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ASTHO Survey Results Linked to PHAB Accreditation Domains Jim Pearsol, Chief Program Officer Public Health Performance

ASTHO Survey Results Linked to PHAB Accreditation Domains Jim Pearsol, Chief Program Officer Public Health Performance. Association of State and Territorial Health Officials May, 2008.

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ASTHO Survey Results Linked to PHAB Accreditation Domains Jim Pearsol, Chief Program Officer Public Health Performance

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  1. ASTHO Survey Results Linked to PHAB Accreditation DomainsJim Pearsol,Chief Program OfficerPublic Health Performance Association of State and Territorial Health Officials May, 2008

  2. Eighty-two percent of states and territories responded to ASTHO’s State and Territorial Public Health Survey, which examined the central functions of state and territorial public health agencies. In addition to informing the Public Health Accreditation Board’s (PHAB) standard development work, survey results will inform the branding and marketing of public health to policymakers and the general public, and serve as the foundation for a public health information and analysis system. In this presentation, survey results are linked directly to Accreditation domains – created by PHAB and similar to the ten Essential Public Health Services. Executive Summary

  3. Background • Survey Partners: • Robert Wood Johnson Foundation (RWJF) • Centers for Disease Control and Prevention (CDC) • Public Health Foundation (PHF) • Goal: Define the purposes, functions, roles and responsibilities of state public health agencies. • Results: 47 responses (46 states and District of Columbia, 82% response rate)

  4. Survey Purposes • Describe State and Territorial Health Agency (STHA) structure and function • Contribute to development of PHAB STHA Accreditation Standards & Measures • Inform STHA marketing “message” to policy makers and general public • Populate a S/T Public Health Information and Analysis System at ASTHO

  5. Respondent Information Activities Organization for Federal Initiatives STHA Descriptors STHA Personnel State Organizational Structure Agency Mission STHA Scope of Work 75 + survey questions Web survey tool Planning and Quality Improvement Relationship with Local Public Health Agencies STHA Training Emergency Preparedness Infrastructure Partnership and Collaboration STHA Performance Activities STHO Qualifications and Experience Survey Subheadings

  6. Link ASTHO Survey Results with PHAB Accreditation Domains* • Compiled aggregate survey results for each item in the ASTHO Survey • Linked aggregate ASTHO survey results to PHAB accreditation domains • Created a draft list of standards for PHAB workgroup review and evaluation * “Accreditation Domains” are similar to the ten Essential Public Health Services

  7. 1. Monitor health status STHA Epidemiology/Surveillance Activities (>90%): 98% Communicable Diseases, Injury 96% Vital Statistics, Cancer Incidence, Perinatal events/risk factors, Behavioral Risk Factors 92%, Chronic Diseases, 90% Syndromic Surveillance STHA Electronic data exchange (>65% send and receive data): 96% Reportable diseases 92% Vital records, Lab reporting 90% Childhood immunizations 85% WIC 80% MCH reporting 75% Outbreak management 73% Geo-coded data for mapping 65% Medicaid billing STHA Exchange informationof any type (>73%)with: LHDs, Hospitals, providers, CHCs, other HC providers, health insurers, cancer societies, emergency responders, environmental health orgs, coop ext, schools, parks and rec, transportation, CBOs/nfps, faith-based, universities, businesses and media STHA created a state Health Improvement Plan (HIP) using a state health assessment (HA) (>56%) STHA conducted an overall state health assessment (67%)

  8. 2. Protect people from health problems and health hazards STHA has a stronger infrastructure due to emergency preparedness efforts (>88%) 94% Communication system, epi & surv, planning, surge 92% Workforce and relationships with other fed, state and local agencies 88% Lab services 83% Legal basis for public health action STHA engaged in preparedness activities (>96%) 98% Bioterrorism, Natural disaster, Nuclear disaster, and Chemical disaster response 96% Explosion disaster response STHA environmental protection activities (>48%): 92% Food safety education 69% Radiation control 83% Environmental epidemiology 60% Radon control 70% Toxicology 48% Private & Public Water Supply and Indoor Air Assuring preparedness for a health emergency (Ranked #2, in priority activities planned for current fiscal year – Health Reform was #1)

  9. 3. Provide people with health information Media: STHA exchanged info (96%) or worked on joint projects (63%) STHA increased collaboration & exchange information, last 3 years (>47%) 55% Business 53% health insurers 51% Community health centers 49% Community-based organizations and schools 47% Other health care providers and faith communities STHA expenditures: Non-clinical prevention (69%), clinical (31%) STHA primary prevention services (>54%) 92% Tobacco prevention 77% HIV counseling 54% Unintended 85% Obesity 71% Diabetes pregnancy 81% Injury prevention 65% Violence prevention 79% STD counseling 58% Hypertension

  10. 4. Engage community to solve ph problems STHA has a strategic plan (73%) Used MAPP in some capacity (73%) – state, reference, or collaboration State HIP: within 3 years (56%); 3 years ago (23%); no (21%) Plan to update HIP in next 3 years (81%) State HIP linked to LHD HIP- yes (25%); some (27%); no (15%) State provides policy engagement (>65%) 79% Emergency responders and Local health departments 65% Hospitals and community –based organizations STHA works together on activities/projects (>61%): Universities, schools, hospitals, community-based organizations, community health centers, cancer societies, faith-based, other health care providers, local health departments, health insurers, physicians, cooperative extensions, businesses, environmental and conservation groups, media, parks and recreation, and tribal.

  11. 5. Develop ph policies and plans STHA has specific authority (>46%) 100% Collect health data 63% License health professionals 98% Manage vital statistics 56% Issue certificates of need 79% Conduct health planning 46% operate health facilities 77% Declare an emergency Within past year, STHA adopted new public health regulation (83%) Created a state HIP using a state HA (>56%) State HIP: within 3 years (56%); 3 years ago (23%); no (21%) Plan to update HIP in next 3 years (81%) STHA has a strategic plan (73%) State HIP linked to LHD HIP- yes (25%); some (27%); no (15%)

  12. 6. Enforce ph laws and regulations Authority to adopt public health laws and regulations (STHA, 47%) 83% State legislature 33% Governor 44% STHA 21% State board of health Educate about laws and regulations (>51%) 77% Local health departments 56% Hospitals 75% Emergency responders 50% Community-based organizations 67% Laboratories Regulation, inspection or licensing (>52%) 77% Laboratories 65% Hospice and long term care 73% Hospitals 60% Lead inspection 71% Food service establishment 54% Campgrounds/RVs, assisted living, other h facility 69% Swimming pools 52% Body Piercing/Tattooing STHA environmental protection activities (>48%): 92% Food safety education 69% Radiation control 83% Environmental epidemiology 60% Radon control 70% Toxicology 48% Private & Public Water Supply and Indoor Air Other (>67%) 73% Veterinarian PH activities; 69% trauma system; and 67% IRB

  13. 7. Help people receive health services Role of STHA in Access to health care (>25%) 85% Health disparities initiatives 46% Outreach and Enrollment for Med. Ins. 81% Minority health 40% EMS and oral health 65% Rural health 29% SCHIP 48% Certifying authority for federal reimbursement 25% Tribal health & faith-based programs Created a state HIP using a state HA (>56%) State HIP – last 3 years (56%); 3 years ago (23%); no (21%) Plan to update HIP in next 3 years (81%) Specialized MCH services (>23%) 67% CSHCN 27% Non-WIC nutrition counseling 48% WIC 29% School health (non-clinical) 42% Early intervention 23% EPSDT 29% Family planning/prenatal care

  14. 8. Maintain a competent ph workforce Sources of STHA workforce development (rank order) • STHA in-house training • Schools of Public Health/Public Health Graduate Programs • Federal Government • National associations • Other state agencies • Health professional agencies STHA has a designated training coordinator (63%) STHA provides workforce technical assistance (>29%) 73% Local health departments 42% Community-based organizations 69% EMR 29% Laboratories 46% Hospitals STHA oversees professional licensing (>22%) 27% Nurses; 25% Physicians and PAs; and 23% Dentists *See also ASTHO 2007 State Public Health Workforce Survey

  15. 9. Evaluate and improve ph programs STHA maintains registries (>85%) 78% Cancer registry and Childhood Immunization 74% Birth Defects Overall health assessments (67%) STHA has its own quality improvement (QI) process in place 36% Fully or partially department-wide 56% Fully or partially in specific programs 19% No STHA has a formal performance management program in place (standards, measures, progress reports, and QI process) 42% Fully or partially department-wide 35% Fully or partially in specific programs 23% No Created a state HIP using a state HA (>56%) STHA provides QI/Performance technical assistance (>60%) 79% LHDs; 77% Labs; 75% EMRs; 73% Hospitals; and 60% Community-based organizations

  16. 10. Contribute to/apply evidence base Top priorities for STHA for current fiscal year (rank order) • Health system reform • Assuring preparedness for a health emergency • Assuring a local public health presence throughout the state • Developing effective health policy • Developing innovations in any area • Focusing on early detection or population protection measures • Monitoring the state’s population health • Implementing quality improvement programs • Other • Attaining workforce stability

  17. 11. Manage resources STHA has primary responsibility for federal initiatives (>50%) 96% TANF & HPSA 77% Rural health & WIC 94% Mental Health Block Grant 71% HRSA & CDC Preparedness 92% Vital Statistics and PHHS Block Grant 69% Healthy people 90% HIV Pharmacies (ADAP) 60% HIV Title V & Family Planning Title X 88% Cancer prevention & control STHA sources of revenue 45% Direct federal funds 4% Regulatory fees 24% State (excluding pass through) 16% Medicaid 8% Other (Inter-agency transfers, other dedicated or shared funds) STHA has authority to establish fees for services (60%) STHA has a system for LHDs to report to state (71%)

  18. 12. Govern resources Structure of the STHA: 58% Free-standing independent agency 40% Under a larger agency Organizational relationship between STHAs and LHDs: 40% Decentralized control (local services provided through local gov’t or boards) 18% Mixed control (some local services provided by state and some by locals) 17% Shared control (local services are subject to shared authority of state and local entities) 15% Centralized control (local services provided through units of state) 10% No local health departments Authority in states (highest percentages, STHA percentages) Hire or appoint agency head: 81% Governor; 0% STHA Approve STHA budget: 88% State legislature; 19% STHA Adopt public health laws and regulations: 83% State legislature; 44% STHA Establish fees for services: 85% State legislature; 60% STHA Establish taxes (millage, levy, etc.): 85% State legislature; 0% STHA Place public health levy on ballot: 69% State legislature; 2% STHA

  19. Closing thoughts…. • This is just a “tip of the iceberg” report of the ASTHO STHA survey data • Other ASTHO surveys to consider – Minority health/health disparities survey of STHA Offices of Minority Health (pending), ASTHO Workforce Survey, ASTHO/NACCHO Survey of RHIOs, ASTHO preparedness surveys, etc. • For more information, please contact: Jim Pearsol, Lindsey Caldwell, or Michael Dickey at ASTHO • www.astho.org or 202-371-9090

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