by Jill Rosenthal and Manel Kappagoda of ChangeLab Solutions
The United States ranked 15th among affluent countries in life expectancy in 1980. By 2009, it had dropped to 27th place. Our fragmented health care delivery and public health systems, and the lack of coordination between the two, has resulted in an imbalance of high health spending and poor health outcomes.
A recent report by the Robert Wood Johnson Foundation’s Commission to Build a Healthier America, confirms what we already know: dramatically changing these statistics requires a combined approach that comprises investment in health care delivery and expanding “our focus to address how to stay healthy in the first place.”
This report, developed by the National Academy for State Health Policy and produced by ChangeLab Solutions, highlights leading states’ approaches to support community-based prevention initiatives by bridging the health care delivery and public health systems. It examines various mechanisms – both previously existing and created through health reform – that states can leverage to implement sustainable community-based prevention programs. They include Medicaid waivers, federal grants, accountable care and medical home models, pooled funding, and new federal requirements for nonprofit hospitals. The report includes opportunities and lessons from featured states (California, Maryland, Massachusetts, Minnesota, North Carolina, Oregon, Texas, and Vermont).
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States can make important strides in eradicating cervical cancer deaths. This report features promising state and federally qualified health center policies that support high performance in cervical cancer screening within the context of the medical home. Drawing from Colorado, Maine, Maryland, New York, Texas, Vermont, and Virginia, this report summarizes innovative programs, practices, and partnerships that facilitate improvement in cervical cancer screening. Experiences in these states offer examples for adoption by others to ensure high-quality preventive care for women. This publication was made possible through the support of the Health Resources and Services Administration.
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This report provides practical information that states and community groups can use to develop evaluation components for community-based projects that focus on children’s health promotion. Through an examination of seven representative projects, the report offers examples and lessons learned related to various aspects of evaluation, among them: design, process and partnerships, outcomes, and dissemination.
Programs may need to address underlying tensions that may exist between program administrators and evaluators when trying to determine the balance between the community’s interest in evaluation and the evaluator and funders’ concerns with rigorous evaluation methodologies. Being clear about the purpose of the evaluation, listening to stakeholder needs, and designing well-constructed evaluations can alleviate some of these concerns.