Methods for Leveraging a Health Information Exchange for Public Health: Lessons Learned from the NW-PHIE Experience

The intent of this article is to provide public health and health information exchanges (HIEs) insight into activities and processes for connecting public health with clinical care through HIEs. In 2007 the CDC issued a Request for Proposal (RFP) for the “Situational Awareness through Health Information Exchange” project. The project’s goals are to connect public health with health information exchanges (HIEs) to improve public health’s real-time understanding of communities’ population health and healthcare facility status. This article describes the approach and methodology used by the Northwest Public Health Information Exchange to achieve the project’s goals. The experience of the NWPHIE Collaboration provides an organizational and operational roadmap for implementing a successful regional HIE that ensures secure exchange and use of electronic health information between local and state public health and health care entities.     

Charting the future of community health promotion: recommendations from the National Expert Panel on Community Health Promotion

In the decades since chronic illnesses replaced infectious diseases as the leading causes of death, public health researchers, particularly those in the field of health promotion and chronic disease prevention, have shifted their focus from the individual to the community in recognition that community-level changes will foster and sustain individual behavior change. The former emphasis on individual lifestyle change has been broadened to include social and environmental factors, often without increased resources. To find new ways to support community health promotion at the national level, the National Center for Chronic Disease Prevention and Health Promotion and the Division of Adult and Community Health invited an external panel of experts to participate in the National Expert Panel on Community Health Promotion. This article highlights the process through which the expert panel developed its eight recommendations. The recommendations include issues related to community-based participatory research and surveillance, training and capacity building, new approaches for health and wellness, and changes in federal investments. They illustrate the steps needed to broaden the traditional scope of public health and to advance a new vision for improving community health and wellness.     

Peer Reviewed: Charting the Future of Community Health Promotion: Recommendations From the National Expert Panel on Community Health Promotion

In the decades since chronic illnesses replaced infectious diseases as the leading causes of death, public health researchers, particularly those in the field of health promotion and chronic disease prevention, have shifted their focus from the individual to the community in recognition that community-level changes will foster and sustain individual behavior change. The former emphasis on individual lifestyle change has been broadened to include social and environmental factors, often without increased resources. To find new ways to support community health promotion at the national level, the National Center for Chronic Disease Prevention and Health Promotion and the Division of Adult and Community Health invited an external panel of experts to participate in the National Expert Panel on Community Health Promotion. This article highlights the process through which the expert panel developed its eight recommendations. The recommendations include issues related to community-based participatory research and surveillance, training and capacity building, new approaches for health and wellness, and changes in federal investments. They illustrate the steps needed to broaden the traditional scope of public health and to advance a new vision for improving community health and wellness.     

Growing from Our Roots: Strategies for Developing Culturally Grounded Health Promotion Interventions in American Indian,Alaska Native,and Native Hawaiian Communities

Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts “from the ground up.” Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions.

     

突发公共卫生事件现场资料分析

资料分析是现场调查的重要环节，是控制突发公共卫生事件的关键步骤。其目的是查明事件的性质及原因，为控制提供依据。     

1985至2013年北京市学龄儿童健康水平变化趋势

  目的   分析2016 — 2017年中国西部地区11个省、直辖市（不包括西藏自治区）12～17岁儿童青少年血脂异常流行状况。  方法  以“中国儿童与乳母营养健康监测”项目2016 — 2017年研究的12～17周岁未成年人作为研究对象,分析调查对象在不同人口学特征、体格特征下的脂质水平及高胆固醇血症、高甘油三酯血症、高密度脂蛋白胆固醇降低、低密度脂蛋白胆固醇升高、非高密度脂蛋白胆固醇升高的流行状况。  结果  调查对象的高胆固醇血症检出率为1.27 %,高甘油三酯血症检出率为5.65 %,低密度脂蛋白胆固醇升高检出率为1.39 %,高密度脂蛋白胆固醇降低检出率为16.21 %,非高密度脂蛋白胆固醇升高检出率为1.28 %,血脂异常检出率为21.12 %,肥胖调查对象的血脂异常检出率为50.86 %。不同人口学特征、体格特征调查对象的血脂水平和血脂异常存在差异（P < 0.05）。  结论  中国西部地区近五分之一儿童存在血脂异常现象,肥胖儿童的血脂异常流行现状严峻,且不同特征人群的血脂异常有一定差异。     

加强福建卫生人才队伍建设的对策与措施

针对福建省卫生人力资源现状和存在问题,结合深化医药卫生体制改革新要求,从改进卫生人力资源配置、提高医学人才培养质量、加强高层次人才队伍建设、基层卫生人才队伍建设、临床医师培养、公共卫生人才队伍建设、中医药人才队伍建设等方面提出对策与措施。     

Chronic Pain and Health Care Spending: An Analysis of Longitudinal Data from the Medical Expenditure Panel Survey

ObjectiveTo estimate average incremental health care expenditures associated with chronic pain by health care service category, expanding on prior research that focused on specific pain conditions instead of general pain, excluded low levels of pain, or did not incorporate pain duration.ConclusionsChronic pain limitations are associated with higher health care expenditures. Results underscore the substantial cost of pain to the health care system.     

A Qualitative Study on Preventing Gestational Diabetes in Native Hawaiian and Pacific Islander Adolescent Females: Perspectives from an Expert Panel of Health Care Providers

The authors examined perspectives of health care providers (HCPs) who serve Native Hawaiian and Pacific Islander (NH/PI) adolescents to inform the adaption of an existing American Indian and Alaska Native-specific gestational diabetes mellitus (GDM) risk reduction and preconception counseling program entitled Stopping GDM, for NH/PI adolescents. Hawai‘i-based HCPs (n=14) who care for NH/PI adolescent females volunteered for this expert panel focus group study. These HCP participants served as an expert panel specific to their experiences in providing primary care and reproductive health care/family planning, and their perspectives regarding GDM risk reduction for NH adolescents. Several key themes emerged from these expert panel focus groups: (1) importance of multi-generational family involvement and support; (2) need to address the social determinants of health; (3) strengths-based strategies and recommendations to engage adolescents in a preconception counseling and GDM risk-reduction education program. Findings will inform the adaptation of Stopping GDM into a more holistic, multi-level, strengths-based, culturally tailored GDM risk reduction intervention that fosters empowerment and builds on the resilience of NH/PI communities.     

Health expectancy: an indicator for change? Technology Assessment Methods Project Team.

STUDY OBJECTIVE--Health expectancy is an increasingly used indicator of population health status. It collapses both mortality and morbidity into a single indicator, and is therefore preferred to the total life expectancy index for populations with low mortality but high morbidity rates. Three methods of calculation exist: the Sullivan, double decrement, and multi-state methods. This report aims to describe their relative advantages and limitations when used to monitor changes in population health status over time. DESIGN--The differences between the three methods are explained. Using a dynamic model of heart disease, the effect of the introduction of thrombolytic treatment on the survival of patients with acute myocardial infarction is calculated. The resulting changes in health expectancy are calculated according to the Sullivan and multi-state methods. MAIN RESULTS--As opposed to the double decrement and the multi-state methods, the Sullivan method produces spurious trends in health expectancy in response to the change in survival. CONCLUSIONS--Estimates of health expectancy in a dynamic situation can be very misleading when based on the Sullivan method, with its attractively moderate data requirements. The multi-state method, which requires longitudinal studies of population health status, is often indispensable.     

Health-related workplace productivity measurement: general and migraine-specific recommendations from the ACOEM Expert Panel.

An establishment of health-related productivity measurements and critical evaluation of health-related productivity tools is needed. An expert panel was created. A literature search was conducted to identify health-related productivity measurement tools. Each instrument was reviewed for: 1) supporting scientific evidence (e.g., reliability and validity); 2) applicability to various types of occupations, diseases, and level of severity of disease; 3) ability to translate data into a monetary unit; and 4) practicality. A modified Delphi technique was used to build consensus. The expert panel recommended absenteeism, presenteeism, and employee turnover/replacement costs as key elements of workplace health-related productivity measurement. The panel also recommended that productivity instruments should: 1) have supporting scientific evidence, 2) be applicable to the particular work setting, 3) be supportive of effective business decision-making, and 4) be practical. Six productivity measurement tools were reviewed. The panel recommended necessary elements of workplace health-related productivity measurement, key characteristics for evaluating instruments, and tools for measuring work loss. Continued research, validation, and on-going evaluation of health-related productivity instruments are needed.     

Applied Strategies for Improving Patient Safety: A Comprehensive Process To Improve Care in Rural and Frontier Communities

CONTEXT: Medical errors and patient safety have gained increasing attention throughout all areas of medical care. Understanding patient safety in rural settings is crucial for improving care in rural communities. PURPOSE: To describe a system to decrease medical errors and improve care in rural and frontier primary care offices. METHODS: Applied Strategies for Improving Patient Safety (ASIPS) was a demonstration project designed to collect and analyze medical error reports and use these reports to develop and implement interventions aimed at decreasing errors. ASIPS participants were clinicians and staff in 2 practice-based research networks: the Colorado Research Network (CaReNet) and the High Plains Research Network (HPRN). This paper describes ASIPS in HPRN. Findings: Fourteen HPRN practices with a total of 150 clinicians and staff have participated in ASIPS. Participants have submitted 128 reports. Diagnostic tests were involved in 26% of events; medication errors appeared in 20% of events. Communication errors were reported in 72%. Two learning groups developed "Principles for Process Improvement" for medication errors and diagnostic testing errors. Several safety "alerts" were issued to improve care, and 2 interventions were implemented to decrease errors. CONCLUSIONS: A safe and secure reporting system that relies on voluntary reporting from clinicians and staff can be successfully implemented in rural primary care settings. Information from reports can be used to identify processes that can be improved.     

Leveraging healthcare for the greater good: lessons learned from the National Centers of Excellence in Women's Health

The creation of the National Centers of Excellence in Women's Health (CoE) program in 1996 by the Office on Women's Health, Department of Health and Human Services, included the stipulation that each institution awarded a CoE contribute at least a 25% match for the federal funds. Even the combination of these two sources of monies was insufficient for each CoE to accomplish its goals, however, so leveraging funds became necessary for each CoE to function effectively. The forms of leveraging varied from CoE to CoE, in part as a result of the institutional environment and the unique possibilities each permitted and in part as a result of the creativity of the leaders of the CoEs. This paper describes the concepts and some applications of leveraging in the setting of the CoEs, which might be applicable to other settings as well.     

Toward an Evidence-Based Definition and Classification of Carbohydrate Food Quality: An Expert Panel Report

Carbohydrate-containing crops provide the bulk of dietary energy worldwide. In addition to their various carbohydrate forms (sugars, starches, fibers) and ratios, these foods may also contain varying amounts and combinations of proteins, fats, vitamins, minerals, phytochemicals, prebiotics, and anti-nutritional factors that may impact diet quality and health. Currently, there is no standardized or unified way to assess the quality of carbohydrate foods for the overall purpose of improving diet quality and health outcomes, creating an urgent need for the development of metrics and tools to better define and classify high-quality carbohydrate foods. The present report is based on a series of expert panel meetings and a scoping review of the literature focused on carbohydrate quality indicators and metrics produced over the last 10 years. The report outlines various approaches to assessing food quality, and proposes next steps and principles for developing improved metrics for assessing carbohydrate food quality. The expert panel concluded that a composite metric based on nutrient profiling methods featuring inputs such as carbohydrate–fiber–sugar ratios, micronutrients, and/or food group classification could provide useful and informative measures for guiding researchers, policymakers, industry, and consumers towards a better understanding of carbohydrate food quality and overall healthier diets. The identification of higher quality carbohydrate foods could improve evidence-based public health policies and programming—such as the 2025–2030 Dietary Guidelines for Americans.