Public Health Practice vs Research: Implications for Preparedness and Disaster Research Review by State Health Department IRBs

2008 ◽  
Vol 2 (3) ◽  
pp. 185-191 ◽  
Author(s):  
David Perlman
Keyword(s):  
Public Health ◽  
Personal Information ◽  
Human Subjects ◽  
Public Health Practice ◽  
Health Department ◽  
Systematic Investigation ◽  
Research Review ◽  
Health Departments ◽  
State Health ◽  
Public Health Preparedness

ABSTRACTUnder the current US Department of Health and Human Services regulatory and ethical system for research involving human subjects, research is defined in terms of several key concepts: intent, systematic investigation, and generalizability. If an investigator engages in a systematic investigation designed or intended to contribute to generalizable knowledge, then he or she is engaged in research. If that research involves living individuals and the investigator will either interact or intervene with people or obtain their identifiable personal information, then the research must be prospectively reviewed by an institutional review board (IRB), a federally mandated committee that ensures the ethical and regulatory appropriateness of proposed research. In public health institutions, and especially at state departments of health, this definition of research may prove vexing for determining when particular public health activities must be reviewed by IRBs. This article outlines several reasons for such vexation and 2 key responses from major public health stakeholders. In the current climate of public health preparedness initiatives at state health departments for disasters and bioterrorism, how research is defined vis-à-vis public health interventions may add even more confusion to preparedness initiatives and pose difficulties in determining when IRB review and the added protections it affords are appropriate. This article suggests several practical ways to avoid confusion and attempts to strike a balance between the need for expeditious approvals of research-based responses to public health disasters and to ensure proper protections for human subjects at state health departments. It is hoped that these suggestions can assist not only state health departments but also academically based researchers who either collaborate with those departments or whose research will need to be reviewed by their IRBs. (Disaster Med Public Health Preparedness. 2008;2:185–191)

Assessing the Capacity of State Physical Activity Programs—A Baseline Perspective

2010 ◽  
Vol 7 (1) ◽  
pp. 119-126 ◽  
Author(s):  
Tamara Vehige Calise ◽  
Sarah Martin
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Physical Inactivity ◽  
Public Health Practice ◽  
Health Department ◽  
Health Departments ◽  
State Health ◽  
Chi Square ◽  
Prevalence Of Obesity ◽  
Physical Activity Programs

Background:Physical inactivity is one of the top 3 risk factors associated with an increased prevalence of obesity and other chronic diseases. The public health infrastructure positions state health departments to address physical inactivity. To examine preparedness, all 50 health departments were assessed, using the 5 benchmarks developed by CDC for physical activity and public health practice, on their capacity to administer physical activity programs.Methods:States were scored on a 5-point scale for each benchmark. The top 2 high and low scores were combined to create 2 categories. Exact Chi-square analyses were performed.Results:States with CDC obesity funding scored higher on 4 benchmarks than states without. States with a state physical activity plan scored higher on all benchmarks than states without. States with a physical activity coalition scored higher on 2 benchmarks than states without.Conclusions:At the time of the assessment, approximately 20% of state physical activity programs could have improved in the use of evidence-based strategies and planning and evaluation approaches. Furthermore, many programs seemed to have limited sustainability. The findings of this report serve as a baseline of the capacity and infrastructure of state health department physical activity programs.

scholarly journals 965. Partnering with State Health Departments: A Road Map for Collaboration Using Public Health Enhanced HIV/AIDS Reporting System (eHARS)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S512-S513
Author(s):  
John R Bassler ◽  
Emily B Levitan ◽  
Lauren Ostrenga ◽  
Danita C Crear ◽  
Kendra L Johnson ◽  
...  
Keyword(s):  
Public Health ◽  
Reporting System ◽  
Health Department ◽  
Distributed Data ◽  
Summary Statistics ◽  
Health Departments ◽  
State Health ◽  
State Health Department ◽  
Data Network ◽  
Hiv Aids

Abstract Background Academic and public health partnerships are a critical component of the Ending the HIV Epidemic: A Plan for America (EHE). The Enhanced HIV/AIDS Reporting System (eHARS) is a standardized document-based surveillance database used by state health departments to collect and manage case reports, lab reports, and other documentation on persons living with HIV. Innovative analysis of this data can inform targeted, evidence-based interventions to achieve EHE objectives. We describe the development of a distributed data network strategy at an academic institution in partnership with public health departments to identify geographic differences in time to HIV viral suppression after HIV diagnosis using eHARS data. Figure 1. Distributed Data Network Methods This project was an outgrowth of work developed at the University of Alabama at Birmingham Center for AIDS Research (UAB CFAR) and existing relationships with the state health departments of Alabama, Louisiana, and Mississippi. At a project start-up meeting which included study investigators and state epidemiologists, core objectives and outcome measures were established, key eHARS variables were identified, and regulatory and confidentiality procedures were examined. The study methods were approved by the UAB Institutional Review Board (IRB) and all three state health department IRBs. Results A common data structure and data dictionary across the three states were developed. Detailed analysis protocols and statistical code were developed by investigators in collaboration with state health departments. Over the course of multiple in-person and virtual meetings, the program code was successfully piloted with one state health department. This generated initial summary statistics, including measures of central tendency, dispersion, and preliminary survival analysis. Conclusion We developed a successful academic and public health partnership creating a distributed data network that allows for innovative research using eHARS surveillance data while protecting sensitive health information. Next, state health departments will transmit summary statistics to UAB for combination using meta-analytic techniques. This approach can be adapted to inform delivery of targeted interventions at a regional and national level. Disclosures All Authors: No reported disclosures

An Enhanced Approach to Distinguishing Public Health Practice and Human Subjects Research

2005 ◽  
Vol 33 (1) ◽  
pp. 125-141 ◽  
Author(s):  
James G. Hodge
Keyword(s):  
Public Health ◽  
Health Care Providers ◽  
Human Subjects ◽  
Public Health Practice ◽  
Disease Outbreaks ◽  
Systematic Investigation ◽  
Health Data ◽  
Care Providers ◽  
Health Practice ◽  
Human Subjects Research

What are the Differences between Public Health Practice and Research? This perplexing question constantly arises in the planning and performance of public health activities involving the acquisition and use of identifiable health information. Public health agencies collect and analyze significant identifiable health data from health care providers, insurers, other agencies, or individuals to perform an array of public health activities. These activities include surveillance (e.g., reporting requirements, disease registries, sentinel networks), epidemiological investigations (e.g., to investigate disease outbreaks), and evaluation and monitoring (e.g., public health program development and analysis, oversight functions). Few debate that these essential public health activities, often specifically authorized by law, are classifiable as public health practice.Other public health activities in which identifiable health data are acquired or used, however, can resemble, include, or constitute human subjects research. “Human subjects research” is legally defined as “a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge” that involves living human subjects (or their identifiable, private data).

Improving Public Health Preparedness Capacity Measurement: Development of the Local Health Department Preparedness Capacities Assessment Survey

2013 ◽  
Vol 7 (6) ◽  
pp. 578-584 ◽  
Author(s):  
Mary V. Davis ◽  
Glen P. Mays ◽  
James Bellamy ◽  
Christine A. Bevc ◽  
Cammie Marti
Keyword(s):  
Public Health ◽  
Factor Analysis ◽  
Health Department ◽  
Local Health Department ◽  
Kappa Statistics ◽  
Local Health ◽  
Health Departments ◽  
Public Health Preparedness ◽  
Assessment Survey ◽  
Legal Infrastructure

AbstractObjectiveTo address limitations in measuring the preparedness capacities of health departments, we developed and tested the Local Health Department Preparedness Capacities Assessment Survey (PCAS).MethodsPreexisting instruments and a modified 4-cycle Delphi panel process were used to select instrument items. Pilot test data were analyzed using exploratory factor analysis. Kappa statistics were calculated to examine rater agreement within items. The final instrument was fielded with 85 North Carolina health departments and a national matched comparison group of 248 health departments.ResultsFactor analysis identified 8 initial domains: communications, surveillance and investigation, plans and protocols, workforce and volunteers, legal infrastructure, incident command, exercises and events, and corrective action. Kappa statistics and z scores indicated substantial to moderate agreement among respondents in 7 domains. Cronbach α coefficients ranged from 0.605 for legal infrastructure to 0.929 for corrective action. Mean scores and standard deviations were also calculated for each domain and ranged from 0.41 to 0.72, indicating sufficient variation in the sample to detect changes over time.ConclusionThe PCAS is a useful tool to determine how well health departments are performing on preparedness measures and identify opportunities for future preparedness improvements. Future survey implementation will incorporate recent Centers for Disease Control and Prevention's Public Health Preparedness Capabilities: National Standards for State and Local Planning. (Disaster Med Public Health Preparedness. 2013;7:578–584)

scholarly journals Applied Epidemiology Workforce Growth and Capacity Challenges: The Council of State and Territorial Epidemiologists 2017 Epidemiology Capacity Assessment

2019 ◽  
Vol 134 (4) ◽  
pp. 379-385 ◽  
Author(s):  
Jessica Arrazola ◽  
Mia N. Israel ◽  
Nancy Binkin
Keyword(s):  
Public Health ◽  
Health Department ◽  
The United States ◽  
Current Status ◽  
Public Health Department ◽  
Health Departments ◽  
State Health ◽  
Public Health Services ◽  
Full Capacity ◽  
Council Of State

Objectives: To better understand the current status and challenges of the state public health department workforce, the Council of State and Territorial Epidemiologists (CSTE) assessed the number and functions of applied public health epidemiologists at state health departments in the United States. Methods: In 2017, CSTE emailed unique online assessment links to state epidemiologists in the 50 states and the District of Columbia (N = 51). The response rate was 100%. CSTE analyzed quantitative data (27 questions) on funding, the number of current and needed epidemiologists, recruitment, retention, perceived capacity, and training. CSTE coded qualitative data in response to an open-ended question that asked about the most important problems state epidemiologists face. Results: Most funding for epidemiologic activities came from the federal government (mean, 77%). State epidemiologists reported needing 1199 additional epidemiologists to achieve ideal capacity but noted challenges in recruiting qualified staff members. Respondents cited opportunities for promotion (n = 45, 88%), salary (n = 41, 80%), restrictions on merit raises (n = 36, 70%), and losses to the private or government sector (n = 33, 65%) as problems for retention. Of 4 Essential Public Health Services measured, most state epidemiologists reported substantial-to-full capacity to monitor health status (n = 43, 84%) and diagnose and investigate community health problems (n = 47, 92%); fewer respondents reported substantial-to-full capacity to conduct evaluations (n = 20, 39%) and research (n = 11, 22%). Conclusions: Reliance on federal funding negatively affects employee retention, core capacity, and readiness at state health departments. Creative solutions for providing stable funding, developing greater flexibility to respond to emerging threats, and enhancing capacity in evaluation and applied research are needed.

scholarly journals Preparing for State Health Department Accreditation: Pivotal Roles for Public Health Surveillance

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Christopher D. Williams
Keyword(s):  
Public Health ◽  
Health Informatics ◽  
Public Health Surveillance ◽  
Health Department ◽  
Health Surveillance ◽  
Health Departments ◽  
Public Health Informatics ◽  
State Health ◽  
State Health Department ◽  
The Public

Many State Health Departments (SHDs) are considering or preparing for voluntary accreditation through the Public Health Accreditation Board (PHAB). With the 2014 release of PHAB's Standards & Measures Version 1.5, health departments must adhere to specific documentation criteria regarding measures for public health surveillance. This presentation will provide one SHD's approach to identifying appropriate documents to meet the public health surveillance measures from a public health informatics perspective. A document selection matrix may be helpful to other SHDs considering accreditation.

scholarly journals Extending the Use of Healthcare-Associated Infections and Antibiotic Use and Resistance Surveillance Data

2020 ◽  
Vol 41 (S1) ◽  
pp. s233-s233
Author(s):  
Muzna Mirza ◽  
Lauren Wattenmaker ◽  
Odion Clunis ◽  
Wendy Vance ◽  
Shunte Moon ◽  
...  
Keyword(s):  
Public Health ◽  
Data Access ◽  
Antibiotic Use ◽  
Health Department ◽  
Targeted Prevention ◽  
Local Health ◽  
Health Departments ◽  
State Health ◽  
Healthcare Associated Infection ◽  
Healthcare Associated

Background: The CDC National Healthcare Safety Network (NHSN) is the nation’s most widely used healthcare-associated infection (HAI) and antibiotic use and resistance (AUR) surveillance system. More than 22,000 healthcare facilities report data to the NHSN. The NHSN data are used by facilities, the CDC, health departments, the CMS, among other organizations and agencies. In 2017, the CDC updated the NHSN Agreement to Participate and Consent (Agreement), completed by facilities, broadening health department access to NHSN data and extending eligibility for data use agreements (DUAs) to local and territorial health departments. DUAs enable access to NHSN data reported by facilities in the health department’s jurisdiction and have been available to state health departments since 2011. The updated agreement also enables the CDC to provide NHSN data to health departments for targeted prevention projects outbreak investigations and responses. Methods: We reviewed the current NHSN DUA inventory to assess the extent to which health departments use the NHSN’s new data access provisions and used semistructured interviews with health department staff, conducted via emails, phone, and in person conversations, to identify and describe their NHSN data uses. Results: As of late 2019, the NHSN has DUAs with health departments in 17 states, 7 local health departments (including municipalities and counties), and 1 US territory. The NHSN also has received requests from 2 state health departments for data supporting HAI prevention projects. Health departments with DUAs described improved relationships with facilities in their jurisdictions because of new opportunities to offer NHSN data analysis assistance to facilities. One local health department analyzed their NHSN carbapenem-resistant Enterobacteriaceae (CRE) data to identify (1) facilities in its jurisdiction with comparatively high CRE infection burden and (2) geographic areas to target for a CRE isolate submission program. Outreach to facilities with high CRE burden led to enrollment of 15 clinical laboratories into a voluntary isolate submission program to analyze CRE isolates for additional characterization. Examples of health departments’ use of data for action include: notifying facilities with high standardized infection ratios (SIRs) and sharing Targeted Assessment for Prevention (TAP) reports. Conclusions: The NHSN’s role as a shared surveillance resource has expanded in multiple public health jurisdictions as a result of new data access provisions. Health departments are using NHSN data in their programmatic responses to HAI and AR challenges. New access to NHSN data is enabling public health jurisdictions to assess problems and opportunities, provide guidance for prevention projects, and support program evaluations.Funding: NoneDisclosures: None

scholarly journals An Academic–Practice Partnership at the University of Washington School of Public Health: The Student Epidemic Action Leaders (SEAL) Team

2018 ◽  
Vol 133 (6) ◽  
pp. 749-758 ◽  
Author(s):  
Maayan Simckes ◽  
Beth Melius ◽  
Vivian Hawkins ◽  
Scott Lindquist ◽  
Janet Baseman
Keyword(s):  
Public Health ◽  
Communicable Disease ◽  
Public Health Practice ◽  
Health Department ◽  
Public Health Department ◽  
University Of Washington ◽  
Local Public Health ◽  
School Of Public Health ◽  
State And Local ◽  
The University

In 2015, the University of Washington School of Public Health, Department of Epidemiology established the Student Epidemic Action Leaders (SEAL) team to provide public health students with experience in field epidemiology in state and local public health communicable disease divisions. The University of Washington Department of Epidemiology developed the SEAL team in collaboration with the Washington State Department of Health to offer public health graduate students opportunities to contribute to the real-time needs of public health agencies during a communicable disease event and/or preparedness event. The SEAL team combines classroom and field-based training in public health practice and applied epidemiology. During the first 2 years of the SEAL team (2016-2018), 34 SEALs were placed at 4 agencies contributing more than 1300 hours of assistance on 24 public health projects.

scholarly journals Prioritizing Workforce Development Training in State Health Departments Using TRAIN: Challenges and Opportunities

2019 ◽  
Vol 134 (2) ◽  
pp. 172-179
Author(s):  
Magali Angeloni ◽  
Ron Bialek ◽  
Michael P. Petros ◽  
Michael C. Fagen
Keyword(s):  
Public Health ◽  
Core Competencies ◽  
Public Health Workforce ◽  
Current Status ◽  
Full Time ◽  
Health Departments ◽  
State Health ◽  
Training Tool ◽  
Management Platform ◽  
Organizational Features

Objective: The objectives of this study were (1) to obtain data on the current status of public health workforce training and the use of the Training Finder Real-Time Affiliate Network (TRAIN), a public health learning management platform, in state health departments, and (2) to use the data to identify organizational features that might be affecting training and to determine barriers to and opportunities for improving training. Methods: We conducted structured interviews in 2014 with TRAIN administrators and performance improvement managers (n = 14) from 7 state health departments that were using TRAIN to determine training practices and barriers to training. We determined key organizational features of the 7 agencies, including training structure, required training, TRAIN administrators’ employment status (full time or part time), barriers to the use and tracking of core competencies in TRAIN, training needs assessment methods, leadership support of training and staff development, and agency interest in applying for Public Health Accreditation Board accreditation. Results: We identified 4 common elements among TRAIN-affiliated state health departments: (1) underuse of TRAIN as a training tool, (2) inadequate ownership of training within the organization, (3) insufficient valuation of and budgeting for training, and (4) emerging collaboration and changing perceptions about training stimulated by agency preparation for accreditation. Conclusions: Public health leaders can increase buy-in to the importance of training by giving responsibility for training to a person, centralizing training, and setting expectations for the newly responsible training leader to update training policy and require the use of TRAIN to develop, implement, evaluate, monitor, and report on agency-wide training.

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