The Relationship Between State Public Health System Performance & Certain State Health Agency Characteristics
Richard Ingram M.Ed.1; Ariel Langevin1; Martha C. Riddell, Dr. P.H.1; Michelyn Bhandari, Dr. P.H.2; William A. Mase ,Dr. P.H.3
1 University of Kentucky Center for Public Health Systems and Services
Research 2 Eastern Kentucky University 3 University of Cincinnati College of
Medicine Department of Public Health Sciences
Background
• Both CDC PHSR research agenda and Council on Linkages Summary of PHSR Research Needs address the need to examine relationship between health agency characteristics and performance* • While some research has been done at local level, little is known about the relationship between state health system performance and state health agency characteristics
– Establishing the relationships between performance and agency characteristics can be cornerstone of efforts to effectively target limited funds to improve community health * http://www.phf.org/link/phsr/phsragendas.pdf
* Lenaway D, Halverson P, Sotnikov S, Tilson H, Corso L, Millington W. Public health systems research: setting a national agenda. Am J Public Health. 2006 Mar;96(3):410‐3. Epub 2006 Jan 31
Background
Design/Methods
• National Public Health Performance Standards Program (NPHPSP) State Public Health System Assessment Instrument developed by Association of State and Territory Health Officials (ASTHO) and CDC to measure state system performance
• Cross sectional design
• Link data from the 16 completed NPHPSP Version 1.0 State Public Health System Assessment instruments with corresponding data from 2005
State Health Officials Salary and Infrastructure Survey
• Analyze data for significance using SPSS version 16
– Allows measurement of state system performance in assuring the 10 Essential Public Health Services
• ASTHO 2005 State Health Officials Salary and Infrastructure Survey contains data on state health agency characteristics
– Finance, agency structure, agency responsibilities, state health officer characteristics
Continuous ASTHO Variables
EPHS
P value
# FTEs
EPHS 1
EPHS 2
.014
.043
Annual Budget of State
Health Agency (no Medicaid)
EPHS 10
.002
State Contribution to Budget
EPHS 3
.046
EPHS 10
.002
EPHS 7
.020
# Years SHO employed in Public Health
– Pearson’s for continuous data
– ANOVA for categorical data
– t‐test for dichotomous data
Results
• Pearson’s suggests that the number of full time employees at a state health agency are significantly positively correlated with EPHS 1 and 2
• Suggests that the annual budget of the state health agency (no Medicaid dollars) significantly associated with EPHS 10
• Suggests that the state contribution to budget significantly associated with EPHS 3 & 10
• Suggests that the length of SHO’s employment in public health significantly associated with EPHS 7 Results
Categorical ASTHO Variables
EPHS
P value
State SHO appointed by Board or Commission EPHS 4
.035
State SHO Reports to Governor EPHS 4
.035
Dichotomous ASTHO Variables
EPHS
Sec. HHS Budget Involvement
EPHS .048
4
P value
SHO Educational Bckgrd. MD/DO
EPHS .003
5
SHO Educational Bckgrd. Board Certified
EPHS .029
8
Dichotomous ASTHO Variables
EPHS
P value
Agency is free standing (not umbrella) EPHS .009
4
State Statute requires experience in PH EPHS .016
practice or teaching
3
EPHS .002
6
State Statute requires “other” response EPHS .005
option
5
EPHS .050
8
• ANOVA suggests that significant differences in performance for EPHS 4 existed between systems where the SHO is appointed by a board or commission and those where the SHO is appointed by the governor or cabinet secretary • Suggests that significant differences in performance for EPHS 4 existed between systems where the SHO reports to the governor and those where the SHO reports to a board or the Secretary of HHS Results
• t‐test suggests significant negative relationship between involvement of the secretary of HHS in agency budget and performance on EPHS 4 • Suggests significant positive association between SHO educational background as an MD/DO and performance on EPHS 5
• Suggests significant positive association between board certification of SHO and performance on EPHS 8 Results
• t‐test suggests that free standing agencies perform significantly better at assuring EPHS 4 • Suggests that agencies in states that require the SHO to have experience in public health practice or teaching perform significantly better at assuring EPHS 3 and 6
• Suggests that responded to the “other” category for SHO statutory requirements performed significantly better at assuring EPHS 5 and 8
Limitations
• Self reported data
• Small number of respondents
• Many factors outside those measured may impact agency performance Future Directions
• Combine NPHPSP Version 2.0 data with 1.0 data to get larger data set (5 additional and D.C.)
• Combine NPHPSP data with newest ASTHO data
• Link State and local performance data with ASTHO data, if complementary data exists, to explore relationship between state characteristics, and state and local performance