HS315 Unit 3 Core Function Analysis Example

Two Cases Under One Roof: A Unit 3 Core Function Analysis of a Shelter Cluster Investigation in Composite Drayton County

[Student Name]

Purdue University Global

HS315: Practices in Public Health

Unit 3 Core Function Analysis

[Instructor Name]

[Date]

The cluster, the shelter and the county are composite; the core functions, the essential services framework and the outbreak report cited are real.

The Three Core Functions

The Institute of Medicine's 1988 report The Future of Public Health sorted the work of public health agencies into three core functions, labeled assessment, policy development and assurance in that order (Institute of Medicine, 1988). Assessment is the regular gathering and study of data on how healthy a community is and why. Policy development turns that knowledge into priorities and rules. Assurance checks that the services people need truly arrive. In 2020 the Ten Essential Public Health Services were revised and arranged around the same three functions, with equity placed at the center (Public Health National Center for Innovations, 2020). The essential services give the functions a working vocabulary: monitoring health status and investigating hazards under assessment; communicating, mobilizing partners and creating policies under policy development; and assuring an effective system, a competent workforce and access to care under assurance.

This paper follows one activity through all three. Most textbook examples assign a program to one function. The argument here is that a single, ordinary investigation passes through all of them in a matter of days.

The Case

In February, Drayton Regional Medical Center reported a 47-year-old man admitted with a bloodstream infection from group A strep that began at a wound on his shin. He had been sleeping at the Fifth Street Shelter. Nineteen days later the hospital reported a second case, a 52-year-old man with necrotizing infection of the foot, who had slept in the same shelter dormitory. A public health nurse opened an investigation the morning of the second report.

Assessment: What the Investigation Learned

The nurse's first steps were assessment. She interviewed the second patient in the hospital and reviewed the first patient's record. She asked the shelter for its sign-in logs, which showed that both men had slept in the same dormitory for at least six nights during the two weeks before the first case. She asked the hospital laboratory to forward both specimens so the state laboratory could type them and tell the department whether one strain caused both infections.

The investigation also produced information the county had not collected before. With shelter staff, the nurse conducted a wound check of residents willing to take part on two evenings. Of [71] residents present, [58] agreed, and [14] had an open wound, most on the feet or lower legs. That figure is now the county's only estimate of wound prevalence in its shelter population, and it went into the department's annual communicable disease report.

The investigation did not only find out what happened to two men; it produced the first count of open wounds in the county's shelter population, which is assessment data the department had never had.

Assessment work in this case included monitoring the community's health, through the reported cases themselves, and investigating a hazard, through the shelter logs and the strain typing.

Policy Development: What Made the Investigation Possible

None of the assessment would have happened without decisions made years earlier. The nurse could act because the state's communicable disease rule lists invasive group A strep as a reportable condition, which obliged the hospital to notify the department and authorized the department to investigate. That rule is policy development, done by the state, long before this cluster.

Two local policies also mattered. The county's memorandum of understanding with the Fifth Street Shelter, signed after an influenza outbreak three winters earlier, required the shelter to share sign-in records with the health department during a communicable disease investigation. Without it, the nurse would have had to ask for a court order or rely on memory. And the department's own procedure for clusters, adopted after the Anchorage outbreak among homeless adults was reported (Mosites et al., 2018), named two linked cases within four weeks as the point at which the department would act at the site, not just on the cases.

The cluster then fed new policy development. After the investigation, the health officer asked the shelter board to add a second shower night and a laundry rotation for bedding, and the board agreed. The department also wrote the wound check into its cluster procedure so it would happen every time.

Assurance: What Reached People

Assurance is the function in which services reach the people who need them. In this case it happened in the shelter's dining room. During the wound checks, the nurse cleaned and dressed the [14] wounds she found, referred [3] people with spreading redness to the health center the next morning, and arranged a ride for one man whose leg was hot and swollen to the emergency department that night. Shelter staff were given gloves, dressing supplies and a one-page guide to what a worsening wound looks like.

None of those [14] people would have sought care for a wound on their own that week. Most did not think a sore on the foot was a medical problem. The assurance function, in this case, meant bringing basic care to people where they were sleeping, during the hours they were there.

Which Function Does the Activity Mainly Serve?

Most descriptions would file a cluster investigation under assessment, since its formal purpose is to find out what happened. That is correct as far as it goes. But in this case the most lasting effects were in the other two functions. The wound check became policy, and the dressings and referrals were assurance. If the investigation had stopped at interviewing two patients and filing a report, the shelter would have been in the same condition the following month.

The analysis suggests a different way to read the three functions. They are not separate programs that a health department runs in parallel. They are stages that a single good investigation moves through: it learns something, it changes a rule, and it puts care where the rule says it should go. Seeing the functions in one case makes it easier to see where a department is weak. Drayton County had strong assessment and policy development in this case, because rules were already in place. Its assurance depended on one nurse's willingness to stay late, and that is the gap the rest of this course will address.

Implications for the County

Three practical points follow. First, the shelter agreement was the hidden asset, and similar agreements should exist with the family shelter and the day center. Second, the wound check produced information worth collecting regularly, not only during a cluster. Third, assurance in this population requires staff who can work evenings in places that are not clinics, which the department currently does not budget for.

References

Institute of Medicine. (1988). The future of public health. National Academy Press. https://doi.org/10.17226/1091

Mosites, E., Frick, A., Gounder, P., Castrodale, L., Li, Y., Rudolph, K., Hurlburt, D., Lecy, K. D., Zulz, T., Adebanjo, T., Onukwube, J., Beall, B., Van Beneden, C. A., Hennessy, T., McLaughlin, J., & Bruce, M. G. (2018). Outbreak of invasive infections from subtype emm26.3 group A Streptococcus among homeless adults, Anchorage, Alaska, 2016-2017. Clinical Infectious Diseases, 66(7), 1068-1074. https://doi.org/10.1093/cid/cix921

Public Health National Center for Innovations. (2020). 10 essential public health services. Public Health Accreditation Board. https://phnci.org/transformation/essential-public-health-services