Search

Objective. We identify economic costs associated with communicable disease (CD) monitoring/surveillance in Colorado local public health agencies and identify possible economies of scale. Data Sources/Study Setting. Data were collected via a survey of local public health employees engaged in CD work. Survey respondents logged time spent on CD surveillance for 2-week periods in the spring of 2014 and fall of 2014. Forty-three of the 54 local public health agencies in Colorado participated. Study Design. We used a microcosting approach. We estimated a statistical cost function using cost as a function of the number of reported investigable diseases during the matched 2-week period. We also controlled for other independent variables, including case mix, characteristics of the agency, the community, and services provided. Data Collection/Extraction Methods. Data were collected from a microcosting survey using time logs. Principal Findings. Costs increased at a decreasing rate as cases increased, with both cases ([beta] = 431.5, p < .001) and cases squared ([beta] = -3.62, p = .05) statistically significant. Conclusions and Implications. The results of the model suggest economies of scale. Cost per unit is estimated to be one-third lower for high-volume agencies as compared to low-volume agencies. Cost savings could potentially be achieved if smaller agencies shared services. Key Words. Public health services and systems research, communicable disease surveillance, economies of scale, In 2012, the Institute of Medicine published a report entitled For the Public's Health: Investing in a Healthier Future, which included a call to action toward the development of a [...]

Objectives: Public health accreditation is a 7-step process that starts with a period of preapplication during which a health department assesses its readiness for accreditation. However, no tools with established reliability and validity that quantitatively measure a local health department’s (LHD’s) capacity for accreditation are available to complete this initial step. We developed and validated a survey to measure accreditation capacity for LHDs.Methods: From January through April 2015, we administered a cross-sectional electronic survey instrument with 15 questions that tapped into domains of capacity for public health accreditation. We analyzed and grouped responses by using a confirmatory maximum likelihood factor analysis with oblique rotations. We assessed reliability by using Cronbach α, and we assessed validity by comparing responses with previously established instruments. We administered the survey to 174 LHD directors in Colorado, Kansas, and Nebraska, 153 (88%) of whom responded.Results: The factor analysis produced a 3-factor model of accreditation capacity, suggesting that accreditation capacity depends on 3 distinct latent constructs: support for accreditation, preparation, and planning and approach. The model had good scale reliability (average Cronbach α = 0.7) and validity (average factor correlation = 0.43).Conclusions: The survey developed and scored in this analysis can be used by LHDs to inform the feasibility of initiating the time-intensive and costly process of accreditation.

Objectives: Interest is increasing in collaborations between public health and primary care to address the health of a community. Although the understanding of how these collaborations work is growing, little is known about the barriers facing these partners at the local level. The objective of this study was to identify barriers to collaboration between primary care and public health at the local level in 4 states.Methods: The study team, which comprised 12 representatives of Practice-Based Research Networks (networks of practitioners interested in conducting research in practice-based settings), identified 40 key informants from the public health and primary care fields in Colorado, Minnesota, Washington State, and Wisconsin. The key informants participated in standardized, semistructured telephone interviews with 8 study team members in 2014 and 2015. Interviews were audio recorded and transcribed verbatim. We analyzed key themes and subthemes by drawing on grounded theory.Results: Primary care and public health participants identified similar barriers to collaboration. Barriers at the institutional level included the challenges of the primary care environment, in which providers feel overwhelmed and resources are tight; the need for systems change; a lack of partnership; and geographic challenges. Barriers to collaboration included mutual awareness, communication, data sharing, capacity, lack of resources, and prioritization of resources.Conclusions: Some barriers to collaboration (eg, changes to health care billing, demands on provider time) require systems change to overcome, whereas others (eg, a lack of shared priorities and mutual awareness) could be addressed through educational approaches, without adding resources or making a systemic change. Overcoming these common barriers may lead to more effective collaboration.