Saving Lives and Saving Money: The Role of North Carolina Health Departments in Medicaid Managed Care.

A new Medicaid system is emerging in North Carolina in which accountable care organizations will aim to improve both the quality and value of health care. We explore how local health departments can apply their expertise in population health to help achieve these goals.

Designing for dissemination: lessons in message design from "1-2-3 pap".

Despite a large number of evidence-based health communication interventions tested in private, public, and community health settings, there is a dearth of research on successful secondary dissemination of these interventions to other audiences. This article presents the case study of "1-2-3 Pap," a health communication intervention to improve human papillomavirus (HPV) vaccination uptake and Pap testing outcomes in Eastern Kentucky, and explores strategies used to disseminate this intervention to other populations in Kentucky, North Carolina, and West Virginia. Through this dissemination project, we identified several health communication intervention design considerations that facilitated our successful dissemination to these other audiences; these intervention design considerations include (a) developing strategies for reaching other potential audiences, (b) identifying intervention message adaptations that might be needed, and (c) determining the most appropriate means or channels by which to reach these potential future audiences. Using "1-2-3 Pap" as an illustrative case study, we describe how careful planning and partnership development early in the intervention development process can improve the potential success of enhancing the reach and effectiveness of an intervention to other audiences beyond the audience for whom the intervention messages were originally designed.

Local health department priority setting: an exploratory study.

Priority setting is an integral part of the community health assessment process since it helps direct the allocation of limited public health resources among competing needs. There is a recognized need for a systematic mechanism to prioritize community health issues in objective, data-driven, quantifiable measures. This exploratory study examined the extent to which data-driven objective criteria were considered important to public health officials in North Carolina and, specifically, the extent to which they chose between objective and subjective criteria in establishing public health priorities. The differences between the health officers' practice (criteria they actually used) and their preferences (criteria thought to be important) were also assessed. It was found that NC health directors generally used subjective criteria more often than objective criteria when deciding on the most important health issues in their communities. A considerable segment of the respondents, however, considered objective criteria more important, even though subjective criteria were the dominant influence in their actual practice of priority setting. Our preliminary results suggest that officers' education and tenure may influence their practice and preferences. Perceived and real barriers to the use of data-driven objective criteria for priority setting are an important topic for future public health research.

Adoption of Evidence-Based Interventions in Local Health Departments: "1-2-3 Pap NC".

Descriptions of barriers and facilitators to adoption of evidence-based interventions in local health departments (LHDs) are limited. This study was conducted by the North Carolina Public Health Practice-Based Research Network to identify factors associated with adoption of an evidence-based human papillomavirus video intervention, "1-2-3 Pap NC," in North Carolina LHDs. A sequential mixed-method study design was used. Data from the 2013 National Profile of Local Health Departments were used to test associations between LHD characteristics and adoption of the intervention. Qualitative, key stakeholder interviews with LHD directors provided the context for quantitative data. Data collection and analysis continued from March 3, 2014, to September 15, 2014. Overall, 28% of North Carolina health jurisdictions (33 of 100 counties) implemented the intervention. Of the three channels used to deliver the intervention to clients, most LHDs opted to show the video in the exam room (42%), followed by website/other social media (36%) and video loop in the lobby/waiting room (22%). In logistic regression, gender of the director (female) was significantly and positively associated with adoption of the intervention (AOR=4.44, p<0.05). Being a first-time director was marginally significant (AOR=0.28, p=0.074), suggesting first-time directors were less likely to adopt. Qualitative results suggested that aspects of communication (awareness and positive attitudes) and agency directors' evaluation of resources, balanced against intervention complexity and flexibility, competing priorities, and mandates, influenced adoption. Adoption of evidence-based interventions by LHDs is critical to improve population health. Practice-based research can contribute to understanding facilitators and modifying barriers to this process.

NC CATCH: Advancing Public Health Analytics.

The North Carolina Comprehensive Assessment for Tracking Community Health (NC CATCH) is a Web-based analytical system deployed to local public health units and their community partners. The system has the following characteristics: flexible, powerful online analytic processing (OLAP) interface; multiple sources of multidimensional, event-level data fully conformed to common definitions in a data warehouse structure; enabled utilization of available decision support software tools; analytic capabilities distributed and optimized locally with centralized technical infrastructure; two levels of access differentiated by the user (anonymous versus registered) and by the analytical flexibility (Community Profile versus Design Phase); and, an emphasis on user training and feedback. The ability of local public health units to engage in outcomes-based performance measurement will be influenced by continuing access to event-level data, developments in evidence-based practice for improving population health, and the application of information technology-based analytic tools and methods.