- and organization-level. This type III hybrid effectiveness-implementation trial was funded by the National Institute on Drug Abuse to evaluate whether a multi-level implementation strategy, the Science of Service Laboratory (SSL), can effectively promote CM implementation in opioid treatment programs. Specific aims will test the effectiveness of the SSL on implementation outcomes (primary aim) and patient outcomes (secondary aim), as well as test putative mediators of implementation outcomes (exploratory aim).MethodsUtilizing a fully powered type III hybrid effectiveness-implementation trial with a stepped wedge design, we propose to randomize a cohort of 10 opioid treatment programs to receive the SSL across four steps. Each step, an additional 2–3 opioid treatment programs will receive the SSL implementation strategy, which has three core components: didactic training, performance feedback, and external facilitation. At six intervals, each of the 10 opioid treatment programs will provide de-identified electronic medical record data from all available patient charts on CM delivery and patient outcomes. Staff from each opioid treatment program will provide feedback on contextual determinants influencing implementation at three timepoints.DiscussionBetween planning of this protocol and receipt of funding, the landscape for CM in the USA changed dramatically, with multiple Departments of Health launching state-wide CM initiatives. We therefore accelerated the protocol timeline and offered some cursory training resources to all sites as a preparation activity. We also began partnering with multiple Departments of Health to evaluate their rollout of CM using the measures outlined in this protocol.Trial registrationThis study protocol is registered via ClinicalTrials.gov Identifier: NCT05702021. Date of registration: January 27, 2023.

Cross-Sector Intervention Strategies to Target Childhood Food Insecurity in North Carolina

Background Childhood food insecurity increased considerably during the COVID-19 pandemic and is associated with compromised health. Health care systems are increasingly prioritizing food insecurity interventions to improve health, but it is unclear how health systems collaborate with other sectors that are addressing food insecurity. In this study, we aimed to evaluate existing collaborations and explore opportunities for further cross-sector engagement. Methods From December 2020 to March 2021, we conducted semi-structured interviews (N = 34) with informants involved in increasing child food access in North Carolina. Our informants represented different sectors, including community (e.g., food pantry), education (e.g., school lunch program), and government (e.g., Supplemental Nutrition Assistance Program). Rapid qualitative analysis was used to interpret the results and identify themes. Results Informants rarely mentioned the health care sector as a source of referrals or as a collaborator. Barriers limiting access to food insecurity programs were exacerbated by the COVID-19 pandemic, including lack of transportation, stigma deterring use, limited food choice, and burdensome enrollment processes. Stakeholders recommended mitigating barriers through the expansion of food delivery, co-localization of assistance programs in schools and health care settings, increased food choice, and supporting cross-program enrollment mechanisms. Limitations The majority of the stakeholders represented programs from five counties in central North Carolina, with only a few representing statewide initiatives. Conclusions The COVID-19 pandemic both highlighted the fragmented system of food insecurity organizations and accelerated development of cross-sector collaborations to reduce access barriers. Health care systems are siloed from school and community efforts but have the opportunity to leverage ongoing innovative policy initiatives to construct novel cross-sector models. Such models can better link food insecurity screening with community-based solutions to address family-level food access barriers.

Shared or Self-rule? Regional Legislative Initiatives in Multi-level Spain, 1979-2021

ABSTRACT This paper examines regional legislative initiatives in Spain, a mechanism of shared-rule regulated in article 87.2 of the Spanish Constitution. Through description and analysis of an original dataset covering all legislative terms from 1978 to 2021, it is shown how this specific mechanism has not accomplished its shared-rule objective. Moreover, the article identifies patterns that determine the strategic use, intensity and failure or success of the legislative initiatives. We find diverging trends across regions exemplified by Catalonia, the most active territory but with a very low approval rate. Overall, the analysis underlines how the state-wide scope initiatives seem to have a strategic rather than a legislative purpose while, on the other hand, regional scope initiatives are explained by minor self-rule objectives.

Trends in U.S. adolescent physical activity and obesity: A 20-year age-period-cohort analysis.

Adolescent obesity can lead to long-term health problems and is a topic of major concern in pediatric and broader medical and public health spheres. Numerous national and state-wide initiatives aimed at increasing physical activity and/or improving nutrition in this age group have assumed the goal of reducing the prevalence adolescent obesity. We assess trends in U.S. adolescent physical activity and body mass index between 1999 and 2019. Using data from the U.S. Youth Risk Behaviour Surveillance System, we analyse data from 144 544 14-to-18-year-old respondents. We use multilevel linear and logistic regression to perform age-period-cohort analyses attributing changes in physical activity and body mass index over time to these three sources. Age and period effects are strong in all outcomes studied. Physical activity consistently decreases with age across the study period. Age trends in obesity have reversed in recent years, with older adolescents now more likely to be have obesity than younger adolescents. Both female and Asian adolescents report less physical activity but lower rates of obesity than their male and non-Asian counterparts. The reversal of obesity trends by age with little change in physical activity over the study period suggests other lifestyle factors have changed over the study period to increase the prevalence of obesity in older adolescents.

Study Links Long-Term Cannabis Use, Cognitive Deficits

Study Links Long-Term Cannabis Use, Cognitive Deficits

Health and Family Welfare Status of Mundari Sub-caste of Bagdah Block under the District of North 24 Parganas, West Bengal

Over 84 million of India’s people belong to Scheduled Tribes. While tribal populations make up only 8% of India’s population, they account for over a quarter of the country’s poorest people. The paper represents, considerable progress over the years - poverty among tribal groups declined by more than a third between 2011 and 2022 - nearly half the country’s Scheduled Tribe population remains in poverty, due to their low starting point. The Bagdah block of North 24 Parganas, has the largest population of Scheduled Tribes like Mundari sub-caste in the district, constituting over 6.39% of the block population. The paper also represents the family system and Mundari caste solidarity the need for seeking guidance in intimate family matter from people outside the family or caste group did not often arise. Even if such necessity arose, the people sought the advice of friends, priests or senior members of their community. The disintegration of the families was also not to the extent as it is today, particularly in the Bagdah block as a study area. The paper has also clear presentation of In recent years, there have been a number of additional statewide initiatives to enhance the reach and quality of healthcare to improve the health of people. These include the multi-disease surveillance system, several measures towards streamlining drug procurement, distribution and rational use of drugs; total risk coverage for five major communicable diseases through the Panchabyadhi Chikitsa Scheme, the Infant Mortality Rate Reduction Mission, mandatory pre-/post-graduate placement of doctors to serve in difficult areas establishment of district cadres for paramedical staff, among others for family well fare development in Bagdah block.

Preparing School Leaders to Advance Equity in Computer Science Education

&lt;p&gt;&lt;strong&gt;Background and Context:&lt;/strong&gt; Most large-scale statewide initiatives of the Computer Science for All (CS for All) movement have focused on the classroom level. Critical questions remain about building school and district leadership capacity to support teachers while implementing equitable computer science education that is scalable and sustainable.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; This statewide research-practice partnership, involving university researchers and school leaders from 14 local education agencies (LEA) from district and county offices, addresses the following research question: What do administrators identify as most helpful for understanding issues related to equitable computer science implementation when engaging with a guide and workshop we collaboratively developed to help leadership in such efforts?&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Method:&lt;/strong&gt; Participant surveys, interviews, and workshop observations were analyzed to understand best practices for professional development supporting educational leaders.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Findings:&lt;/strong&gt; Administrators value computer science professional development resources that: (a) have a clear focus on “equity;” (b) engage with data and examples that deepen understandings of equity; (c) provide networking opportunities; (d) have explicit workshop purpose and activities; and (e) support deeper discussions of computer science implementation challenges through pairing a workshop and a guide.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Implications:&lt;/strong&gt; Utilizing Ishimaru and Galloway’s (2014) framework for equitable leadership practices, this study offers an actionable construct for equitable implementation of computer science including (a) how to build equity leadership and vision; (b) how to enact that vision; and (c) how to scale and sustain that vision. While this construct applies to equitable leadership practices more broadly across all disciplines, we found its application particularly useful when explicitly focused on equity leadership practices in computer science.&lt;/p&gt;

Implementation of Health-Related Social Needs Screening at Michigan Health Centers: A Qualitative Study.

Federally qualified health centers (FQHCs) are leaders in screening for and addressing patient's health-related social needs but variation exists in screening practices. This variation is relatively unexplored, particularly the influences of organizational and state policies. We employed a qualitative descriptive approach to study social needs screening practices at Michigan FQHCs to characterize screening processes and identify drivers of variation in screening implementation. Site visits and semistructured interviews were conducted from October 2016 through March 2017, to explore implementation of social needs screening in clinical practice. Five FQHCs were selected through maximum variation sampling. Within each site, snowball sampling identified care team members highly knowledgeable about social needs screening. We conducted 4 to 5 interviews per site. Transcripts were analyzed using a thematic approach. We interviewed 23 participants from 5 sites; these sites varied by geography, age distribution, and race/ethnicity. We identified 4 themes: (1) statewide initiatives and local leadership drove variation in screening practices; (2) as community health workers (CHWs) played an integral role in identifying patients' needs, their roles often shifted from that of screener to implementer; (3) social needs screening data was variably integrated into electronic health records and infrequently used for population health management; and (4) sites experienced barriers to social needs screening that limited the perceived impact and sustainability. FQHCs placed value on the role of CHWs, on sustainable initiatives, and on funding to support continued social needs screening in primary care settings.

Hospital Quality Improvement Interventions, Statewide Policy Initiatives, and Rates of Cesarean Delivery for Nulliparous, Term, Singleton, Vertex Births in California

Safe reduction of the cesarean delivery rate is a national priority. To evaluate the rates of cesarean delivery for nulliparous, term, singleton, vertex (NTSV) births in California in the context of a statewide multifaceted intervention designed to reduce the rates of cesarean delivery. Observational study of cesarean delivery rates from 2014 to 2019 among 7 574 889 NTSV births in the US and at 238 nonmilitary hospitals providing maternity services in California. From 2016 to 2019, California Maternal Quality Care Collaborative partnered with Smart Care California to implement multiple approaches to decrease the rates of cesarean delivery. Hospitals with rates of cesarean delivery greater than 23.9% for NTSV births were invited to join 1 of 3 cohorts for an 18-month quality improvement collaborative between July 2016 and June 2019. Within the collaborative, multidisciplinary teams implemented multiple strategies supported by mentorship, shared learning, and rapid-cycle data feedback. Partnerships among nonprofit organizations, state governmental agencies, purchasers, and health plans addressed the external environment through transparency, award programs, and incentives. The primary outcome was the change in cesarean delivery rates for NTSV births in California and a difference-in-differences analysis was performed to compare cesarean delivery rates for NTSV births in California vs the rates in the rest of the US. A mixed multivariable logistic regression model that adjusted for patient-level and hospital-level confounders also was used to assess the collaborative and the external statewide actions. The cesarean delivery rates for NTSV births at hospitals participating in the collaborative were compared with the rates from the nonparticipating hospitals and the rates in the participating hospitals prior to participation in the collaborative. A total of 7 574 889 NTSV births occurred in the US from 2014 to 2019, of which 914 283 were at 238 hospitals in California. All California hospitals were exposed to the statewide actions to reduce the rates of cesarean delivery, including the 149 hospitals that had baseline rates of cesarean delivery greater than 23.9% for NTSV births, of which 91 (61%) participated in the quality improvement collaborative. The rate of cesarean delivery for NTSV births in California decreased from 26.0% (95% CI, 25.8%-26.2%) in 2014 to 22.8% (95% CI, 22.6%-23.1%) in 2019 (relative risk, 0.88; 95% CI, 0.87-0.89). The rate of cesarean delivery for NTSV births in the US (excluding California births) was 26.0% in both 2014 and 2019 (relative risk, 1.00; 95% CI, 0.996-1.005). The difference-in-differences analysis revealed that the reduction in the rate of cesarean delivery for NTSV births in California was 3.2% (95% CI, 1.7%-3.5%) higher than in the US (excluding California). Compared with the hospitals and the periods not exposed to the collaborative activities, and after adjusting for patient characteristics and time using a modified stepped-wedge analysis, exposure to collaborative activities was associated with a lower odds of cesarean delivery for NTSV births (24.4% vs 24.6%; adjusted odds ratio, 0.87 [95% CI, 0.85-0.89]). In this observational study of NTSV births in California from 2014 to 2019, the rates of cesarean delivery decreased over time in the setting of the implementation of a coordinated hospital-level collaborative and statewide initiatives designed to support vaginal birth.

Quantification of Potential Inequities in Breast Cancer Incidence in New Mexico Through Bayesian Disease Mapping.

IntroductionThe incidence of breast cancer among non-Hispanic American Indian and Alaska Native (AI/AN) women varies across the United States. We applied county-level Bayesian disease mapping to quantify potential inequities in 10-year breast cancer incidence in New Mexico to better inform health equity initiatives among its non-Hispanic at-risk AI/AN population.MethodsWe used data from the Surveillance, Epidemiology, and End Results (SEER) program from 2005 through 2014 to identify new cases of breast cancer in New Mexico’s 33 counties. To account for spatial variation, a county-level Area Deprivation Index, and the small area estimation problem inherent in these data, we borrowed strength globally and locally by applying Bayesian disease mapping to the counts of age-adjusted county-level breast cancer incidence. We quantified the disparity effect, as measured by the age-adjusted rate ratio, comparing the incidence of breast cancer between at-risk non-Hispanic AI/AN and non-Hispanic White women and assessed whether the ratio differed among counties.ResultsAccounting for over-dispersion and spatial correlation among the 33 counties and a county-level Area Deprivation Index, the posterior mean of the overall age-adjusted rate ratio was 0.384 (95% credible interval, 0.253­–0.546). The age-adjusted rate of breast cancer in non-Hispanic AI/AN women was 0.38 times the corresponding age-adjusted rate for non-Hispanic White women; however, a significant reduction in breast cancer incidence was observed in 16 of the 33 counties.ConclusionThe application of Bayesian disease mapping to these data provided substantial evidence of an overall disparity in breast cancer incidence between at-risk non-Hispanic AI/AN and non-Hispanic White women in New Mexico, which was more marked than previously reported and limited to certain counties. Targeted statewide and county-level health-equity initiatives may lead to a reduction in these disparities.

Case analyses of state-sponsored asthma quality improvement interventions – benefits and technical assistance efforts

Objective A cross-case analysis was used to discover how two states benefited from expanded use of evaluation for asthma quality improvement initiatives. If an asthma quality improvement (QI) initiative is successfully evaluated, data can inform how to effectively integrate clinical practice guidelines and circumvent non-clinical reasons that interrupt QI projects such as low staff interest. This article addresses a gap in the literature on quality of evaluation support needed to improve and sustain asthma QI at local health care organizations by describing the similar discoveries observed at two independent QI statewide initiatives in Indiana and Montana. Methods As part of a larger review, two states funded through the National Asthma Control Program at the Centers for Disease Control and Prevention were identified based on similarities in evaluation approaches. Each state used an iterative stakeholder-driven evaluation approach, mixed methods, process evaluation indicators, and active use of evaluation findings. The asthma QI initiatives and evaluations in Indiana and Montana were coordinated independent of each other. Results Although both states found that asthma QI initiatives improved health outcomes, evaluation data were able to further pinpoint areas that would improve quality of technical support to health care organizations and identify markers of sustainability, such as nontraditional benefits to staff, and intervention sites. Conclusion Findings suggest that when evaluation is used to guide implementation, data are available to develop site-specific assistance and identify sustainability markers to prevent interruption of positive health outcomes associated with an asthma QI initiative.

Bootstrapping implementation research training: A successful approach for academic health centers.

Demand for building competencies in implementation research (IR) outstrips supply of training programs, calling for a paradigm shift. We used a bootstrap approach to leverage external resources and create IR capacity through a novel 2-day training for faculty scientists across the four Texas Clinical & Translational Science Awards (CTSAs). The Workshop combined internal and external expertise, targeted nationally established IR competencies, incorporated new National Institutes of Health/National Cancer Institute OpenAccess online resources, employed well-known adult education principles, and measured impact. CTSA leader buy-in was reflected in financial support. Evaluation showed increased self-reported IR competency; statewide initiatives expanded. The project demonstrated that, even with limited onsite expertise, it was possible to bootstrap resources and build IR capacity de novo in the CTSA community.