Assessing the Public Health System in Delaware

Assessment Results

Essential Public Health Service # 10:
Research for New Insights and Innovative Solutions to Health Problems

On December 20, 2006, an Assessment Team including representatives from the Division of Public Health (DPH), Henrietta Johnson Medical Center, Delaware Healthcare Commission, University of Delaware, Delaware Valley Outcomes Research, and Nemours completed the National Public Health Performance Standards (NPHPS) instrument on Essential Service # 10: Research for New Insights and Innovative Solutions to Health Problems. This essential service model standard includes a state public health system that:

1. identifies and contributes to research activities that aid in the implementation of all the essential public health services,
2. links with research institutions and institutions of higher learning, and
3. assists partners with the interpretation of research.

The Assessment Team examined four indicator categories for the essential service:

1. planning and implementation;
2. technical assistance and support;
3. evaluation and quality improvement; and
4. resources.

The team identified strengths and gaps in Delaware’s public health system performance of these indicator areas.

The Assessment Team rated the Delaware public health system as having partially met the model standard in the area of evaluation/quality control and resources. Within evaluation/quality control, Delaware does an excellent job utilizing findings from reviews to improve research activities. Delaware partners, who conduct research, manage current research resources well and invest resources in analytical tools necessary to support research functions.

The Team identified noticeable gaps in planning/implementation and technical assistance/support. Gaps included:

1. a fragmented public health research agenda
2. no statewide communication process for sharing research findings, and
3. there is little help provided for research activities or assisting in use of the research findings.

Evaluation of the Assessment Process:

The overall evaluation results indicated that participants felt that it was beneficial to assess this essential service. The introduction and the background provided for the process were good. Scoring on a number of the instrument questions varied widely. Some questions were difficult to interpret and there was not sufficient time to fully discuss. Time was also limited in terms of sharing insights and suggestions for immediate improvement opportunities.

Sharing of “Take Away” Thoughts

The sharing of “take away” thoughts by the assessment team always provides good feedback. One participant felt this was a good process and the discussion emphasized the importance of collaboration and determining common areas of need. Bringing people together to share expertise represents the first steps toward real collaboration in this area. Another participant said it is important to take a hard look at infrastructure and how other states are managing research allocations. He was part of the statewide health agenda as a member of the Healthy Delaware 2010 consortium and knows the importance of follow through and support. Another member noted that the value will be in the outcome and follow-up and this assessment was a good start. Not knowing what is going on in all the research pieces is problematic. If partners knew what was happening, there would be interest in and opportunity for collaboration, assistance, and funding. The discussion led one member to say that we should link with people doing research and think in terms of research questions to ask regarding services provided. Then look at what interventions could be applied for preventive measures. Since this is the final essential service to be assessed, one of the Core team participants voiced hope that we can turn what we have learned into a path forward and observed that the process itself has helped partners work as a system versus working as a part of a system. There was also recognition that the scores were not important per se, and although participants have struggled with what they do not know, the knowledge gained has established a baseline for improvement.

Priority List

Each member of the assessment team was asked to vote on a scale of 1 - 10 on the importance and priority of each of the four indicator categories with 10 being the highest priority. Below are the indicator areas with the priority scores and a summary of strengths (in italic) and gaps (in bold ) that were identified in the Delaware public health system.

10.1 Planning and Implementation (priority rank: 9)

• The University of Delaware has a long relationship with DPH and the Health Care Commission.
• Survey research looks at all of Delaware’s population.
• We have the pieces to be able to research for health improvements.
• We have examples of research used in the field.
• We do some market research.
• We use the Healthy Delaware 2010 as a plan.
• At one time, Christiana was working on pulling together key groups to develop a research agenda.
• Research is not a set process – each research group does their own thing.
• There is no established research agenda – Delaware is often reactionary; we may do research because it is on the Governor’s agenda, or a specific area.
• It is hard to tell what the next “hot” topic will be.
• Delaware does not have a collaborative research agenda.
• Research is frustrating at times – struggling with causes to address.

10.2 Technical Assistance/Support (priority rank: 7)

• There is a lot of collaboration among partners.
• When collaboration does occur, it includes interpretation.
• Collaboration with state entities and non-profits is sometimes lacking.
• Entities do not work together as a system.
• We do research but it does not always get to the people who need it.

10.3 Evaluation/Quality Improvement (priority rank: 8)

• Everyone who conducts research seeks to improve their research.
• To the extent that research occurs, it will tend to be limited and may not be system wide.
• Delaware dropped the CAPS (consumer survey) program.
• There are gaps in discharge registry data and limitations in the hospital discharge data – more and more health services are delivered outside the hospital.
• Research is more individual focused than population focused.

10.4 Resources (priority rank: 10)

• A function of Public Health is to provide data for research.
• DHIN was implemented as an information exchange.
• Delaware lacks the infrastructure to support the research initiatives.
• Resources that are available are not very well managed.
• It is difficult to pull people together to do even one topic research area.
• There is no real repository of research findings.
• The University needs to go where the money is.
• There is limited staff in programs and there is a lack of dedicated structure, i.e. don’t have critical mass.
• IT systems don’t always communicate.
• So much data, but don’t know where to find it.

Next Steps:

Participants mentioned several steps that should be taken:

• Access to the information would be beneficial.
• Have follow-up forums with same or similar group to come together monthly or quarterly for 6-12 months to discuss how to move key recommendations to fruition.
• Look at adequacy of state public health infrastructure. Would like to see “agenda setting” committee that takes a truly statewide perspective.

The original planning committee and assessment Core Team will meet in January to review the assessment process and determine the next steps toward improving the Delaware public health system.

• Go back to 2006 Assessment Meetings and Summaries

Last Updated: Wednesday January 10 2007