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From Theory to Practice: What drives the core business of public health? AcademyHealth 2005 Annual Research Meeting Tina Anderson Smith, MPH June 27, 2005. Research Questions. What is the current core business of Georgia’s governmental public health agency?

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From Theory to Practice: What drives the core business of public health?

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From Theory to Practice:

What drives the core business

of public health?

AcademyHealth 2005 Annual Research Meeting

Tina Anderson Smith, MPH

June 27, 2005


Research Questions

  • What is the current core business of Georgia’s governmental public health agency?

  • What is the “ideal” core business of Georgia’s governmental public health agency?


Principal Findings

  • Relevant, but not resonant

  • Practice Paradox

    • Current core business not aligned with “ideal” core business

  • Driver Dilemma

    • Current drivers not aligned with “ideal” drivers

  • Strategy Shortage

    • Call for public health leadership and collaboration


State Context

  • 8.5 million residents +

  • Relatively younger and more diverse

  • 13% below Federal Poverty Level

  • Poor health status, disparities

  • 1 million + Medicaid

  • 1 million + uninsured

  • Rural access issues


Public Health Agency Infrastructure

  • State agency within Department of Human Resources

  • 18 District Offices

  • 159 Local Health Departments

  • 6,000 DPH Staff

  • Approximately $624 million budget in 2004

  • State public health spending $7 per capita


Methods: Design

  • Case study approach

    • Primary Unit: State public health agency

    • Embedded Units:

      • District and local agencies

      • Resource flow, collaboration, structure, strategy, and staff perceptions

    • Contextual Elements:

      • Political, economic, financing, and regulatory environment, as well as stakeholder perceptions


Methods

  • Data sources

    • Interviews (n=69)

      • Internal and External Stakeholders

    • Focus groups (86 participants in 6 groups)

    • Archival documents

  • Analysis

    • Emergent, data-based, inductive

    • Holistic

    • Triangulation

    • Participant Validation


Principal Findings

  • Relevant, but not resonant

  • Practice Paradox

    • Current core business not aligned with “ideal” core business

  • Driver Dilemma

    • Current drivers not aligned with “ideal” drivers

  • Strategy Shortage

    • Call for public health leadership and collaboration


Practice Paradox


Current Drivers

Money

Safety Net

Uninsured

Performance-based budgeting

Regulation

Leaders’ philosophies

Ideal Drivers

Need

Evidence-based practices

State strategy informed by local perspective

Local culture

Driver Dilemma


State of Georgia

Federal Funds

Other Funds/TSF

Ryan White

Hospital ICTF

Foundations

Division of

Public Health

County Funds

Program GIA

Regular GIA

Administrative

County Health Dept.

County Fees

District Office

Lead County

Money

Conceptual Flow of Funding


Summary

  • Practice preferences aligned with the 10 Essential Services

  • Current core business not aligned with theoretical ideal

  • Inherent systemic challenges mediate translation of theory into practice

  • Moving toward “ideal” practice requires addressing larger system drivers


Implications

  • Understanding practice drivers and their impact on performance is essential

  • May be difficult in some states to balance essential services without broader policy change

    • Performance Standards

    • Accreditation

  • Emerging role for public health to participate in, even lead, broader policy conversations


Possibilities

  • “Upstream” interventions to address drivers of practice may emerge as important compliment to more proximal strategies – structure and process – to improve public health performance.


Acknowledgements

  • Georgia Division of Public Health

  • Georgia Health Policy Center Team:

    • Karen Minyard, Ph.D.

    • Chris Parker, M.D., M.P.H.

    • Beverly Tyler

    • Rachel Ferencik, M.P.A.


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