1 / 25

Assessing local public health capacity and performance in diabetes prevention and control

Assessing local public health capacity and performance in diabetes prevention and control. Deborah Porterfield, MD MPH University of North Carolina-Chapel Hill and RTI International AcademyHealth PHSR Interest Group 6.07. Problem statement: Local public health and chronic disease.

korbin
Download Presentation

Assessing local public health capacity and performance in diabetes prevention and control

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Assessing local public health capacity and performance in diabetes prevention and control Deborah Porterfield, MD MPH University of North Carolina-Chapel Hill and RTI International AcademyHealth PHSR Interest Group 6.07

  2. Problem statement: Local public health and chronic disease • Available evidence suggests that chronic disease activities in local health departments (LHDs) lag behind the historically important issues of control of infectious diseases, maternal and child health, and environmental health. (NACCHO, 2006) • In order to improve LHD performance in chronic disease, we must first describe current practice, and develop valid measures of performance

  3. Measuring diabetes prevention and control in North Carolina LHDs • Diabetes as a model chronic disease for study • State Diabetes Prevention and Control Program • Provides technical assistance and funding to LHDs (Diabetes Today)

  4. Objectives • Measure capacity of NC LHDs to conduct diabetes prevention and control activities. • Measure levels of performance in diabetes related prevention and control services and programs in NC LHDs. • Assess characteristics of local health departments and their jurisdictions (communities) that may be associated with higher performance.

  5. Examine differences in capacity and performance between LHDs that have received training and funds through a specific federal and state program, Diabetes Today, and those who have not, in order to assess if participation has increased capacity and performance.

  6. Survey administration • Mailed survey • Participants: All local health departments in North Carolina (n=85) • Instrument adapted from the Local Public Health System Performance Assessment • 10 Essential Services • Additional diabetes-specific questions

  7. Measuring “capacity” and “performance” • Capacity defined as FTEs in diabetes prevention or control • Performance defined as self-reported provision of program or service • 33 yes/no questions combined into a 10 point index, one point for each Essential Service

  8. Based on model of public health performance by Handler, et al (2001) • Other characteristics of LHD and community under categories of “Macro Context”, “Structural Capacity”, and “LHD Mission” • Main predictors of interest: History of Diabetes Today (or Project IDEAL) funding; Mission statement; estimates of need • Size of LHD considered to be a confounder • Accreditation status not considered as confounder

  9. Secondary data sources • County-specific sociodemographic and medical care data • Diabetes Prevention and Control Program, DPH • NC Health Professions Data system • US Census • NC Community Health Center Association • Profile survey of the National Association of City and County Health Officers (NACCHO)

  10. Data Analysis • Univariate descriptions • Bivariate analyses to examine relationship between performance and LHD or jurisdiction characteristics • T-tests and Spearman correlation coefficients • Limited multiple linear regression modeling • the effect of confounding assessed one variable at a time

  11. Results • 100% response • 2 mailings, reminder postcards, phone follow up

  12. LHD characteristics Number of FTEs (median) 80 (IQR 51-128) Expenditures, million (median) $ 4.81 (IQR 2.95-8.0) Accredited 31% Diabetes Today funding 35% Project IDEAL funding 4% Full time medical director 20% DM or chronic disease in mission 18.9%

  13. Characteristics of LHD jurisdictions Single-county 93% Population >100k 31% Urban 47% % population below poverty (mean) 14% (sd 4.2) Any C/MHC or free clinic 71% Physician/100k ratio (median) 62.0 (IQR 47.8-89.0) Est. diabetes prevalence (mean) 9.1% (sd 0.93)

  14. Capacity: FTEs • Prevention FTEs (median) 0.05 (IQR 0-0.5) • Control FTEs (median) 0.1 (IQR 0-0.5) • 40% have no FTEs devoted to prevention or control

  15. Performance by Essential Service

  16. Performance index • Mean 3.5 (range 0-9.2; sd 1.9)

  17. Associations between index and LHD characteristics R* or Mean index P Number of FTEs 0.349 0.003 Expenditures, in millions 0.363 0.002 Accredited Yes 4.30 0.025 No 3.23 Diabetes Today funding Yes 4.08 0.030 No 3.15 Project Ideal funding Yes 6.70 0.002 No 3.36

  18. Associations between index and jurisdiction characteristics R* or Mean index P Population>100k Yes 4.26 0.010 No 3.13

  19. Regression models • To understand the association between Diabetes Today funding and performance index • Controlling for population size did not change the association between DT funding and the performance index.

  20. Conclusions • Limited capacity (FTEs) • Variation in performance of Essential Services • Surveillance, health education, linking to services HIGH • Research, evaluation, policy LOW • Specific questions with notable results: • Assessment of availability of clinical care or diabetes education LOW • Community based screening HIGH

  21. Total performance not higher in areas with greater need (prevalence of diabetes, availability of primary care) • Funding from state health department or foundation and the size of the LHD are associated with performance

  22. Limitations • Self-report • Types, numbers of respondents • Item validity and reliability • Measuring capacity and performance • Cross-sectional design • Generalizability • Other characteristics of LHD not measured

  23. Implications • Although some NC LHDs are able to provide diabetes services and programs with limited resources, the findings suggest the opportunity to enhance local public health practice through targeted funding • Specific findings can influence technical assistance provided by the state DPCP to LHDs

  24. Acknowledgments • The NC Association of Local Health Directors Health Promotion Committee: Curtis Dickson and Beth Lovette • NC Division of Public Health: Janet Reaves, RN, MPH; Marcus Plescia, MD, MPH • UNC School of Public Health and the NC Institute for Public Health: Ed Baker, MD, MPH; Mary Davis, DrPH, MSPH; Bob Konrad, PhD; Bryan Weiner, PhD • Data for this study were obtained from the 2005 National Profile of Local Health Departments, a project supported through a cooperative agreement between the National Association of County and City Health Officials and the Centers for Disease Control and Prevention (U50/CCU302718). • Work funded by the Pfizer Scholars Grants in Public Health

  25. Deborah Porterfield, MD, MPH Department of Social Medicine UNC Chapel Hill School of Medicine porterfi@email.unc.edu 919/843-6596

More Related