Name: Scott H.

Frank, MD, MS
Affiliation: Case Western Reserve University
Presentation Title: Early Experience with the
Ohio Practice Based Research Network
Meeting: Preventive Medicine 2011
Held by: American College of Preventive
Medicine
Date: 02/17/11
Place: Grand Hyatt San Antonio, TX
Early Experience with the
Ohio Practice Based
Research Network
Scott Frank, MD, MS
Director, Master of Public Health Program
Case Western Reserve University School of
Medicine
Director, Shaker Heights Health Department
Learning Objectives
Describe the structure and approach of
the Ohio public health practice based
research network
List early efforts at public health PBRN
research in Ohio
Discuss lessons from practical application
of the PBRN approach in public health
The Ohio PBRN Experience
Second Cohort
Based in the Case Western Reserve
University MPH Program
PBRN History and Shared PBRN Resource
Center
Connection to the Prevention Research Center for
Healthy Neighborhoods
Connection to CWRU Clinical and Translational
Science Collaborative
Co-PIs both based in public health practice
and academic public health
RAPHI Partners
Ohio local health departments (128 in 88 counties)
All Ohio academic public health programs (7)
CWRU, NEOUCM-P, OSU, University of Cincinnati,
Wright State University, Northwest Consortium, Kent
State University
The Ohio Department of Health
The Ohio Public Health Partnership (5)
Association of Ohio Health Commissioners, Ohio
Public Health Association, Ohio Environmental Health
Association, Ohio Society of Public Health Educators,
Ohio Association of Boards of Health
Motivating & Recruiting
Involvement
Many hands make light work
Research questions are initiated from the passion
of the public health practice community
Need to demonstrate the value and worth of local
public health
Need to understand what works and what doesnt
Need to identify and disseminate best practices in
Ohio health departments
Opportunity to build closer partnerships
Funding uniquely available through RAPHI to
address Ohio public health priorities
RAPHI Process
Monthly meetings of the Executive Committee
2 PIs
Project Coordinator
LHD Representative
Academic Representative
Ohio Department of Health Representative
Ohio Public Health Partnership Representative
Monthly Meetings of the Committee of the Whole
Monthly Meetings with the National Coordinating
Committee
Regular meetings related to specific projects

Current Projects
Investigating the Use of Public Health
Information Technology in Local Health
Departments
Variation in Enforcement of the Ohio Smoke
Free Work Place Act by Local Health
Departments
Direct Observation of Local Public Health:
The Role of the Local Health Department in
Prevention, Investigation, and Intervention
with Foodborne Illness
Proposed Projects
Assessing the Process and Outcomes of a QI
Project Initiated by Public Health Nurses
A multistate Quick-Strike PBRN project
The Local Ohio Public Health Law Database:
A Resource to Enhance the Health of All
Ohioans
Submitted to the Ohio State Bar Foundation
A Partnership between Public Health and
Primary Care PBRNs: Using the Electronic
Health Record to Strengthen the Relationship
between Public Health and Medicine
Submitted to CWRU CTSA
Public Health Information
Technology
Purpose: Investigate the current state of
PHIT in Ohio local health departments
(LHD), including
current capacity
current applications
perceived needs
perceived value
best PHIT practices
receptivity to an expanded role for PHIT
Enforcement of the Ohio
Smoke-Free Work Place Act
Objective 1: Determine barriers,
incentives, practice patterns, and opinions
among the PH workforce involved in
enforcement.
Objective 2: Identify differences in these
factors across rural/suburban/urban
jurisdictions, PH agency factors, levels of
employment and their associations
Enforcement of the Ohio
Smoke-Free Work Place Act
Data: Focus groups and phone interviews
at executive and direct enforcement
(E/DE) levels were used to collect
comments on enforcement practice
Critical issues were identified to develop
an online survey (currently in field) that
targets the statewide PH workforce
Enforcement of the Ohio
Smoke-Free Work Place Act
Focus Group Results
Agencies use registered sanitarians, health
educators and contracted inspectors for
enforcement.
Worker safety spurred practice change.
State reimbursement for timely and appropriately
documented enforcement can often determine
whether agencies enforce or opt out, leaving
enforcement to the State PH agency.
Public health workers generally believe most
businesses adapted easily.
Few agencies recover enforcement costs.
Food and business inspections are seen as
priorities.
Direct Observation of Local Public
Health
Lack of credible evidence regarding the
types and levels of workforce,
infrastructure, related resources, and
financial investments in public health limit
elaboration of a rational approach to
changing the public health system in the
face of health reform.
Direct Observation of Local Public
Health
Purpose: Using the Foodborne Illness as a
public health archetype, the Direct
Observation of Local Public Health
(DOLPH) study will seek to illuminate the
Black Box of public health practice
structure, process, and outcome of the
local health department (LHD) role in
Foodborne Illness prevention,
investigation, and intervention.
Direct Observation of Local Public
Health
Insights from the Direct
Observation of Primary Care
Study
Suggested Implications for
Public Health Research
Conduct research from a
generalist perspective
Conduct research from a public
health practice perspective
Involve clinicians and office staff
from community practices
Involve public health practitioners
and office staff from local health
departments
Commit to a transdisciplinary
team
Commit to a transdisciplinary
research team, given the
transdisciplinary nature of public
health practice
Use a multimethod research
approach
Use a multimethod research
approach
Remain open to emerging ideas
and insights
Remain open to emerging ideas
and insights
Think big, but start small Think big, but start small
Direct Observation of Local Public
Health
DOLPH will implement a direct observation
methodology utilized to build a foundation of
knowledge about primary care practice.
This multimethod assessment process (MAP) will be
used to understand the complex reality of public health
practice through a comparative case study design
integrating epidemiologic approaches with qualitative
methods.
Direct observations will be performed by trained
student observers from all 7 Ohio academic public
health programs and sample of 30 diverse LHDs.
DOLPH measures will be developed from established
practice standards for Foodborne Illness.
Ohio RAPHI Summary
Many hands have made light work
Research questions have been initiated from the
passion of the public health practice community
We have an opportunity to demonstrate the value
and worth of local public health
We have an opportunity to investigate what works
and what doesnt
We are identifying best practices in Ohio health
departments
We have built closer partnerships
We have found funding uniquely available through
RAPHI to address Ohio public health priorities