Making the case for using financial indicators in local public health agencies.

The strength of the public health infrastructure determines the ability of local public health agencies to respond to emergencies and provide essential services. Organizational and systems capacity measures and assessments are important components of the public health infrastructure. Hospitals and governments have a long tradition of using financial indicators to assess fiscal and operational activities. We reviewed the literature on how hospitals use financial indicators to monitor financial risk, promote organizational sustainability, and improve organizational capacity. Given that financial indicators have not generally been employed by public health practitioners, we discuss how these measures can be applied to local public health agencies to improve their organizational capacity.

Improving diabetes care using a multitiered quality improvement model.

The authors report the results of implementing a diabetes mellitus guideline in a group practice in which uniform, technology-generated care processes were produced for patients, clinical staff, and providers. The objective was to increase the annual rate of recommended tests and examinations for patients with diabetes and to reduce levels of glycosylated hemoglobin, blood pressure, and low-density lipoprotein cholesterol. A process change for type 2 diabetes mellitus was implemented that included changes in office visit structure, protocol-driven electronic prompts for nursing and physician staffs, clinical decision support built into a new electronic medical record form, and audit with feedback. Twelve primary care physicians treated a total of 1592 patients with diabetes between January 2007 and January 2008. There were prompt and statistically significant improvements in 5 process measures and 2 outcome measures; a quality summary measure showed 8% overall improvement. Statistically significant improvements with moderate effect size were observed after a multitiered intervention.

The MAPP training program evaluation.

This article reports on an evaluation of regional training programs designed to increase the knowledge and use of Mobilizing for Action through Planning and Partnerships (MAPP). The objectives for the MAPP training program included teaching participants about MAPP resources on the Web, providing participants with instruction about what MAPP is, and why it is important for community health improvement. Participants were also instructed on how to implement MAPP through a series of concrete steps such as mobilizing community partnerships, creating an action plan, conducting a series of assessments, and identifying strategic issues. An on-site survey with pretraining and posttraining questions and a follow-up survey were developed and administered to participants to assess their readiness levels to access MAPP resources and actively use and promote MAPP in their communities. The findings indicate that participants' knowledge of MAPP and confidence to use it improved as a result of training. Six months after training, participants' readiness levels increased from pretraining levels in the areas of incorporating MAPP into their roles, presenting MAPP to community partners, and using MAPP for community health improvement projects. Making changes in their organizations and communities to implement MAPP did not change significantly from pretraining levels. Just under half of training participants were implementing MAPP 6 months posttraining.

Lessons from the MAPP demonstration sites.

This article describes one component of a three-part evaluation of a community health improvement model called MAPP (Mobilizing for Action through Planning and Partnerships). This component examined the use of MAPP by nine local public health agencies that acted as demonstration sites. Using qualitative data from telephone interviews, focus group data, and document reviews, the evaluators identified four themes associated with how MAPP was implemented and the factors that influenced implementation. A level of activity was assigned to each site for each of the four themes. Combining data from multiple demonstration sites, evaluators characterized common activities for each theme. Findings reveal that those sites with health director buy-in and full-time coordination for MAPP were associated with high levels of partnership development. The MAPP Web site, in its current state, does not appear to provide an advantage over using a printed copy of MAPP. Evaluation data from training programs and Web site users (the other two components of the evaluation) support key findings from the demonstration sites and reveal crosscutting themes for all components of the MAPP evaluation. Investigating other situational and contextual factors that influence the nature and success of MAPP implementation would be useful.

Improving care for children with attention deficit hyperactivity disorder: assessing the impact of self-assessment and targeted training on practice performance.

OBJECTIVES: Major gaps exist between usual clinical practice and evidence-based recommendations for care. Many interventions to improve care are costly and time intensive. This study sought to determine whether a clinician's self-assessment of their practice performance for the diagnosis and management of children with attention deficit hyperactivity disorder (ADHD) followed by attendance at a 2-day conference focused on system change would result in improvement in care. DESIGN: Quasi-experimental-before and after with external controls. PARTICIPANTS: Clinician attendees compared with convenience sample of nonattendees. OUTCOMES: Consistency with 10 specific recommendations from the American Academy of Pediatrics Guidelines concerning ADHD. ANALYSIS: Logistic regression, with use of generalized estimating equations to account for clustering of subjects within clinician practices. RESULTS: Widespread deficiencies in care were present prior to the intervention. Practice improved significantly more among conference attendees in 2 of the 10 performance measures (evaluation for coexisting conditions and offering treatment options), with positive trends in most of the other indicators. CONCLUSIONS: Practice assessment and system-based training may be a cost-effective strategy to improve practice performance.

Mass vaccination campaign following community outbreak of meningococcal disease.

During December 12-29, 1998, seven patients ages 2-18 years were diagnosed with serogroup C meningococcal disease in two neighboring Florida towns with 33,000 residents. We evaluated a mass vaccination campaign implemented to control the outbreak. We maintained vaccination logs and recorded the resources used in the campaign that targeted 2- to 22-year-old residents of the two towns. A total of 13,148 persons received the vaccinations in 3 days. Vaccination coverage in the target population was estimated to be 86% to 99%. Five additional cases of serogroup C meningococcal disease occurred in the community during the year after the campaign began, four in patients who had not received the vaccine. The cost of control efforts was approximately $370,000. Although cases continued to occur, the vaccination campaign appeared to control the outbreak. Rapid implementation, a targeted approach, and high coverage were important to the campaign's success.