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  1. Article ; Online: Local Public Health System Capabilities and COVID-19 Death Rates.

    Brosi, Deena N / Mays, Glen P

    Public health reports (Washington, D.C. : 1974)

    2022  Volume 137, Issue 5, Page(s) 980–987

    Abstract: Objectives: Efforts to contain the health effects of the COVID-19 pandemic have achieved less success in the United States than in many comparable countries. Previous research documented wide variability in the capabilities of local public health ... ...

    Abstract Objectives: Efforts to contain the health effects of the COVID-19 pandemic have achieved less success in the United States than in many comparable countries. Previous research documented wide variability in the capabilities of local public health systems to carry out core disease prevention and control activities, but it is unclear how this variability relates to COVID-19 control. Our study explored this relationship by using a nationally representative sample of 725 US communities.
    Methods: We used data collected from the National Longitudinal Survey of Public Health Systems to classify each community into 1 of 3 ordinal categories indicating limited, intermediate, or comprehensive public health system capabilities. We used 2-part generalized linear models to estimate the relationship between public health system capabilities and COVID-19 death rates while controlling population and community characteristics associated with COVID-19 risk.
    Results: Across 3 waves of the pandemic in 2020, we found a significant negative association between COVID-19 mortality and public health system capabilities. Compared with comprehensive public health systems, intermediate public health systems had an average of 4.97 to 19.02 more COVID-19 deaths per 100 000 residents, while limited public health systems had an average of 5.95 to 18.10 more COVID-19 deaths per 100 000 residents.
    Conclusion: Overall, communities with stronger public health capabilities had significantly fewer deaths. Future initiatives to strengthen pandemic preparedness and reduce health disparities in the United States should focus on local public health system capabilities.
    MeSH term(s) COVID-19/epidemiology ; Humans ; Longitudinal Studies ; Pandemics ; Public Health ; United States/epidemiology
    Language English
    Publishing date 2022-05-28
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 120953-x
    ISSN 1468-2877 ; 0033-3549
    ISSN (online) 1468-2877
    ISSN 0033-3549
    DOI 10.1177/00333549221097660
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  2. Article ; Online: Examining Characteristics of Local Public Health Systems With Exceptional Tribal Organization Participation.

    Bauer, Kyla L / Mitchell, Amelia L / Mays, Glen P

    Journal of public health management and practice : JPHMP

    2023  Volume 30, Issue 2, Page(s) 274–284

    Abstract: Objective: To learn feasible ways to increase multisector community partnership with tribal organizations, meaning tribal health authorities or American Indian and Alaska Native (AI/AN)-serving organizations, by examining characteristics of local public ...

    Abstract Objective: To learn feasible ways to increase multisector community partnership with tribal organizations, meaning tribal health authorities or American Indian and Alaska Native (AI/AN)-serving organizations, by examining characteristics of local public health systems with exceptional tribal organization participation.
    Design, setting, and participants: In total, 728 local public health departments were surveyed in 2018 to generate a nationally representative sample of local public health systems in the United States. A positive deviance approach using logistic regression helped identify local public health systems that had tribal organization participation despite characteristics that make such participation statistically unlikely. Local public health systems with exceptional tribal organization participation were compared with systems with conventional participation, examining measures known to impact the formation of public health partnerships.
    Main outcome measure: This study used an exploratory logistic regression approach to identify unique characteristics of local public health systems with exceptional tribal organization participation.
    Results: Of 728 health systems surveyed, 21 were identified as having exceptional tribal organization participation. Across varying thresholds to identify exceptional participation, having a higher network density and prioritizing equity in public health activities were found to consistently distinguish exceptional tribal organization participation in both nonrural and rural areas.
    Conclusions: Public health partnerships with tribal organizations are possible even in circumstances that make them unlikely. Efforts to build denser networks of collaborating organizations and prioritize equity may help public health systems achieve success with tribal organization partnerships.
    MeSH term(s) Humans ; Public Health ; Surveys and Questionnaires ; United States ; Health Services, Indigenous ; American Indian or Alaska Native
    Language English
    Publishing date 2023-11-30
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2027860-3
    ISSN 1550-5022 ; 1078-4659
    ISSN (online) 1550-5022
    ISSN 1078-4659
    DOI 10.1097/PHH.0000000000001840
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  3. Article ; Online: Who Delivers Maternal and Child Health Services? The Contributions of Public Health and Other Community Partners.

    Quinlan, Taryn A G / Mitchell, Amelia L / Mays, Glen P

    The Milbank quarterly

    2023  Volume 101, Issue 1, Page(s) 179–203

    Abstract: Policy Points Local health departments with direct maternal and child health service provisions exhibit greater social service collaboration, thereby enhancing community capacity to improve health care access and social determinant support. These ... ...

    Abstract Policy Points Local health departments with direct maternal and child health service provisions exhibit greater social service collaboration, thereby enhancing community capacity to improve health care access and social determinant support. These findings may prioritize collaboration as a community-based effort to reduce disparities in maternal and child health and chronic disease.
    Context: Improving maternal and child health (MCH) care in the United States requires solutions to address care access and the social determinants that contribute to health disparities. Direct service provision of MCH services by local health departments (LHDs) may substitute or complement public health services provided by other community organizations, impacting local service delivery capacity. We measured MCH service provision among LHDs and examined its association with patterns of social service collaboration among community partners.
    Methods: We analyzed the 2018 National Longitudinal Survey of Public Health Systems and 2016 National Association of County and City Health Officials Profile data to measure the LHD provision of MCH services and the types of social services involved in the implementation of essential public health activities. We compared the extensive and intensive margins of social service collaboration among LHDs with any versus no MCH service provision. We then used latent class analysis (LCA) to classify collaboration and logistic regression to estimate community correlates of collaboration.
    Findings: Of 620 LHDs, 527 (85%) provided at least one of seven observed MCH services. The most common service was Special Supplemental Nutrition Program for Women, Infants, and Children (71%), and the least common was obstetric care (15%). LHDs with MCH service provision were significantly more likely to collaborate with all types of social service organizations. LCA identified two classes of LHDs: high (n = 257; 49%) and low (n = 270; 51%) collaborators. Between 74% and 96% of high collaborators were engaged with social service organizations that provided basic needs services, compared with 31%-60% of low collaborators. Rurality and very high maternal vulnerability were significantly correlated with low collaboration among MCH service-providing LHDs.
    Conclusions: LHDs with direct MCH service provision exhibited greater social service collaboration. Collaboration was lowest in rural communities and communities with very high maternal vulnerability. Over half of MCH service-providing LHDs were classified as low collaborators, suggesting unrealized opportunities for social service engagement in these communities.
    MeSH term(s) Infant ; Child ; Pregnancy ; Humans ; United States ; Female ; Public Health ; Child Health Services ; Maternal-Child Health Services ; Social Work ; Health Services Accessibility ; Local Government
    Language English
    Publishing date 2023-01-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632829-5
    ISSN 1468-0009 ; 0887-378X
    ISSN (online) 1468-0009
    ISSN 0887-378X
    DOI 10.1111/1468-0009.12600
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  4. Book ; Online: Responding to COVID-19

    Mays, Glen P

    Glen Mays

    Emerging Health System Preparedness Research for Colorado & Beyond

    2020  

    Keywords Health Policy ; Health Services Research ; Public Health ; covid19
    Publishing date 2020-03-26T07:00:00Z
    Publisher SelectedWorks
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Association Between Insurer Connectivity in Appalachian Population Health Networks and Preventable Hospitalizations: Evidence from Kentucky.

    Hogg-Graham, Rachel / Gatton, Kelsey R / Ingram, Rick / Mays, Glen P

    Journal of Appalachian health

    2023  Volume 5, Issue 2, Page(s) 15–31

    Abstract: Introduction: Addressing complex health and social needs requires cross-sector collaboration to deliver medical, social, and population health services at the community level. Capacity in community health and social services networks may be constrained ... ...

    Abstract Introduction: Addressing complex health and social needs requires cross-sector collaboration to deliver medical, social, and population health services at the community level. Capacity in community health and social services networks may be constrained in regions like Appalachia due to the combined effects of rurality and persistently poor health and social outcomes. One way that cross-sector networks serving low-resource communities can expand their capacity is by engaging partners, like health insurers, who can leverage resources from outside the local area.
    Purpose: This study examines insurer connectivity in cross-sector networks across Kentucky's geographic regions and the association between connectivity and the probability of an individual experiencing a preventable hospitalization.
    Methods: A cross-sectional design was used that linked data from the National Longitudinal Survey of Public Health Systems (NALSYS) with 2018 patient-level Kentucky hospital discharge data to examine the association between insurer connectivity in community networks and preventable hospitalizations across urban, rural non-Appalachian, and Appalachian regions.
    Results: Analysis of the data shows substantial geographic variation in the association between insurer connectivity in community networks and preventable hospitalization. Insurer connectivity in rural Appalachian communities was associated with lower likelihood that an individual was admitted for a preventable hospitalization (
    Implications: Findings suggest insurer connectivity in cross-sector community health and social services networks has the potential to strengthen network capacity to address preventable hospitalizations and improve health outcomes and well-being for the people of Appalachia.
    Language English
    Publishing date 2023-08-01
    Publishing country United States
    Document type Journal Article
    ISSN 2641-7804
    ISSN (online) 2641-7804
    DOI 10.13023/jah.0502.03
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  6. Article ; Online: Identifying Value-Added Population Health Capabilities to Strengthen Public Health Infrastructure.

    Hogg-Graham, Rachel / Graves, Elizabeth / Mays, Glen P

    The Milbank quarterly

    2022  Volume 100, Issue 1, Page(s) 261–283

    Abstract: Policy Points While the coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and ... ...

    Abstract Policy Points While the coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and fragmentation in delivery systems. The results of our study suggest that the public health system structure can be strengthened through the targeted implementation of high-value population health capabilities. Prioritizing the delivery of value-added population health capabilities can help communities efficiently use limited time and resources and identify the most effective pathways for building a stronger public health system and improving health outcomes over time.
    Context: While the novel coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and fragmentation in public health delivery systems. Information about the relative value in the implementation of recommended population health capabilities can help communities prioritize their use of limited time and resources and identify the most effective pathways for building a stronger public health system.
    Methods: We used a longitudinal cohort design with data from the National Longitudinal Survey of Public Health Systems to examine longitudinal and geographic trends in the delivery of population health capabilities and their impact on system strength across communities in the United States. We used linear probability models to ascertain whether the delivery of certain capabilities added value to public health system strength.
    Findings: Those communities with the strongest classification of public health system structure in both urban and rural areas implemented the largest set of population health capabilities. Results from the linear probability model indicate that a set of population health capabilities are associated with increased public health system strength. Key activities include allocating resources based on a community health plan, surveying the community for behavioral risk factors, analyzing the data on preventive services use, and engaging community stakeholders in health improvement planning (p < 0.01).
    Conclusions: The results of this study suggest that public health systems can be strengthened through the targeted implementation of high-value population health capabilities. Prioritizing the delivery of value-added population health capabilities may help communities increase their public health system's capacity and improve health outcomes.
    MeSH term(s) COVID-19/epidemiology ; COVID-19/prevention & control ; Health Planning ; Humans ; Longitudinal Studies ; Population Health ; Public Health ; United States/epidemiology
    Language English
    Publishing date 2022-02-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632829-5
    ISSN 1468-0009 ; 0887-378X
    ISSN (online) 1468-0009
    ISSN 0887-378X
    DOI 10.1111/1468-0009.12553
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  7. Article ; Online: Best of ARM: Evaluating engagement in multisector community health networks: The case of tribal organizations.

    Owsley, Kelsey M / Bauer, Kyla L / Mays, Glen P

    Health services research

    2022  Volume 57, Issue 5, Page(s) 1077–1086

    Abstract: Objective: To quantify variation in public health system engagement with tribal organizations across a national sample of communities and to identify predictors of engagement.: Data sources: We used 2018 National Longitudinal Survey of Public Health ... ...

    Abstract Objective: To quantify variation in public health system engagement with tribal organizations across a national sample of communities and to identify predictors of engagement.
    Data sources: We used 2018 National Longitudinal Survey of Public Health Systems data, a nationally representative cohort of the US public health systems.
    Study design: Social network analysis measures were computed to indicate the extent of tribal organization participation in public health networks and to understand the sectors and social services that engage with tribal organizations in public health activities. Two-part regression models estimated predictors of tribal engagement.
    Data collection: A stratified random sample of local public health agencies was surveyed, yielding 574 respondents. An additional cohort of oversampled respondents was also surveyed to include jurisdictions from the entire state upon the request of their respective state health departments (n = 154). Analyses were restricted to jurisdictions with a nearby American Indian and Alaska Native (AI/AN) serving health facility, yielding a final sample size of 258 local public health systems.
    Principal findings: When an AI/AN serving health facility was present in the region, tribal organizations participated in 28% of public health networks and 9% of implemented public health activities. Networks with tribal engagement were more comprehensive in terms of the breadth of sectors and social services participating in the network and the scope of public health activities implemented relative to networks without tribal engagement. The likelihood of tribal engagement increased significantly with the size of the AI/AN population, the presence of a tribal facility with Indian Health Service funding in the region, and geographic proximity to reservation land (p < 0.10).
    Conclusions: The vast majority of public health networks do not report engagement with tribal organizations. Even when AI/AN serving health facilities are present, reported engagement of tribal organizations remains low.
    MeSH term(s) Alaska Natives ; Community Networks ; Humans ; Indians, North American ; Public Health ; United States ; United States Indian Health Service
    Language English
    Publishing date 2022-06-06
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 410435-3
    ISSN 1475-6773 ; 0017-9124
    ISSN (online) 1475-6773
    ISSN 0017-9124
    DOI 10.1111/1475-6773.14012
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  8. Article ; Online: Public Health Systems and Social Services: Breadth and Depth of Cross-Sector Collaboration.

    Hamer, Mika K / Mays, Glen P

    American journal of public health

    2020  Volume 110, Issue S2, Page(s) S232–S234

    Abstract: Objectives. ...

    Abstract Objectives.
    MeSH term(s) Cooperative Behavior ; Humans ; Intersectoral Collaboration ; Public Health ; Public Health Administration/statistics & numerical data ; Social Welfare/statistics & numerical data ; Social Work/statistics & numerical data ; United States
    Language English
    Publishing date 2020-07-14
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 121100-6
    ISSN 1541-0048 ; 0090-0036 ; 0002-9572
    ISSN (online) 1541-0048
    ISSN 0090-0036 ; 0002-9572
    DOI 10.2105/AJPH.2020.305694
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  9. Article ; Online: US Hospital Service Availability and New 340B Program Participation.

    Owsley, Kelsey M / Hasnain-Wynia, Romana / Rooks, Ronica N / Tung, Gregory J / Mays, Glen P / Lindrooth, Richard C

    JAMA health forum

    2024  Volume 5, Issue 5, Page(s) e240833

    Abstract: Importance: The US 340B Drug Pricing Program enables eligible hospitals to receive substantial discounts on outpatient drugs to improve hospitals' financial sustainability and maintain access to care for patients who have low income and/or are uninsured. ...

    Abstract Importance: The US 340B Drug Pricing Program enables eligible hospitals to receive substantial discounts on outpatient drugs to improve hospitals' financial sustainability and maintain access to care for patients who have low income and/or are uninsured. However, it is unclear whether hospitals use program savings to subsidize access as intended.
    Objective: To evaluate whether the 340B program is associated with improvements in access to hospital-based services and to test whether the association varies by hospital ownership.
    Design, setting, and participants: Difference-in-differences and cohort analysis from 2010 to 2019. Never and newly participating 340B general, acute, nonfederal hospitals in the US using data from the American Hospital Association's Annual Survey of Hospitals merged with hospital and market characteristics. Data were analyzed from January 1, 2023, to January 31, 2024.
    Exposures: New enrollment in 340B between 2012 and 2018.
    Main outcomes and measures: Total number of unprofitable service lines, ie, substance use, psychiatric (inpatient and outpatient), burn clinic, and obstetrics services; and profitable services, ie, cardiac surgery and orthopedic, oncologic, neurologic, and neonatal intensive services.
    Results: The study sample comprised a total of 2152 hospitals, 1074 newly participating and 1078 not participating in the 340B program. Participating hospitals were more likely than nonparticipating hospitals to be critical access and teaching hospitals, have higher Medicaid shares, and be located in rural areas and in Medicaid expansion states. At public hospitals, participation in the 340B program was associated with a significant increase in total unprofitable services (0.21; 95% CI, 0.04 to 0.38; P = .02) and marginal increases in substance use (5.4 percentage points [pp]; 95% CI, -0.8 pp to 11.6 pp; P = .09) and inpatient psychiatric (6.5 pp; 95% CI, -0.7 pp to 13.7 pp; P = .09) services. Among nonprofit hospitals, there was no significant association between 340B and service offerings (profitable and unprofitable) except for an increase in oncologic services (2.5 pp; 95% CI, 0.0 pp to 5.0 pp; P = .05).
    Conclusions and relevance: The finding of the cohort study indicate that participation in the 340B program was associated with an increase in unprofitable services among newly participating public hospitals. Nonprofit hospitals were largely unaffected. These findings suggest that public hospitals responded to 340B savings by improving patient access, whereas nonprofits did not. This heterogeneous response should be considered when evaluating the eligibility criteria for the 340B program and how it affects social welfare.
    MeSH term(s) Humans ; United States ; Health Services Accessibility/statistics & numerical data ; Health Services Accessibility/economics ; Drug Costs ; Medically Uninsured/statistics & numerical data
    Language English
    Publishing date 2024-05-03
    Publishing country United States
    Document type Journal Article
    ISSN 2689-0186
    ISSN (online) 2689-0186
    DOI 10.1001/jamahealthforum.2024.0833
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  10. Article ; Online: Longitudinal Trends in Insurer Participation in Multisector Population Health Activities.

    Hogg-Graham, Rachel / Waters, Teresa M / Clear, Emily R / Pearson, Kendall / Benitez, Joseph A / Mays, Glen P

    Inquiry : a journal of medical care organization, provision and financing

    2024  Volume 61, Page(s) 469580241249092

    Abstract: Healthcare organizations increasingly engage in activities to identify and address social determinants of health (SDOH) among their patients to improve health outcomes and reduce costs. While several studies to date have focused on the evolving role of ... ...

    Abstract Healthcare organizations increasingly engage in activities to identify and address social determinants of health (SDOH) among their patients to improve health outcomes and reduce costs. While several studies to date have focused on the evolving role of hospitals and physicians in these types of population health activities, much less is known about the role health insurers may play. We used data from the National Longitudinal Survey of Public Health Systems for the period 2006 to 2018 to examine trends in health insurer participation in population health activities and in the multi-sector collaborative networks that support these activities. We also used a difference-in-differences approach to examine the impact of Medicaid expansion on insurer participation in population health networks. Insurer participation increased in our study period both in the delivery of population health activities and in the integration into collaborative networks that support these activities. Insurers were most likely to participate in activities focusing on community health assessment and policy development. Results from our adjusted difference-in-differences models showed variation in association between insurer participation in population health networks and Medicaid expansion (Table 2). Population health networks in expansion states experienced significant increases insurer participation in assessment (4.48 percentage points,
    MeSH term(s) Humans ; United States ; Longitudinal Studies ; Insurance, Health/statistics & numerical data ; Population Health ; Medicaid/statistics & numerical data ; Insurance Carriers/statistics & numerical data ; Insurance Carriers/trends ; Social Determinants of Health
    Language English
    Publishing date 2024-04-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 42153-4
    ISSN 1945-7243 ; 0046-9580
    ISSN (online) 1945-7243
    ISSN 0046-9580
    DOI 10.1177/00469580241249092
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