Beth E. Quill

Demonstrating excellence in practice-based research for public health

This document explores the opportunity for scholarship to enhance the evidence base for academic public health practice and practice-based research. Demonstrating Excellence in Practice-Based Research for Public Health defines practice-based research; describes its various approaches, models, and methods; explores ways to overcome its challenges; and recommends actions for its stakeholders in both academic and practice communities. It is hoped that this document will lead to new partnership opportunities between public health researchers and public health practitioners to strengthen the infrastructure of public health and add new dimensions to the science of public health practice. Demonstrating Excellence in Practice-Based Research for Public Health is intended for those who produce, participate in, and use practice-based research. This includes academic researchers and educators, public health administrators and field staff, clinical health professionals, community-based organizations and professionals, and interested members of the public.

Demonstrating excellence in practice-based teaching for public health.

Demonstrating Excellence in Practice-based Teaching for Public Health is a report intended to provide a resource for practice-based teaching of public health and includes a brief explanation of terms and practices, as well as suggestions on methodologies for implementation. No comparable resource currently exists that assists faculty and practice partners to recognize, implement, and promote practice-based teaching. This article summarizes findings from the report, including an explanation of practice-based teaching, its guiding principles, practical approaches, and recommendations on sustaining and advancing partnerships for professional public health education and training.

Ethical Issues in Conducting Migrant Farmworker Studies

Migrant farmworkers should be considered a vulnerable population because they work in a hazardous industry, are often members of an ethnic minority, have known difficulty in accessing health care, and are often of lower socioeconomic status. For these reasons, too, it is extremely important to conduct health-related research with this often-underserved group. However, because migrant farmworkers are vulnerable, investigators must be especially vigilant in protecting them from the potential harms of research and in ensuring that the special ethical issues that arise in research with this population are identified and addressed for every project. In response to the National Cancer Institutes concerns about the feasibility of conducting epidemiologic studies among migrant farmworkers, researchers undertook four feasibility studies near the Texas-Mexico border. Each study raised different, complex ethical questions that challenged the investigators, but whose resolution turned out to be crucial to the success of the studies.

Clinical, sociodemographic, and local system factors associated with a hospital death among cancer patients

ObjectiveThe study was conducted to examine factors associated with hospital deaths among a group of cancer patients.Patients and methodsA retrospective chart review of the M. D. Anderson Cancer Center Tumor Registry was conducted. Participants were all adult cancer patients, residents of the State of Texas diagnosed and treated since January 1, 1990, and who died during the years 1999 and 2000. The study outcome was the site of death.Main resultsThe inclusion criteria were met by 866 patients of whom 504 (58%) died in a hospital. The group included 489 (56%) men. A number of 641 (74%) were White, 104 (12%) Hispanic, 92 (11%) Black, and 29 (3%) of other origin. The majority, 501 (58%), had been diagnosed with stage IV disease, and the median survival time was 14 months. Multivariate logistic regression analysis showed patients diagnosed with hematologic cancers to be significantly more likely (p<0.001) of dying in hospitals, odds ratio [OR 2.88] and confidence interval [95% CI 1.79–4.63], women diagnosed with breast and gynecological cancers were significantly less likely (p=0.03) of dying at hospitals odds ratio [OR 0.64] and confidence interval [95% CI 0.42–0.96], when compared with patients diagnosed with other cancers. Lower household income per zip code of residency was marginally associated (p=0.06) with hospital deaths.ConclusionsThe study identified groups of cancer patients at risk of hospital death. These results should account when planning the allocation of hospital palliative care services as well as when informing policy decisions about health care financing and delivery of these services.

Education for the public health profession: a new look at the Roemer proposal.

Demands for a high level of professionalism in public health practice, and concomitant strengthening of public health education to match 21st-century community challenges provide an opportunity to reconsider the current paradigm for professional degrees in public health. In this article, we consider whether the currently typical public health education meets the requirements of a professional education, examine the current state of public health education, and provide a rationale for renewed emphasis on the doctor of public health (DrPH) degree. We also present one potential three-year DrPH curriculum to stimulate further discussion, while acknowledging the multiple challenges that face any school of public health moving to implement such an education.

Professionalism and ethics in the public health curriculum.

As the publics health-care needs increase in complexity, renewed attention is being given to the ethical dimensions of public health decision-making and the development of public health ethics as a bounded area of teaching and research. This article provides an overview of approaches to public health ethics and decision-making, and suggests ways to incorporate the professionalism competencies into the teaching of public health practice. The teaching of ethics language, concepts, and tools for decision analysis helps to prepare students for the inevitable ethical choices they will have to make in their professional practice. The teaching of ethics and professionalism and the experiences of professionals enrich each other and foster the critical link between education and practice.

On academics: perspectives on the future of academic public health practice.

The Center for Public Health Practice at the University of Pittsburgh’s Graduate School of Public Health started in 1995, simultaneously with similar units at virtually every other Association of Schools of Public Health (ASPH) member school of the mid-1990s. It was a time when the academic public health community, motivated by the Institute of Medicine’s 1988 report,1 was attending seriously to the quality and dimensions of its relationships with the professionals, agencies, and organizations that made up the field of public health practice. Of the then 28 fully accredited schools of public health, all were conducting continuing education programs, student internships and practica, and faculty members’ consultation services to the field.2 However, at that same time, academic approaches to meeting the needs of research, teaching, and service for professional practice were not very deeply institutionalized. Institutional funding for practice activities was rare; and, most often, such activities were left to the discretion of individual faculty members.2 A high degree of variability in emphasis on professional practice existed among schools and among departments within schools. For example, well into the late 1990s, not all schools had been assessed for adherence to a new accreditation criterion requiring that students in the curricula of every master’s degree in public health (MPH) have a directed practice experience.3 By 2005, much had changed. By then, the ASPH Council of Practice Coordinators had advanced standards for academic public health practice (APHP), defining it as the applied, interdisciplinary pursuit of scholarship in the field of public health.4 The Council had also written about practice-based teaching5 and practice-based research.6 In 2005, deans of schools of public health recognized the centrality of practice to their schools’ missions by organizing a Practice Committee within the ASPH governing structure. Much of the early vision for practice-oriented scholarship had been realized, and it was time to pause and reflect. In October of 2005, the University of Pittsburgh’s On Academics Center for Public Health Practice (CPHP) celebrated its 10th anniversary by hosting a one-day symposium titled “Perspectives on Transforming the Field of Academic Public Health Practice.” The goals of the symposium were to: (1) reflect upon the history of academic public health practice; (2) identify the successes, experiences, considerations, and perspectives related to APHP; and (3) recommend ways of transforming it. The presenters were outstanding scholar-practitioners whose experience spanned national to local practice and whose affiliations included government as well as academia. This article is a synthesis of the themes and ideas that emerged throughout the symposium.