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An Important and Long-Awaited Opportunity

Posted By Sonja A. Rasmussen and Renee Bougard, Friday, February 26, 2016
Updated: Friday, February 26, 2016

“I was very excited to learn that public health departments around the country can now use Block Grant funding to support increased access to library services. The availability of journals, publications, and up-to-date science will be a huge boon to the public health workforce at the state and local levels.”

- Tim Jones, State Epidemiologist, Tennessee Department of Health


It was just this January that CDC and the National Library of Medicine announced that public health departments can now use funding from the CDC Preventive Health and Health Services (PHHS) Block Grant to access journals, publications, the latest evidence, and additional resources through the Public Health Information Access Project (PHIAP) of the National Library of Medicine. The mechanism was developed through the Centers for Surveillance, Epidemiology and Laboratory Services at the Centers for Disease Control working with partners inside CDC and outside the agency.

The goal of the project is to provide low-cost access to high-value, evidence-based resources to improve public health practice in state public health departments. Costs must be tied to state work plans.

In 2015, CSTE reported on its year-long assessment on the scientific writing needs and trends for applied epidemiologists. CSTE’s Applied Epidemiology Scientific Writing Trends, Needs, and Recommendations, 2014 noted that just over half the respondents reported access to peer-reviewed literature (55%), oftentimes through academic appointments. One of the recommendations from the report was to encourage scientific writing partnering with libraries or universities to ensure access to peer-reviewed literature.

Jones noted the same limitations for his colleagues in Tennessee. “Up until now, access at our health department has been limited to a handful of federal assignees or folks with faculty appointments somewhere, and there is widespread enthusiasm at all levels here about this new initiative to expand that access. I think it will enhance our ability to make more rapid, evidence-based decisions and policies, as well as encourage publication and wider dissemination of reports on the important work being done on the front lines of public health.”

Access to library services through PHIAP is already making a difference in state health departments around the country.

“Here in Connecticut, we modify our Youth Risk Behavior Survey and this year, staff at our State Department of Education wanted to capture information about students experiencing housing insecurity. We know there is health and academic risk in this vulnerable population. Having the resources available through the Public Health Information Access Project greatly helped us find relevant research on this topic to better inform our survey development workgroup.”

− Connecticut Department of Public Health

“Having resources to learn the microbiological and medical/epidemiological facets of what my customers are dealing with helps me ask better questions and collect better data, which drives better decisions (and ultimately, better health outcomes and longer lives – which is why health departments exist in the first place). Thanks again for doing what you are doing to make our jobs easier, and our people healthier.”

− Colorado Department of Public Health and Environment Lab

“I just used this fabulous resource to help me find published information on metrics for evaluating patient navigation during diagnosis and treatment of breast and cervical cancer and the cost effectiveness of cancer patient navigation and….I hit the jackpot. No more ‘you must be subscribed to download the full text…’ It was well worth my 90 minutes of training.”

− Connecticut Department of Public Health


We’re very pleased this collaboration is making these services available to all who need them. If you’re interested in obtaining access to library resources for your state health department, talk with the people at the state that develop the block grant funds budget about possibly including this item in your state work plan.
 
Sonja A. Rasmussen, MD, MS, is director of the CDC Division of Public Health Information and Dissemination and editor-in-chief of the Morbidity and Mortality Weekly Report. Renee Bougard, MLIS is outreach librarian at the NN/LM National Network Office of the NIH/National Library of Medicine. For information about PHIAP or how to access library services, please visit: http://nnlm.gov/phiap.

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The Illinois Experience: The Perspective of Illinois Department of Public Health’s CSTE Fellows

Posted By Justin Albertson, Whitney Clegg, and Andrew Beron, Friday, February 19, 2016
Updated: Wednesday, February 17, 2016
Untitled Document

Illinois covers 58,000 square miles and is home to 13 million people, making it the fifth most populous state in the country. The city of Chicago draws travelers from across the globe, with 50.2 million visitors in 2014 alone—many of whom enter Chicago via one of the world’s busiest airports, O’Hare International Airport. While a majority of the state’s population resides in the Chicago metropolitan area, the nation’s third largest, the state is also populated by smaller cities and rural countryside. Illinois’s size, large population, and diverse city and rural residents contribute to a number of infectious disease and public health-related challenges. In the past two years alone, Illinois has had to respond to suspect cases of Middle East Respiratory Syndrome (MERS), Zika virus, and the need to screen travelers from West Africa for Ebola.

As CSTE Applied Epidemiology fellows, we have been able to participate in numerous infectious disease outbreak investigations across the state. In a sense, we’ve been able to act as a rapid response team, quickly addressing important public health issues in Illinois to implement control measures and promote disease prevention. Elements of outbreak response include data collection, management, analysis; implementation of outbreak control measures; and communication and coordination with public health partners and stakeholders. In 2015, we conducted on-site investigations for seven outbreak events, including:

  • Measles among infants at a child care center in suburban Chicago
  • Group A Streptococcus infections among residents and staff at a long-term care facility
  • Invasive MRSA infections among patients receiving epidural steroid injections at a pain management clinic
  • Meningococcal disease among men who have sex with men in the Chicago area
  • Laboratory specimen contamination with Geotrichum, a rare fungus, causing a pseudo-outbreak at a large hospital
  • Legionellosis at a large veterans’ home
  • Necrotizing enterocolitis among infants being cared for in a neonatal intensive-care unit
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These investigations helped to identify needed control measures, to pinpoint infection control deficiencies at long-term care facilities, and to facilitate distribution of vaccines to susceptible populations. The CSTE Applied Epidemiology Fellowship program has provided support to Illinois to respond to pressing public health needs across the state quickly. It has allowed us to gain expertise and skills in outbreak investigations and epidemiologic methods.

Justin Albertson, MS, Whitney Clegg, MD, MPH, and Andrew J. Beron, MPH, MLS(ASCP)CM are fellows in the CSTEApplied Epidemiology Fellowship. For more information on how to host fellows or become a fellow, visit the Applied Epidemiology Fellowship page on the CSTE website.

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Colorado’s Family Planning Game-Changing Program

Posted By Jody Camp, Friday, February 12, 2016
Updated: Thursday, February 4, 2016
Beginning in 2008, the Colorado Department of Public Health’s (CDPHE) Family Planning Program (FPP) received an eight-year, private donation to the program. Through the privately funded Colorado Family Planning Initiative (CFPI), the FPP expanded access to the most effective long-acting methods of contraception, specifically intrauterine devices (IUD) and contraceptive implants, throughout the state. The results have been astounding:
  • Since the start of the Colorado Family Planning Initiative, the birth rate for young women ages 15 to19 has been cut nearly in half, falling 48 percent between 2009 and 2014.
  • A similar downward trend can be seen among women ages 20 to 24, with birth rates dropping 20 percent between 2009 and 2014.
  • The number of repeat teen births (teens giving birth for the second or third time, etc.) dropped 58 percent between 2009 and 2014.
  • The abortion rate among women 15-19 fell by 48 percent and among women 20-24 by 18 percent between 2009 and 2014.
“Similar to Colorado, Mesa County’s unintended pregnancy rate continues to decrease. However, our teen birth rate is 30% higher than the state. As a result of Colorado LARC funding, Mesa County efforts to address unintended pregnancy have been successful. In 2015 our LARC procedures were double those in 2014 and triple from 2013. Because of Colorado LARC funding, we are able to keep units in stock, allowing for same-day attention to patients. We know through experience that asking clients to wait several days for an appointment or asking them to return for subsequent visits increases the likelihood they’ll not follow through with a procedure. The LARC program is one of the few public health efforts to have measurable community impacts in a fairly short amount of time.”

Jeff Kuhr, PhD, Executive Director, Mesa County Health Department
CDPHE’s LARC Program has brought a local and national spotlight to the effectiveness of long-acting, reversible contraceptive use and the health, economic and social impacts it makes to society. The following are a few highlights:
  • The Family Planning Program (FPP) submitted a journal article to Guttmacher Institute’s Perspectives on Sexual and Reproductive Health. The article entitled, "Game Change in Colorado: Widespread Use of LARC Methods and Rapid Decline in Births among Young Low-Income Women".
    https://www.guttmacher.org/pubs/journals/46e1714.html
  • To assist with the dissemination of the journal article, Colorado Governor, John Hickenlooper, and CDPHE Executive Director, Dr. Larry Wolk, co-hosted a press conference at the Colorado Capitol Building in July 2014. The press attention was overwhelmingly positive, including these examples:
Looking to the future, the Family Planning Program aims to build on its past successes and ensure the sustainability of the LARC program. Most recently, the FPP is working on a potential project to fund school-based health centers that provide family planning services. In addition, relationships are being built with birthing hospitals around the state to partner on post-partum LARC insertion. CDPHE has also submitted a request to Colorado's Joint Budget Committee to increase funding to the CDPHE Family Planning Program to sustain this momentum.
Jody Camp, MPH is Family Planning Section Manager at the Colorado Department of Public Health and Environment. To learn more about Maternal & Child Health epidemiology, join the MCH Subcommittee and explore related activities.

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Using Cyberspace to Address Infectious Syphilis in Rhode Island

Posted By Thomas E. Bertrand, Friday, February 5, 2016
Updated: Thursday, February 4, 2016

Mirroring national trends, Rhode Island has observed an upswing in infectious syphilis cases in recent years among gay, bisexual, and other men who have sex with men (GBMSM). In 2005 there were just 14 cases of infectious syphilis among GBMSM in Rhode Island. This number increased to 80 cases in 2014, a 417% increase. Many of these cases are individuals who use cell phone apps and online websites to meet their partners. With the goal of reaching these individuals “where they are at,” the Rhode Island Department of Health (RIDOH) embarked on an internet-based campaign to promote syphilis prevention and testing, with some encouraging results.

 

The first step of the campaign was to create a webpage entitled “Sexual Health Information for Gay Men” (www.health.ri.gov/sex/for/gaymen/) on the RIDOH website. This page provides simple health recommendations for syphilis prevention and testing, as well as links to other helpful sites that provide GBMSM-specific local information, such as finding a gay-friendly doctor using www.men2menri.org.

 
A campaign was developed with input from local GBMSM community groups and patients at STD clinics, who recommended that the advertisement be simple, eye-catching, and non-judgmental. Using successful examples from Denver Public Health, an ad was adapted and used as part of a six-week “run” on eight popular websites and cell phone apps (e.g., Manhunt, GRINDR, Scruff) that GBMSM use to meet partners.


Upon launch of the campaign, the RIDOH “Sexual Health Information for Gay Men” webpage jumped into the top ten most-viewed pages on the RIDOH website and stayed there for the duration of the campaign, with an average of 206 visitors per day. Approximately 92% of the hits to the webpage were attributed to mobile phone usage. During this time, visits to the www.men2men.ri.og website experienced a 125% rise, and the number of patients visiting The Miriam Hospital STD clinic that named the RIDOH website as a referral source increased substantially. Based on local GBSM population estimates, it is projected that 20% to 25% of GBMSM in Rhode Island saw the campaign ad and clicked through to the RIDOH website.
 
This project demonstrated that an online public health campaign targeting GMSM may be effective in directing a significant proportion of the MSM community to a health department website and subsequently prompting them to access STD/HIV clinical services and additional web-based sexual health information.
Thomas E. Bertrand, MPH, MA is chief of the Center for HIV, Hepatitis, STD, and TB at the Rhode Island Department of Health in Providence, Rhode Island. To learn more about CSTE activities in STD epidemiology, explore the STD Subcommittee and other Infectious Disease subcommittees.

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Motivating for Continuous Quality Improvement

Posted By Kelly Gerard, Friday, January 29, 2016
Updated: Friday, January 29, 2016

Denver Public Health, the host-site agency for my fellowship, is driven by an internal desire to improve its processes and outcomes. This desire is achieved through Continuous Quality Improvement (QI), an ongoing effort to increase an agency’s approach to manage performance, motivate improvement, and capture lessons learned in areas that may or may not be measured as part of the public health department accreditation process. Denver Public Health’s approach to QI is guided by Lean. Lean is a systematic approach, based on the Toyota Production System of Lean principles and tools, with a defined improvement process to identify and eliminate waste such as inefficiency, error, and redundancy.1 Through a Lean-driven QI process, Denver Public Health improves the efficiency, effectiveness, quality, or performance of services, processes, capacities, and outcomes.2

Awarding QI Efforts

Denver Public Health established a Quality Committee to oversee efforts related to QI projects, staff QI training, customer satisfaction, and related communications. It is a multi-disciplinary committee with representation from all divisions.3 The Quality Committee is also responsible for selecting recipients for the Oppy Award. The Oppy Award provides recognition to teams and programs for exceptional QI projects. Projects are voted on by the Quality Committee each month, and Oppy travels to each winner to be proudly displayed. Winners are encouraged to decorate and add “flair” to Oppy. A picture of Oppy with the award winners is taken and shared on the agency’s intranet site and on bulletin boards throughout the department. The mascot represents the core values of continuous quality improvement and encourages and promotes a QI culture in public health.
 
Example QI Projects that have won the Oppy Award:
  • Screening, Brief Intervention, Referral to Treatment (SBIRT) process improvement in the STD Clinic to identify, reduce and prevent problematic use, abuse and dependence on alcohol and illicit drugs 4
  • Text message reminders for travel patients in the Immunization and Travel Clinic
  • Personnel Grant Management (PGM) system in the Public Health Administration team
  • Travel authorizations process improvement by a cross-departmental team to simplify and standardize the travel authorization process
  • Vaccine preventable disease response by Epidemiology and Preparedness and Immunization and Travel Clinic teams
  • Email best practices by a cross-departmental team to reduce the burden of email and improve the consistency of emails originating from our department
  • Optimizing the Grant Tracking Database by the Public Health Administration team and Kelly Gerard
 
Call to Action
QI in public health is a continuous and ongoing effort to focus on improvement activities that are responsive to community needs and improving population health. 5 Public health departments wanting to achieve measurable improvements should consider adopting Lean principles and tools and promoting a QI culture. Successful implementation of QI requires a commitment throughout all levels of the organization. An effective way to engage and motivate employees is through internal awards, such as the Oppy Award, to acknowledge QI efforts throughout the department.
 
References
  1. Lean Systems Improvement, Lean at Denver Health: Saving Lives, Saving Money, Saving Jobs, Denver Health, 2012.
  2. Public Health Foundation and the National Public Health Performance Standards Program, Acronyms, Glossary, and Reference Terms, CDC, 2007.
  3. Denver Public Health, Performance Improvement Plan, 2015.
  4. SAMHSA-HRSA Center for Integrated Health Solutions, accessed from web: http://www.integration.samhsa.gov/resource/sbirt-resource-page
  5. Riley, Moran, Corso, Beitsch, Bialek, and Cofsky, Defining Quality Improvement in Public Health, Journal of Public Health Management and Practice, January/February, 2010.
Kelly Gerard, MSHI, RHIA is an Applied Public Health Informatics Fellow at Denver Public Health, Denver Health in Denver, Colorado. APHIF applications are due Monday. To apply for APHIF, HSIP, and I-TIPP fellowships, please visit the Project SHINE website.
 

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Raleigh to Bamako: CSTE Influenza Surveillance International Consultancy

Posted By Lauren Thie, Friday, January 22, 2016
Updated: Tuesday, January 12, 2016

CSTE provides international consultancies for its members to support CDC programs. You may have a colleague who went to West Africa to help support Ebola efforts through CSTE. When I joined CSTE in 2011 as a new North Carolina health department employee, I had recently returned home from some international work. I let CSTE know I would be interested in international consultancy, and what my skills were. Through the CSTE international consultancy program, I was able to assist in an influenza epidemiological surveillance review in Bamako, Mali in September 2015.

I received training for the influenza surveillance review in advance of my departure. CSTE colleagues experienced in surveillance reviews offered their expertise and documents from their previous reviews in West Africa. CDC-CSTE calls were held to offer me training for the consultancy. CDC shared background documents on Mali’s influenza work. North Carolina public health has a strong history of international consultancy and influenza work, and colleagues shared their wealth of experience. I left for Bamako in early September feeling prepared.

Mali is located in West Africa, sharing borders with 7 different countries. It is south of Algeria, west of Niger, north of Burkina Faso and Cote d’Ivoire, and east of Mauritania and Senegal. Mali is twice the size of Texas and is home to 15 million people. Bamako is the capital city, located in western Mali. Bamako’s population is two million and is the sixth fastest growing city in the world.

The CDC Influenza program and the Center for Vaccine Development Mali planned the surveillance review itinerary and most of the logistics. During my week in Bamako, I used the CDC surveillance tool to document Mali’s influenza surveillance program in laboratory, Influenza-Like Illness (ILI), and Severe Acute Respiratory Illness (SARI) surveillance sites, and nationwide epidemiological surveillance. I recorded what Mali’s influenza epidemiologists, clinicians, and laboratory scientists shared with me about their budding program. With the help of CDC colleagues in Atlanta and Accra, I reported to CDC on the overall system, SARI, ILI, laboratory, data, a SARI sentinel site visit (Gabriel Toure Hospital Pediatric Department, Bamako), and an ILI site visit (Commune I, Bamako).

My international consultancy work with CSTE and CDC on influenza surveillance was inspiring. Professionally, I was impressed by my public health colleagues in Bamako. I have done several public health projects in lower resource settings and this was by far the most impressive I have seen. With time, I believe the Mali influenza program will be an example in West Africa. I am grateful to CSTE, CDC, and the Center for Vaccine Development Mali for an outstanding epidemiology experience during my September 2015 visit.


Touring the Center for Vaccine Development Mali’s (CVD-Mali) laboratory, which performs influenza testing. Left to right: Dr. Boubou Tamboura (CVD-Mali laboratory director, Bamako, Mali), Dr. Talla Nzussouo (CDC epidemiology and laboratory regional advisor based in Accra, Ghana), me (Lauren Thie, NC Division of Public Health, CSTE member), Thelma Williams (CDC project officer, based in Atlanta, USA).


Lauren Thie, MSPH is an Environmental Program Consultant in Occupational and Environmental Epidemiology at the North Carolina Division of Public Health. For more information on international consultancies, please contact CSTE. CSTE is seeking epidemiologists for rapid Ebola deployment in West Africa, including Portuguese and French speakers.
 

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ICD-10 Coding for Contraceptives in Oregon

Posted By Rachel Linz, Friday, January 15, 2016
Updated: Tuesday, January 12, 2016
The Reproductive Health Program in Oregon is a little different than in most other states. Not only do we administer a Title X grant (Title X of the Public Health Services Act, signed into law by President Richard Nixon in 1970, is the only federal funding dedicated solely to family planning services), but we also administer a Section 1115 family planning demonstration waiver through the Centers for Medicare and Medicaid Services (CMS), despite being within our state’s Public Health Division rather than our state’s Medicaid office. Our waiver is called Oregon ContraceptiveCare, or CCare, and covers family planning and contraceptive management services for individuals who are U.S. citizens or lawful permanent residents with household incomes up to 250% of the federal poverty level and who are not enrolled in the state’s Medicaid program. The RH Program’s provider network includes all local public health departments in the state as well as Planned Parenthood health centers, university health centers, community health centers and School-Based Health Centers, totaling 150 clinics statewide. Through our entire provider network, we serve over 80,000 clients annually.
One area of focus for the Oregon RH Program has been to increase access to long-acting reversible contraceptives, or LARC methods. These include contraceptive implants and intrauterine devices, are effective for up to 3-10 years depending on type, and have failure rates similar to sterilization methods (see Figure 1). In fact, LARC methods are about 20 times more effective at preventing pregnancy than birth control pills! We provide technical assistance and training for clinicians and billing staff regarding insertion and removal of LARC devices, billing, reimbursement and maintenance of device stock on site, and best practices regarding client counseling techniques to increase client success with their methods, regardless of which method a client chooses.
As all readers of CSTE Features no doubt know, the United States transitioned to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) on October 1, 2015. For the Oregon RH Program, we are fortunate that our clinical data collection is narrowly focused and we only require diagnosis codes for visits under CCare, not for Title X (which covers a broader scope of services than CCare). Because of CMS requirements, CCare visits must include a primary diagnosis code indicating that contraceptive management was the primary purpose of visit (V25 codes under ICD-9, Z30 codes under ICD-10). To assist our provider network in managing the transition, we created a crosswalk that includes the ICD-9 codes for each contraceptive method alongside the appropriate ICD-10 code, as well as the Healthcare Common Procedure Coding System (HCPCS) supply codes associated with each method type (see Figure 2).
The biggest challenge with coding for the Oregon RH Program under ICD-9 has continued under ICD-10: several contraceptive methods do not have their own unique codes. We’ve all heard about new ICD-10 codes that have been created to document very specific types of injuries in specific locations, but what has not been in the news is the fact that the most effective LARC method, the hormonal implant (<0.5% failure rate) actually lost its unique codes that it had under ICD-9! Of the 18 different contraceptive methods available in the U.S., only four have their own specific diagnosis codes: intrauterine devices, oral contraceptives, injectable contraceptives, and natural family planning. Both female and male sterilization methods use the same diagnosis codes.
Our solution, which aligns with recommendations from national family planning and coding experts, is the following: for hormonal methods that do not have their own specific codes (the contraceptive implant, patch and ring), to use the codes for “unspecified” contraceptives (Z30.019 for initial encounter, Z30.40 for follow-up or surveillance encounters). For less effective methods that do not have their own specific codes (cervical cap, diaphragm, sponge, female and male condoms, and spermicide), we recommend using codes for “other” contraceptives (Z30.018 and Z30.49). This way, although we cannot determine specific contraceptive methods from diagnosis codes alone, we can determine the approximate level of effectiveness. The bottom line is that other information, such as HCPCS codes and National Drug Code (NDC) numbers, is required to determine exactly which contraceptive methods are dispensed. Additional ICD-10 codes may become available in the future, but for now, tracking ongoing use of certain long-acting methods remains a challenge.

Figure 1. Contraceptive method effectiveness. Most effective methods include the contraceptive implant, intrauterine devices, and sterilization methods. Moderately effective methods include injectables, pills, patches, rings and diaphragms.

Figure 2. A portion of the Oregon RH Program’s ICD-9/ICD-10 crosswalk. Under ICD-10, the hormonal implant lost its unique diagnosis codes while injectable contraceptives gained unique codes. Other methods such as the diaphragm have never had their own unique codes.

Rachel Linz, MPH is an Informatics Training in Place Program (I-TIPP) fellow and senior research analyst with the Reproductive Health Program at the Oregon Health Authority. To learn more about ICD-9 and ICD-10, join subcommittees in the Surveillance/Informatics Steering Committee.

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All’s Well That Ends Well: CSTE Priorities Fare Well in Year-End Spending Bill

Posted By Emily J. Holubowich , Monday, January 4, 2016
Updated: Monday, January 4, 2016

Emily Holubowich, Senior Vice President at CRD Associates, is CSTE’s Washington representative and leads our advocacy efforts in the nation’s capital.

After a couple of fiscal “close calls” this fall—shutdown threats, last-minute budget negotiations, and a couple of stopgap spending measures to keep the government running—Congress ultimately passed and the President quickly signed the Consolidated Appropriations Act of 2015 before heading home for the holidays. This trillion-dollar spending measure provided appropriations for all “discretionary” government functions, including those administered by the Department of Health and Human Services.

In the end, public health fared well, all things considered. The Centers for Disease Control and Prevention (CDC) received nearly $7.2 billion in the “omnibus” spending bill for fiscal year (FY) 2016. That’s a $277.7 million (four percent) increase over FY 2015 levels. This funding includes nearly $6.3 billion in discretionary budget authority, as well as more than $892 million in mandatory Prevention and Public Health Fund (PPHF) dollars and $15 million from the Public Health and Social Services Emergency Fund.

The overall increase in funding should translate into good news for state and territorial epidemiologists. The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) received nearly $580 million, including $52 million from PPHF. This funding level represents a $175 million (43 percent) increase over FY 2015. Within NCEZID, the antibiotic resistance (AR) initiative would receive $160 million in new funding; less than the President’s requested $264 million for CDC. Based on the President’s budget request submitted to Congress in early 2015, we would expect much of the NCEZID funding, including AR, to support core infectious disease surveillance capacity at state and local health departments through Epidemiology and Laboratory Capacity (ELC) grants. This funding would be in addition to $40 million from the mandatory PPHF provided to ELC grants for the fifth consecutive year in the omnibus. The final spending measure requires CDC to submit to Congress a detailed spend plan for AR within 60 days of the legislation’s enactment, so more specific information about ELC funding and the bill’s impact on states and territories will be available soon.

Among our other NCEZID appropriations priorities, food safety received increased funding ($52 million) and advanced molecular detection was flat funded ($30 million).

The Public Health Workforce program, through which the CDC/CSTE Applied Epidemiology Fellowship receives funding, is also provided flat funding of $52.2 million and no supplemental PPHF funding. The appropriations bills do not specify how much funding would be dedicated to the Applied Epidemiology Fellowship program per se, but with flat funding of the program we might expect flat funding for our fellows. The President had requested a $15.2-million increase in budget authority for Public Health Workforce, as well as $36.2 million in PPHF. Three years ago, Congress eliminated $15 million in PPHF dollars for Public Health Workforce in the wake of sequestration.

Some other notable items related to public health:

  • The National Center for Injury Prevention and Control received $70 million to combat the opioid epidemic, a $50 million increase over FY 2015 levels.
  • National Center for Environmental Health budget was increased by $2.9 million over FY 2015 and most of the cuts proposed in earlier spending legislation were restored with the exception of the $2.8-million “Built Environment and Health Initiative,” which was eliminated.
  • Funding for CDC’s tobacco programs sustained a $6.5 million cut compared to FY 2015, but was mostly restored after being cut by $100 million in proposed spending bills.

With the enactment of FY 2016 spending legislation, legislators will begin work in earnest on FY 2017 spending legislation when they return to Washington in January. CSTE will once again partner with the Association of Public Health Laboratories and other colleagues in the public health community to advocate for our key priorities—strong support for disease monitoring and for training the next generation of epidemiologists. In addition, our executive leaders are travelling to Washington in early February to discuss our funding requests with key decision-makers in Congress and the administration. Until then, we anxiously await the release of the President’s final budget request of the administration, expected to be released the first week in February, to see what the White House has in store for disease surveillance.

For more information about funding levels for your specific priorities, please click here for a copy of the omnibus spending legislation, and click here for a copy of the accompanying report that provides more detailed instructions about public health funding levels and intended purposes.

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Epidemiology Resources at the National Institutes of Health (NIH)

Posted By D. Rebecca Prevots, Tuesday, December 22, 2015
Updated: Friday, December 18, 2015

Editor’s note: CSTE Executive Board Secretary-Treasurer and Hawaii State Epidemiologist, Sarah Park, recently met up with D. Rebecca Prevots, Ph.D., Chief of the Epidemiology Unit of the Laboratory of Clinical Infectious Diseases, Division of Intramural Research at the National Institute of Allergy and Infectious Diseases (NIAID) at NIH. Sarah recommended that Rebecca write this blog for CSTE describing the epidemiology research and support at NIH and how she might help CSTE members with applied epi questions not addressed by other federal partners.

I will give an overview of epidemiology and epidemiologic capacity at NIH based on my experience here. Since I spent 12 years at CDC and now 12 years at NIH, I do have some perspective into how epi fits into these different cultures (the more academic and the more applied public health). NIH is a very big place, with the 27 different institutes and centers comprising the National Institutes of Health (note the “s”). Most institutes have extra- and intramural groups, with the extramural groups funding research outside of NIH and the intramural groups conducting research on the NIH campus. Approximately 90% of the NIH budget goes to extramural research, usually in the form of grants to academic institutions, and the remainder is for intramural research.

In addition to the intra\extramural distinction, each institute or center varies in its mission, structure, and function, and therefore it is difficult to provide one picture of epidemiology across NIH. Most large institutes (NCI, NIAID, NIEHS, NHLBI, and NICHD) have intra- and extramural epidemiology groups. The descriptions of the various epidemiology groups can be found on the NIH webpage under their respective institutes. The epidemiology groups in each institute will have expertise related to their specific areas of study. The main mission of the NIH is biomedical research in support of human health, which the epidemiology units complement in a variety of ways that include:

  1. design and analysis of NIH clinical studies,
  2. involvement in design and analysis of field studies, and
  3. analysis of large datasets to look at population patterns

The nature of the ongoing research varies widely, but intramural epi researchers at those institutes typically do original research, usually in populations outside of NIH. The overarching mission of intramural epi groups is to add value to the mission by focusing on rare diseases or high-risk research that otherwise wouldn’t get funded extramurally.

I can speak to what I know best: in my epi group at NIAID, we seek to lead and support research within the Division of Intramural Research. This includes research on rare lung diseases from nontuberculous mycobacteria and fungi, design and analysis of clinical research data, analysis of population-based data (e.g., datasets from the Centers for Medicaid and Medicare Services and the Agency for Health Research and Quality), and using approaches such as spatial analysis to better understand risk factors for some conditions. We also provide epidemiologic expertise into international field studies conducted by NIH, such as the intramural-conducted field studies of malaria in Mali.

In summary, there is epi expertise at NIH, and that expertise varies widely across groups. Certainly if there is a topic of interest (such as NTM), there are often experts here who can help. And certainly I would be interested in fostering ties with CSTE!

Dr. Prevots can be reached by email at rprevots@niaid.nih.gov.

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Chronic Disease Evaluation

Posted By Virginia Dick, Friday, December 18, 2015
Updated: Friday, December 18, 2015
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Evaluation is a crucial activity for many state and local public health agencies. In addition to the evaluation requirements in many federal funding programs, more and more states are recognizing the need and value of conducting thorough process and outcome evaluations of local, state, and regional efforts. All funders, governmental and non-governmental, are placing an increasing emphasis on demonstrating the impact of the program, policy or system change.

 

It is only through a comprehensive evaluation that jurisdictions can gain a better understanding of the impact of programs or policy changes as well as the key components involved in implementation of those programs and policies. Many evaluators, myself included, advocate that there is a critical need for process evaluation as well as outcome evaluation. A solid process evaluation provides the foundation for understanding why a program, system change, or policy had the anticipated impact (or not) as well as what components were most critical and how replication can occur in other settings.

 

Unfortunately, evaluation responsibilities often fall to epidemiologists or data managers who have little direct evaluation training and experience. In ideal circumstances, epidemiologists and evaluators work hand in hand during evaluation to provide the most thorough review of the process as well as aligning related data elements and issues. However, due to staffing and funding challenges, many jurisdictions are not able to have both of these positions engaged on the same effort at the same time, or the staff are spread across many efforts. Building evaluation capacity within the current epidemiology workforce is one way to help build the overall evaluation capacity within jurisdictions.

 

In 2015, CSTE conducted a four-part webinar series to discuss and examine public health evaluation. The series was designed to provide a high-level overview discussion of evaluation and how evaluation broadly should be approached. While the series was developed in conjunction with the Chronic Disease Subcommittee, the presentations were done in a manner to allow generalizability across all areas of public health. All of the webinars are available in the CSTE webinar library and can be viewed at any time. Below is a brief description of each of the webinars as well as the link to the webinar itself if you would like to learn more about any of the topics.

  • Lesson 1: Focusing your Evaluation Design (February 19, 2015) - Webinar Slides
    This webinar focuses on understanding how to begin the evaluation design purpose. Key questions that guided the discussion included understanding how, why and when evaluations begin, identifying the purpose and key stakeholders, and balancing utility and feasibility.

    Some “think about it” questions that were generated included: What is the first step in determining your evaluation design? What are some of the primary reasons for conducting evaluations? What is the biggest challenge you face in determining evaluation design, engaging stakeholders, and determining what tools to use?

  • Lesson 2: Approaches to Evaluation / Evaluation Types (March 19, 2015) - Webinar Slides
    This webinar discussed the strengths, weaknesses, and primary focuses of four primary approaches to evaluation. The four approaches that were discussed in depth include Utilization-focused evaluation, Developmental evaluation, Theory Driven, and the Kirkpatrick model. In addition, time was spent discussing the difference between summative and formative evaluations and outcome and process evaluations. While discussing the differences, it is also important to consider the interconnectedness between the different types.

    “Think about it” questions to consider from this week included: examining which evaluation approach you are most comfortable with, identifying what types of evaluation are typically conducted within your agency, and whether your approach is consistent with the types of evaluation that you have typically been involved with in your agency.

  • Lesson 3: Outcome/Process Evaluations (April 16, 2015) - Webinar Slides
    This webinar spent significantly more time delving into the distinction between and relationship among formative/summative and outcome/process evaluation. Items considered and discussed including the appropriate different types of questions for each type of evaluation, how different evaluation theories or approaches examine each of the types of evaluation, and most appropriate data, analysis, and reporting mechanisms for each type of evaluation. Significant time was spent in this session discussing the importance of mixed methods designs in robust evaluations.

    “Think about it” questions that were generated from this session included considering the most appropriate evaluation questions for each evaluation type, examining how summative evaluations can be used to inform programmatic practice, and thinking about the pitfalls of relying on only summative evaluation reports.

  • Lesson 4: Data Visualization and Reporting ( June 14, 2015) - Webinar Slides
    The final webinar in this series discussed data visualization and reporting. In particular, how to determine the best reporting mechanisms for various stakeholder audiences, different methods for visualizing data, and the critical importance of different reporting tools were all discussed. This session tied together several underlying themes from the other sessions, including consideration of all stakeholders and ensuring the usability and relevance of the evaluation by all stakeholders.

    Some of the “think about it” questions that were generated at this session included how to handle challenging responses from stakeholders to evaluation findings, how to identify and engage with key stakeholders to discuss the data, and how stakeholders can support evaluation efforts by providing more detailed understanding of key findings.


Dr. Virginia Dick is director of research and evaluation at CSTE. If you are interested in discussing evaluation in more detail, please feel free to contact her at vdick@cste.org. For other interesting webinars on data and applied public health epidemiology issues, visit the webinar library.

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