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1.
N C Med J ; 81(1): 5-13, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908325

RESUMO

BACKGROUND In 2016, the North Carolina Division of Public Health (DPH) launched the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program to provide 5 local health departments (LHDs) with financial resources and technical assistance to address 3 aims: improve birth outcomes, reduce infant mortality, and improve health for children from birth to 5 years.METHOD: State legislation established an academic-practice partnership between NCDPH and the University of North Carolina at Chapel Hill (UNC) to provide program evaluation and implementation coaching to LHDs. ICO4MCH used a collective impact framework, principles of implementation science, and a health equity approach to implement evidence-based strategies to address the program's aims.RESULTS: A shared measurement system was developed by an evaluation stakeholders group led by the NCDPH and UNC in which LHDs reported data on a quarterly basis and the evaluators returned reports to drive improvements. Structured assessments and technical assistance provided by implementation coaches helped grantees address barriers to implementation including cultivating and sustaining a diverse community action team, addressing staff turnover, and using data to drive improvements.LIMITATIONS: It was challenging for grantees to balance community needs and build partnerships in the first year while integrating data from multiple assessments into action plans to meet the performance measures. It was necessary to streamline assessments and reduce indicators to make data more actionable.CONCLUSION: An academic-practice partnership was integral to successful implementation of the ICO4MCH program and may serve as a model for moving evidence-based maternal child health programs to practice in LHDs.


Assuntos
Saúde da Criança , Promoção da Saúde/organização & administração , Relações Interinstitucionais , Saúde Materna , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , North Carolina , Gravidez , Avaliação de Programas e Projetos de Saúde
2.
Am J Community Psychol ; 63(3-4): 527-545, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30706946

RESUMO

System dynamics (SD) methods, from qualitative causal loop diagramming to quantitative simulation modeling, have the potential to be powerful tools for engaging community stakeholders interested in improving health. However, the extent to which SD drives collective action to improve community health is unclear. The objective of this review was to understand how often, why, and how SD has been used by cross-sector community collectives. Of 409 identified manuscripts describing application of SD to community health, only 31 (7.6%) documented cross-sector collective use of these tools. All 31 had as a purpose using SD to better understand community health problems, but only seven (22.6%) documented a collective action taken as the result. In nine of the 31 articles (29.0%), no learning, decisions, or action was documented. The most common form of collective participation in SD work among the seven collectives reporting resulting action was building the SD model, with implementing a new program or practice the most frequently mentioned collective action resulting. Cost and access were the most common system outcomes studied, and chronic diseases and prevention were commonly mentioned as the focal health outcomes. Overall, SD methods seem underutilized for engaging cross-sector collectives in addressing complex community health problems.

3.
Matern Child Health J ; 23(7): 979-988, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30671712

RESUMO

Objectives A skilled workforce is essential to advancing maternal and child health (MCH) in a rapidly changing public health system. Little is known about the MCH workforce's existing capacity to maximize opportunities afforded by ongoing change. We assessed MCH workforce capacity in three areas: Systems Integration, Evidence-Based Decision-Making, and Change Management/Adaptive Leadership. We then examined associations between workforce capacity and modifiable workforce development strategies/resources. Methods Data are from the Public Health Workforce Interests and Needs Survey (PH WINS). The present study was limited to employees working in MCH programs (weighted N = 3062). Workforce capacity was operationalized as self-reported awareness of public health trends and proficiency to perform related skills in the three areas. Survey-weighted generalized estimating equations were used to fit logistic regression models accounting for employee clustering within states. Results While awareness of public health trends was low, the majority of employees (> 70% in each area) reported proficiency to perform skills related to these trends. Capacity was lowest in Systems Integration. Employee engagement in academic partnerships and higher state contributions to MCH program budgets were the strategies/resources most consistently associated with higher capacity. Workplace support was the strongest correlate of capacity in Change Management/Adaptive Leadership. Conclusions for Practice Although employees lacked familiarity with specific public health trends, they were proficient in skills needed to engage in related work. Still, areas for improvement remain. Results provide a baseline against which future training efforts can be evaluated. Academic partnerships and MCH program funding may be useful to prioritize in the context of health transformation.


Assuntos
Mão de Obra em Saúde/estatística & dados numéricos , Educação Profissional em Saúde Pública/métodos , Educação Profissional em Saúde Pública/tendências , Prática Clínica Baseada em Evidências/métodos , Mão de Obra em Saúde/tendências , Humanos , Determinação de Necessidades de Cuidados de Saúde , Competência Profissional , Autorrelato , Desenvolvimento de Pessoal/métodos , Análise de Sistemas
4.
Matern Child Health J ; 22(2): 154-165, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29302863

RESUMO

Objective As part of the National MCH Workforce Development Center, an innovative internship program placed MCH undergraduate and graduate students in summer practica in state Title V agencies. Graduate student mentoring of undergraduates and leadership and professional development training and support are key features of the program. The objective of this paper is to report on the results of the evaluation of the MCH Paired Practica Program in its pilot years, 2014-2016. Methods Students completed pre and post internship questionnaires which included closed as well as open-ended questions. In addition, the Title V state health agency preceptors completed a questionnaire at the end of each summer. Results Over the 3-year pilot project, a total of 17 teams participated. Students were from 6 of the 13 graduate Centers of Excellence in MCH programs in Schools of Public Health and two undergraduate MCH Pipeline Programs. There were 11 participating states. After the practicum experience, there was a significant increase in students' confidence in a number of measures related to working in complex, dynamic environments and in their ability to contribute to improvements in MCH population health. Students reported having more confidence in their ability to function effectively as an informal/formal MCH leader (p = 0.02), more confidence in their ability to contribute to improvements in MCH population health (p = 0.04), and being more prepared to enter the workforce after the practicum experience (p = 0.07), although there was no significant change in students' (n = 22) interest in seeking a job in a Title V agency or a community based organization with a MCH focus. Nearly 60% of the students did state at the posttest that they would likely seek additional education in MCH. Overall, the Title V preceptors (n = 14) were very positive about the program although in some instances there was less confidence in the knowledge and skills of the undergraduate students. Conclusion The MCH Paired Practica Program is a unique effort to go beyond the academic training of undergraduate and graduate MCH students to provide them with direct exposure to the field, as well as leadership, mentorship, and professional development training. While some challenges emerged related to differences in skills between undergraduates and graduate MCH students, participating students demonstrated clear improvements in their leadership skills including increased confidence in their ability to take initiative, provide opinions and feedback, to function informally or formally as leaders, and to contribute to improvements in MCH population health.


Assuntos
Saúde da Criança , Ocupações em Saúde/educação , Liderança , Saúde Materna , Tutoria , Adulto , Criança , Feminino , Humanos , Masculino , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
5.
Matern Child Health J ; 22(1): 17-23, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29101524

RESUMO

Purpose An assessment of the National Maternal and Child Health Workforce Development Center (the Center) was conducted to describe (1) effects of the Center's training on the use of collaborative leadership practices by MCH leaders, and (2) perceived barriers to collaboration for MCH leaders. The Center provides services to strengthen MCH professionals' skills in three core areas: Change Management/Adaptive Leadership, Evidence-Based Decision Making, and Systems Integration. Description This descriptive qualitative study compares eight interview responses from a sample of the Center's participants and findings from a document review of the training curriculum against an existing framework of collaborative leadership themes. Assessment Systems thinking tools and related training were highly referenced, and the interviewees often related process-based leadership practices with their applied learning health transformation projects. Perceived barriers to sustaining collaborative work included: (1) a tendency for state agencies to have siloed priorities, (2) difficulty achieving a consensus to move a project forward without individual partners disengaging, (3) strained organizational partnerships when the individual representative leaves that partnering organization, and (4) difficulty in sustaining project-based partnerships past the short term. Conclusion The findings in this study suggest that investments in leadership development training for MCH professionals, such as the Center, can provide opportunities for participants to utilize collaborative leadership practices.


Assuntos
Comportamento Cooperativo , Mão de Obra em Saúde , Liderança , Centros de Saúde Materno-Infantil/organização & administração , Competência Profissional , Saúde Pública/educação , Desenvolvimento de Pessoal , Adulto , Criança , Saúde da Criança , Feminino , Pessoal de Saúde/educação , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Pessoal/métodos
6.
J Public Health Manag Pract ; 24(1): 75-80, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28885320

RESUMO

OBJECTIVE: The purpose of this research is to use the Public Health Workforce Interests and Needs Survey to assess in greater detail state injury prevention staff perceptions of policy development and related skills and their awareness and perception of "Health in All Policies" (HiAP). DESIGN: The Public Health Workforce Interests and Needs Survey gauged public health practitioners' perspectives on workplace environment, job satisfaction, national trends, and training needs, and gathered demographics on the workforce. This study utilizes data from the state health agency frame only, focusing solely on those permanently employed, central office staff in injury prevention. Respondents were sampled from 5 paired Health and Human Services regions. SETTING/PARTICIPANTS: Approximately 25 000 invitations were sent to central office employees. The response rate was 46% (n = 10 246). The analysis in this article includes only injury prevention employees with programmatic roles, excluding clerical and custodial staff, providing us with a total of 97 respondents. When weighted, this resulted in a weighted population size of 365 injury prevention workers. MAIN OUTCOME MEASURES: The main outcome measures include demographics, responses to understanding of and skill levels related to policy development, and perceptions of HiAP public health trend. RESULTS: State injury prevention workers reported lower policy-making skill but had an overall appreciation of the importance of policies. In general, state injury prevention workers heard of HiAP, thought there should be more emphasis on it, but did not think that HiAP would have an impact on their day-to-day work. CONCLUSIONS/IMPLICATIONS FOR POLICY AND PRACTICE: Efforts are needed for all state injury prevention workers to become better skilled in policy development, implementation, and evaluation in order to become stronger injury prevention advocates and role models.


Assuntos
Percepção , Formulação de Políticas , Papel Profissional/psicologia , Saúde Pública , Ferimentos e Lesões/prevenção & controle , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos
7.
Health Serv Res ; 53(4): 2368-2383, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-28726272

RESUMO

OBJECTIVE: To examine effects of maternity care coordination (MCC) on perinatal health care utilization among low-income women. DATA SOURCES: North Carolina Center for Health Statistics Baby Love files that include birth certificates, maternity care coordination records, WIC records, and Medicaid claims. STUDY DESIGN: Causal effects of MCC participation on health care outcomes were estimated in a sample of 7,124 singleton Medicaid-covered births using multiple linear regressions with inverse probability of treatment weighting (IPTW). PRINCIPAL FINDINGS: Maternity care coordination recipients were more likely to receive first-trimester prenatal care (p < .01) and averaged three more prenatal visits and two additional primary care visits during pregnancy; they were also more likely to participate in WIC and to receive postpartum family planning services (p < .01). Medicaid expenditures were greater among mothers receiving MCC. CONCLUSIONS: Maternity care coordination facilitates access to health care and supportive services among Medicaid-covered women. Increased maternal service utilization may increase expenditures in the short run; however, improved newborn health may reduce the need for costly neonatal care, and by implication the need for early intervention and other supports for at-risk children.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde Materna , Medicaid/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , North Carolina , Pobreza , Gravidez , Estados Unidos , Adulto Jovem
8.
Matern Child Health J ; 21(11): 2001-2007, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28780683

RESUMO

Purpose The National Maternal and Child Health Workforce Development Center at UNC Chapel Hill (the Center), funded by the Maternal and Child Health Bureau, provides Title V state/jurisdiction leaders and staff and partners from other sectors with opportunities to develop skills in quality improvement, systems mapping and analysis, change management, and strategies to enhance access to care to leverage and implement health transformation opportunities to improve the health of women and children. Description Since 2013, the Center has utilized a variety of learning platforms to reach state and jurisdiction Title V leaders. In the intensive training program, new skills and knowledge are applied to a state-driven health transformation project and include distance-based learning opportunities, multi-day, in-person training and/or onsite consultation, as well as individualized coaching to develop workforce skills. Assessment The first intensive cohort of eight states reported enhanced skills in the core areas of quality improvement, systems mapping and analysis, change management, and strategies to enhance access to care which guided changes at state system and policy levels. In addition, teams reported new and/or enhanced partnerships with many sectors, thereby leveraging Title V resources to increase its impact. Conclusion The Center's provision of core workforce skills and application to state-defined goals has enabled states to undertake projects and challenges that not only have a positive impact on population health, but also encourage collaborative, productive partnerships that were once found to be challenging-creating a workforce capable of advancing the health and wellbeing of women and children.


Assuntos
Serviços de Saúde Materna , Centros de Saúde Materno-Infantil/organização & administração , Desenvolvimento de Pessoal , Educação Continuada , Humanos , Liderança , Competência Profissional , Desenvolvimento de Pessoal/métodos , Estados Unidos , Recursos Humanos
9.
Soc Sci Med ; 145: 98-106, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26460509

RESUMO

Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent.


Assuntos
Administração de Caso/economia , Assistência Centrada no Paciente/economia , Política , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Serviços de Saúde Materno-Infantil/economia , Serviços de Saúde Materno-Infantil/provisão & distribução , Medicaid/economia , North Carolina , Assistência Centrada no Paciente/métodos , Pobreza , Gravidez , Saúde Pública/economia , Saúde Pública/métodos , Estados Unidos
10.
Am J Public Health ; 105 Suppl 2: S211-6, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25689215

RESUMO

OBJECTIVES: We examined associations between local health department (LHD) spending, staffing, and services and community health outcomes in North Carolina. METHODS: We analyzed LHD investments and community mortality in North Carolina from 2005 through 2010. We obtained LHD spending, staffing, and services data from the National Association of City and County Health Officials 2005 and 2008 profile surveys. Five mortality rates were constructed using Centers for Disease Control and Prevention mortality files, North Carolina vital statistics data, and census data for LHD service jurisdictions: heart disease, cancer, diabetes, pneumonia and influenza, and infant mortality. RESULTS: Spending, staffing, and services varied widely by location and over time in the 85 North Carolina LHDs. A 1% increase in full-time-equivalent staffing (per 1000 population) was associated with decrease of 0.01 infant deaths per 1000 live births (P < .05). Provision of women and children's services was associated with a reduction of 1 to 2 infant deaths per 1000 live births (P < .05). CONCLUSIONS: Our findings, in the context of other studies, provide support for investment in local public health services to improve community health.


Assuntos
Tomada de Decisões , Governo Local , Administração em Saúde Pública/estatística & dados numéricos , Prática de Saúde Pública/estatística & dados numéricos , Humanos , Mortalidade , North Carolina , Admissão e Escalonamento de Pessoal , Administração em Saúde Pública/economia , Administração em Saúde Pública/normas , Prática de Saúde Pública/economia , Prática de Saúde Pública/normas , Estudos Retrospectivos
11.
J Public Health Manag Pract ; 21(2): 208-13, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25627330

RESUMO

OBJECTIVES: The recent recession has weakened the US health and human service safety net. Questions about implications for mothers and children prompted this study, which tested for changes in maternal service use and outcomes among North Carolina women with deliveries covered through Medicaid before and after a year of significant state budget cuts. METHODS: Data for Medicaid covered deliveries from April-June 2009 (pre) and from April-June 2010 (post) were derived from birth certificates, Medicaid claims and eligibility files, and WIC (Special Supplemental Food Program for Women, Infants and Children) records. These time periods represent the quarter immediately before as well as the final quarter of a state fiscal year 2010 (July 2009-June 2010) characterized by substantial state budget cuts, including an October 2009 reduction in reimbursement rates for maternity care coordination. We examined how often women received medical care, maternity care coordination, family planning services, and the average numbers of obstetrical encounters, as well as the prevalence of excessive pregnancy weight gain, preterm delivery, and low birth weight. RESULTS: By the end of a year of substantial state budget cuts, women covered through Medicaid had fewer obstetrical visits in all trimesters as well as postpartum (P < .001). Maternal weight gain, preterm delivery, and low birth weight were stable. CONCLUSIONS: One key aspect of medical service use decreased for women enrolled in Medicaid by the end of a year of major state health and human services budget cuts. Maternal and infant child health outcomes measured in this study did not change during that year. Future monitoring is warranted to ensure that maternal health service access remains adequate.


Assuntos
Orçamentos/normas , Acesso aos Serviços de Saúde/normas , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/estatística & dados numéricos , Adulto , Orçamentos/legislação & jurisprudência , Feminino , Humanos , Recém-Nascido , Medicaid/estatística & dados numéricos , North Carolina/epidemiologia , Gravidez , Fatores Socioeconômicos , Estados Unidos
12.
Matern Child Health J ; 19(1): 121-7, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24770956

RESUMO

Care coordination services that link pregnant women to health-promoting resources, avoid duplication of effort, and improve communication between families and providers have been endorsed as a strategy for reducing disparities in adverse pregnancy outcomes, however empirical evidence regarding the effects of these services is contradictory and incomplete. This study investigates the effects of maternity care coordination (MCC) on pregnancy outcomes in North Carolina. Birth certificate and Medicaid claims data were analyzed for 7,124 women delivering live infants in North Carolina from October 2008 through September 2010, of whom 2,255 received MCC services. Propensity-weighted analyses were conducted to reduce the influence of selection bias in evaluating program participation. Sensitivity analyses compared these results to conventional ordinary least squares analyses. The unadjusted preterm birth rate was lower among women who received MCC services (7.0 % compared to 8.3 % among controls). Propensity-weighted analyses demonstrated that women receiving services had a 1.8 % point reduction in preterm birth risk; p < 0.05). MCC services were also associated with lower pregnancy weight gain (p = 0.10). No effects of MCC were seen for birthweight. These findings suggest that coordination of care in pregnancy can significantly reduce the risk of preterm delivery among Medicaid-enrolled women. Further research evaluating specific components of care coordination services and their effects on preterm birth risk among racial/ethnic and geographic subgroups of Medicaid enrolled mothers could inform efforts to reduce disparities in pregnancy outcome.


Assuntos
Resultado da Gravidez/epidemiologia , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos , Declaração de Nascimento , Feminino , Disparidades nos Níveis de Saúde , Humanos , Recém-Nascido de Baixo Peso , Medicaid , Registro Médico Coordenado , North Carolina/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Análise de Regressão , Estados Unidos/epidemiologia , Ganho de Peso , Adulto Jovem
13.
J Public Health Manag Pract ; 18(6): 571-6, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23023282

RESUMO

The objective of this article was to describe factors that contribute to successful translation of science into evidence-based practices and their implementation in public health practice agencies, based on a review of the literature and evidence from a series of case studies. The case studies involved structured interviews with key informants in 4 health departments and with 4 corresponding partners from academic institutions. Interviews were recorded and transcribed, coded by 2 independent, trained coders, using a standard codebook. A thematic analysis of codes was conducted. Coding was entered into Atlas TI software for further analysis. Results from the literature review indicated that only approximately half of programs implemented in state and local health departments were evidence based. Lack of time, inadequate funding, and absence of cultural and managerial support-including incentives-are among the most commonly cited barriers to implementing evidence-based practices. Findings from the case studies suggest that these health departments, successful in implementing evidence-based practices, have strong relationships and good communication channels established with their academic partner(s). There is strong leadership engagement from within the health department and in the academic institution. Implementation of evidence-based programs was most often related to high priority community needs and the availability of resources to address these needs. The practice agencies operate with a culture of quality improvement throughout the agency. Information technology, training, how the interventions are bundled, including their complexity and ability to be customized and resource requirements are all fruitful avenues for further research.


Assuntos
Assistência à Saúde/normas , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Implementação de Plano de Saúde/organização & administração , Comportamento de Busca de Informação , Governo Local , Humanos , Prática de Saúde Pública , Pesquisa Médica Translacional
15.
J Public Health Manag Pract ; 15(2): E22-33, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19202403

RESUMO

Local public health agencies (LPHAs) are faced with many challenges in their role as an integral part of the public health system. It is important to better understand the demands on and the capacity of LPHAs to respond to these challenges. Determining what factors can improve LPHA performance is critical to helping LPHAs face their challenges.The objective of this study was to determine what factors are associated with LPHA performance improvement in North Carolina from 1999 to 2004. In North Carolina, several data sources regarding predictors of LPHA performance, including LPHA workforce, LPHA characteristics, public health expenditures, and population characteristics, are available. Improvement in LPHA performance was measured by nine indicators across diverse services that were collected over multiple years. Linear regression was used to evaluate the significance of predictor variables.Our findings indicate that workforce characteristics such as occupational classification and experience of the workforce, LPHA characteristics such as number of full-time employees, as well as population characteristics are important predictors of LPHA performance.This study provides insight into what is needed to better address LPHA performance improvement. More importantly, study findings indicate which workforce characteristics can be targeted to enhance LPHA performance improvement over time.


Assuntos
Saúde Pública/métodos , Previsões , Humanos , Governo Local , North Carolina , Projetos Piloto , Saúde Pública/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos
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