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State health departments and Prevention Research Centers (PRCs) have complementary mandates and expertise important to improving population health. State health departments manage and administer numerous programs with broad population reach. PRCs bridge dissemination and implementation research and public health practice to improve health programming and outcomes. This paper describes the 15-year partnership between the Washington State Department of Health and the PRC at the University of Washington. Through this partnership, the Washington State Department of Health increases their research and evaluation capacity by working with the University of Washington PRC, and the University of Washington PRC receives opportunities to apply evidence in a variety of practice settings, expand the reach of their research-tested programs to new populations, and form new partnerships. The partnership focused initially on improving colorectal cancer screening rates through increased dissemination and implementation of evidence-based interventions. The partnership scope has grown to include small cancer screening projects in worksites and healthcare systems, Washington's Colorectal Cancer Control Program, breast and cervical cancer screening, hypertension control, and worksite health promotion. The partnership yields three main types of outcomes that strengthen practice and science: (1) findings from each major assessment or evaluation activity, published in the peer-reviewed literature when possible; (2) use of the findings to improve public health practice and impact; and (3) training opportunities for employees of local and state health departments and public health students. PRCs, health departments, and the populations they serve have much to gain from this type of partnership.

Between 1992 and 2011, the Centers for Disease Control and Prevention’s (CDC’s) Prevention Research Centers (PRC) Program had a series of five directors. In the following Commentary, four of these five directors offer their reflections on the program during their periods of leadership.

Editors’ Note: We invited a sample of AJPM’s Editorial Board, supplement guest editors, and longtime colleagues and contributors to share their experiences and impressions of the impact of AJPM on their respective domains. We were particularly fond of Ken Powell’s analogy to being “tenders of the planted seed”—as planters, weeders, and harvesters—watching and nurturing the growth of AJPM, and have elected to lead with his commentary. In the mid-1940s my brothers and I helped our father tend our victory garden. We were suburbanites and our small garden shared a vacant lot with the concrete foundation of a home abandoned in mid-construction during the Depression. We helped plant, weed, and harvest the crops. I especially liked the tall stalks of sweet corn that grew taller than I was. Many years later, in the mid-1990s, I met a couple of other gardeners: Kevin Patrick and Doug Scutchfield visited the Centers for Disease Control (now the Centers for Disease Control and Prevention) to discuss their plans as the editors of the American Journal of Preventive Medicine. I was working in a Branch that was trying to understand the public health importance of regular physical activity, and they had the foresight to know we were planting some seeds in an important new area. I’m not sure that I had even heard of AJPM before their visit. A few years later, while the field of physical activity and public health continued to grow, I shifted my focus to violence and injury prevention. Once again, the team of Patrick and Scutchfield recognized the importance of this topic to the field of preventive medicine. By the turn of the century my work had shifted from the national to the state level. I tried to keep up with the literature by reading or scanning articles as I rode the subway to and from work. The Georgia Division of Public Health had no access to a library so I circulated my personal copy of the American Journal of Preventive Medicine to my team in the Chronic Disease and Injury Epidemiology Section because it contained by far the most articles of interest and practical application for us. Isn’t it interesting to watch things grow. Gardens, journals, and the fields of public health and preventive medicine.

Background The Guide to Community Preventive Services ( Community Guide ) offers evidence-based intervention strategies to prevent chronic disease. The American Cancer Society (ACS) and the University of Washington Health Promotion Research Center co-developed ACS Workplace Solutions (WPS) to improve workplaces' implementation of Community Guide strategies. Purpose To test the effectiveness of WPS for midsized employers in low-wage industries. Design Two-arm RCT; workplaces were randomized to receive WPS during the study (intervention group) or at the end of the study (delayed control group). Setting/participants Forty-eight midsized employers (100–999 workers) in King County WA. Intervention WPS provides employers one-on-one consulting with an ACS interventionist via three meetings at the workplace. The interventionist recommends best practices to adopt based on the workplace's current practices, provides implementation toolkits for the best practices the employer chooses to adopt, conducts a follow-up visit at 6 months, and provides technical assistance. Main outcome measures Employers' implementation of 16 best practices (in the categories of insurance benefits, health-related policies, programs, tracking, and health communications) at baseline (June 2007–June 2008) and 15-month follow-up (October 2008–December 2009). Data were analyzed in 2010–2011. Results Intervention employers demonstrated greater improvement from baseline than control employers in two of the five best-practice categories; implementing policies (baseline scores: 39% program, 43% control; follow-up scores: 49% program, 45% control; p =0.013) and communications (baseline scores: 42% program, 44% control; follow-up scores: 76% program, 55% control; p =0.007). Total best-practice implementation improvement did not differ between study groups (baseline scores: 32% intervention, 37% control; follow-up scores: 39% intervention, 42% control; p =0.328). Conclusions WPS improved employers' health-related policies and communications but did not improve insurance benefits design, programs, or tracking. Many employers were unable to modify insurance benefits and reported that the time and costs of implementing best practices were major barriers. Trial registration This study is registered at clinicaltrials.gov NCT00452816.

Context Public health leaders are making difficult decisions about how to maximize the effectiveness of public health services with diminishing funds. Quality improvement (QI) interventions seek to improve the efficiency and effectiveness of public health programs, services, or organizations. The purpose of this study was to review the literature to describe public health system QI interventions and their impact on public health practices and health outcomes. Evidence acquisition A systematic review was conducted using PRISMA guidelines. Three databases were searched for peer-reviewed articles that included public health quality improvement–related terms in their abstracts. Articles published in 1990–2010 that described results from QI interventions conducted within the U.S. public health system were included. Evidence synthesis Fifteen studies were identified, reporting on 18 separate QI interventions. Studies fell naturally into three functional categories: organization-wide QI, program- or service-specific QI, and administrative or management function QI. Few of the studies linked their improvements directly to a health outcome or predictors of health outcomes. Studies generally were implemented in state-level or large local public health departments. Conclusions Formally published QI interventions may not be representative of typical, smaller-scale QI activities. Collection and distribution of QI results associated with proven, effective public health interventions and that quantify the benefits of QI practices in public health should be a goal. More research is needed to definitively “connect the dots” between QI efforts, resulting practice improvements, and actual (or predictors of) health outcome improvements. Future studies should examine QI in diverse public health systems.

Methods: The assessment of services’ value for the U.S. population was based on two dimensions: burden of disease prevented by each service and cost effectiveness. Methods were developed for measuring these criteria consistently across different types of services. A companion article describes the methods in greater detail. Each service received 1 to 5 points on each of the two dimensions, for total scores ranging from 2 to 10. Priority opportunities for improving delivery rates were determined by comparing the ranking of services with what is known of current delivery rates nationally. Results: The highest ranked services (scores of 71) with the lowest delivery rates (#50% nationally) are providing tobacco cessation counseling to adults, screening older adults for undetected vision impairments, offering adolescents an anti-tobacco message or advice to quit, counseling adolescents on alcohol and drug abstinence, screening adults for colorectal cancer, screening young women for chlamydial infection, screening adults for problem drinking, and vaccinating older adults against pneumococcal disease.

Objectives: This paper describes the methods used in the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide ) for conducting systematic reviews of economic evaluations across community health-promotion and disease-prevention interventions. The lack of standardized methods to improve the comparability of results from economic evaluations has hampered the use of data on costs and financial benefits in evidence-based reviews of effectiveness. The methods and instruments developed for the Guide provide an explicit and systematic approach for abstracting economic evaluation data and increase the usefulness of economic information for policy making in health care and public health. Methods: The following steps were taken for systematic reviews of economic evaluations: (1) systematic searches were conducted; (2) studies using economic analytic methods, such as cost analysis or cost-effectiveness, cost-benefit or cost-utility analysis, were selected according to explicit inclusion criteria; (3) economic data were abstracted and adjusted using a standardized abstraction form; and (4) adjusted summary measures were listed in summary tables. Results: These methods were used in a review of 10 interventions designed to improve vaccination coverage in children, adolescents and adults. Ten average costs and 14 cost-effectiveness ratios were abstracted or calculated from data reported in 24 studies and expressed in 1997 USD. The types of costs included in the analysis and intervention definitions varied extensively. Gaps in data were found for many interventions.

Systematic reviews and evidence-based recommendations are increasingly important for decision making in health and medicine. Over the past 20 years, information on the science of synthesizing research results has exploded. However, some approaches to systematic reviews of the effectiveness of clinical preventive services and medical care may be less appropriate for evaluating population-based interventions. Furthermore, methods for linking evidence to recommendations are less well developed than methods for synthesizing evidence. The Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommenda- tions (the Guide) will evaluate and make recommendations on population-based and public health interventions. This paper provides an overview of the Guide's process to systemati- cally review evidence and translate that evidence into recommendations. The Guide reviews evidence on effectiveness, the applicability of effectiveness data, (i.e., the extent to which available effectiveness data is thought to apply to additional populations and settings), the intervention's other effects (i.e., important side effects), economic impact, and barriers to implementation of interventions. The steps for obtaining and evaluating evidence into recommendations involve: (1) forming multidisciplinary chapter development teams, (2) developing a conceptual approach to organizing, grouping, selecting and evaluating the interventions in each chapter; (3) selecting interventions to be evaluated; (4) searching for and retrieving evidence; (5) assessing the quality of and summarizing the body of evidence of effectiveness; (6) translating the body of evidence of effectiveness into recommendations; (7) considering information on evidence other than effectiveness; and (8) identifying and summarizing research gaps. Systematic reviews of and evidence-based recommendations for population-health interven- tions are challenging and methods will continue to evolve. However, using an evidence-based approach to identify and recommend effective interventions directed at specific public health goals may reduce errors in how information is collected and interpreted, identify important gaps in current knowledge thus guiding further research, and enhance the Guide users' ability to assess whether recommendations are valid and prudent from their own perspectives. Over time, all of these advantages could help to increase agreement regarding appropriate community health strategies and help to increase their implementation. Medical Subject Headings (MeSH): community health services, decision making; evidence- based medicine; systematic reviews; methods; population-based interventions; practice guidelines; preventive health services; public health practice; task force (Am J Prev Med

Context: Because human and financial resources are limited, health efforts must focus on prevention strategies that yield the most benefit for the investment. Many current strategies identified in the literature offer opportunities to promote health at a reasonable cost. Objective: To present a literature-based review of evidence demonstrating that prevention can be an effective and wise use of resources through CDC’s An Ounce of Prevention … What Are the Returns? Second Edition. Design: Systematic review of cost-effectiveness literature for a selected group of prevention strategies. Setting: Prevention strategies relevant to the U.S. population. Results: Data indicate that the health conditions considered can be addressed through prevention strategies that are either cost effective or cost saving. Conclusions: An Ounce of Prevention … What Are the Returns? Second Edition can be used to conveniently access information on prevention strategies, the diseases and injuries they address, and their cost effectiveness. It also complements other comprehensive prevention guides. However, limitations of the available cost-effectiveness studies indicate that standardized procedures should be followed for studies of all recommended prevention strategies. Researchers must standardize review procedures to improve both the quality and comparability of studies.

Introduction: Tobacco use, diet and physical activity patterns, and alcohol use are the leading causes of death in the United States. To make major improvements in the health status of the population, behavioral risk factors for disease must be addressed. Methods: We propose a brief survey of behavioral risk factors for enrollees of health care organizations, employer groups, or other adult populations that can be used to profile the health risk behaviors of a population, assess performance of prevention and risk reduction programs, or make comparisons with other populations. The survey contains questions about tobacco, diet, physical activity, alcohol, firearms, motor vehicle safety, sexual behavior, and drugs. Results: Recommendations for survey items, implementation, and calculation of performance measures are given. Conclusions: Widespread adoption of this type of survey would be a major step forward in acknowledging the impact that behavior has on health and in furthering individual and organizational accountability for improving health risk behaviors.

The Guide to Community Preventive Services (Community Guide) offers evidence-based intervention strategies to prevent chronic disease. The American Cancer Society (ACS) and the University of Washington Health Promotion Research Center co-developed ACS Workplace Solutions (WPS) to improve workplaces' implementation of Community Guide strategies.To test the effectiveness of WPS for midsized employers in low-wage industries.Two-arm RCT; workplaces were randomized to receive WPS during the study (intervention group) or at the end of the study (delayed control group).Forty-eight midsized employers (100-999 workers) in King County WA.WPS provides employers one-on-one consulting with an ACS interventionist via three meetings at the workplace. The interventionist recommends best practices to adopt based on the workplace's current practices, provides implementation toolkits for the best practices the employer chooses to adopt, conducts a follow-up visit at 6 months, and provides technical assistance.Employers' implementation of 16 best practices (in the categories of insurance benefits, health-related policies, programs, tracking, and health communications) at baseline (June 2007-June 2008) and 15-month follow-up (October 2008-December 2009). Data were analyzed in 2010-2011.Intervention employers demonstrated greater improvement from baseline than control employers in two of the five best-practice categories; implementing policies (baseline scores: 39% program, 43% control; follow-up scores: 49% program, 45% control; p=0.013) and communications (baseline scores: 42% program, 44% control; follow-up scores: 76% program, 55% control; p=0.007). Total best-practice implementation improvement did not differ between study groups (baseline scores: 32% intervention, 37% control; follow-up scores: 39% intervention, 42% control; p=0.328).WPS improved employers' health-related policies and communications but did not improve insurance benefits design, programs, or tracking. Many employers were unable to modify insurance benefits and reported that the time and costs of implementing best practices were major barriers.This study is registered at clinicaltrials.gov NCT00452816.

Public health leaders are making difficult decisions about how to maximize the effectiveness of public health services with diminishing funds. Quality improvement (QI) interventions seek to improve the efficiency and effectiveness of public health programs, services, or organizations. The purpose of this study was to review the literature to describe public health system QI interventions and their impact on public health practices and health outcomes.A systematic review was conducted using PRISMA guidelines. Three databases were searched for peer-reviewed articles that included public health quality improvement-related terms in their abstracts. Articles published in 1990-2010 that described results from QI interventions conducted within the U.S. public health system were included.Fifteen studies were identified, reporting on 18 separate QI interventions. Studies fell naturally into three functional categories: organization-wide QI, program- or service-specific QI, and administrative or management function QI. Few of the studies linked their improvements directly to a health outcome or predictors of health outcomes. Studies generally were implemented in state-level or large local public health departments.Formally published QI interventions may not be representative of typical, smaller-scale QI activities. Collection and distribution of QI results associated with proven, effective public health interventions and that quantify the benefits of QI practices in public health should be a goal. More research is needed to definitively "connect the dots" between QI efforts, resulting practice improvements, and actual (or predictors of) health outcome improvements. Future studies should examine QI in diverse public health systems.

Background: The ultimate intent of healthcare performance measures is to improve health status by stimulating improvements to healthcare quality. This report evaluates how well current performance measurement sets address the leading causes of illness and death in the United States, using the Health Plan Employer Data and Information Set (HEDIS) as an example. Methods: We assessed whether HEDIS measures exist for the leading causes of illness and death according to five commonly used indices: physiologic cause of death, underlying cause of death, disability-adjusted life years, healthcare expenditures, and missed work days. Results: Fewer than one half of the leading causes of morbidity and mortality are addressed by current measures. Conclusions: The opportunities for using accurate and meaningful measurement for disease prevention and health promotion are substantial, yet this potential remains only partly realized and depends on further expansion of performance measurement efforts.

On January 15–16, 1997, about a year ago, more than 650 health professionals gathered in Atlanta to attend the conference, “Prevention in Managed Care: Joining Forces for Value and Quality.” The conference was designed to bring together key and diverse stakeholders in the public’s health—persons whose professional responsibilities and objectives are similar, who need to work together to improve the nation’s health, but who have not yet established relationships and networks for collaboration. The nine sponsoring organizations (pp. 123–124), representing public health agencies, managed care organizations, purchasers, foundations, and government, exemplified these organizations and health professionals. The conference format afforded opportunities for discussing preventive health issues such as immunization, cancer screening, adolescent health, and violence as well as issues of purchasing and contracting for preventive health services and of having data for intervention and fiscal decision making, performance measurement, accreditation, and assessment. As important, it was hoped that, through interacting and sharing perspectives on roles and responsibilities as part of the conference workshops, communication and partnerships for prevention would grow. Traditional public health leaders joined with managed care officials and providers, public and private sector purchasers of health benefits, and community health professionals and foundation leaders to discuss perspectives, responsibilities, and logistical and technical realities for bridging the chasm between public and private sector health responsibilities. For many individuals in public health, this was their first interaction with representatives from managed care organizations, and vice versa. These Proceedings include