Public Health Laboratories and Health System Change . Literature Review


Because our subject matter has not been widely studied, we initiated a broad literature review consisting of four components: (1) search of peer reviewed literature; (2) search of grey literature; (3) internet search; and (4) review of the CDC's Morbidity and Mortality Weekly Report (MMWR). We also accessed literature by asking our interviewees for additional sources, as described below.

We searched peer-reviewed sources using bibliographic databases of the National Library of Medicine (MedLARS). We performed direct search of MedLINE (citations of peer-reviewed journal literature), HealthSTAR (citations of journal literature and other sources in health services research, technology assessment, and health planning), and HSRProj (citations of recent and ongoing health services research funded by government and the private sector). The search covered English-language publications. We used a number of the MeSH (Medical Subject Headings)1 terms and key word combinations to identify relevant articles:

Figure 1: MeSH Terms Used

  • laboratories and managed care organizations
  • public health laboratories
  • public/private partnership and managed care
  • public health department and private sector
  • public health lab and health market change
  • lab and delivery of health care
  • public health lab and delivery system
  • lab and health care market

We also searched grey literature from newsletters, press releases, specialty business and medicine journals, on-line materials, and other sources, including:

Lexis/Nexis -- Contains major archives of federal and state case law, statutes of all 50 states, state and federal regulations, and public records from major U.S. states. Lexis/Nexis contains national and international newspapers, newswires, magazines, trade journals, and business publications.

DialogTM  -- An on-line service that contains over 450 electronic libraries covering a broad range of disciplines. These libraries contain documents from the scientific and technical literature, trade journals, newspapers, and newswires (includes HSRProj, a database of ongoing health services research activities).

Lexis/Nexis searches were restricted to the past two years and the search terms had to appear in either the abstract, leading paragraph, or title.

The search strategy and key words for these searches were as follows:

Figure 2: Key Search Words

  • public health laboratories and managed care
  • public health laboratories and United States
  • {public/private partnerships or
  • private/public partnerships or
  • public health service AND private sector or
  • public health department AND private sector}AND
  • {managed care } AND
  • {laboratories or laboratory}

For the Internet searches, we scanned the Yahoo! and Infoseek search engines for articles using the following keyword search terms:

Figure 3: Internet Search Terms

  • public health laboratories,
  • public health & safety    or
  • diseases & conditions   or
  • environmental health

We also wanted to identify literature pertaining to the involvement of managed care relative to PHLs in the areas of disease surveillance and outbreaks. To facilitate this, we manually searched the MMWR from 1994 through the end of 1996 for titles related to managed care and disease outbreaks. Overall, we found two articles describing outbreaks in WA and NM that precipitated limited interaction between MCOs and public health agencies involved in responding to the outbreaks.

We also requested relevant literature on PHLs from the Association of State and Territorial Public Health Lab Directors (ASTPHLD); the Clinical Laboratory Management Association (CLMA); and from Dr. Michael Skeels, the Director of the Oregon State PHL, who is actively engaged in relevant research. The counts presented below include relevant articles identified by examining the bibliographies of articles located through the search engines.

In total, we identified 140 articles in our literature search. We excluded articles that did not contain information relevant to our key study questions. We found a total of 24 relevant articles that were directly applicable to clinical laboratories, health system change, and PHLs (see Figure 4 below).

Figure 4: Literature Search Results

Source of Information Number of Articles Identified Number of Relevant Articles Summarized
MedLARS   40 4
Nexis/Lexis and DialogTM 81 5
Internet Sources 4 4
MMWR 2 2
Other Sources* 13 9
Total 140 24

*Literature from ASTPHLD, Oregon State PHL Director, Clin. Lab Manufact. Association, and Goldman Sachs

A complete bibliography is contained in Appendix A. Key points from the literature with specific relevance to our study are footnoted throughout this report.