Assessing Targeted Funding to State Health Departments: Can Federal Funding Develop Capacity for the Prevention of Healthcare-associated Infections? Open Access

Abstract

Background

Healthcare-associated infections (HAIs) contribute to increased morbidity, mortality and
healthcare costs in the United States and recently have gained attention as a national public
health threat. A call to action has been issued by federal agencies to encourage incentives,
research, surveillance, and the employment of evidence-based practices to forward progress
towards the elimination of HAIs. Federal initiatives, including a Department of Health and
Human Services action plan, Center for Medicare and Medicaid Service pay for performance
incentives, and the American Recovery and Reinvestment Act (ARRA) funding to state health
departments have supported an atmosphere of HAI awareness, surveillance, and prevention. To
improve HAI prevention capacity, valid surveillance must be conducted to monitor ongoing rates
and successes of prevention programs.

Methods
This project evaluates the HAI prevention capacity developed in the first year of ARRA funding
at the state health department. Factor analysis is used to determine state health department
characteristics before the receipt of ARRA funding that constitutes baseline capacity for HAI
prevention. Descriptive statistics are used to quantify successes and barriers for each of the three
targeted funding areas: Infrastructure, Surveillance, and Prevention Collaboratives. Finally,
longitudinal mixed effects models are used to monitor state and national trends in participation in
the National Healthcare Safety Network (NHSN).

Results
A factor analysis of capacity indicators extracted from state funding application materials
revealed three distinct factors characterizing baseline HAI prevention capacity: Human Capital
and Expertise, Campaigns and Trainings, and Collaborative Efforts. States receiving ARRA
funding met programmatic goals in year one for all three targeted funding areas; however, all
states reported barriers to implementation of activities. Longitudinal modeling of NHSN
participation for facilities reporting CLABSIs in their ICUs in states without reporting mandates
showed significant increases in rates of participation during the ARRA time period for states
funded to improve surveillance capabilities.

Conclusions
Targeted federal funding appeared to successfully achieve programmatic year one goals for the
development of state health department capacity for the prevention of HAIs. Future work should
focus on continued programmatic success, as well as attempt to quantify outcomes such as
infections prevented, deaths averted, and costs saved.

Table of Contents

Table of Contents

Introduction…………………………………………………………..……………………..……1
Statement of Research Questions……………………….……....…..……….….17
Methods………………………………………………………………………..…..………..…….18
Data Sources………………………………………………………………..…..…….……..18
Analysis……………………………………………………………………….......…….……..21
Descriptive Statistics…………………………………………………..…………….……21
Factor Analysis………………………………………………………….......………………21
NHSN Participation Denominator……………………………….…...…...…………23
Piece-wise Linear Modeling…………………………………………..……...…………24
Longitudinal Modeling………………………………………….……....……...………..26
Inference for the Mixed Effects Model………………………………….…………28
Longitudinal Modeling of Enrollment Rates…………………….………….…….29
Results…………………………………………………………………………...…….…………..30
Baseline………………………………………………………...…………..…….………..…..31
Year One…………………………………………………….…..…………..….………......33
Infrastructure ………………………………………………..………..……..…………...34
Surveillance…………………………………………………..………………..…...….…..35
Prevention Collaboratives……………………………….…….……………...……….37
Factor Analyses…………………………………………………….……………..…….....39
NHSN Denominator……………………………………………….……..…….…………...41
Piece-wise Linear Regression Models……………………………………………...42
Mixed Effects Models……………………………….………………………....………...44
Inference for the Mixed Effects Model……………….…..…..…....………….47
Discussion……………………………………………….………………..…….……..………...48
Limitations…………………………………………………....………………………………..54
Future Work…………………………………………………....……………………………….56
Tables and Figures…………………………………………………………….……..……...60
Appendix One………………………………….…..……………………..……...….…......89
References………………………………..…………………………..…….…..……..….....91

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Biostatistics and Bioinformatics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Biology, Biostatistics Health Sciences, Public Health
Keyword	Prevention Capacity National Healthcare Safety Network State Health Department American Recovery and Reinvestment Act Healthcare-associated Infections Mixed Effects Models
Committee Chair / Thesis Advisor	Johnson, Brent, Emory University
Committee Members	Cochran, Ronda, CDC
Partnering Agencies	CDC

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