Carrie E. Fry (
Sayeh S. Nikpay is an assistant professor in the Department of Health Policy at Vanderbilt University School of Medicine, in Nashville, Tennessee.
Health Aff (Millwood). 2018 Jan;37(1):22-29. doi: 10.1377/hlthaff.2017.1125.
Increasingly, public and private resources are being dedicated to community-based health improvement programs. But evaluations of these programs typically rely on data about process and a pre-post study design without a comparison community. To better determine the association between the implementation of community-based health improvement programs and county-level health outcomes, we used publicly available data for the period 2002-06 to create a propensity-weighted set of controls for conducting multiple regression analyses. We found that the implementation of community-based health improvement programs was associated with a decrease of less than 0.15 percent in the rate of obesity, an even smaller decrease in the proportion of people reporting being in poor or fair health, and a smaller increase in the rate of smoking. None of these changes was significant. Additionally, program counties tended to have younger residents and higher rates of poverty and unemployment than nonprogram counties. These differences could be driving forces behind program implementation. To better evaluate health improvement programs, funders should provide guidance and expertise in measurement, data collection, and analytic strategies at the beginning of program implementation.
越来越多的公共和私人资源被专门用于基于社区的健康改善计划。但是，这些计划的评估通常依赖于关于过程的数据和没有对照社区的前后研究设计。为了更好地确定实施基于社区的健康改善计划与县级健康结果之间的关联，我们使用了 2002-06 年期间的公开可用数据，为进行多项回归分析创建了一组倾向得分加权对照。我们发现，实施基于社区的健康改善计划与肥胖率降低不到 0.15%、报告健康状况不佳或一般的比例甚至更小、吸烟率略有上升有关。这些变化都没有显著意义。此外，与非项目县相比，项目县的居民往往更年轻，贫困率和失业率更高。这些差异可能是计划实施的驱动因素。为了更好地评估健康改善计划，资助者应在计划实施之初就提供测量、数据收集和分析策略方面的指导和专业知识。
