Oregon's Approach To Demonstrating The Value Of A Modern Public Health System Through Accountability Metrics.

Oregon's public health system uses accountability metrics to improve health, eliminate inequities, and practice stewardship. First enacted into law during the 2015 legislative session, with additions and clarifications made in the 2017 session, these metrics promote collective action across sectors, bring attention to the root causes of health inequities, and hold public health authorities accountable for performance improvement as they carry out core public health functions. This article describes the development of Oregon's accountability metrics and implications for future practice. In 2023, Oregon's public health leaders adopted a new set of health outcome indicators and process measures for communicable disease control and environmental health, with performance tied to financial incentives. Oregon's process is a model for other states developing an accountability framework in their pursuit of public health transformation. Oregon's work contributes to legislative and other policy decisions for measuring the success of approaches to eliminating health inequities and for applying performance-based incentives within the public health system.

Resetting the Course for Foundational Public Health Services (FPHS) During COVID-19.

CONTEXT: Underfunding of the governmental public health system in the United States has been a problem for many years, and the COVID-19 pandemic revealed the significant gaps in public health infrastructure that have resulted from this inadequate funding. PROGRAM: The states of Ohio, Oregon, and Washington received funding in 2016 to define, measure, and advocate for the foundational public health services (FPHS) delivered by the governmental public health system. They have taken unique but related approaches to strengthening work in the areas of categorical public health programs and the underlying infrastructure and capabilities that support the programmatic work. IMPLEMENTATION: All 3 states conducted assessments of gaps and funding needs that have allowed them to advocate for, and receive, limited resources for the governmental public health system. These resources were used to strengthen the public health system in ways that assisted with pandemic response. The pandemic also provided many opportunities for the states to demonstrate the importance of the foundational capabilities (assessment, communications, partnership development, policy, leadership, quality improvement, emergency response planning) and public health infrastructure in the areas of information technology and laboratory capacity. These opportunities allowed states to make progress in obtaining funding for FPHS. CONCLUSION: While heavily focused on the program area of communicable disease control, the pandemic response highlighted the importance of having a robust public health infrastructure that is well supported in the areas of foundational capabilities. Substantial infrastructure investments will allow health departments to close gaps in health inequities; contribute to the significant work needed postpandemic in the areas of chronic disease, behavioral health, climate change, and social determinants of health; and be better prepared for future emergencies.

Implementing a Multipartner HPV Vaccination Assessment and Feedback Intervention in an Integrated Health System.

CONTEXT: Human papillomavirus (HPV) vaccine initiation rates are persistently lower than rates for other adolescent-recommended vaccines. Assessment and feedback interventions are a recommended strategy for improving vaccination rates. OBJECTIVE: To provide a guide for implementing a multipartner intervention to increase HPV vaccine initiation rates. SETTING: Nine primary care facilities within the Kaiser Permanente Northwest (KPNW) health care system. INTERVENTION: In 2015-2016, we implemented a system-wide assessment and feedback intervention to promote HPV vaccination. In partnership with the Centers for Disease Control and Prevention, the Oregon Immunization Program, and KPNW's leadership, we developed an education session combining information on HPV infection, parental communication strategies, and facility-specific coverage data. RESULTS: Twelve months postintervention, HPV dose 1 vaccination coverage increased from 71% to 72% among females and from 65% to 68% among males. CONCLUSIONS: A collaborative approach was critical to engaging leadership and enlisting support from providers and to developing appropriate materials for clinical audiences. Information provided here can be used as a guide for conducting assessment and feedback interventions focused on HPV vaccination initiation.

Rules and tools that improved vaccines for children vaccine-ordering practices in Oregon: a 2010 pilot project.

OBJECTIVE: This project's objective was to enhance efforts to improve vaccine-ordering efficiencies among targeted clinics using publicly purchased vaccines. DESIGN: Using an assessment of ordering behavior developed by the Centers for Disease Control and Prevention, we selected and trained immunization providers and assessed improvements in ordering behavior by comparing ordering patterns before and after the intervention. SETTING: A total of 144 Vaccines for Children program providers in Oregon. PARTICIPANTS: We assessed 144 providers trained in the Economic Order Quantity process between January and November 2010. INTERVENTION (IF APPLICABLE): Providers were invited to participate in regional trainings. Trainings included assignment of ordering frequency and dissemination of tools to support adherence to the recommended ordering frequency. MAIN OUTCOME MEASURE(S): The percent increase in targeted clinics ordering according to recommended order frequency and the resulting decrease in orders placed, as an outcome of training and ordering tools. RESULTS: Only 35% of targeted providers were ordering according to the recommended ordering frequency before the project began. After completing training, utilizing ordering tools and ordering over a 7-month period, 78% of the targeted clinics were ordering according to the recommended frequency, a 120% increase in the number of clinics ordering with the recommended frequency. At baseline, targeted clinics placed 915 total vaccine orders over a 7-month period. After completing training and participating in the Economic Order Quantity process, only 645 orders were placed, a reduction of 30% . CONCLUSIONS: The initiative was successful in reducing the number of orders placed by Vaccines for Children providers in Oregon. A previous effort to reduce ordering, without the use of training or tools, did not achieve the same levels of provider compliance, suggesting that the addition of staff and development of tools were helpful in supporting behavior change and improving providers' ability to adhere to assigned order frequencies. Reducing order frequency results in more efficient vaccine ordering patterns and benefits vaccine distributors, Oregon Immunization Program staff, and provider staff.