Population Health and Health Policy
This editorial highlights the progress of public health accreditation efforts as discussed by the articles in this special issue. This issue represents an important step toward establishing a stronger evidence base for the national accreditation program, and the articles within this issue address many of the research agenda topics, including technical assistance, connections with public health categorical programs, readiness, and the impact of accreditation on public health departments of many sizes, types, and structures.
This article describes case reports that highlight the journey of accreditation through the lens of 11 health departments at various stages in the process. These case reports call attention to the link between accreditation and quality improvement.
Suggested Citation: Joly, B., & Davis, M. V. (2014). Introduction to case reports: One goal-many journeys. Journal of Public Health Management and Practice, 20(1), 64-65. doi: 10.1097/PHH.0b013e3182a958da
Telemental health has long been promoted in rural areas to address chronic access barriers to mental health care. While support and enthusiasm for telemental health in rural areas remains quite high, we lack a clear picture of the reality of telemental health in rural areas, compared to its promise. This Research & Policy Brief reports on the first part of our study—the online survey of 53 telemental health programs—and describes the organizational setting, services provided, and the staff mix of these programs. We draw from our telephone interviews with 23 of these programs to help describe the organizational context of telemental health programs.
- The scope and volume of services provided are often modest suggesting that the business case for these programs may be weaker than the clinical case.
- The programs in our study were able to secure funding and other supports to implement services, but their ability to maintain and expand services to address unmet need is less certain.
- Telemental health primarily addresses issues related to the distribution of providers and travel distances to care. However, there are underlying practice management issues, common to all mental health practices in rural areas, which pose challenges to the scope and sustainability of telemental health, including reimbursement, provider recruitment and retention, practice economies of scale, high rates of uninsurance, and high patient “no show” rates.
- It is becoming increasingly apparent that telehealth technology, by itself, cannot overcome service delivery challenges without underlying reform to the mental health service system.
Lambert, D., Gale, J., Hansen, A. Y., Croll, Z., & Hartley, D. (2013). Telemental health in today's rural health system. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.
First STEPS (Strengthening Together Early Preventive Services) is a learning initiative supported by Maine's CHIPRA quality demonstration grant to support measure-driven practice improvement in pediatric and family practices across the state on improving developmental, autism, and lead screening for children. This report, authored by research staff at the USM Muskie School, evaluates the impact of Phase II of Maine's First STEPS initiative, which was implemented from May to December 2012 and included 12 practices serving more than 20,000 children on MaineCare (Maine's Medicaid system). The authors assess changes in developmental, autism, and lead screening rates and evidence-based office processes in participating practices before and after the initiative, as well as related systems changes. They also summarize lessons learned in implementing changes in practices and challenges in using CHIPRA and IHOC developmental, autism, and lead screening measures at the practice-level to inform quality improvement.
Suggested Citation: Fox K, Gray C, Elbaum-Williamson M. First STEPS Phase II Initiative: Improving Developmental, Autism, and Lead Screening for Children. Portland, ME: University of Southern Maine, Muskie School of Public Service; August, 2013. Improving Health Outcomes for Children (IHOC) Final Evaluation Report.
This evalution report, authored by research staff at the USM Muskie School, assesses the change in immunization rates in participating pediatric and family practices that serve a high volume of children insured by MaineCare (Maine's Medicaid system). The authors also summarize lessons learned in implementing changes in practices and challenges in using the immunization measures at the practice-level to inform quality improvement.
Background: Through the Improving Health Outcomes for Children (IHOC) grant, Maine Quality Counts is leading the First STEPS (Strengthening Together Early Prevention Services) Learning Initiative to support Maine’s primary care practices in improving preventive and screening processes for children and building medical homes. The First STEPS Learning Initiative is being implemented in phases, with the first phase (September 2011 - August 2012) focusing on improving immunizations for children and adolescents. As part of the initiative, IHOC identified specific immunization measures to be improved. First STEPS provides wide-ranging and in-depth quality improvement, coaching, andata monitoring of standard quality measures, and educations support to pediatric and family medicine practices as they continue to enhance health outcomes for children. The goal of Phase I was to improve immunization rates in participating practices by at least 4 percentage points within one year of project initiation by implementing changes in office procedures advocated by the American Academy of Pediatrics’ Bright Futures curriculum.
Suggested Citation: Fox K, Gray C. First STEPS Phase I Initiative: Improving Immunizations for Children and Adolescents. Portland, ME: University of Southern Maine, Muskie School of Public Service; March, 2013. Improving Health Outcomes for Children (IHOC) Final Evaluation Report.
Education: University of Southern Maine, BA Social Work, 1994; University of Southern Maine, Muskie School of Public Service, MS Health Policy, 1998; Ph.D, 2012.
Areas of Expertise: health insurance coverage, the uninsured, children's health, rural health.
Research Interests: policy options for covering the uninsured, dynamics of health insurance coverage, individual health insurance, access to health care services for vulnerable populations (low-income individuals, children, rural residents).
Talbot, J.A., Coburn, A., Croll, Z., & Ziller, E. (2013). Rural Considerations in Establishing Network Adequacy Standards for Qualified Health Plans in State and Regional Health Insurance Exchanges. Journal of Rural Health, 29(3), 327-335.
Ziller, E.C., Lenardson, J.D., & Coburn, A.F. (2012). Health care access and use among the rural uninsured. Journal of Health Care for the Poor and Underserved, 23(3), 1327-1345.
Thomas, J.W., Ziller, E.C., & Thayer, D. (2010). Low costs of defensive medicine, small savings from tort reform. Health Affairs, 29(9), 1578-1584.
Ziller, E.C., Anderson, N.J., & Coburn, A.F. (2010). Access to rural mental health services: Service use and out-of-pocket costs. Journal of Rural Health, 26(3), 214-24.
Yousefian, A., Ziller, E., Swartz, J., & Hartley, D. (2009). Active living for rural youth: Addressing physical inactivity in rural communities. Journal of Public Health Management and Practice: Special Issue on Rural Public Health, 15(3), 223-231.
Ziller, E.C., Coburn, A.F., Anderson, N.J., & Loux, S.L. (2008). Uninsured rural families. Journal of Rural Health, 24(1), 1-11.
Hartley, D., Ziller, E., Loux, S., Gale, J., Lambert, D., & Yousefian, A.E. (2007). Use of Critical Access Hospital emergency rooms by patients with mental health symptoms. Journal of Rural Health, 23(2), 108-115.
Ziller, E.C., Coburn, A.F., & Yousefian, A.E. (2006). Out-of-pocket health spending and the rural underinsured. Health Affairs, 25(6), 1688-1699.
Ziller, E.C., Coburn, A.F., McBride, T.D., & Andrews, C. (2004). Patterns of individual health insurance coverage, 1996-2000. Health Affairs, 23(6), 210-221.
Coburn, A.F., McBride, T.D., & Ziller, E.C. (2002). Patterns of health insurance coverage among rural and urban children. Medical Care Research and Review, 59(3), 272-292.