PHAST receives funding from the de Beaumont Foundation and the US Department of Health and Human Services Office of Minority Health.

PHAST supports Public Health Systems and Services Research (PHSSR), a field of study that examines the organization, financing, and delivery of public health services and the impact of these services on population health.

You can read about our previous grant-funded work on this page. Follow the links to the right to learn more about PHAST findings.


Completed Projects

User-centered design of data visualizations for public health practice to promote equity in rural populations
Principal Investigator: B. Bekemeier

Sponsor: University of Washington School of Nursing Office for Nursing Research (7/1/2019 - 6/30/2021)

The purpose of the grant was to learn about the needs and preferences of data dashboards among local public health professionals.  Our team conducted 10 focus groups with public health professionals to determine their use, needs, and preferences for using data and visualizations.

Developing a Uniform Chart of Accounts
Principal Investigator: B. Bekemeier
Principal Investigator: S. Singh

Sponsor: RWJF #75301 (3/15/2018 - 3/14/2020)

There are almost as many accounting systems as there are state and local public health departments.  In order to compare and evaluate spending across agencies and to estimate program and unit costs, a standard way of recording these data is essential.  The overall goal for the second phase of PHAST’s uniform COA efforts is to advance the adoption and use of the uniform COA crosswalk by public health agencies across the United States, focusing specifically on local health departments (LHDs).

Building a Sustainable Model for Advancing Standardized Public Health Services Measures
Principal Investigator: B. Bekemeier

Sponsor: RWJF #73270 (1/15/2016 – 01/14/2018)

This project worked towards adoption and integration of a uniform set of standardized preventive service measures that depict local public health activity in multiple state systems. The PHAST team also developed an interactive dashboard to encourage adoption of the standardized Measures.

Developing a Uniform Chart of Accounts
Principal Investigator: B. Bekemeier
J. Marlowe, Co-Investigator

Sponsor: RWJF #73187 (12/15/2015 – 03/14/2017)

There are almost as many accounting systems as there are state and local public health departments.  In order to compare and evaluate spending across agencies and to estimate program and unit costs, a standard way of recording these data is essential.  Extending the work begun by the Public Health Informatics Institute (PHII) and the Foundational Public Health Services (FPHS), PHAST determined the feasibility of implementing a uniform chart of accounts (COA) to track public health expenditures and revenue in local and state health departments.

Inter-Organizational Collaboration in Local Public Health Systems: Implications for Costs, Impact, and Management Capacity
Principal Investigator: J. Marlowe
B. Bekemeier, Co-Investigator

Sponsor: RWJF #72055 (8/15/14 – 8/14/16)

This study examined the following question: Does cross-jurisdictional sharing (CJS) influence the volume, intensity, and unit costs of services delivered by local health districts (LHDs)? Conventional wisdom suggests cross-jurisdictional sharing among LHDs can improve service quality and cost (Madmala, et. al. 2014). In concept, CJS can drive down costs by spreading overhead and indirect costs through joint purchases of capital equipment, cooperating on regional education and outreach efforts, or sharing staff, among other tactics. Moreover, CJS can promote information sharing and policy coordination among LHD staff and boards, thus encouraging adoption of evidence-based practice and ultimately improving service quality and reach. Prior to this study, these assertions were virtually untested. The Public Health (PH) Practice Based Research Networks (PBRNs) of New York (NY), Washington (WA), and Wisconsin (WI) participated in this research.

Making Data accessible for Public Health Decision-Making in Washington
Principal Investigator: B. Bekemeier

Sponsor: Research & Intramural Funding Program, UW School of Nursing (4/1/2014 – 3/31/2015)

Local Health Department (LHD) leaders face difficulty when attempting to use existing data as evidence for decision-making. This project made detailed, annual LHD service and financial data accessible to Washington (WA) public health leaders in a meaningful form for decision-making. A sample of leaders from WA LHDs participated in an iterative process integrating practitioner feedback with subsequent visualization designs to make meaningful data more accessible.

Studying Local Health Departments with Positive Deviant Outcomes for Maternal and Child Health to Improve Public Health Practice
Principal Investigator: T. Klaiman
B. Bekemeier, Co-Investigator

Sponsor: RWJF #71595 (1/14 – 1/16)

This study used a mixed-methods, positive deviance approach to learn from local health departments (LHDs) that have better than expected maternal and child health (MCH) outcomes compared to their peers. Through working with existing quantitative data from the PHAST database of LHD inputs and outcomes, a qualitative component was used with identified “positive deviant” LHDs to help understand not only WHAT is happening in local public health practice, but WHY LHDs have achieved better than expected outcomes. Results are reported in BMC Public Health.

Developing a National System to Support Public Health Activities and Services Tracking—The PHAST Study
Principal Investigator: B. Bekemeier

Sponsor: RWJF #71472 (12/15/2013 – 12/14/2015)

The lack of detailed, accessible public health system data in a useable form has hampered the generation of evidence for public health practice and evidence-based decision-making. To satisfy the need for a system to track the output, reach, and impact public health services and activities have on the populations they serve, this project continued work toward a national set of standardized measures of public health service activity. The project built on the Multi-Network Practice and Outcome Variation Examination (MPROVE) study, working with health officials from a wide range of states to establish the prospective collection of MPROVE measures. Ultimately a multi-year, multi-state panel dataset of standardized MPROVE service measures will be available for rigorous research and for policy and practice-based decision-making.

Costs and Cost-drivers of Providing Foundational Public Health Services in Washington State and Relationships with Structural and Community Factors
Principal Investigator: B. Bekemeier
J. Marlowe, Co-Investigator

Sponsor: RWJF #7113 (7/15/2013 – 1/14/2015)

Despite national efforts in the past decade to advance public health system performance in the U.S., communities are not equitably served by a core capacity for health promotion and protection. In this study of costs and cost drivers, Washington's Public Health Practice-Based Research Network established a unit of cost for providing each of 12 foundational public health services and capabilities. Knowledge gaps regarding factors that influence effective and equitable service delivery were addressed as well.

Descriptive Analysis of Local Public Health System Funding in Washington State
Principal Investigator: B. Bekemeier

Sponsor: Washington State Department of Health (DOH) # N20482 and #A80123 (11/1/2012 – 3/31/2012, renewed 10/1/2013 – 6/30/2014)

This project built on the PHAST database, data processing, and data analysis methods developed since January 2010. The PHAST team worked closely with the Washington Department of Health to produce a comprehensive overview of local public health funding from 1993 to 2011. Descriptive analyses focused on identifying trends in expenditures, funding sources, and variations in per capita expenditures across local health jurisdictions. This work supported the Washington Public Health Improvement Partnership’s analyses of funding availability and needs with respect to providing Foundational Public Health Services.

Washington Practices and Outcomes Variation Study (WPROV Study)
Principal Investigator: B. Kling
B. Bekemeier, Co-Investigator

Sponsor: RWJF # 69953 (4/15/2012 – 10/14/2013)

The WPROV Study helped advance Washington’s (WA) research and measurement efforts, while also bringing WA’s public health system measurement experiences and assets to the multi-state MPROVE project led by Glen Mays and the National Coordinating Center for Public Health Practice-Based Research Networks. The study team served as an effective partner in the development and implementation of the measures for the multi-state MPROVE Project and to improve WA’s public health system measurement efforts through the refinement and expansion of specific local health department service measures and the related data collected across agencies in WA.

Assessing Effectiveness of Public Health Services in Population Health and Reducing Health Disparities
Principal Investigator: B. Bekemeier

Sponsor: RWJF #69688 (12/1/2011 – 5/31/2014)

The 2008-09 economic recession dramatically reduced the resources available to local health departments (LHDs), allowing a “natural experiment” for examining relationships between changes in expenditures and changes in population proximal health outcomes. This study used LHD expenditure data for well-defined service categories across multiple states from 2000 to 2011. Partnerships with Public Health Practice-based Research Networks (PBRN) supported the participatory approach we used to examine a poorly understood area of Public Health Systems and Services Research (PHSSR).

Monitoring Changes to Public Health Services & Impact on Vulnerable Populations
Principal Investigator: B. Bekemeier

Sponsor: Robert Wood Johnson Foundation – Nurse Faculty Scholars Program Grant # 68042 (9/2010 - 8/2013)

This multi-state Public Health Practice-based Research Networks study initiated a mechanism for examining health outcomes related to variation and change in local public health practice over time. Through the establishment of a national network of partners engaged in the provision and collection of local public health system administrative data, this funding led to the ongoing Public Health Activities and Services Tracking (PHAST) Study.