Costs of Implementing Teen Dating Violence and Youth Violence Prevention Strategies: Evidence From 5 CDC-Funded Local Health Departments

OBJECTIVES

In 2016, the Centers for Disease Control and Prevention supported 5 local health departments (LHDs) to implement teen dating violence and youth violence primary prevention strategies across multiple levels of the social-ecological model and build capacity for the expansion of such prevention efforts at the local level. The objective of this study was to estimate the total cost of implementing primary prevention strategies for all LHDs across 3 years of program implementation.

METHODS

We used a microcosting analytic approach to identify resources and compute costs for all prevention strategies implemented by LHDs. We computed the total program cost, total and average cost per strategy by social-ecological model level, and average cost of implementation per participant served by the program. All costs were inflated via the monthly Consumer Price Index and reported in August 2020 dollars.

RESULTS

For 3 years of program implementation, the total estimated cost of implementing teen dating violence and youth violence primary prevention strategies was >$7.1 million across all 5 LHDs. The largest shares of program-related costs were program staff (55.9%-57.0%) and contracts (22.4%-25.5%). Among prevention strategies, the largest share of total costs was for strategies implemented at the community level of the social-ecological model (42.8%).

CONCLUSIONS

The findings from this analysis provide a first look at the total costs of implementing comprehensive teen dating violence and youth violence primary prevention strategies and serve as a foundation for investments in local violence prevention funding for young people.

State health departments leverage pharmacy partnerships across the nation to advance diabetes care initiatives

BACKGROUND

In 2018, the Centers for Disease Control and Prevention (CDC)'s Division of Diabetes Translation (DDT) initiated a five-year cooperative agreement funding opportunity with departments of health in every state and the District of Columbia. The funded recipients pursued activities that strengthened diabetes management and type 2 diabetes prevention interventions within their jurisdictions. An option to involve the pharmacy sector in their diabetes-related interventions was available.

OBJECTIVES

This research aims to understand who public health departments partnered with in the pharmacy sector and identify the types of activities pursued together to expand access to diabetes-related interventions.

METHODS

A review of annual work plans and progress reports submitted to CDC by recipients during the first four years of the funding cycle was conducted. Descriptions of work conducted in partnership with pharmacies, pharmacists, or pharmacy organizations were flagged for review, coding, and analysis.

RESULTS

Of the 51 public health department recipients, 48 collaborated with pharmacy partners within their jurisdictions. Activities were developed and carried out in ways that utilized the pharmacy workforce to support public health diabetes initiatives, such as the development and delivery of diabetes self-management education and support and type 2 diabetes prevention programs in pharmacies (68.8%), delivery of diabetes-related training for the pharmacy workforce (91.7%), and support of billing and sustainability efforts for pharmacy-based diabetes services (52.1%).

CONCLUSION

State public health department diabetes program personnel cultivated productive relationships with a variety of members of the pharmacy workforce. Through these partnerships, they leveraged one another's resources, expertise, and mutual determination to prepare and carry out diabetes-related interventions within their states. This document provides pharmacists and pharmacy decision-makers with foundational knowledge that can lead to increased engagement with public health partners to expand diabetes management and prevention services in pharmacy settings.

Photorhabdus asymbiotica, a pathogen emerging on two continents that proves that there is no substitute for a well-trained clinical microbiologist

A 54-year-old ranch hand presented to the emergency room with an alleged spider bite and multiple abscesses. Both wound and blood cultures grew Photorhabdus asymbiotica, an enteric gram-negative rod that was initially misidentified by the hospital's rapid identification system. Clinical laboratories should be aware of the limitations of their rapid identification systems and always use them as an adjunct to analysis of morphological and phenotypic traits.

Data used to improve quality of health care

Many factors are involved in improving the quality of health care. Using data to measure performance is an essential element. Whether the objective is to improve outcomes (e.g., reducing mortality among patients hospitalized with acute myocardial infarction) or to improve a process of care (e.g., increasing the rate of beta blocker administration at discharge in patients with acute myocardial infarction), data are central to assessing the quality of health care. Data help determine where opportunities for improvement exist and document the impact that system change interventions have made on the outcomes or processes of care for a clinical condition or topic. Measuring performance is critical to learning how your practice compares with best practices. If you haven't measured, you do not know. This article will focus specifically on the role and use of data to improve processes of health care for Medicare beneficiaries. Examples of projects and results are cited from the work of the Texas Medical Foundation, which is the Medicare peer review organization under the Health Care Financing Administration's Health Care Quality Improvement Program.

The microbiota of periodontal pockets with different depths in therapy-resistant periodontitis

This study presents the composition of the cultivable microbiota colonising periodontal pockets of different depths among 2 patient-groups classified as non-responsive (NR-group; 11 participants) or responsive (R-group; 10 participants) to periodontal treatment. Microbiological samples from three types of pocket (< 4 mm deep A-samples; 4-5 mm B-samples; > 5 mm C-samples) were analysed by cultural methods for putative periodontitis pathogens, microbial groups constituting > or = 5% of the total cultivable flora and opportunistic pathogens. Actinomyces naeslundii, A. israelii, Bacteroides forsythus, Fusobacterium spp, Porphyromonas gingivalis, Prevotella intermedia, Peptostreptococcus micros, anaerobic streptococci and facultative anaerobic streptococci were most prevalent. Actinobacillus actinomycetemcomitans, Staphylococcus aureus, enteric rods and yeasts were less prevalent. The periodontitis pathogens Bacteroides forsythus, Fusobacterium spp, Porphyromonas gingivalis, Prevotella intermedia and Peptostreptococcus micros constituted together (on average) < or = 23% of the viable counts in the A- and B-samples of both patient groups and in the C-samples of the R-group. In the C-samples of the NR-group their mean counts were 45%. Correlations were found between smoking habits and the five pathogens in the C-samples and in pooled pocket depth samples. The results show that groups of periodontopathogens should be considered a causal factor in therapy-resistant periodontitis. Further, smoking and deep pockets can enhance a shift in the balance of the subgingival microflora predisposing a site to disease and a susceptible host may be the pre-requisite to therapy-resistant periodontitis.

Aspirin administration for cardiac-related acute chest pain/angina: increased use in Medicare patients

BACKGROUND

Coronary heart disease (CHD), the leading cause of death in the United States, accounted for approximately 490,000 deaths in 1993. Angina pectoris, a manifestation of CHD, accounted for 13,586 Medicare discharges in 1993 in Texas. A pilot project showed aspirin prophylaxis that reduces cardiovascular morbidity and mortality in individuals with acute angina is underused. Texas Medical Foundation collaborated with 10 acute-care facilities to improve aspirin prophylaxis.

METHODS

Collaborators assessed processes of care and implemented clinical pathways to improve aspirin administration. Data were abstracted from medical records before and after pathway implementation to evaluate impact.

RESULTS

Aspirin administration during hospital stay increased 10.8%, aspirin administration on discharge increased 11.7%, and average time from arrival to aspirin administration decreased 2.9 hours.

CONCLUSIONS

Results suggest collaborator-implemented clinical pathways significantly improved care received by Medicare patients admitted for cardiac-related acute chest pain/angina. Data suggest room for further improvement.

Methodology of quality improvement projects for the Texas Medicare population

The Texas Medical Foundation, the quality improvement organization for the state of Texas, develops local quality improvement projects for the Medicare population. These projects are developed as part of the Health Care Quality Improvement Program undertaken by the Health Care Financing Administration. The goal of a local quality improvement project is to collaborate with providers to identify and reduce the incidence of unintentional variations in the delivery of care that negatively impact outcomes. Two factors are critical to the success of a quality improvement project. First, as opposed to peer review that is based on implicit criteria, quality improvement must be based on explicit criteria. These criteria represent key steps in the delivery of care that have been shown to improve outcomes for a specific disease. Second, quality improvement must be performed in partnership with the health care community. As such, the health care community must play an integral role in the design and evaluation of a quality improvement project and in the design and implementation of the resulting quality improvement plan. Specifically, this article provides a historical perspective for the transition from peer review to quality improvement. It discusses key steps used in developing and implementing local quality improvement projects including topic selection, quality indicator development, collaborator recruitment, and measurement of performance/improvement. Two Texas Medical Foundation projects are described to highlight the current methodology and to illustrate the impact of quality improvement projects.