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This study describes the results of an analysis of the relationship between local public health agency performance and health outcomes. Findings support the model that local public health agency performance affects community health status, and depending on the outcome, performance contributions vary. New hypotheses are offered that could help determine how system performance affects health outcomes. [ABSTRACT FROM AUTHOR]

Healthy People 2010 national objectives seek to engage public health systems in health improvement. Focusing on "healthy communities," the article describes the readiness of U.S. counties to meet targets and the technical assistance that may be needed. Using rate comparisons and trends, four readiness-to-improve health categories are calculated for nine mortality rates. Greatest readiness for improvement was found for coronary heart disease mortality, where the fewest jurisdictions (35%) were static, having neither met targets nor improved; least readiness (65%) was observed for colon and rectum cancer and suicide. Nevertheless, some counties (50-1,050) were exemplary, already meeting the target and still improving. [ABSTRACT FROM AUTHOR]

This article describes one effort to develop management tools that will help public health administrators and policy makers implement comprehensive public health strategies. It recounts the ongoing development of a methodology through which the Essential Public Health Services can be related to public health budgets, appropriations, and expenditures. Through three pilot projects involving: (1) nine state health agencies, (2) three local health agencies, and (3) all local jurisdictions and the state health agency in one state, a workable methodology for identifying public expenditures lot comprehensive public health programming has been identified. [ABSTRACT FROM AUTHOR]

The objective of this study is to determine the effects of early newborn hospital discharge policy on hospital readmission for Medicaid infants. It is a multiple year, retrospective study in which early hospital discharges were followed using Medicaid claims data to determine the rate of readmissions for newborns during 1989- 1992, the years in which this policy became widespread in Maryland. Analysis compares early discharges, using χ2 tests, and calculates odds ratios to estimate the risk of readmissions. Our results found significant increases in early discharges for Medicaid newborns over time among sick newborns. The odds of readmissions for nor mal babies discharged early were about the same as for those kept longer, but for sick babies discharged early they were significantly greater, especially during the early study years. Findings from this natural experi ment indicate that early discharge of Medicaid new borns with physical problems increases their likelihood of readmissions. Careful attention to the needs of these higher risk infants must be a part of any hospital or managed care program implementing early discharge policy. [ABSTRACT FROM PUBLISHER]

Objective: It is widely accepted that smoking prevalence and poverty predict the occurrence of lung cancer mortality. The question asked in the study was: What are the important factors for counties that are useful to public health professionals? We sought to provide an answer, using a recursive partitioning approach applied to county-level indicators., Methods: Classification and regression tree analysis is relatively unexplored for its utility in public health. Using available ecologic data, county lung cancer mortality was modeled by several predictor variables from a larger set of candidates. We constructed a tree on the basis of statistical software, R., Results: Seven groupings were defined. Not surprisingly, smoking prevalence was a major determiner of tree nodes, as were prior coronary heart disease mortality, poverty, and National Air Toxics Assessment excess cancer deaths estimates. Lung cancer mortality groupings ranged from 47 per 100000 in the best 2 groupings (leaves) to 85 per 100000 in the worst grouping of 52 local jurisdictions., Conclusions: Ecologic data portrayed in a classification and regression tree have utility for spurring etiologic investigation, tracking county outcomes, developing policy at any governmental level, and guiding program design and management. Community by community, improvements are not yet at Healthy People 2010 targets. Individual communities may benefit through efforts to focus attention on aspects such as smoking levels, poverty, air quality, or region, highlighted by this analysis.