Measuring Local Public Health and Primary Care Collaboration: A Practice-Based Research Approach.

OBJECTIVE: To describe the degree of public health and primary care collaboration at the local level and develop a model framework of collaboration, the Community Collaboration Health Model (CCHM). DESIGN: Mixed-methods, cross-sectional surveys, and semistructured, key informant interviews. SETTING: All local health jurisdictions in Colorado, Minnesota, Washington, and Wisconsin. PARTICIPANTS: Leaders from each jurisdiction were identified to describe local collaboration. Eighty percent of local health directors completed our survey (n = 193), representing 80% of jurisdictions. The parallel primary care survey had a 31% response rate (n = 128), representing 50% of jurisdictions. Twenty pairs of local health directors and primary care leaders participated in key informant interviews. MAIN OUTCOME MEASURE(S): Thirty-seven percent of jurisdictions were classified as having strong foundational and energizing characteristics in the model. Ten percent displayed high energizing/low foundational characteristics, 11% had high foundational/low energizing characteristics, and 42% of jurisdictions were low on both. RESULTS: Respondents reported wide variation in relationship factors. They generally agreed that foundational characteristics were present in current working relationships but were less likely to agree that relationships had factors promoting sustainability or innovation. CONCLUSIONS: Both sectors valued working together in principle, yet few did. Identifying shared priorities and achieving tangible benefits may be critical to realizing sustained relationships resulting in population health improvement. Our study reveals broad variation in experiences among local jurisdictions in our sample. Tools, such as the CCHM, and technical assistance may be helpful to support advancing collaboration. Dedicated funding, reimbursement redesign, improved data systems, and data sharing capability are key components of promoting collaboration. Yet, even in the absence of new reimbursement models or funding mechanisms, there are steps leaders can take to build and sustain their relationships. The self-assessment tool and the CCHM can identify opportunities for improving collaboration and link practitioners to strategies.

Local health department factors associated with performance in the successful implementation of community-based strategies: a mixed-methods approach.

OBJECTIVES: We examined which local health department (LHD)-level factors contributed to successful implementation of policy, systems, and environmental change strategies in Minnesota. METHODS: We used a retrospective mixed-methods design to evaluate the relationship between the Statewide Health Improvement Plan (SHIP) grant initiative and key predictor variables (2009-2011). We obtained quantitative capacity data for 91 cities and counties in Minnesota; in addition, we conducted 15 key informant interviews to examine factors that facilitated and acted as barriers to LHD performance. RESULTS: Grantee performance was distributed as follows: exceeds expectations (29.7%), meets expectations (55.0%), and is approaching expectations (15.3%). Organizational quality improvement (QI) maturity was strongly positively associated with grantee performance on SHIP. Organizations with high QI maturity, effective leadership, efficient decision-making, and successful regional or cross-jurisdictional partnerships were more likely to be rated as exceeding expectations. CONCLUSIONS: This study successfully translated practice-based research findings into tangible outcomes, including new system-level performance measures for local public health and recommendations for shaping the statewide initiative examined in this study. The approach taken in this study to systematically monitor communications, dissemination, and translation may be a model for others.

Developing a taxonomy for the science of improvement in public health.

CONTEXT: Quality improvement (QI) methods have been used for almost a decade in public health departments to increase effectiveness and efficiency. Although results are rapidly accumulating, the evidence for the science of improvement is shallow and limited. To advance the use and effectiveness of QI in public health, it is important to develop a science of improvement using practice-based research to build an evidence base for QI projects. OBJECTIVES: This purpose of this study is to advance the science of improvement in public health departments with 3 objectives: (1) establish a taxonomy of QI projects in public health, (2) categorize QI projects undertaken in health departments using the taxonomy, and (3) create an opportunity modes and effects analysis. DESIGN: This study is a qualitative analysis of archival data from 2 separate large databases consisting of 51 QI projects undertaken in public health departments over the last 5 years. SETTING AND PARTICIPANTS: The study involves 2 separate QI collaboratives. One includes Minnesota health departments; the other is a national collaborative. MAIN OUTCOME MEASURES: We propose a standardized case definition, common metrics, and a taxonomy of QI projects to begin building the evidence base for QI in public health and to advance the science of continuous quality improvement. RESULTS: All projects created an aim statement and used metrics while 53% used a specific QI model with an average of 3.25 QI techniques per project. Approximately 40% of the projects incorporated a process control methodology, and 60% of the projects identified the process from beginning to end, while 11 of 12 PHAB (Public Health Accreditation Board) domains were included. CONCLUSIONS: The findings provide a baseline for QI taxonomy to operationalize a science of improvement for public health departments.