Using Systems Science to Inform Population Health Strategies in Local Health Departments: A Case Study in San Antonio, Texas.

Objectives: Because of state and federal health care reform, local health departments play an increasingly prominent role leading and coordinating disease prevention programs in the United States. This case study shows how a local health department working in chronic disease prevention and management can use systems science and evidence-based decision making to inform program selection, implementation, and assessment; enhance engagement with local health systems and organizations; and possibly optimize health care delivery and population health.

Methods: The authors built a systems-science agent-based simulation model of diabetes progression for the San Antonio Metropolitan Health District, a local health department, to simulate health and cost outcomes for the population of San Antonio for a 20-year period (2015-2034) using 2 scenarios: 1 in which hemoglobin A1c (HbA1c) values for a population were similar to the current distribution of values in San Antonio, and the other with a hypothetical 1-percentage-point reduction in HbA1c values.

A Framework for Assessing the Value of Investments in Nonclinical Prevention.

We present a high-level framework to show the process by which an investment in primary prevention produces value. We define primary prevention broadly to include investments in any of the determinants of health. Although it builds on previously developed frameworks, ours incorporates several additional features.

Perceived impacts of health care reform on large urban health departments.

Context: The Patient Protection and Affordable Care Act (ACA) is changing the landscape of health systems across the United States, as well as the functioning of governmental public health departments. As a result, local health departments are reevaluating their roles, objectives, and the services they provide.

Objective: We gathered perspectives on the current and future impact of the ACA on governmental public health departments from leaders of local health departments in the Big Cities Health Coalition, which represents some of the largest local health departments in the country.

The future of urban health: needs, barriers, opportunities, and policy advancement at large urban health departments.

Context: More than 2800 local health departments (LHDs) provide public health services to more than 300 million individuals in the United States. This study focuses on departments serving the most populous districts in the nation, including the members of the Big Cities Health Coalition (BCHC) in 2013.

Objective: To systematically gather leadership perspectives on the most pressing issues facing large, urban health departments.

Organizational characteristics of large urban health departments.

Approximately 150 million Americans lived in large metropolitan jurisdictions in 2013. About 1 in 7 Americans is served by a member of the Big Cities Health Coalition (BCHC), a group of 20 of the largest local health departments (LHDs) in the United States. In this brief, we describe the organizational characteristics of the country's largest health departments, including those that form the BCHC, and quantify the differences and variation among them.

Performance management models for public health: Public Health Accreditation Board/Baldrige connections, alignment, and distinctions.

Context: The nationally known Malcolm Baldrige Award for Excellence ("Baldrige program") recognizes outstanding performance management and is specifically cited by the Public Health Accreditation Board (PHAB) as a potential framework for PHAB's requisite performance management system. The authors developed a crosswalk that identifies alignments between the 2 programs and is a highlight of the Quest for Exceptional Performance tool that is intended to help health departments capitalize on the connections between the 2 programs.

Objective: To provide deeper insight into the most robust connections between the 2 programs.

Methodological challenges of multiple-component intervention: lessons learned from a randomized controlled trial of functional recovery after hip fracture.

We conducted a randomized controlled trial to assess the efficacy and safety of a multiple-component intervention designed to improve functional recovery after hip fracture. One hundred seventy-six patients who underwent surgery for a primary unilateral hip fracture were assigned randomly to receive usual care (control arm, n = 86) or a brief motivational videotape, supportive peer counseling, and high-intensity muscle-strength training (intervention arm, n = 90). Between-group differences on the physical functioning, role-physical, and social functioning domains of the SF-36 were assessed postoperatively at 6 months.

Academic health departments: from theory to practice.

In August of 2003, 23 institutions submitted proposals to build closer ties between state and local public health departments and schools of public health in response to a solicitation from the Association of Schools of Public Health supported by the Centers for Disease Control and Prevention. This article describes the strategies proposed to build collaboration between public health academia and practice. Qualitative analysis discerned five principal approaches: the development of comprehensive planning processes; reform of the way practica are planned and implemented; the identification and nurturing of boundary-spanning individuals in academia and health agencies; the fostering of new approaches to joint research; and workforce development programs.

Preferences for arthritis care among urban African Americans: "I don't want to be cut".

Despite greater disability from knee osteoarthritis among Blacks, Whites are 3-5 times more likely to have total knee replacement (TKR). The authors explored whether beliefs among Blacks about arthritis and surgery contribute to this disparity. Ninety-four Blacks, ages 50 to 89, with knee arthritis underwent semistructured qualitative interviews regarding disability, beliefs about arthritis, beliefs about TKR, and treatment preferences.