TY - JOUR AB - OBJECTIVES: This study examines organizational characteristics and market conditions likely to influence collaborative relationships between public health agencies and community medical care providers. METHODS: Public health directors in 60 US counties were surveyed by telephone concerning their relationships with area community hospitals (n = 263) and community health centers (n = 85). Multivariate models were used to estimate the effects of organizational and market characteristics on collaboration. RESULTS: Collaboration was reported among 55% of the hospitals and 64% of the health centers. Certain forms of collaboration were more likely in markets characterized by higher HMO penetration and lower HMO competition. CONCLUSIONS: Targeted efforts to facilitate collaboration may be required in settings where institutional and market incentives are lacking. AD - Public Health Practice Program Office, Centers for Disease Control and Prevention, Atlanta, Ga., USA. AN - 11111265 AU - Halverson, P. K. AU - Mays, G. P. AU - Kaluzny, A. D. C2 - PMC1446432 DA - Dec DP - NLM ET - 2000/12/09 IS - 12 J2 - American journal of public health KW - Attitude of Health Personnel Community Health Centers/*organization & administration *Cooperative Behavior Cross-Sectional Studies Economic Competition *Health Care Sector Health Maintenance Organizations/organization & administration Health Services Research Hospitals, Community/*organization & administration Humans *Interinstitutional Relations Logistic Models Multivariate Analysis Organizational Culture Ownership Physician Executives/*psychology *Public Health Administration Surveys and Questionnaires United States LA - eng N1 - Halverson, P K Mays, G P Kaluzny, A D Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. United States Am J Public Health. 2000 Dec;90(12):1913-6. PY - 2000 SN - 0090-0036 (Print) 0090-0036 SP - 1913-6 ST - Working together? Organizational and market determinants of collaboration between public health and medical care providers T2 - Am J Public Health TI - Working together? Organizational and market determinants of collaboration between public health and medical care providers UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446432/pdf/11111265.pdf VL - 90 ID - 70 ER - TY - JOUR AB - Alliances between managed care plans and public health agencies are a growing phenomenon in local health care markets, with profound implications for health care quality, cost, and accessibility. A typology of interorganizational relations between managed care plans and local public health agencies is drawn from observations of over 60 public health jurisdictions. Relations are described along three dimensions corresponding to the strategic intent, functional operation, and structural design of each alliance type. The identified models of interaction reveal the motivations for forming alliances, the mechanics of their operation, and the possible outcomes. These alliances suggest that a wide range of interorganizational strategies is possible in order to pursue the shared interests of local public health agencies and managed care plans. Nonetheless, public health agencies may face challenges in forging managed care alliances that benefit community-wide populations and that are open to participation by the full spectrum of health care providers in the community. AD - Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill 27599-7400, USA. paul_halverson@bdunc.edu AN - 9063302 AU - Halverson, P. K. AU - Mays, G. P. AU - Kaluzny, A. D. AU - Richards, T. B. C2 - PMC2751038 DP - NLM ET - 1997/01/01 IS - 1 J2 - The Milbank quarterly KW - Contract Services Health Maintenance Organizations/organization & administration Health Planning Health Services Accessibility Humans *Interinstitutional Relations Managed Care Programs/*organization & administration *Models, Organizational Preferred Provider Organizations/organization & administration *Public Health Administration Quality of Health Care United States LA - eng N1 - Halverson, P K Mays, G P Kaluzny, A D Richards, T B Journal Article United States Milbank Q. 1997;75(1):113-38. PY - 1997 SN - 0887-378X (Print) 0887-378x SP - 113-38 ST - Not-so-strange bedfellows: models of interaction between managed care plans and public health agencies T2 - Milbank Q TI - Not-so-strange bedfellows: models of interaction between managed care plans and public health agencies UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751038/pdf/milq_046.pdf VL - 75 ID - 65 ER - TY - JOUR AB - OBJECTIVES: We investigated changes in hospital participation in local public health systems and the delivery of public health activities over time and assessed the relationship between hospital participation and the scope of activities available in local public health systems. METHODS: We used longitudinal observations from the National Longitudinal Survey of Public Health Systems to examine how hospital contributions to the delivery of core public health activities varied in 1998, 2006, and 2012. We then used multivariate regression to assess the relationship between the level of hospital contributions and the overall availability of public health activities in the system. RESULTS: Hospital participation in public health activities increased from 37% in 1998 to 41% in 2006 and down to 39% in 2012. Regression results indicated a positive association between hospital participation in public health activities and the total availability of public health services in the systems. CONCLUSIONS: Hospital collaboration does play an important role in the overall availability of public health services in local public health systems. Efforts to increase hospital participation in public health may have a positive impact on the scope of services provided and population health in US communities. AD - Rachel A. Hogg is with the School of Public Affairs, University of Colorado, Denver. Glen P. Mays and Cezar B. Mamaril are with the Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington. AN - 26066929 AU - Hogg, R. A. AU - Mays, G. P. AU - Mamaril, C. B. C2 - PMC4504280 DA - Aug DO - 10.2105/ajph.2015.302563 DP - NLM ET - 2015/06/13 IS - 8 J2 - American journal of public health KW - Cooperative Behavior Hospitals, Urban/*organization & administration/statistics & numerical data Humans Longitudinal Studies Public Health/methods/statistics & numerical data Public Health Administration/*methods/statistics & numerical data United States LA - eng N1 - 1541-0048 Hogg, Rachel A Mays, Glen P Mamaril, Cezar B Journal Article Research Support, Non-U.S. Gov't United States Am J Public Health. 2015 Aug;105(8):1646-52. doi: 10.2105/AJPH.2015.302563. Epub 2015 Jun 11. PY - 2015 SN - 0090-0036 SP - 1646-52 ST - Hospital Contributions to the Delivery of Public Health Activities in US Metropolitan Areas: National and Longitudinal Trends T2 - Am J Public Health TI - Hospital Contributions to the Delivery of Public Health Activities in US Metropolitan Areas: National and Longitudinal Trends UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504280/pdf/AJPH.2015.302563.pdf VL - 105 ID - 58 ER - TY - JOUR AB - OBJECTIVES: We identified factors associated with local health department (LHD) adoption and discontinuation of clinical services. METHODS: We used multivariate regression with 1997 and 2008 LHD survey and area resource data to examine factors associated with LHDs maintaining or offering more clinical services (adopter) versus offering fewer services (discontinuer) over time and with the number of clinical services discontinued among discontinuers. RESULTS: Few LHDs (22.2%) were adopters. The LHDs were more likely to be adopters if operating in jurisdictions with local boards of health and not in health professional shortage areas, and if experiencing larger percentage increase in non-White population and Medicaid managed care penetration. Discontinuer LHDs eliminated more clinical services in jurisdictions that decreased core public health activities' scope over time, increased community partners' involvement in these activities, had larger increases in Medicaid managed care penetration, and had lower LHD expenditures per capita over time. CONCLUSIONS: Most LHDs are discontinuing clinical services over time. Those that cover a wide range of core public health functions are less likely to discontinue services when residents lack care access. Thus, the impact of discontinuation on population health may be mitigated. AD - Both authors are with the Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles. AN - 24228663 AU - Hsuan, C. AU - Rodriguez, H. P. C2 - PMC3910038 DA - Jan DO - 10.2105/ajph.2013.301426 DP - NLM ET - 2013/11/16 IS - 1 J2 - American journal of public health KW - Delivery of Health Care/*organization & administration Health Facility Closure Health Services Accessibility Health Services Research Humans Local Government Organizational Objectives Public Health Administration/*standards Risk Factors United States LA - eng N1 - 1541-0048 Hsuan, Charleen Rodriguez, Hector P T32 HS000046/HS/AHRQ HHS/United States TL1 TR000121/TR/NCATS NIH HHS/United States TL1TR000121/TR/NCATS NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. United States Am J Public Health. 2014 Jan;104(1):124-33. doi: 10.2105/AJPH.2013.301426. Epub 2013 Nov 14. PY - 2014 SN - 0090-0036 SP - 124-33 ST - The adoption and discontinuation of clinical services by local health departments T2 - Am J Public Health TI - The adoption and discontinuation of clinical services by local health departments VL - 104 ID - 48 ER - TY - JOUR AB - OBJECTIVES: A typology of local public health systems was recently introduced, and a large degree of structural transformation over time was discovered in the systems analyzed. We present a qualitative exploration of the factors that determine variation and change in the seven structural configurations that comprise the local public health delivery system typology. METHODS: We applied a 10-item semistructured telephone interview protocol to representatives from the local health agency in two randomly selected systems from each configuration--one that had maintained configuration over time and one that had changed configuration over time. We assessed the interviews for patterns of variation between the configurations. RESULTS: Four key determinants of structural change emerged: availability of financial resources, interorganizational relationships, public health agency organization, and political relationships. Systems that had changed were more likely to experience strengthened partnerships between public health agencies and other community organizations and enjoy support from policy makers, while stable systems were more likely to be characterized by strong partnerships between public health agencies and other governmental bodies and less supportive relationships with policy makers. CONCLUSIONS: This research provides information regarding the determinants of system change, and may help public health leaders to better prepare for the impacts of change in the areas discussed. It may also help those who are seeking to implement change to determine the contextual factors that need to be in place before change can happen, or how best to implement change in the face of contextual factors that are beyond their control. AD - University of Kentucky College of Public Health, Lexington, KY 40536, USA. rcingr2@uky.edu AN - 22379221 AU - Ingram, R. C. AU - Scutchfield, F. D. AU - Mays, G. P. AU - Bhandari, M. W. C2 - PMC3268806 DA - Mar-Apr DO - 10.1177/003335491212700210 DP - NLM ET - 2012/03/02 IS - 2 J2 - Public health reports (Washington, D.C. : 1974) KW - Cooperative Behavior Delivery of Health Care/*economics/*organization & administration Humans Longitudinal Studies Organizational Innovation/*economics *Politics Public Health Public-Private Sector Partnerships Surveys and Questionnaires LA - eng N1 - 1468-2877 Ingram, Richard C Scutchfield, F Douglas Mays, Glen P Bhandari, Michelyn W Journal Article United States Public Health Rep. 2012 Mar-Apr;127(2):208-15. doi: 10.1177/003335491212700210. PY - 2012 SN - 0033-3549 SP - 208-15 ST - The economic, institutional, and political determinants of public health delivery system structures T2 - Public Health Rep TI - The economic, institutional, and political determinants of public health delivery system structures UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268806/pdf/phr127000208.pdf VL - 127 ID - 54 ER - TY - JOUR AB - OBJECTIVES: We examined the availability and perceived effectiveness of 20 basic public health activities in the communities where most Americans reside. METHODS: A self-administered questionnaire was mailed to the 497 directors of US local health departments serving at least 100 000 residents. RESULTS: On average, two thirds of the 20 public health activities were performed in the local jurisdictions surveyed, and the perceived effectiveness rating averaged 35% of the maximum possible. In multivariate models, availability of public health activities varied significantly according to population size, socioeconomic measures, local health department spending, and presence of local boards of health. CONCLUSIONS: Local public health capacity varies widely across the nation's most populous communities, highlighting the need for targeted improvement efforts. AD - Mathematica Policy Research, Washington, DC, USA. MaysGlenP@uams.edu AN - 15249309 AU - Mays, G. P. AU - Halverson, P. K. AU - Baker, E. L. AU - Stevens, R. AU - Vann, J. J. C2 - PMC1448383 DA - Jun DP - NLM ET - 2004/07/14 IS - 6 J2 - American journal of public health KW - Efficiency, Organizational/*statistics & numerical data Humans *Public Health Practice Surveys and Questionnaires United States *Urban Population LA - eng N1 - Mays, Glen P Halverson, Paul K Baker, Edward L Stevens, Rachel Vann, Julie J Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. United States Am J Public Health. 2004 Jun;94(6):1019-26. PY - 2004 SN - 0090-0036 (Print) 0090-0036 SP - 1019-26 ST - Availability and perceived effectiveness of public health activities in the nation's most populous communities T2 - Am J Public Health TI - Availability and perceived effectiveness of public health activities in the nation's most populous communities UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448383/pdf/0941019.pdf VL - 94 ID - 49 ER - TY - JOUR AB - BACKGROUND: Many health care organizations have begun to pursue collaborative approaches for addressing community-level health issues. To understand how these community health alliances develop and operate, a descriptive study was conducted within a nationally selected group of 60 local communities and supplemented by detailed case studies in 8 communities. ALLIANCE MODELS: A broad array of organizations were found to participate in community health alliances. Moreover, alliances were found to vary considerably. Strategically, alliances focused on one of three primary objectives: acquiring needed organizational knowledge and skills; addressing common resource needs; and pursuing a shared organizational mission. Functionally, alliances were observed in the areas of service delivery, planning and policy development, surveillance and assessment, and education and outreach. Structurally, alliances were found to operate through one of four interorganizational arrangements; informal collaboration, contractual agreements, shared governance, and shared ownership. ALLIANCE DEVELOPMENT: Organizational characteristics such as ownership type, organizational proximity, and market share appear to be important in the development of community health alliances. Community and market characteristics--including health resource availability, HMO penetration, and market consolidation--also appear to be influential in alliance development. Longitudinal observations suggest that alliances evolve over time in response to changing community health needs and organizational objectives. ALLIANCE MANAGEMENT: Several managerial tasks appear to be important to successful alliance operations, including developing a shared vision of collaboration; devising explicit strategies for addressing participation constraints; ensuring the compatibility of organizational incentives; managing communication and information flows across organizations; and developing appropriate processes for performance monitoring. CONCLUSIONS: The observed variation in alliance structures and functions appears healthy rather than problematic, as organizations develop arrangements to fit community needs, organizational capacities, and market conditions. AD - Center for Public Health Practice, University of North Carolina at Chapel Hill 27599-7400, USA. glen_mays@unc.edu AN - 9801951 AU - Mays, G. P. AU - Halverson, P. K. AU - Kaluzny, A. D. DA - Oct DP - NLM ET - 1998/11/05 IS - 10 J2 - The Joint Commission journal on quality improvement KW - Community Health Planning/*organization & administration Community Networks/*organization & administration Contract Services/organization & administration *Cooperative Behavior Decision Making, Organizational Health Care Coalitions Health Services Research Humans *Models, Organizational Organizational Case Studies Organizational Culture Ownership/organization & administration Total Quality Management/*organization & administration United States LA - eng N1 - Mays, G P Halverson, P K Kaluzny, A D Journal Article United States Jt Comm J Qual Improv. 1998 Oct;24(10):518-40. PY - 1998 SN - 1070-3241 (Print) 1070-3241 SP - 518-40 ST - Collaboration to improve community health: trends and alternative models T2 - Jt Comm J Qual Improv TI - Collaboration to improve community health: trends and alternative models VL - 24 ID - 51 ER - TY - JOUR AB - Growth in managed care enrollment potentially creates incentives for health plans to become involved in public health activities, such as health promotion and disease prevention interventions, and care for vulnerable populations. Using cross-sectional data from 60 diverse markets, this study explores the extent to which health maintenance organizations (HMOs) form cooperative alliances with local public health agencies to perform such activities. Results from multivariate models suggest that the incentives for cooperation vary substantially with health plan ownership and market structure. In view of recent HMO industry trends, these findings raise questions about the ability of alliances to integrate the practice of public health and medicine on a broad national scale, as some proponents suggest they do. AD - Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, USA. AN - 11252448 AU - Mays, G. P. AU - Halverson, P. K. AU - Kaluzny, A. D. AU - Norton, E. C. DA - Winter DP - NLM ET - 2001/03/17 IS - 4 J2 - Inquiry : a journal of medical care organization, provision and financing KW - Cooperative Behavior Cross-Sectional Studies Health Maintenance Organizations/*organization & administration/*statistics & numerical data/utilization Health Promotion Humans *Interinstitutional Relations Models, Organizational Motivation Multivariate Analysis Ownership Preventive Health Services Public Health Administration/*statistics & numerical data United States LA - eng N1 - Mays, G P Halverson, P K Kaluzny, A D Norton, E C Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. United States Inquiry. 2000-2001 Winter;37(4):389-410. PY - 2000 SN - 0046-9580 (Print) 0046-9580 SP - 389-410 ST - How managed care plans contribute to public health practice T2 - Inquiry TI - How managed care plans contribute to public health practice VL - 37 ID - 59 ER - TY - JOUR AB - OBJECTIVE: The authors examine the extent and nature of managed care plans participating in local public health activities. METHODS: In 1998, the authors surveyed the directors of all US local health departments serving jurisdictions of at least 100,000 residents to collect information about public health activities performed in their jurisdictions and about organizations participating in the activities. Multivariate logistic and linear regression models were used to examine organizational and market characteristics associated with managed care plan participation in public health activities. RESULTS: Managed care plans were reported to participate in public health activities in 164 (46%) of the jurisdictions surveyed, and to contribute to 13% of the public health activities performed in the average jurisdiction. Plans appeared most likely to participate in public health activities involving the delivery or management of personal health services and the exchange of health-related information. Managed care participation was more likely to occur in jurisdictions with higher HMO penetration, fewer competing plans, and larger proportions of plans enrolling Medicaid recipients. Participation was positively associated with the overall scope and perceived effectiveness of local public health activities. CONCLUSIONS: Although plans participate in a narrow range of activities, these contributions may complement the work of public health agencies. AD - Mathematica Policy Research, Washington, DC 20024, USA. gmays@mathematica-mpr.com AN - 11889275 AU - Mays, G. P. AU - Halverson, P. K. AU - Stevens, R. C2 - PMC1913663 DO - 10.1093/phr/116.S1.50 DP - NLM ET - 2002/03/13 J2 - Public health reports (Washington, D.C. : 1974) KW - Administrative Personnel Catchment Area (Health) Community Health Planning/*statistics & numerical data Cooperative Behavior Data Collection Decision Making, Organizational Health Care Sector Humans Interinstitutional Relations Linear Models Managed Care Programs/organization & administration/*statistics & numerical data/utilization Medicaid Multivariate Analysis Ownership Primary Prevention Public Health Administration Public Health Practice/*statistics & numerical data United States LA - eng N1 - Mays, G P Halverson, P K Stevens, R CA S230-15/16/CA/NCI NIH HHS/United States Journal Article Research Support, U.S. Gov't, P.H.S. United States Public Health Rep. 2001;116 Suppl 1:50-67. doi: 10.1093/phr/116.S1.50. PY - 2001 SN - 0033-3549 (Print) 0033-3549 SP - 50-67 ST - The contributions of managed care plans to public health practice: evidence from the nation's largest local health departments T2 - Public Health Rep TI - The contributions of managed care plans to public health practice: evidence from the nation's largest local health departments UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913663/pdf/pubhealthrep00206-0052.pdf VL - 116 Suppl 1 ID - 52 ER - TY - JOUR AB - OBJECTIVES: We examined public health system responses to economic shocks using longitudinal observations of public health activities implemented in US metropolitan areas from 1998 to 2012. METHODS: The National Longitudinal Survey of Public Health Systems collected data on the implementation of 20 core public health activities in a nationally representative cohort of 280 metropolitan areas in 1998, 2006, and 2012. We used generalized estimating equations to estimate how local economic shocks relate to the scope of activities implemented in communities, the mix of organizations performing them, and perceptions of the effectiveness of activities. RESULTS: Public health activities fell by nearly 5% in the average community between 2006 and 2012, with the bottom quintile of communities losing nearly 25% of their activities. Local public health delivery fell most sharply among communities experiencing the largest increases in unemployment and the largest reductions in governmental public health spending. CONCLUSIONS: Federal resources and private sector contributions failed to avert reductions in local public health protections during the recession. New financing mechanisms may be necessary to ensure equitable public health protections during economic downturns. AD - Glen P. Mays is with the Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington. At the time of this study, Rachel A. Hogg was with the National Coordinating Center for Public Health Services and Systems Research, College of Public Health, University of Kentucky, Lexington. Glen P. Mays is also a guest editor for this supplement issue. AN - 25689201 AU - Mays, G. P. AU - Hogg, R. A. C2 - PMC4355691 DA - Apr DO - 10.2105/ajph.2014.302456 DP - NLM ET - 2015/02/18 J2 - American journal of public health KW - Economic Recession/*statistics & numerical data Humans Longitudinal Studies Public Health Administration/*economics Public Health Practice/*economics *Urban Population LA - eng N1 - 1541-0048 Mays, Glen P Hogg, Rachel A UL1 TR000117/TR/NCATS NIH HHS/United States UL1TR000117/TR/NCATS NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Am J Public Health. 2015 Apr;105 Suppl 2:S280-7. doi: 10.2105/AJPH.2014.302456. Epub 2015 Feb 17. PY - 2015 SN - 0090-0036 SP - S280-7 ST - Economic shocks and public health protections in US metropolitan areas T2 - Am J Public Health TI - Economic shocks and public health protections in US metropolitan areas UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355691/pdf/AJPH.2014.302456.pdf VL - 105 Suppl 2 ID - 53 ER - TY - JOUR AB - OBJECTIVE: To examine whether local expenditures for public health activities influence area-level medical spending for Medicare beneficiaries. DATA SOURCES AND SETTING: Six census surveys of the nation's 2,900 local public health agencies were conducted between 1993 and 2013, linked with contemporaneous information on population demographics, socioeconomic characteristics, and area-level Medicare spending estimates from the Dartmouth Atlas of Health Care. DATA COLLECTION/EXTRACTION: Measures derive from agency survey data and aggregated Medicare claims. STUDY DESIGN: A longitudinal cohort design follows the geographic areas served by local public health agencies. Multivariate, fixed-effects, and instrumental-variables regression models estimate how area-level Medicare spending changes in response to shifts in local public health spending, controlling for observed and unmeasured confounders. PRINCIPAL FINDINGS: A 10 percent increase in local public health spending per capita was associated with 0.8 percent reduction in adjusted Medicare expenditures per person after 1 year (p < .01) and a 1.1 percent reduction after 5 years (p < .05). Estimated Medicare spending offsets were larger in communities with higher rates of poverty, lower health insurance coverage, and health professional shortages. CONCLUSIONS: Expanded financing for public health activities may provide an effective way of constraining Medicare spending, particularly in low-resource communities. AD - Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY. Center for Health Services Research, University of Kentucky, Lexington, KY. AN - 29130263 AU - Mays, G. P. AU - Mamaril, C. B. C2 - PMC5682130 DA - Dec DO - 10.1111/1475-6773.12785 DP - NLM ET - 2017/11/14 J2 - Health services research KW - Humans *Local Government Longitudinal Studies Medicare/*economics Public Health/*economics Retrospective Studies Socioeconomic Factors United States Public health services health economics medical care spending LA - eng N1 - 1475-6773 Mays, Glen P ORCID: http://orcid.org/0000-0002-7837-6812 Mamaril, Cezar B ORCID: http://orcid.org/0000-0002-3744-9069 UL1 TR000117/TR/NCATS NIH HHS/United States Journal Article United States Health Serv Res. 2017 Dec;52 Suppl 2:2357-2377. doi: 10.1111/1475-6773.12785. PY - 2017 SN - 0017-9124 SP - 2357-2377 ST - Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities T2 - Health Serv Res TI - Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities UR - http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12785/abstract?systemMessage=Please+be+advised+that+we+experienced+an+unexpected+issue+that+occurred+on+Saturday+and+Sunday+January+20th+and+21st+that+caused+the+site+to+be+down+for+an+extended+period+of+time+and+affected+the+ability+of+users+to+access+content+on+Wiley+Online+Library.+This+issue+has+now+been+fully+resolved.++We+apologize+for+any+inconvenience+this+may+have+caused+and+are+working+to+ensure+that+we+can+alert+you+immediately+of+any+unplanned+periods+of+downtime+or+disruption+in+the+future. VL - 52 Suppl 2 ID - 68 ER - TY - JOUR AB - The US health system faces mounting pressure to improve population health. Research suggests a need for greater coordination and alignment across the sectors that deliver medical, public health, and social services. This study uses sixteen years of data from a large cohort of US communities to measure the extent and nature of multisector contributions to population health activities and how these contributions affect community mortality rates. The results show that deaths due to cardiovascular disease, diabetes, and influenza decline significantly over time among communities that expand multisector networks supporting population health activities. The findings imply that incentives and infrastructure supporting multisector population health activities may help close geographic and socioeconomic disparities in population health. AD - Glen P. Mays (glen.mays@uky.edu) is the F. Douglas Scutchfield Endowed Professor in Health Services and Systems Research, College of Public Health, at the University of Kentucky, in Lexington. Cezar B. Mamaril is an assistant professor in the Department of Health Management and Policy, College of Public Health, University of Kentucky. Lava R. Timsina is a graduate research assistant in the Department of Health Management and Policy, College of Public Health, University of Kentucky. AN - 27834240 AU - Mays, G. P. AU - Mamaril, C. B. AU - Timsina, L. R. DA - Nov 1 DO - 10.1377/hlthaff.2016.0848 DP - NLM ET - 2016/11/12 IS - 11 J2 - Health affairs (Project Hope) KW - Health Promotion/Disease Prevention Organization and Delivery of Care Public Health LA - eng N1 - 1544-5208 Mays, Glen P Mamaril, Cezar B Timsina, Lava R Journal Article United States Health Aff (Millwood). 2016 Nov 1;35(11):2005-2013. doi: 10.1377/hlthaff.2016.0848. PY - 2016 SN - 0278-2715 SP - 2005-2013 ST - Preventable Death Rates Fell Where Communities Expanded Population Health Activities Through Multisector Networks T2 - Health Aff (Millwood) TI - Preventable Death Rates Fell Where Communities Expanded Population Health Activities Through Multisector Networks VL - 35 ID - 66 ER - TY - JOUR AB - OBJECTIVES: Although a growing body of evidence demonstrates that availability and quality of essential public health services vary widely across communities, relatively little is known about the factors that give rise to these variations. We examined the association of institutional, financial, and community characteristics of local public health delivery systems and the performance of essential services. METHODS: Performance measures were collected from local public health systems in 7 states and combined with secondary data sources. Multivariate, linear, and nonlinear regression models were used to estimate associations between system characteristics and the performance of essential services. RESULTS: Performance varied significantly with the size, financial resources, and organizational structure of local public health systems, with some public health services appearing more sensitive to these characteristics than others. Staffing levels and community characteristics also appeared to be related to the performance of selected services. CONCLUSIONS: Reconfiguring the organization and financing of public health systems in some communities-such as through consolidation and enhanced intergovernmental coordination-may hold promise for improving the performance of essential services. AD - Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA. gpmays@uams.edu AN - 16449584 AU - Mays, G. P. AU - McHugh, M. C. AU - Shim, K. AU - Perry, N. AU - Lenaway, D. AU - Halverson, P. K. AU - Moonesinghe, R. C2 - PMC1470518 DA - Mar DO - 10.2105/ajph.2005.064253 DP - NLM ET - 2006/02/02 IS - 3 J2 - American journal of public health KW - Community Health Services/economics/legislation & jurisprudence/*organization & administration Health Policy Humans Public Health Practice/*economics/legislation & jurisprudence Quality of Health Care/economics/*organization & administration LA - eng N1 - Mays, Glen P McHugh, Megan C Shim, Kyumin Perry, Natalie Lenaway, Dennis Halverson, Paul K Moonesinghe, Ramal Journal Article Research Support, U.S. Gov't, P.H.S. United States Am J Public Health. 2006 Mar;96(3):523-31. doi: 10.2105/AJPH.2005.064253. Epub 2006 Jan 31. PY - 2006 SN - 0090-0036 (Print) 0090-0036 SP - 523-31 ST - Institutional and economic determinants of public health system performance T2 - Am J Public Health TI - Institutional and economic determinants of public health system performance UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470518/pdf/0960523.pdf VL - 96 ID - 62 ER - TY - JOUR AB - Public health activities in the United States are delivered through multiple public and private organizations that vary widely in their resources, missions, and operations. Without strong coordination mechanisms, these delivery arrangements may perpetuate large gaps, inequities, and inefficiencies in public health activities. We examined evidence and uncertainties concerning the use of partnerships to improve the performance of the public health system, with a special focus on partnerships between public health agencies and health care organizations. We found that the types of partnerships likely to have the largest and most direct effects on population health are among the most difficult, and therefore least prevalent, forms of collaboration. High opportunity costs and weak and diffuse participation incentives hinder partnerships that focus on expanding effective prevention programs and policies. Targeted policy actions and leadership strategies are required to illuminate and enhance partnership incentives. AD - F. Douglas Scutchfield, University of Kentucky, Lexington, Kentucky, USA. gpmays@uams.edu AN - 20950523 AU - Mays, G. P. AU - Scutchfield, F. D. C2 - PMC2995603 DA - Nov DP - NLM ET - 2010/10/19 IS - 6 J2 - Preventing chronic disease KW - *Cooperative Behavior Local Government Public Health Administration/*methods *Public-Private Sector Partnerships United States LA - eng N1 - 1545-1151 Mays, Glen P Scutchfield, F Douglas 1UL1RR029884/RR/NCRR NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Prev Chronic Dis. 2010 Nov;7(6):A116. Epub 2010 Oct 15. PY - 2010 SN - 1545-1151 SP - A116 ST - Improving public health system performance through multiorganizational partnerships T2 - Prev Chronic Dis TI - Improving public health system performance through multiorganizational partnerships UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995603/pdf/pcd76A116.pdf VL - 7 ID - 61 ER - TY - JOUR AB - CONTEXT: Policy discussions about improving the U.S. health care system increasingly recognize the need to strengthen its capacities for delivering public health services. A better understanding of how public health delivery systems are organized across the United States is critical to improvement. To facilitate the development of such evidence, this article presents an empirical method of classifying and comparing public health delivery systems based on key elements of their organizational structure. METHODS: This analysis uses data collected through a national longitudinal survey of local public health agencies serving communities with at least 100,000 residents. The survey measured the availability of twenty core public health activities in local communities and the types of organizations contributing to each activity. Cluster analysis differentiated local delivery systems based on the scope of activities delivered, the range of organizations contributing, and the distribution of effort within the system. FINDINGS: Public health delivery systems varied widely in organizational structure, but the observed patterns of variation suggested that systems adhere to one of seven distinct configurations. Systems frequently migrated from one configuration to another over time, with an overall trend toward offering a broader scope of services and engaging a wider range of organizations. CONCLUSIONS: Public health delivery systems exhibit important structural differences that may influence their operations and outcomes. The typology developed through this analysis can facilitate comparative studies to identify which delivery system configurations perform best in which contexts. AD - Fay W. Boozman College of Public Health, University of Arkansas, Little Rock, AR 72205, USA. gpmays@uams.edu AN - 20377759 AU - Mays, G. P. AU - Scutchfield, F. D. AU - Bhandari, M. W. AU - Smith, S. A. C2 - PMC2888010 DA - Mar DO - 10.1111/j.1468-0009.2010.00590.x DP - NLM ET - 2010/04/10 IS - 1 J2 - The Milbank quarterly KW - Cohort Studies Community Networks/*organization & administration Delivery of Health Care/*organization & administration Health Services Accessibility/*organization & administration Humans Longitudinal Studies Models, Organizational Primary Health Care/*organization & administration *Public Health Quality Assurance, Health Care/organization & administration Regional Medical Programs/organization & administration United States LA - eng N1 - 1468-0009 Mays, Glen P Scutchfield, F Douglas Bhandari, Michelyn W Smith, Sharla A UL1 RR029884/RR/NCRR NIH HHS/United States 1UL1RR029884/RR/NCRR NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Milbank Q. 2010 Mar;88(1):81-111. doi: 10.1111/j.1468-0009.2010.00590.x. PY - 2010 SN - 0887-378x SP - 81-111 ST - Understanding the organization of public health delivery systems: an empirical typology T2 - Milbank Q TI - Understanding the organization of public health delivery systems: an empirical typology UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888010/pdf/milq0088-0081.pdf VL - 88 ID - 69 ER - TY - JOUR AB - OBJECTIVES: To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation. DATA SOURCES AND SETTING: Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources. STUDY DESIGN: A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics. PRINCIPAL FINDINGS: The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending. CONCLUSIONS: The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities. AD - Department of Health Policy & Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. gpmays@uams.edu AN - 19686249 AU - Mays, G. P. AU - Smith, S. A. C2 - PMC2758407 DA - Oct DO - 10.1111/j.1475-6773.2009.01014.x DP - NLM ET - 2009/08/19 IS - 5 Pt 2 J2 - Health services research KW - *Health Expenditures Humans Longitudinal Studies Models, Econometric Multivariate Analysis Public Health Administration/*economics Public Health Practice/*economics Regression Analysis Residence Characteristics Retrospective Studies United States LA - eng N1 - 1475-6773 Mays, Glen P Smith, Sharla A U01 CA114607/CA/NCI NIH HHS/United States CA114607/CA/NCI NIH HHS/United States Comparative Study Journal Article Multicenter Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Health Serv Res. 2009 Oct;44(5 Pt 2):1796-817. doi: 10.1111/j.1475-6773.2009.01014.x. Epub 2009 Aug 17. PY - 2009 SN - 0017-9124 SP - 1796-817 ST - Geographic variation in public health spending: correlates and consequences T2 - Health Serv Res TI - Geographic variation in public health spending: correlates and consequences UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758407/pdf/hesr0044-1796.pdf VL - 44 ID - 57 ER - TY - JOUR AB - Public health encompasses a broad array of programs designed to prevent the occurrence of disease and injury within communities. But policy makers have little evidence to draw on when determining the value of investments in these program activities, which currently account for less than 5 percent of US health spending. We examine whether changes in spending by local public health agencies over a thirteen-year period contributed to changes in rates of community mortality from preventable causes of death, including infant mortality and deaths due to cardiovascular disease, diabetes, and cancer. We found that mortality rates fell between 1.1 percent and 6.9 percent for each 10 percent increase in local public health spending. These results suggest that increased public health investments can produce measurable improvements in health, especially in low-resource communities. However, more money by itself is unlikely to generate significant and sustainable health gains; improvements in public health practices are needed as well. AD - Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. gpmays@uams.edu AN - 21778174 AU - Mays, G. P. AU - Smith, S. A. C2 - PMC4019932 C6 - NIHMS578120 DA - Aug DO - 10.1377/hlthaff.2011.0196 DP - NLM ET - 2011/07/23 IS - 8 J2 - Health affairs (Project Hope) KW - *Evidence-Based Practice Financing, Government/*trends Humans Mortality/*trends Public Health/*economics United States/epidemiology LA - eng N1 - 1544-5208 Mays, Glen P Smith, Sharla A UL1 RR029884/RR/NCRR NIH HHS/United States 1UL1RR029884/RR/NCRR NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Health Aff (Millwood). 2011 Aug;30(8):1585-93. doi: 10.1377/hlthaff.2011.0196. Epub 2011 Jul 21. PY - 2011 SN - 0278-2715 SP - 1585-93 ST - Evidence links increases in public health spending to declines in preventable deaths T2 - Health Aff (Millwood) TI - Evidence links increases in public health spending to declines in preventable deaths UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019932/pdf/nihms578120.pdf VL - 30 ID - 56 ER - TY - JOUR AB - The authors review empirical studies published between 1990 and 2007 on the topics of public health organization, financing, staffing, and service delivery. A summary is provided of what is currently known about the attributes of public health delivery systems that influence their performance and outcomes. This review also identifies unanswered questions, highlighting areas where new research is needed. Existing studies suggest that economies of scale and scope exist in the delivery of public health services, and that key organizational and governance characteristics of public health agencies may explain differences in service delivery across communities. Financial resources and staffing characteristics vary widely across public health systems and have expected associations with service delivery and outcomes. Numerous gaps and uncertainties are identified regarding the mechanisms through which organizational, financial, and workforce characteristics influence the effectiveness and efficiency of public health service delivery. This review suggests that new research is needed to evaluate the effects of ongoing changes in delivery system structure, financing, and staffing. AD - Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. gpmays@uams.edu AN - 19215851 AU - Mays, G. P. AU - Smith, S. A. AU - Ingram, R. C. AU - Racster, L. J. AU - Lamberth, C. D. AU - Lovely, E. S. DA - Mar DO - 10.1016/j.amepre.2008.11.008 DP - NLM ET - 2009/02/14 IS - 3 J2 - American journal of preventive medicine KW - Delivery of Health Care/economics/manpower/*organization & administration Efficiency, Organizational Financing, Government Humans Outcome and Process Assessment (Health Care) Public Health/economics/manpower/*methods *Public Health Administration/economics/manpower Research/organization & administration United States LA - eng N1 - 1873-2607 Mays, Glen P Smith, Sharla A Ingram, Richard C Racster, Laura J Lamberth, Cynthia D Lovely, Emma S Journal Article Research Support, Non-U.S. Gov't Review Netherlands Am J Prev Med. 2009 Mar;36(3):256-65. doi: 10.1016/j.amepre.2008.11.008. PY - 2009 SN - 0749-3797 SP - 256-65 ST - Public health delivery systems: evidence, uncertainty, and emerging research needs T2 - Am J Prev Med TI - Public health delivery systems: evidence, uncertainty, and emerging research needs UR - https://ac.els-cdn.com/S0749379708009598/1-s2.0-S0749379708009598-main.pdf?_tid=0f34f3a4-0b9d-11e8-86af-00000aacb361&acdnat=1517963163_39102b157d570baab70686ecb63b2a2c VL - 36 ID - 67 ER - TY - JOUR AB - OBJECTIVES: We examined the associations of local public health system organization and local health department resources with county-level sexually transmitted disease (STD) incidence rates in large US health jurisdictions. METHODS: We linked annual county STD incidence data (2005-2008) to local health department director responses (n = 211) to the 2006 wave of the National Longitudinal Study of Local Public Health Systems, the 2005 national Local Health Department Profile Survey, and the Area Resource File. We used nested mixed effects regression models to assess the relative contribution of local public health system organization, local health department financial and resource factors, and sociodemographic factors known to be associated with STD incidence to county-level (n = 307) STD incidence. RESULTS: Jurisdictions with local governing boards had significantly lower county-level STD incidence. Local public health systems with comprehensive services where local health departments shoulder much of the effort had higher county-level STD rates than did conventional systems. CONCLUSIONS: More integration of system partners in local public health system activities, through governance and interorganizational arrangements, may reduce the incidence and burden of STDs. AD - Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA. hrod@ucla.edu AN - 22813090 AU - Rodriguez, H. P. AU - Chen, J. AU - Owusu-Edusei, K. AU - Suh, A. AU - Bekemeier, B. C2 - PMC3482023 DA - Sep DO - 10.2105/ajph.2011.300497 DP - NLM ET - 2012/07/21 IS - 9 J2 - American journal of public health KW - African Continental Ancestry Group Chlamydia Infections/epidemiology Data Collection Delivery of Health Care/economics/*organization & administration Delivery of Health Care, Integrated Female Gonorrhea/epidemiology Health Resources Humans Incidence Longitudinal Studies Male Public Health Sex Factors Sexually Transmitted Diseases/*epidemiology/ethnology Socioeconomic Factors United States/epidemiology LA - eng N1 - 1541-0048 Rodriguez, Hector P Chen, Jie Owusu-Edusei, Kwame Suh, Allen Bekemeier, Betty Journal Article Research Support, Non-U.S. Gov't United States Am J Public Health. 2012 Sep;102(9):1773-81. doi: 10.2105/AJPH.2011.300497. Epub 2012 Jul 19. PY - 2012 SN - 0090-0036 SP - 1773-81 ST - Local public health systems and the incidence of sexually transmitted diseases T2 - Am J Public Health TI - Local public health systems and the incidence of sexually transmitted diseases VL - 102 ID - 64 ER - TY - JOUR AB - OBJECTIVE: To examine the extent to which local health department (LHD) assurance of select services known to promote and protect the health of older adults is associated with more favorable population health indicators among seniors. DESIGN: Data from the California Health Interview Survey (CHIS: 2003, 2005, and 2007) were linked with the 2005 wave of the National Association of County and City Health Officials profile survey and the Area Resource File to assess the association of LHD assurance and senior health indicators. Assurance was measured by an index of 5 services, either directly provided or contracted by LHDs: cancer screening, injury prevention, comprehensive primary care, home health care, and chronic disease prevention. Multilevel regression models estimated the association of LHD assurance of services and each of 6 older adult health indicators, controlling for individual, LHD, and county characteristics that included key social determinants of health, such as poverty. SETTING: Fifty-seven California counties. PARTICIPANTS: 33,154 older adults (age 65 and older). MAIN OUTCOME MEASURES: Colorectal cancer screening, mammography, healthy eating, physical activity, and multiple falls among older adults. RESULTS: Local health departments provided or contracted a median of 2 of the 5 services. In adjusted analyses, LHD assurance of services was generally unassociated with the seniors' health behaviors, screening, and falls. Greater LHD expenditures per capita were associated with significantly better mammography screening rates (adjusted odds ratio [AOR] = 1.22, P < 0.01) compared to jurisdictions in the bottom one-third of per capita LHD spending. Greater county-level poverty (a social determinant of health) was associated with greater junk food consumption (AOR = 1.14, P < 0.01) and worse fruit and vegetable consumption (AOR = 0.97, P < 0.01). Highly impoverished counties were consistently in the bottom quartile of performance across all indicators. CONCLUSIONS: The LHD's assurance of select services known to promote and protect the health of older adults does not appear to translate into higher rates of colorectal cancer screening, mammography, healthy eating, physical activity, and fewer falls among seniors. County-level poverty is most strongly associated with older adult health, underscoring a key barrier to address in local senior health improvement efforts. AD - Department of Health Policy and Management (Dr Rodriguez) and Center for Health Policy Research (Drs Rodriguez and Wang), Fielding School of Public Health, University of California, Los Angeles; Department of Sociology and Anthropology, University of Maryland, Baltimore (Dr Herrera); and Public Health Institute, Oakland, California (Dr Jacobson). AN - 23838898 AU - Rodriguez, H. P. AU - Herrera, A. P. AU - Wang, Y. AU - Jacobson, D. M. DA - Nov-Dec DO - 10.1097/PHH.0b013e31828e25e5 DP - NLM ET - 2013/07/11 IS - 6 J2 - Journal of public health management and practice : JPHMP KW - Aged Aged, 80 and over California Female Health Behavior Health Services/utilization *Health Services Accessibility/economics Health Status Humans *Local Government Male *Public Health Practice Qualitative Research Regression Analysis LA - eng N1 - 1550-5022 Rodriguez, Hector P Herrera, Angelica P Wang, Yueyan Jacobson, Dawn M Journal Article Research Support, Non-U.S. Gov't United States J Public Health Manag Pract. 2013 Nov-Dec;19(6):550-61. doi: 10.1097/PHH.0b013e31828e25e5. PY - 2013 SN - 1078-4659 SP - 550-61 ST - Local health department assurance of services and the health of California's seniors T2 - J Public Health Manag Pract TI - Local health department assurance of services and the health of California's seniors VL - 19 ID - 63 ER - TY - JOUR AD - School of Public Health, University of North Carolina at Chapel Hill, USA. Bill_Roper@unc.edu AN - 9842939 AU - Roper, W. L. AU - Mays, G. P. DA - Nov 25 DP - NLM ET - 1998/12/08 IS - 20 J2 - Jama KW - *Interinstitutional Relations Interprofessional Relations *Managed Care Programs *Public Health Administration United States LA - eng N1 - Roper, W L Mays, G P Journal Article United States JAMA. 1998 Nov 25;280(20):1739-40. PY - 1998 SN - 0098-7484 (Print) 0098-7484 SP - 1739-40 ST - The changing managed care-public health interface T2 - Jama TI - The changing managed care-public health interface UR - https://jamanetwork.com/journals/jama/article-abstract/188190?redirect=true VL - 280 ID - 50 ER - TY - JOUR AB - OBJECTIVES: We measured the perceived effectiveness of core public health services at the community level, and we assessed whether certain system factors were associated with perceived effectiveness. METHODS: We used data from the National Longitudinal Survey of Local Public Health Systems, conducted in 1998 and 2006, to examine the effects of the contributions of health departments and the participation of other agencies to core functions on the perceived effectiveness of community delivery of core assessment, policy development, and assurance functions. RESULTS: Perceived effectiveness increased over time for all 3 core function areas (range = 41%-53% in 2006). Multivariable results showed that local health department contribution to effort was positively associated with perceived effectiveness of public health core functions. The significance of participation of individual types of agencies or organizations varied by core function areas, except for local government agencies and hospitals, which were significantly positively associated with all 3 core function areas. CONCLUSIONS: We furthered our understanding of the significance of the contributions and participations of local health departments and of other individual agencies or organizations in the perceived effectiveness of delivery of core functions. AD - At the time of this study, Amber Sinclair was with the School of Public and International Affairs, University of Georgia, Atlanta. Andrew Whitford is with the School of Public and International Affairs, University of Georgia. AN - 26066965 AU - Sinclair, A. AU - Whitford, A. C2 - PMC4504316 DA - Aug DO - 10.2105/ajph.2015.302586 DP - NLM ET - 2015/06/13 IS - 8 J2 - American journal of public health KW - *Community Participation *Cooperative Behavior Humans Longitudinal Studies Program Evaluation *Public Health/standards Public Health Administration Surveys and Questionnaires LA - eng N1 - 1541-0048 Sinclair, Amber Whitford, Andrew Journal Article Research Support, Non-U.S. Gov't United States Am J Public Health. 2015 Aug;105(8):1638-45. doi: 10.2105/AJPH.2015.302586. Epub 2015 Jun 11. PY - 2015 SN - 0090-0036 SP - 1638-45 ST - Effects of Participation and Collaboration on Perceived Effectiveness of Core Public Health Functions T2 - Am J Public Health TI - Effects of Participation and Collaboration on Perceived Effectiveness of Core Public Health Functions VL - 105 ID - 55 ER - TY - JOUR AB - OBJECTIVES: We estimated the effect of economic constraints on public health delivery systems (PHDS) density and centrality during 3 time periods, 1998, 2006, and 2012. METHODS: We obtained data from the 1998, 2006, and 2012 National Longitudinal Study of Public Health Agencies; the 1993, 1997, 2005, and 2010 National Association for County and City Health Officials Profile Study; and the 1997, 2008, and 2011 Area Resource Files. We used multivariate regression models for panel data to estimate the impact of economic constraints on PHDS density and centrality. RESULTS: Findings indicate that economic constraints did not have a significant impact on PHDS density and centrality over time but population is a significant predictor of PHDS density, and the presence of a board of health (BOH) is a significant predictor of PHDS density and centrality. Specifically, a 1% increase in population results in a significant 1.71% increase in PHDS density. The presence of a BOH is associated with a 10.2% increase in PHDS centrality, after controlling for other factors. CONCLUSIONS: These findings suggest that other noneconomic factors influence PHDS density centrality. AD - Sharla A. Smith, Holly C. Felix, and J. Mick Tilford are with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Science, Little Rock. Glen P. Mays is with the Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington. Geoffrey M. Curran is with the Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Michael A. Preston is with Cancer Control and Population Science, University of Arkansas for Medical Sciences, Little Rock. AN - 26180988 AU - Smith, S. A. AU - Mays, G. P. AU - Felix, H. C. AU - Tilford, J. M. AU - Curran, G. M. AU - Preston, M. A. C2 - PMC4539844 DA - Sep DO - 10.2105/ajph.2015.302769 DP - NLM ET - 2015/07/17 IS - 9 J2 - American journal of public health KW - Cooperative Behavior Humans Longitudinal Studies Public Health Administration/*economics Public Health Practice/economics Residence Characteristics Retrospective Studies LA - eng N1 - 1541-0048 Smith, Sharla A Mays, Glen P Felix, Holly C Tilford, J Mick Curran, Geoffrey M Preston, Michael A Journal Article Research Support, Non-U.S. Gov't United States Am J Public Health. 2015 Sep;105(9):e48-53. doi: 10.2105/AJPH.2015.302769. Epub 2015 Jul 16. PY - 2015 SN - 0090-0036 SP - e48-53 ST - Impact of Economic Constraints on Public Health Delivery Systems Structures T2 - Am J Public Health TI - Impact of Economic Constraints on Public Health Delivery Systems Structures UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539844/pdf/AJPH.2015.302769.pdf VL - 105 ID - 60 ER -