scholarly journals Lessons Learned from a DoD and Virginia Data Sharing Pilot using NSSP ESSENCE

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Erin E. Austin ◽  
Paul E. Lewis ◽  
Arden Norfleet ◽  
Jamaal Russell
Keyword(s):  
Public Health ◽  
Data Sharing ◽  
Syndromic Surveillance ◽  
Data Access ◽  
Pilot Project ◽  
Lessons Learned ◽  
Surveillance Data ◽  
Service Members ◽  
Local Health ◽  
Health Departments

ObjectiveThis panel will focus on the experiences from the Department of Defense (DoD) and Virginia Department of Health (VDH) data sharing project using the National Syndromic Surveillance Program (NSSP) ESSENCE and will discuss lessons learned, challenges, and recommendations within the following areas: 1) data sharing authority, 2) coordination and implementation of data sharing with a focus on personnel, training, and managing access and 3) communication between local, state, and federal agencies.IntroductionThe DoD and VDH both maintain local ESSENCE installations to monitor the health status of their military and civilian populations, respectively, and submit syndromic surveillance data to the NSSP ESSENCE to foster data sharing and collaborative initiatives among public health entities. Military Treatment Facilities (MTFs), housed on DoD installations, provide healthcare to all service members and their beneficiaries stationed in the area. Service members and their beneficiaries represent a substantial portion of the local community and interact with the civilian population throughout daily activities. Sharing syndromic surveillance data between DoD and public health jurisdictions can provide public health situational awareness among both civilian and military populations to support disease surveillance. DoD and VDH engaged in a pilot project to develop processes and procedures for data sharing, data access, and communication with the aim they can serve as best practices for other jurisdictions seeking to share syndromic surveillance data with DoD.DescriptionThe pilot project began in June 2018 with the Centers for Disease Control and Prevention (CDC) NSSP team providing technical support. NSSP ESSENCE users from the VDH state and local health departments across nine Virginia city/counties participated in the project. VDH shared syndromic surveillance data from 34 healthcare facilities (17 urgent cares, 3 emergency care centers, and 14 hospitals) with DoD, which shared syndromic surveillance data from 18 MTFs (16 clinics and 2 hospitals) in Virginia. To standardize the analysis of syndromic surveillance data and use of NSSP ESSENCE across project participants, myESSENCE tabs were created and shared by between VDH and DoD. The goal was to facilitate and enhance communication between local public health departments and their DoD counterparts through the sharing of syndromic surveillance data.How the Moderator Intends to Engage the Audience in Discussions on the TopicThe moderator will solicit feedback from the audience regarding their data sharing experiences with other entities or agencies, data sharing practices, and ideas for use cases when sharing syndromic surveillance data with DoD.

scholarly journals Evaluation Activities from the National Syndromic Surveillance Program

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Sebastian Romano ◽  
Cassandra Davis ◽  
Krystal Collier ◽  
Sara Johnston ◽  
Hana Tesfamichael ◽  
...  
Keyword(s):  
Public Health ◽  
Syndromic Surveillance ◽  
Situational Awareness ◽  
Lessons Learned ◽  
Surveillance Data ◽  
Acceptance Testing ◽  
Surveillance Program ◽  
Local Health ◽  
State And Local ◽  
Surveillance Practice

ObjectiveThe objective of this session is to discuss syndromic surveillance evaluation activities. Panel participants will describe contexts and importance of selected evaluation and performance measurement activities in NSSP. Discussions will explore ways to strengthen evaluation in syndromic surveillance activities in the future.IntroductionSyndromic surveillance uses near-real-time Emergency Department healthcare and other data to improve situational awareness and inform activities implemented in response to public health concerns. The National Syndromic Surveillance Program (NSSP) is a collaboration among state and local health departments, the Centers for Disease Control and Prevention (CDC), other federal organizations, and other entities, to strengthen the means for and the practice of syndromic surveillance. NSSP thus strives to strengthen syndromic surveillance at the national and the state, and local levels through the coordinated activities of the involved partners and the development and use of advanced technologies, such as the BioSense platform. Evaluation and performance measurement are crucial to ensure that the various strategies and activities implemented to strengthen syndromic surveillance capacity and practice are effective. Evaluation activities will be discussed at this session and feedback from audience will be sought with the goal to further strengthen evaluation activities in the future.DescriptionSyndromic surveillance practice among NSSP grant recipients: findings from a telephone based survey – S. Romano This presentation will highlight the development and implementation of a survey among the NSSP grant recipients about their syndromic surveillance practice. The objectives of the survey was to develop knowledge and understanding about: a) characteristics of syndromic surveillance practice at the state and local level among jurisdictions that are NSSP grant recipients; b) challenges encountered by these jurisdictions in conducting syndromic surveillance; and c) strategies that may help address these challenges. The objectives and methods of the survey will be described in detail. The survey is expected to be implemented before the end of this year. Preliminary findings will be presented if available. Lessons learned and strategies to consider for strengthening syndromic surveillance practice will be discussed.Defining a sustainable approach to syndromic surveillance through the AZ BioSense Workgroup Charter – K. Collier, S. Johnston The Arizona BioSense Workgroup has developed a five year charter outlining the method and measures used for implementation and adoption of syndromic surveillance in Arizona. Membership consists of clinicians, IT and public health. The mission and vision help to establish a foundation for building capacity and quality of the syndromic surveillance data, improved population health and emergency response through timely and effective use of the data. Cross-cutting topics resulted in a process for assessing training needs, establishing protocols and evaluation of use cases, shared plans for situational awareness and making public health decisions. This talk will discuss the collaborative approach and how lessons learned will inform future activities.User Acceptance Testing to inform development and enhancement of the BioSense Platform – C. Davis Between June, 2016 and January, 2017, NSSP operationalized an updated BioSense Platform for conducting syndromic surveillance. The platform included ESSENCE, a software that enables analysis and visualization of syndromic surveillance data and the Access Management Center, a tool that enables jurisdictions to manage access to data. The development of and transition to the updated platform was informed by a User Acceptance Testing (UAT) that examined the functionality and usability of the platform and associated tools After webinar based orientation UAT, participants were requested to carry out specific tasks using the updated platform and tools in development. This presentation will discuss the objectives and methods of implementation of the UAT, findings from the UAT, and how these guided transition activities and the refinement of the platform applications.A quantitative and qualitative assessment of user support provided by the NSSP Service Desk – H. Tesfamichael, S. Romano A principal component of NSSP is the BioSense platform that includes health care visits related information, particularly related to emergency department visits, from across the U.S. BioSense and its associated tools, including ESSENCE, the Access Management Center, and Adminer, enable state and local health departments, and other, as appropriate, to use syndromic surveillance data to implement surveillance and assessment activities. The NSSP Service Desk provides technical support to BioSense users to assist with the use of the BioSense platform and its tools Users submit support request tickets through an online application. An analysis of information related to these tickets, including the context of the requests and their resolution status, was conducted to better understand the support needs of users and how well these were being addressed. This presentation will discuss the assessment, findings, and conclusions.How the Moderator Intends to Engage the Audience in Discussions on the TopicThe moderator will introduce the session and the panelists. The moderator will also invite questions and comments from the audience, and will facilitate the discussions. 

scholarly journals Localized Surveillance: A Fresh Perspective for Regional Syndromic Surveillance

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Mansi Agarwal ◽  
Nimi Idaikkadar ◽  
José Lojo ◽  
Kristen Soto ◽  
Robert Mathes
Keyword(s):  
Public Health ◽  
Data Sharing ◽  
Syndromic Surveillance ◽  
Local Scale ◽  
Surveillance Data ◽  
Fresh Perspective

This roundtable will discuss successful syndromic surveillance data sharing efforts that have been used on a local scale for faster, more efficient, and long-term collaboration between neighboring public health jurisdictions.

scholarly journals Regional Governance of Syndromic Surveillance for the Texas Gulf Coast

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Wesley McNeely ◽  
Eunice R. Santos ◽  
Biru Yang ◽  
Kiley Allred ◽  
Raouf R. Arafat
Keyword(s):  
Public Health ◽  
Communities Of Practice ◽  
Syndromic Surveillance ◽  
Health Department ◽  
Regional Governance ◽  
Local Health ◽  
Health Departments ◽  
Care Providers ◽  
Local Health Departments ◽  
Syndromic Surveillance System

ObjectiveDescribe and explain the transition of the syndromic surveillanceprogram at the Houston Health Department (HHD) from being alocally managed and aging system to an ESSENCE system governedby a regional Consortium of public health agencies and stakeholdersin the 13-county area of the southeast Texas.IntroductionSyndromic surveillance systems are large and complex technologyprojects that increasingly require large investments of financial andpolitical capital to be sustainable. What was once a minor surveillancetool in the mid-2000s has evolved into a program that is regardedas valuable to public health yet is increasingly difficult to maintainand operate for local health departments. The Houston HealthDepartment installed a syndromic surveillance system (SyS) sixyears before Meaning Use became known to healthcare communities.The system chosen at the time was the Real-time Outbreak DiseaseSurveillance System (RODS) which, at the time and for its purpose,was a suitable platform for syndromic surveillance. During the past13 years however, maintaining, operating, and growing a SyS by alocal health department has become increasingly difficult. Inclusionin Meaningful Use elevated the importance and profile of syndromicsurveillance such that network growth, transparency of operations,ease of data sharing, and cooperation with other state systems inTexas became program imperatives.MethodsWith support from the informatics group at Tarrant County PublicHealth (TCPH) in the form of mentoring, HHD devised a two prongstrategy to re-invigorate the syndromic program. The first was toreplace RODS with ESSENCE from Johns Hopkins Applied PhysicsLaboratory (JH/APL). The second was to strengthen the regionalnetwork by creating a governance structure that included outsideagencies and stakeholders. The product of this second effort wasthe creation of the Syndromic Surveillance Consortium of SoutheastTexas (SSCSeT) on the Communities of Practice model1usingparliamentary procedure2.ResultsAcquiring ESSENCE and forming SSCSeT were necessary stepsfor the continuing operation of the SyS. The Consortium includesmembers from local health jurisdictions, health care providers, healthpolicy advocates, academicians, and data aggregators. Created asa democratic society, SSCSeT wrote its constitution and by-laws,voted in officers, formed working groups and has begun developingpolicies. The Consortium is cooperating with the Texas Departmentof State Health Services (DSHS) as well as TCPH. Having ESSENCEwill ensure the HHD-SyS will conform to standards being developedin the state and provide a robust syndromic platform for the partnersof the Consortium.ConclusionsSyndromic systems operated by local health departments canadapt to regulatory changes by growing their networks and engagingregional stakeholders using the Communities of Practice model.

scholarly journals Syndromic Surveillance – Reports of Successes from the Field

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Antheny Wilson ◽  
Teresa Hamby ◽  
Wei Hou ◽  
David J Swenson ◽  
Krystal Collier ◽  
...  
Keyword(s):  
Public Health ◽  
Data Quality ◽  
Syndromic Surveillance ◽  
Surveillance Program ◽  
Local Health ◽  
Health Departments ◽  
Local Health Departments ◽  
Success Stories ◽  
Department Of Health ◽  
State And Local

Objective: This panel will:● Discuss the importance of identifying and developing success stories● Highlight successes from state and local health departments to show how syndromic surveillance activities enhance situational awareness and address public health concerns● Encourage discussion on how to further efforts for developing and disseminating success storiesIntroduction: Syndromic surveillance uses near-real-time emergency department and other health care data for enhancing public health situational awareness and informing public health activities. In recent years, continued progress has been made in developing and strengthening syndromic surveillance activities. At the national level, syndromic surveillance activities are facilitated by the National Syndromic Surveillance Program (NSSP), a collaboration among state and local health departments, the CDC, other federal organizations, and other organizations that enabled collection of syndromic surveillance data in a timely manner, application of advanced data monitoring and analysis techniques, and sharing of best practices. This panel will highlight the importance of success stories. Examples of successes from state and local health departments will be presented and the audience will be encouraged to provide feedback.Description: ●Success stories – acknowledging and informing syndromic surveillance practiceThis presentation will discuss the importance of success stories for NSSP focused on increasing syndromic surveillance representativeness, improving data quality, and strengthening syndromic surveillance practices among grant recipients and partners. From the beginning of the program, the identification of success stories has been an important part of the efforts to develop knowledge base that better guide syndromic surveillance program activities.●NJ and BioSense – Making The Connection The New Jersey Department of Health (NJDOH) uses Health Monitoring’s EpiCenter as its primary ED data for syndromic surveillance. This data is also submitted to CDC’s NSSP BioSense Platform. In April 2017, a spike in ED Visits of Interest was identified by a CDC NSSP subject matter expert and brought to the attention of NJDOH’s data analyst. Data showed an increase in “Exposure” and “School Exposure” chief complaints in two contiguous counties. News reports showed the visits resulted from a dormitory fire at a university in the area. The NSSP and NJDOH staff collaboration integrated data from both NJDOH’s EpiCenter and CDC’s BioSense Platform for further investigation. This activity shows BioSense Platform’s potential as an additional syndromic surveillance tool because of its different classifications and keyword groupings.●Evaluation and Performance Measures at the Utah Department of HealthSyndromic surveillance related evaluation activities at the Utah Department of Health requires collaboration between subject matter experts and system users from the UT-NSSP workgroup. The progress is examined quarterly and outcomes compared with the short-, mid-, and long-term outcomes listed in the NSSP logic model to ensure activities are in sync with the program’s overall goals. Throughout the budget year, a variety of tools were used to keep track of the progress. During this session, challenges and successes, lessons learned, and effective strategies will be discussed.●NSSP R tool Data Download Useful in NHThe New Hampshire Department of Health and Human Services (NH DHHS) uses the state-wide Automated Hospital Emergency Department Data (AHEDD) system as its primary syndromic surveillance system. A copy of this data is submitted to CDC’s NSSP BioSense Platform. In July of 2017, NH worked with the NSSP vendor, CDC staff, a jurisdictional expert, NH Division of Information Technology staff, and an external vendor to create an “R” software download in CSV format and home-based NSSP Cognos report. This allowed NH DHHS staff to compare these data to the home-based data and ultimately, it proved to be an important step in the NSSP data quality assessment process.●Achieving success to improve data quality through collaborative Community of Practice partnerships The Data Quality Committee is a forum to identify, discuss, and attempt to address syndromic surveillance data quality issues. Maintaining data quality for the chief complaint field is a priority as it can impact the creation and refinement in the successful application of a syndrome definition for one of the fundamental data elements. An issue was observed in the Arizona data in the BioSense Platform, where chief complaint was being truncated at 200 characters. Through efforts to build relationships from the committee in the Community of Practice, Arizona was able to discover the root causes for the issue, assess if it affected other jurisdictions, and work with the partners to find a feasible resolution. This talk will discuss how this collaborative approach helped improve data quality.How the Moderator Intends to Engage the Audience in Discussions on the Topic: The moderator will introduce the session and the panelists, and will invite questions and comments from the audience.

scholarly journals ESSENCE, the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (Preprint)

2020 ◽  
Author(s):  
Howard Burkom ◽  
Wayne Loschen ◽  
Richard Wojcik ◽  
Rekha Holtry ◽  
Monika Punjabi ◽  
...  
Keyword(s):  
Public Health ◽  
Surveillance System ◽  
Severe Weather ◽  
Lessons Learned ◽  
Local Health ◽  
Walter Reed Army Institute ◽  
Health Departments ◽  
Electronic Surveillance ◽  
Community Based ◽  
Detection And Tracking

BACKGROUND The Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) is a secure web-based tool that enables health care practitioners to monitor health indicators of public health importance for detection and tracking of disease outbreaks, consequences of severe weather, and other events of concern. The ESSENCE concept began in an internally funded project at the Johns Hopkins University Applied Physics Laboratory (JHU/APL), advanced with funding from the State of Maryland, and broadened in 1999 as a collaboration with the Walter Reed Army Institute for Research. Versions of the system have been further developed by JHU/APL in multiple military and civilian programs for timely detection and tracking of health threats. OBJECTIVE Aims of this article are to describe the components and development of a biosurveillance system increasingly coordinating all-hazards health surveillance as well as infectious disease monitoring among large and small health departments, to list key features and lessons learned in the growth of this system, and to describe the range of initiatives and accomplishments of local epidemiologists using it. METHODS Features of ESSENCE include spatial and temporal statistical alerting, custom querying, user-defined alert notifications, geographical mapping, remote data capture, and event communications. For visualization, configurable and interactive modes of data stratification and filtering, graphical and tabular customization, user preference management, and sharing features allow users to query data and view geographic representations, time series and data details pages, and reports. These features allow ESSENCE users to gather and organize the resulting wealth of information into a coherent view of population health status and communicate findings among users. RESULTS The resulting broad utility, applicability and adaptability of this system led to adoption of ESSENCE by the Centers for Disease Control and Prevention (CDC), numerous state and local health departments, and the Department of Defense (DOD) both nationally and globally. An open-source version SAGES is available for global, resource-limited settings. Resourceful users of the US NSSP ESSENCE have applied it to surveillance of infectious diseases, severe weather and natural disaster events, mass gatherings, chronic diseases and mental health, and injury and substance abuse. CONCLUSIONS With emerging high-consequence communicable diseases and other health conditions, the continued user-requirements-driven enhancements of ESSENCE demonstrate an adaptable disease surveillance capability focused on the everyday needs of public health. The challenge of a live system for widely distributed users with multiple different data sources and high throughput requirements has driven an novel, evolving architecture design.

scholarly journals Mandating Syndromic Surveillance Reporting from Emergency Departments: The Washington Experience

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Amanda D. Morse ◽  
Natasha Close ◽  
Cynthia Harry ◽  
Kevin Wickersham
Keyword(s):  
Public Health ◽  
Emergency Departments ◽  
Syndromic Surveillance ◽  
Meaningful Use ◽  
Data Access ◽  
Washington State ◽  
State Agencies ◽  
Local Health ◽  
Diverse Group ◽  
Legislative Session

ObjectiveTo protect syndromic surveillance data reporting from emergency departments in Washington State beyond the cessation of Meaningful Use incentive funding in 2021.IntroductionAs syndromic surveillance reporting became an optional activity under Meaningful Use Stage 3 and incentive funds are slated to end completely in 2021, Washington State sought to protect syndromic reporting from emergency departments. As of December 2016, Washington State emergency departments had received $765,335,529.40 in incentive funding, with facilities receiving an average of three payments of $479,974.04 each.1Considering the public health importance of syndromic surveillance reporting and the fiscal impact of mandatory reporting, the Washington State Department of Health (WA DOH) sought a new statute to require reporting from all emergency departments within the state.MethodsStakeholder negotiations occurred in four distinct phases: initial outreach to gauge support for the proposed legislation and solicit comments on items for inclusion in the bill language (April to October 2016), negotiations on the proposed text (October 2016 to January 2017), sustained contact with key groups during the legislative session (January to May 2017), and targeted messaging and comment solicitation to inform the development of the administrative codes to accompany the statute (May 2017 to March 2018) (Figure 1). WA DOH secured funding from the Washington Traffic Safety Commission (WTSC) to hire a designated staff member to coordinate and lead the syndromic surveillance program’s legislative agenda.ResultsDuring the first phase, WA DOH contacted a diverse group of stakeholders, including 7 state agencies, 5 data provider groups, 3 professional associations, 3 public health non-profits, 35 local health jurisdictions, and 29 Tribal Organizations to provide information on syndromic surveillance and gauge interest in the proposed legislation. Key partners included the WTSC, the Washington State Hospital Administration (WSHA), the Washington Poison Center (WAPC), and several large to medium-sized local health jurisdictions (LHJs).Early stakeholder negotiations indicated broad support among local health jurisdictions, state agencies, programs handling violence and injury topics, communicable disease specialists, the Department of Labor and Industries, and the Office of Financial Management; however, support from data providers was more cautious. Early relationship-building and maintaining frequent contact was key to securing support from data providers and allowed WA DOH to draft a mid-session amendment to the bill granting greater data access for providers and clarifying the foundational fee structure for data distribution.During the second phase of outreach and communication, areas of more intense negotiation included data access levels for providers, timeliness of data availability, and the proposed inclusion of a “sundown clause” which would end the effective period of the statute when federal incentive spending expired.WA DOH secured bipartisan co-sponsorship for the bill in the Washington State Senate and stakeholder negotiations continued throughout the legislative session (January-May 2017). Common concerns from stakeholders and legislators included the maintenance of patient privacy, the costs associated with participation for emergency departments, and data sharing agreements with facilities providing syndromic data.The bill passed unanimously out of the Washington State Senate and with broad bipartisan support out of the Washington State House. Governor Jay Inslee signed the bill into law on May 5, 2017 and WA DOH has continued negotiations as they develop the administrative codes to accompany the statute.ConclusionsBroad and sustained interactions with a diverse group of stakeholders, as well as willingness to compromise on data sharing and cost issues with providers, was key to Washington State’s successful effort to mandate syndromic surveillance reporting from emergency departments.References1. Medicare and Medicaid Incentive Provider Payments By State, Program Type and Provider Type January 2011 to December 2016. Centers for Medicare and Medicaid. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/December2016_PaymentsbyStateProgramandProvider.pdf Last accessed: 11 September 2017. 

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

Patterns of Cross-Sector Collaboration in Local Health Departments: A Cluster Analysis

2020 ◽  
pp. 152483992097298
Author(s):  
Alexis K. Grant
Keyword(s):  
Public Health ◽  
Cluster Analysis ◽  
Determinants Of Health ◽  
Local Health ◽  
Health Departments ◽  
Local Health Departments ◽  
Structural Determinants ◽  
Cluster Assignment ◽  
Cross Sectional ◽  
Top Executive

Local health departments (LHDs) are positioned to act as the community health strategist for their catchment area, which requires cross-sector collaboration. However, little research exists to understand how much and what types of cross-sector collaboration occur and its impact on LHD practice. Data from 490 LHDs who participated in the 2016 National Profile of Local Health Departments survey were analyzed to identify patterns of cross-sector collaboration among LHDs. In the survey, LHDs reported the presence of collaborative activities for each of 22 categories of organizations. Factor analysis was used to identify patterns in the types of organizations with which LHDs collaborate. Then, cluster analysis was conducted to identify patterns in the types of cross-sector collaboration, and cross-sectional analyses examined which LHD characteristics were associated with cluster assignment. LHDs collaborated most with traditional health care–oriented organizations, but less often with organizations focused on upstream determinants of health such as housing. Three distinct clusters represented collaboration patterns in LHDs: coordinators, networkers, and low-collaborators. LHDs who were low-collaborators were more likely to serve smaller populations, be unaccredited, have a smaller workforce, have a White top executive, and have a top executive without a graduate degree. These findings imply that public health practitioners should prioritize building bridges to a variety of organizations and engage in collaboration beyond information sharing. Furthermore, LHDs should prioritize accreditation and workforce development activities for supporting cross-sector collaboration. With these investments, the public health system can better address the social and structural determinants of health and promote health equity.

scholarly journals Actionable lessons for the US COVID vaccine program

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gary L. Freed
Keyword(s):  
Public Health ◽  
Local Health ◽  
National Strategy ◽  
Individual State ◽  
Health Departments ◽  
Local Health Departments ◽  
Public Health Infrastructure ◽  
Health Infrastructure ◽  
The Us ◽  
Vaccine Distribution

AbstractWhen attempting to provide lessons for other countries from the successful Israeli COVID-19 vaccine experience, it is important to distinguish between the modifiable and non-modifiable components identified in the article by Rosen, et al. Two specific modifiable components included in the Israeli program from which the US can learn are (a) a national (not individual state-based) strategy for vaccine distribution and administration and (b) a functioning public health infrastructure. As a federal government, the US maintains an often complex web of state and national authorities and responsibilities. The federal government assumed responsibility for the ordering, payment and procurement of COVID vaccine from manufacturers. In designing the subsequent steps in their COVID-19 vaccine distribution and administration plan, the Trump administration decided to rely on the states themselves to determine how best to implement guidance provided by the Centers for Disease Control and Prevention (CDC). This strategy resulted in 50 different plans and 50 different systems for the dissemination of vaccine doses, all at the level of each individual state. State health departments were neither financed, experienced nor uniformly possessed the expertise to develop and implement such plans. A national strategy for the distribution, and the workforce for the provision, of vaccine beyond the state level, similar to that which occurred in Israel, would have provided for greater efficiency and coordination across the country. The US public health infrastructure was ill-prepared and ill-staffed to take on the responsibility to deliver > 450 million doses of vaccine in an expeditious fashion, even if supply of vaccine was available. The failure to adequately invest in public health has been ubiquitous across the nation at all levels of government. Since the 2008 recession, state and local health departments have lost > 38,000 jobs and spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%. Hopefully, COVID-19 will be a wakeup call to the US with regard to the need for both a national strategy to address public health emergencies and the well-maintained infrastructure to make it happen.

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