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Background: Health care reform has resulted in changes throughout the health system, including the Affordable Care Act (ACA) and IRS requirements that nonprofit hospitals conduct community health needs assessments and develop implementation plans to guide greater investment in their respective communities. This has led to questions of which factors influence hospital interaction and investment in PH systems. Purpose: This paper presents a comprehensive framework, informed by a literature review and expert panel that introduces hypothesized factors related to these outcomes. Methods: To develop a conceptual framework that identifies hypothesized indicators of increased hospital interaction and investment in PH systems, we completed a thorough and iterative review and coding of the literature. We drafted a first version of the conceptual model and convened an expert panel (n=9) to review, further narrow, and refine the conceptual model of indicators. Results: The finalized conceptual framework includes four primary categories: Community Demographics, Legal/Policy Environment, Market Conditions, and the Public Health and Hospital Organization and Systems. Detailed subcategories are included within each category. While we generally hypothesize that these factors determine the extent to which a hospital will interact and invest in PH systems, we indicate only their relational characteristics, not the direction in which these factors are specified. Implications: Ongoing work will test components of the framework utilizing four published datasets. This paper presents the framework to guide future research and funding priorities in the field. [ABSTRACT FROM AUTHOR]

Background. There is a gap in research regarding the resources needed to deliver public health activities, which inhibits informed decision making around investments in public health and the allocation of funds among activities. When conducting cost analyses in public health, it is important to include costs from all cost components, including personnel, non-personnel, and indirect costs. However, defining, identifying, and measuring indirect costs is challenging and can impede studies of this type. Purpose. The purpose of this pilot study is to create a catalog of the methodologies public health researchers have used to account for indirect costs. Methods. We surveyed the final products submitted by the eleven practice-based research networks who received funding from the Robert Wood Johnson Foundation to explore the delivery and cost of public health activities for their indirect cost inclusion method. The primary investigators were contacted to verify their methodology. Ten of the 11 networks (91%) could be reached. Results. Four of the networks used a prenegotiated rate the health department had with the state agency. Three of the networks used a data collection instrument that had public health administrative staff estimate these costs. Three of the networks did not include indirect costs in their analyses. Implications. Although challenging, it is important to include indirect costs in public health cost analyses as they are a real cost to public health departments and research findings without these costs have limited applicability. This review can assist researchers by reviewing approaches previously used by public health researchers. [ABSTRACT FROM AUTHOR]