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Robin Pendley, DrPH , MPH, CPH Assistant Professor, ETSU

The Association in State Health Outcomes by Provider Type Difference in Association Between State-Level Health Outcomes for Direct Patient Care FTEs and Population Based FTEs. Robin Pendley, DrPH , MPH, CPH Assistant Professor, ETSU Department of Health Services Management and Policy

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Robin Pendley, DrPH , MPH, CPH Assistant Professor, ETSU

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  1. The Association in State Health Outcomes by Provider TypeDifference in Association Between State-Level Health Outcomes for Direct Patient Care FTEs and Population Based FTEs Robin Pendley, DrPH, MPH, CPH Assistant Professor, ETSU Department of Health Services Management and Policy October 29, 2012

  2. Efforts to Enumerate Public Health Workforce

  3. Efforts to Enumerate PH Workforce

  4. Efforts to Enumerate PH Workforce

  5. Crawford et al Research Agenda1 • Workforce size and composition • Workforce diversity • Workforce effectiveness and health impact • Recruitment, Retention, and Separation • Worker pay, promotion, and job satisfaction • Demand for public health workforce • Education, training, and credentialing • Public health workforce policy

  6. Relevant studies • Mays 2011-increased spending in public health decreases preventable deaths including infant mortality, diabetes, cardiovascular disease, and cancer2 • Erwin 2010-examined changes in local health department resources with AHR state-level outcomes. Increases in staff significantly associated with decreases in CVD mortality3

  7. Recent PHSSR Agenda • What factors influence the supply of, demand for, and geographic and organizational distribution of workers with the public health workforce? • How does the size and composition of the public health workforce affect the volume, mix, quality, and outcomes of public health strategies delivered at local, state, and national levels?

  8. Purpose • To examine the relationship between workforce, provision of services, and provider type (population-based/clinical) for state health agencies and state level health outcomes • This will not only be the first attempt to examine state health agencies workforce data and health outcomes at the state level but will be among the first to explore Association of State and Territorial Health Officials (ASTHO) data

  9. Methods • Cross-sectional study of secondary data (ASTHO 2010, AHR 2010, Census 2010) • Descriptive Statistics • Bivariate Analyses (p-value less than 0.20) • Multiple Imputation, Multivariate Analyses-Linear Regression, Linear Contrast-Research Question 3

  10. Potential Control Variables • State health department structure • Capacity variables (governance classification, role of state health agencies, does your state have a board of health, Enforcement/adjudicatory powers, expenditures, state health official authority, qualifications, salary • Demographic characteristics-age of population, race, ethnicity

  11. Description of FTEs

  12. Occupational Classifications of FTEs

  13. Research Question • Is the association between state-level health outcomes and direct patient care FTEs different than the association between state-level health outcomes and population-based FTEs? • H0: There is no difference in association between state-level health outcomes and direct patient care FTEs and association between population-based FTEs and state-level health outcomes adjusting for potential control variables. • Ha: There is a difference in association between state-level health outcomes and direct patient care FTEs and association between population-based FTEs and state-level health outcomes adjusting for potential control variables

  14. Linear Contrast Test of Equality 1

  15. Linear Contrast Test of Equality 2

  16. Linear Contrast Test of Equality 3

  17. Linear Contrast Test of Equality 4

  18. Conclusion • Significant differences in association between health outcomes and population based FTEs and association between health outcomes and direct care FTEs

  19. Areas for Future Research • Evidence linking public health workforce to health outcomes is relatively sparse • Comparison of Beck’s NACCHO/CHSI 2010 • Cross-sectional/Longitudinal ASTHO/Commonwealth Report State Scorecard, AHRQ National Healthcare Disparities Report • Repeating Erwin’s study for 2010 • NPHPSP for State

  20. References • 1. Crawford, C.A.G., et al., Perspectives on Public Health Workforce Research. Journal of Public Health Management and Practice, 2009: p. S5-S15. • 2. Mays, G.P. and S.A. Smith, Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths. Health Affairs, 2011. • 3. Erwin, P.C., et al., The Association of Changes in Local Health Department Resources With Changes in State-Level Health Outcomes. Am J Public Health, 2011. 101(4): p. 609-615.

  21. Bivariate Screening

  22. Pearson’s Correlation

  23. ANOVA of Governance and Health Outcomes

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