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Assessing the Roles of Brokerage: An Evaluation of a Hospital-Based Public Health Epidemiologist Program in North Carolina

Bevc, Christine A. PhD, MA; Markiewicz, Milissa L. MPH, MIA; Hegle, Jennifer MPH; Horney, Jennifer A. PhD, MPH; MacDonald, Pia D. M. PhD, MPH

Journal of Public Health Management & Practice: November/December 2012 - Volume 18 - Issue 6 - p 577–584
doi: 10.1097/PHH.0b013e31825fbaf9
Original Articles

Context: The North Carolina Division of Public Health established an innovative program in 2003 that placed public health epidemiologists (PHEs) in hospitals around the state to improve communication between hospitals and local public health departments (LHDs) and bolster public health surveillance and response.

Objective: To use social network analysis to assess how the hospital-based PHE program in North Carolina facilitates the exchange of public health surveillance information.

Design: Using a Gould-Fernandez brokerage analysis, this study examines communication among organizational actors and their dependence on third parties to broker information and knowledge.

Participants: Survey and interview data were collected to identify the interorganizational network among 220 organizational actors and their public health surveillance–related activities, including 11 PHEs, 100 county-level offices of North Carolina's 85 LHDs, and 109 hospitals.

Main Outcome Measures: Social network analysis is used to calculate the frequency with which an actor serves as an intermediary in each of the 5 brokerage roles as well as total brokerage equal to the sum of the number of times an actor occupies each role.

Results: Results identify a frequent tendency for PHEs to serve as an intermediary between LHDs and hospitals. Interactions between these entities are frequently facilitated by PHEs, with a high measure of degree centrality by LHDs and a low frequency of brokerage among hospitals.

Conclusions: Results validate PHEs' mission to enhance communication between LHDs and hospitals around communicable disease surveillance, reporting, and management.

This study uses social network analysis to assess how the North Carolina Division of Public Health established an innovative program of hospital-based public health epidemiologists to facilitate the exchange of public health surveillance information in order to improve communication between hospitals and local public health departments and bolster public health surveillance and response.

UNC Center for Public Health Preparedness, North Carolina Institute for Public Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill (Drs Bevc, Horney, and MacDonald and Mss Markiewicz and Hegle).

Correspondence: Christine A. Bevc, PhD, MA, UNC Center for Public Health Preparedness, North Carolina Institute for Public Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box 8165, Chapel Hill, NC 27599 (bevc@unc.edu).

This research was carried out by the North Carolina Preparedness and Emergency Response Research Center (NCPERRC) at the University of North Carolina at Chapel Hill's Gillings School of Global Public Health and was supported by the Centers for Disease Control and Prevention (CDC) grant P01 TP000296. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

The authors thank Julie Casani, MD, MPH, Lou Turner, DrPH, Megan Davies, MD, and Lana Deyneka, MD with the North Carolina Division of Public Health, along with Benjamin Lind, PhD, Zack Almquist, MA, MS, and the reviewers.

The authors declare no conflicts of interest.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.