Suppt B_Understanding Changes to Local Health Department Clinical Service Provision

Understanding Changes to Local Health Department Clinical Service
Provision
ASPE Generic Information Collection Request
OMB No. 0990-0421

Supporting Statement – Section B

Submitted: October 13, 2015

Program Official/Project Officer

Program Official/Project Officer
Amanda Cash
Senior Health Policy Analyst
U.S. Department of Health and Human Services
Office of the Assistant Secretary for Planning and Evaluation
200 Independence Avenue SW, Washington DC 20201
202.260.0362
Amanda.Cash@hhs.gov

Section B – Data Collection Procedures
1. Respondent Universe and Sampling Methods
This is an exploratory study in which we are trying to learn about effective mechanisms for
monitoring changes to local health department (LHD) clinical service delivery. The data we
collect will be used to potentially inform the design of questions in order monitor changes
over time.
This project proposes to use a positive deviance approach to identify and learn from those
LHDs who have been able to continue providing clinical services in a changing environment.
We aim to examine where supply of clinical services delivered by LHDs are meeting
potential demand for these services. Our sample will be derived from the universe of
county-level local health departments. This will include all local health departments in the
country that serve a single county (excluding multi-county jurisdictions). We will use
quantitative analysis to identify positive deviants, defined as local health department
jurisdictions that provide clinical services to the community, particularly in communities
where there are few other clinical providers. We do not know how many positive deviants
(PDs) will be identified; however, it is likely that there will be more PDs than we are able to
interview. As such, we will identify the interview participants by stratifying PDs by
contextual factors as outlined above in order to get as varied a sample of interviewees as
possible. We anticipate a sample of 30-40 LHDs to be targeted for interviews.
2. Procedures for the Collection of Information
We have developed a telephone interview protocol (not more than 1 hour in length) that
focuses on the following topics: types of services provided, changes in service provisions
over the past 5 years, LHD funding sources, changes in funding over the past 5 years,
interactions with payers (Medicaid, private payers, etc.), and challenges to service
provisions and reimbursement, among other topics.

3. Methods to Maximize Response Rates Deal with Nonresponse
We will recruit participants via email and follow up phone calls to non-respondents.
Additionally, because we will have more positive deviants than we are able to interview, we
will reach out to additional LHDs if the first contacts are non responsive.
4. Test of Procedures or Methods to be Undertaken
We will pilot the interview protocol before interviewing LHD staff; however, the study is
exploratory. Feedback from the key informants identified through the positive deviance
approach will help ASPE and HHS determine if there are questions we can ask to monitor
changes in local health department clinical service delivery.

5. Individuals Consulted on Statistical Aspects and Individuals Collecting and/or
Analyzing Data

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Dr. Nathan Hale and Dr. Tamar Klaiman are experts in analyzing data related to local health
departments and the use of positive deviance methodology and qualitative methods. They
have also consulted with federal staff who have expertise in this area.

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