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The Forces of Change Survey is an annual survey completed by the state and territorial health agencies that comprise the membership of the Association of State and Territorial Health Officials (ASTHO). ASTHO is the national nonprofit organization representing public health agencies in the United States, the U.S. territories and freely associated states, and the District of Columbia, and the over 100,000 public health professionals these agencies employ. The Forces of Change Survey primarily focuses on emergent and rapidly changing trends. The data collected sought to determine the current climate at state and territorial health agencies as it related to budget, workforce, accreditation, and special interest topics. The 2017 Forces of Change Survey examined the following topics:

• Health agency resources
• Activities related to the Zika virus
• Opioid epidemic response
• Communicating the value of public health
• Efforts to advance health equity

The web-based survey, fielded by ASTHO in May of 2017, was administered to state and territorial health agencies through their senior deputies. A total of 52 health agencies responded (from 46 states, Washington, D.C., and five territories and freely associated states). Data included as part of this collection includes one dataset with 122 variables for 52 cases.

This data collection contains the TrainingFinder Real-time Affiliate Integrated Network (TRAIN) database dictionary and three data files derived from the TRAIN database. A project of the Public Health Foundation, TRAIN (www.train.org) is a comprehensive learning resource for public health professionals, such as epidemiologists, public health officials, health educators, environmental health professionals, social workers, nurses, physicians, emergency responders, and mental health providers. Learners can use TRAIN to search for on-site and distance learning courses, register on-line for courses, provide and view feedback about courses, and create a personal training record of competency-based training and continuing education requirements. Course providers can use TRAIN to publicize courses, manage online registration and student rosters, collect feedback from learners, and post course materials and discussion topics.

Core Competencies for Public Health Professionals is a set of skills, knowledge, and attitudes necessary for the broad practice of public health. Adopted by the Council on Linkages Between Academia and Public Health Practice, this list of competencies was incorporated into TRAIN.

Comprising a small subset of the information in the TRAIN database, the three data files were tailored to facilitate public health systems and services research. The first data file contains demographic information about every registered TRAIN learner: street address, county, city, state, ZIP code, country, education level, gender, race, Hispanic origin, birth date, primary language, and secondary language. The second data file is a tabulation which shows the core competencies covered by each course offered through TRAIN, together with the course titles, expiration dates, and the organizations offering the courses. The last data file is a tabulation which shows the number of TRAIN courses and learners by core competency and professional role.

The TRAIN database dictionary describes all of the variables in the TRAIN database, including those not provided with this data collection.

Obtaining a better understanding of the organizational and operational attributes of public health delivery systems is a critical step in elucidating pathways for improving public health services. This survey of local governmental public health agencies was conducted to that end, as part of a larger study designed to classify the structural characteristics of local public health delivery systems and to examine variation and change in these characteristics over time. In 1998 and again in 2006, 2012, 2014, 2016, 2018, and 2023 local governmental public health agencies serving populations of 100,000 residents or more were surveyed about 20 core public health activities devoted to public health assessment, policy development, and assurance.

For each activity, the survey instrument asked agency directors to report whether the activity was performed at all in the agency's jurisdiction and if so, which types of organizations were involved in performing the activity. Response options for the second item consisted of a pre-defined list of organization types, including hospitals, physician practices, health insurers, community health centers, educational institutions, community-based and faith-based organizations, state and local government agencies, and private businesses/employers. The instrument also asked what proportion of the total community effort for each activity was contributed by the local public health agency and asked how effectively the activity was performed.

Prescription for Health was an initiative funded by the Robert Wood Johnson Foundation in collaboration with the Agency for Healthcare Research and Quality. Under this initiative, primary care practice-based research networks (PBRNs) -- groups of ambulatory practices devoted principally to the primary care of patients -- developed, tested, and evaluated innovative strategies to improve the delivery and effectiveness of health behavior change services in primary care practice. The strategies targeted four health risk behaviors: tobacco use, unhealthy diet, lack of physical activity, and risky alcohol use. Prescription for Health was conducted in two rounds. Round one awarded grants to 17 PBRNs to test the feasibility of implementing the strategies, while round two awarded grants to ten PBRNs to measure the strategies' effectiveness and the expenses associated with them. More than a 100 primary care practices from the ten PBRNs participated in the evaluation.

This data collection comprises the data from one of the data collection efforts carried out by the second round: the responses to the Practice Information Form (PIF), a Web-based instrument which captured key organizational attributes of the participating practices. The PIF data were collected at two time points. Baseline data were collected from each practice before the intervention was implemented and follow-up data were collected approximately one year after the start of the intervention.

Information about the practices collected by the PIF include practice type and ownership; characteristics of each clinician and non-clinician staff person; number of vacancies for clinicians and non clinicians; number of exam rooms and volume of office visits; average number of new patients per month; percentages of patients in various age, race, Hispanic origin, and payer categories; and the predominant type of payment arrangement with health plans. In addition, the PIF asked whether a specific health plan controlled over half of the practice's total business; whether the practice had a pay-for-performance program; whether any payers or organizations publicly reported practice level performance information, such as patient satisfaction, chronic care/disease management, and/or preventive service delivery; and whether practices had a formal process for routinely measuring satisfaction among patients, clinicians, and other staff. The PIF also investigated how practices motivated their clinicians and staff; the level of competition among practices in local markets; the use of computers, electronic medical record systems, and patient registries; major changes that affected each practice's ability to make improvements in patient care; factors that prevented practices from translating the results of research into changes in medical practice; and the use of health risk assessment protocols or questionnaires to identify patients who may benefit from counseling or interventions. Questions about the four Prescription for Health behaviors -- physical activity, healthy eating, smoking cessation, and addressing risky drinking -- asked how practices linked patients to outside resources for each of the four behaviors; how practices used evidence-based guidelines and informed patients about recommendations for the behaviors; and which approaches practices used to support patients ready to engage in a behavior change for each of the behaviors.