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Background: Provider concern regarding insurance non-payment for vaccines is a common barrier to provision of adult immunizations. We examined current adult vaccination billing and payment associated with two managed care populations to identify reasons for non-payment of immunization insurance claims., Methods: We assessed administrative data from 2014 to 2015 from Blue Care Network of Michigan, a nonprofit health maintenance organization, and Blue Cross Complete of Michigan, a Medicaid managed care plan, to determine rates of and reasons for non-payment of adult vaccination claims across patient-care settings, insurance plans, and vaccine types. We compared commercial and Medicaid payment rates to Medicare payment rates and examined patient cost sharing., Results: Pharmacy-submitted claims for adult vaccine doses were almost always paid (commercial 98.5%; Medicaid 100%). As the physician office accounted for the clear majority (79% commercial; 69% Medicaid) of medical (non-pharmacy) vaccination services, we limited further analyses of both commercial and Medicaid medical claims to the physician office setting. In the physician office setting, rates of payment were high with commercial rates of payment (97.9%) greater than Medicaid rates (91.6%). Reasons for non-payment varied, but generally related to the complexity of adult vaccine recommendations (patient diagnosis does not match recommendations) or insurance coverage (complex contracts, multiple insurance payers). Vaccine administration services were also generally paid. Commercial health plan payments were greater for both vaccine dose and vaccine administration than Medicare payments; Medicaid paid a higher amount for the vaccine dose, but less for vaccine administration than Medicare. Patients generally had very low (commercial) or no (Medicaid) cost-sharing for vaccination., Conclusions: Adult vaccine dose claims were usually paid. Medicaid generally had higher rates of non-payment than commercial insurance., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Historically, there has been considerable variability in how formative evaluation has been conceptualized and practiced. FORmative Evaluation Consultation And Systems Technique (FORECAST) is a formative evaluation approach that develops a set of models and processes that can be used across settings and times, while allowing for local adaptations and innovations. FORECAST integrates specific models and tools to improve limitations in program theory, implementation, and evaluation. In the period since its initial use in a federally funded community prevention project in the early 1990s, evaluators have incorporated important formative evaluation innovations into FORECAST, including the integration of feedback loops and proximal outcome evaluation. In addition, FORECAST has been applied in a randomized community research trial. In this article, we describe updates to FORECAST and the implications of FORECAST for ameliorating failures in program theory, implementation, and evaluation., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The unification of the American Association for Health Education (AAHE) and the Society for Public Health Education (SOPHE) generates a long-desired synergy, a ramping up of our leadership influence in promoting health. It also serves as an ongoing opportunity to reflect on how we synergize the distinct philosophic, scientific, and practical approaches that our AAHE colleagues bring in constructing a larger tent for public health education. Running parallel to our union with AAHE is the undertaking by several schools of health, physical education, and recreation (HPER) to become schools of public health. The unification between AAHE and SOPHE can be of enormous benefit to such a process. Just as the harmonious integration of two organizations with similar but distinct perspectives depends on compromise and transcendence, the schools that they embody-both public health and HPER-might consider ways to engage in continued dialogue to assure a more expansive paradigm for public health. SOPHE has an important role to play in this process, and with the additional insight and influence that our AAHE colleagues bring, we can become more instrumental as a boundary spanner. Mechanisms for such integration are discussed.

Objective: This article reports on a qualitative study that contrasts implementation patterns across community-based public health initiatives, resulting in a construct for building the capacity of such initiatives in racial and ethnic communities. By specifying which capacities provide optimum leverage, community initiatives may increase precision in developing intervention strategies that are pivotal in producing desired outcomes., Method: Cross-case comparisons were made on the basis of intensive interviews with key initiative leaders., Results: Several capacities distinguish highly successful initiatives from those that had greater difficulty in realizing their goals. Leadership was the most important distinguishing capacity. Organizing capacity, or the propensity to provide structure, operational procedures, oversight, and activity formation, was also critical in leveraging community action and desired outcomes., Conclusion: The study concludes that developing high levels of community capacity where it can produce the most strategic advantage is a promising pathway for mitigating antagonistic social factors.

Background: The Centers for Disease Control and Prevention's (CDC's) Prevention Research Centers (PRC) Program underwent a 2-year evaluation planning project using a participatory process that allowed perspectives from the national community of PRC partners to be expressed and reflected in a national logic model., Context: The PRC Program recognized the challenge in developing a feasible, useable, and relevant evaluation process for a large, diverse program. To address the challenge, participatory and utilization-focused evaluation models were used., Methods: Four tactics guided the evaluation planning process: 1) assessing stakeholders' communication needs and existing communication mechanisms and infrastructure; 2) using existing mechanisms and establishing others as needed to inform, educate, and request feedback; 3) listening to and using feedback received; and 4) obtaining adequate resources and building flexibility into the project plan to support multifaceted mechanisms for data collection., Consequences: Participatory methods resulted in buy-in from stakeholders and the development of a national logic model. Benefits included CDC's use of the logic model for program planning and development of a national evaluation protocol and increased expectations among PRC partners for involvement. Challenges included the time, effort, and investment of program resources required for the participatory approach and the identification of whom to engage and when to engage them for feedback on project decisions., Interpretation: By using a participatory and utilization-focused model, program partners positively influenced how CDC developed an evaluation plan. The tactics we used can guide the involvement of program stakeholders and help with decisions on appropriate methods and approaches for engaging partners.

Aim: The article reports on the recommendations from the Diabetes Primary Prevention Project that was initiated and funded by the Division of Diabetes Translation, Centers for Disease Control and Prevention, and developed by the National Association of Chronic Disease Directors., Method: Essential components of statewide programs are delineated for effective interventions for diabetes primary prevention. The recommendations were derived from a structured process that is detailed on the basis of a cross-comparison of state-level diabetes prevention initiatives in six states where such programs were most developed., Results: The recommendations focus on state-level partnerships, statewide program planning, required resources, policies, benchmarks for progress, and data collection., Conclusion: Illustrations are provided regarding how the project influenced the six participating states in further developing their programs for the primary prevention of diabetes.

A qualitative evaluation was conducted at 15 nationally designated Centers of Excellence in Women's Health (CoEs) that were funded by the U.S. Department of Health and Human Services' (DHHS) Office on Women's Health at the time of data collection. The evaluation focused on organizational issues including: 1) the impact of CoE designation on the recipient institutions; 2) the greatest strengths and challenges affecting the CoEs and their core components of research, clinical care, professional education, leadership, and community outreach; and 3) whether the core components developed an interface and coordinated with one another as intended according to the DHHS national model. A total of 91 individuals were interviewed for the evaluation. The study indicates that the national designation served to legitimize and expand the scope of women's health within the recipient institutions. The CoEs enhanced collaboration among researchers and practitioners, and were able to leverage additional resources. The core components largely were successful at interfacing in accordance with the national model. Notwithstanding these successes, the CoEs remain susceptible to failure if they do not gain additional support for the concept of women's health within the recipient institutions, and will not remain durable without additional and stable funding sources.

A case study was conducted of the formation of a diabetes initiative in a largely African American urban community. The study focused on how confluent the original project model was with actual formation, what benefits were produced, what areas of needed improvement surfaced, and how different stakeholder groups characterized one another's involvement. The project produced several benefits but also experienced needed improvements in its formation, which suffered from a lack of communication, cooperation, and coordination; unclear goals and personnel roles; and early delays. Lessons include treating project formation as an important developmental stage and reducing bureaucratic management approaches not suited for community partnerships.

Although community capacity is a central concern of community development experts, the concept requires clarification. Because of the potential importance of community capacity to health promotion, the Division of Chronic Disease Control and Community Intervention, Centers for Disease Control and Prevention (CDC), convened a symposium in December 1995 with the hope that a consensus might emerge regarding the dimensions that are integral to community capacity. This article describes the dimensions that the symposium participants suggested as central to the construct, including participation and leadership, skills, resources, social and interorganizational networks, sense of community, understanding of community history, community power, community values, and critical reflection. The dimensions are not exhaustive but may serve as a point of departure to extend and refine the construct and to operationalize ways to assess capacity in communities.

To assist state health agencies adopt a new role in cancer prevention and control, the National Cancer Institute (NCI) initiated the Data-based Intervention Research (DBIR) program. The goal of DBIR was to stimulate data-driven activities and to build capacity for ongoing programs within state health agencies to ensure the translation of cancer prevention and control science into practice across the US. Each state funded under the DBIR program was required to conduct four phases of activity: identifying and analyzing relevant data, using these data to develop a state cancer control plan, and implementing and evaluating prevention and control interventions at the local level. This paper presents the results of survey of the 22 states that participated in the DBIR program. The survey is intended as a supplement to the case study also reported in this issue of Health Education Research. Results indicated that states were able to implement the DBIR model and they show the process to be useful to their cancer prevention efforts. DBIR had a major impact on how states will use data in future planning for cancer prevention and control. States had a number of recommendations for how NCI could improve its working relationships with state health agencies.

This paper reports on a qualitative process evaluation of the Data-based Intervention Research (DBIR) program, that was funded by the National Cancer Institute (NCI) and operated in 21 states and the District of Columbia. The goal of DBIR was to build a foundation within state health agencies to ensure the translation of cancer control science into practice. NCI's objective reflected the readiness of cancer control research for public health application, the paucity of cancer control activity within public health settings and the recognition that state health agencies could play a critical role in the effective transfer of research results into public health practice. The qualitative process evaluation reported in this paper is based on one case study of four DBIR programs. The present study indicates that the four state health agencies executed the DBIR program with fidelity. Also, the four states offered a balanced assessment of NCI's role in enabling the state agency operation of DBIR, providing numerous citations illustrating how NCI successfully facilitated organizational capacity as compared to fewer mentions of ways NCI was less than successful. Thus, in funding the DBIR model, NCI was successful in raising state health agency capacity to implement cancer prevention and control programming. Implications for capacity building in state health departments are discussed.

This study was conducted to test an instrument for measuring the level of institutionalization (LoIn) of health promotion programs. Institutionalization occurs when a program becomes an integral part of an organization, and the LoIn instrument is a beginning effort to measure the extent of program integration into organizations. The instrument is based on theory that holds that organizations are composed of production, maintenance, supportive, and managerial subsystems. Institutionalization occurs when a program becomes imbedded into these subsystems. A questionnaire designed to test this construct was mailed to 453 administrators in 141 organizations that operate health promotion programs. Based on 322 usable responses (71%), a confirmatory factor analysis was conducted. The results support the hypothesis of an eight-factor model: four factors concern how routinized the program was in each subsystem and four factors concern the degree of program saturation within each subsystem. Correlations of the eight factors with the number of years the programs had been in operation, and managers' perceptions of program permanency, indicated that the four routinization factors were more highly correlated with program longevity than the four niche saturation factors, and the niche saturation factors were more highly correlated with managers' perceptions of program permanence than the routinization factors. The instrument, which is available from the authors, may be used as both a research instrument and a diagnostic tool in assessing the institutionalization of health promotion programs.

A multidisciplinary approach has been presented for the teaching of clinical genetics to medical students. No set program or specific course has been put forth, but rather a continuous exposure to patients with genetic disorders has been advocated as an integral part of a medical student's learning experience during his or her years of clinical study. Four teaching aims and various approaches to implementing these aims have been discussed. They involve 1) giving the student a broad exposure to clinical genetics, 2) acquainting the student with the main clinical and laboratory procedures used in the diagnosis of genetic diseases, 3) making the student aware of the problems and complexities of genetic counseling, and 4) creating an appreciation for the continuous need for investigative studies. With the exception of genetic counseling, all of the aims could be achieved as the student rotates through the various specialties in the clinical years. However, joint teaching efforts by departments of medical genetics and other clinical departments can and should make for an enriching experience.