Public Health Systems Research: Disease Reporting, Investigation, and Response

Overview

Current public health systems vary greatly in state and local roles, legal authorities, regulations, practices, resources and staffing. These systems and their varied procedures for reporting, investigating and controlling diseases can affect timeliness and completeness of disease detection and response. But far from being an impediment to studying effective disease outbreak response, this heterogeneity presents a natural laboratory to identify those characteristics that are associated with effective detection, investigation and control of diseases and outbreaks.

This opportunity was recognized by the Robert Wood Johnson Foundation in its May 2010 award to NWCPHP researchers to study public health systems for disease reporting, investigation, and response. This project is identifying characteristics of state health departments that are associated with performance related to communicable disease detection, investigation and response, and evaluating how variations in structure, resources and procedures correlate most highly with performance.

Outcomes of this two-year research project will improve the evidence base for public health practices in disease detection, mitigation and response:

1. Develop a baseline for determining where differences exist between the high- and lower-functioning health departments in terms of the quality, sufficiency and appropriateness of the activities and evidence collected.
2. Create a benchmarking standard for other public health agencies to use to assess performance.
3.  Advance public health system performance assessment by creating more concrete measures based on evidence.

Methods

Based on key informant interviews and a wide selection of secondary data sources, including datasets from the Council of State and Territorial Epidemiologists, the investigators create logic models that reflect the functioning of each participating public health system. A panel of experts reviews the logic models and evidence. This expert panel uses a modified RAND Appropriateness Method to rate the different public health systems. A matrix representing the relationship between quality ratings on various measures and the performance of each public health system is then based on the panel's analysis. From this matrix, the researchers propose a set of evidence-based benchmarking standards for public health systems. 

Notes from the Field

• Enrolled six study states and created a characteristic or "evidence" inventory for each state
• Synthesized evidence into a Communicable Disease Logic Model
• Designed a modified RAND Appropriateness Method (RAM) rating tool for subject matter experts to rate the importance of individual indicators in predicting state public health system performance
  

Researchers

Susan Allan MD, JD, MPH (Principal Investigator)
Janet Baseman PhD, MPH (Co-Principal Investigator)

For questions about this project, please contact Debra Revere, MLIS, MA, project manager at drevere@u.washington.edu.