Prevention Research Center, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis 1 Brookings Dr, St. Louis, MO, 63130, USA.
BMC Public Health. 2021 Jan 28;21(1):101. doi: 10.1186/s12889-020-10101-z.
Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones.
A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman's correlation and multinomial logistic regression were used to assess factors in mis-implementation.
Half (50.7%) of respondents were chronic disease program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40).
The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.
在美国，通过应用现有知识，可以预防很大一部分疾病负担。州级公共卫生从业人员处于影响与慢性病相关的项目和政策的理想位置，但这些项目中发生的执行不当的程度在很大程度上是未知的。执行不当是指过早结束有效的项目和政策，或继续执行无效的项目和政策。
2018 年，州卫生部门报告了一项全面调查，评估了执行不当的程度以及对执行不当的多层次影响。问题是从以前的文献中开发出来的。调查通过电子邮件发送给美国各地随机选择的州卫生部门员工。使用 Spearman 相关系数和多项逻辑回归来评估执行不当的因素。
一半（50.7%）的受访者是慢性病项目经理或单位主任。49%的人报告说，他们所在的州卫生部门监督的项目有时、经常或总是继续执行无效的项目。超过 50%的人还报告说，他们所在的州卫生部门有时或经常终止有效的项目。数据表明，执行不当的最强相关因素和预测因素是在组织层面。例如，组织层次的数量阻碍决策，对继续执行无效项目（OR=4.70；95%CI=2.20，10.04）和终止有效项目（OR=3.23；95%CI=1.61，7.40）都有显著影响。
数据表明，改变某些机构的做法可能有助于最大限度地减少执行不当的发生。进一步的研究应侧重于为这些问题增加背景，并帮助机构进行适当的决策。更多地关注执行不当问题将导致更有效地利用有效干预措施和更有效地利用资源，最终改善健康结果。
