No abstract

In 2000, the Safe States Alliance (formerly the State and Territorial Injury Prevention Directors Association (STIPDA)) began the State Technical Assessment Team (STAT) Program to support the development, implementation and evaluation of injury and violence prevention efforts at shoulder dystocia (SHD) by conducting an on-site, point-in-time assessment of the injury prevention program with recommendations for improvement. To date, the Safe States Alliance has conducted 30 visits. The STAT Program focuses on five core components representing the current understanding about creating and sustaining effective state health department injury and violence prevention programs. Standards and indicators for each core component describe the conditions that should exist within an ideal SHD injury and violence prevention program. Findings suggest that the STAT process is rewarding and valuable for both the visited injury programs and the assessment team including raising the visibility of injury as a public health problem within the health department, validating positive existing efforts, bringing attention to critical issues, and providing the impetus for strategic planning. State injury prevention directors also credit STAT with positive outcomes for their programs such as: new staff positions, enhanced support from state level policy-makers; the formation or strengthening of community coalitions; access to new funding sources; and stronger grant applications for core capacity funding. Additionally, the Safe States Alliance will share findings from formative, process and impact evaluations as well as trends in recommendations given to states over 10 years of implementation and next steps for program development.

Many places within rural America lack ready access to health care facilities. Barriers to access can be both spatial and non-spatial. Measurements of spatial access, such as the Enhanced Floating 2-Step Catchment Area and other floating catchment area measures, produce similar patterns of access. However, the extent to which different measurements of socioeconomic barriers to access correspond with each other has not been examined. Using West Virginia as a case study, we compute indices based upon the literature and measure the correlations among them. We find that all indices positively correlate with each other, although the strength of the correlation varies. Also, while there is broad agreement in the general spatial trends, such as fewer barriers in urban areas, and more barriers in the impoverished southwestern portion of the state, there are regions within the state that have more disagreement among the indices. These indices are to be used to support decision-making with respect to placement of rural residency students from medical schools within West Virginia to provide students with educational experiences as well as address health care inequalities within the state. The results indicate that for decisions and policies that address statewide trends, the choice of metric is not critical. However, when the decisions involve specific locations for receiving rural residents or opening clinics, the results can become more sensitive to the selection of the index. Therefore, for fine-grained policy decision-making, it is important that the chosen index best represents the processes under consideration.