The US public health system faces powerful pressures for adaptation and transformation as it moves beyond the Great Recession and progresses deeper into health reform implementation. For many governmental public health agencies, funding and staffing resources remain below their prerecession levels and show little sign of a bounce-back, indicating a new normal of seeking efficiencies in public health protections. At the same time, health insurance coverage expansions under the Affordable Care Act are prompting many public health agencies to renegotiate their roles and responsibilities with medical care providers and payers.1 Some agencies are scaling back their safety-net roles in the direct delivery of personal health services while expanding roles in supporting policy, system, and environmental changes that promote health and safety on a community-wide basis. Others are learning how to bill third-party payers for their services, and forging relationships with new delivery models such as accountable care organizations and patient-centered medical homes. Still others are forging new alliances with schools, worksites, retailers, farmers, housing authorities, and many other sectors to address the health issues embedded within other public and private sector decisions. Amid these changes, modern public health delivery systems are emerging as far more heterogeneous and multiorganizational than ever before.2
The complexity and diversity of these delivery systems create challenges for ensuring that everyone in the United States can benefit from the expanding array of research-tested programs, policies, and interventions that prevent disease and injury and promote health and safety on a population-wide basis. Knowledge about how best to organize, finance, and deliver these public health strategies in complex and constrained delivery systems is too often in short supply. The science surrounding the efficacy of individual public health interventions currently far outpaces the science surrounding the delivery system features and capabilities that support these interventions collectively in real-world settings.3 Consequently, implementation strategies that prove successful in one community may face political, economic, or logistical barriers in other settings. The growing heterogeneity of public health delivery systems demands a highly nuanced evidence base concerning which combination of public health strategies work best, in which organizational and community contexts, for which population segments, with what supporting infrastructure, and at what cost.4
The field of public health services and systems research (PHSSR) has become a leading source for this type of delivery system evidence in public health.5,6 In recent years, national research agendas have been established for the field in key areas of scholarship that include organization and structure, financing and economics, workforce, and information and communication technology.7–11 Dedicated research funding mechanisms have been created by the Robert Wood Johnson Foundation and the US Centers for Disease Control and Prevention (CDC). A constellation of public health practice-based research networks has formed across the United States to support researcher–practitioner collaboration in the production and application of this type of research.12 And a national coordinating center devoted to PHSSR has formed to stimulate scientific innovation, strengthen analytic rigor, promote methodological consistency and comparability, and ensure real-world relevance in this work.
If PHSSR is to realize its full potential in guiding the transformation of the US public health system, it will require “open science” mechanisms for accelerating the production and distribution of highly nuanced research findings about public health delivery.13 Currently, public health delivery systems are changing at a rate that far outpaces traditional research production and distribution cycles, resulting in many missed opportunities for studying and learning from these natural experiments. Mechanisms are needed for rapidly sharing research methodologies and data with other scholars in the field, and for rapidly communicating research results to decision-makers within public health delivery systems. An obvious model is the CDC’s Morbidity and Mortality Weekly Report (MMWR), which widely and freely transmits brief summaries of findings from epidemiological studies to public health and medical professionals across the globe.
The PHSSR field now has its analog to MMWR in the form of a rapid-cycle, peer-reviewed journal Frontiers in Public Health Services and Systems Research.14 Like MMWR, Frontiers publishes short summaries of preliminary results and top-line findings from new PHSSR studies. These summaries focus on how new findings advance the science of PHSSR and inform the transformation of real-world public health delivery systems. Also like MMWR, Frontiers is freely available to both producers and users of the research, with the aim of achieving the broadest possible reach even in low-resource settings. Commentaries are published with some of these articles to help place the new research in context. Frontiers does not replace the need for fully developed empirical research articles, but rather it offers a mechanism for rapidly disseminating early findings and emerging methods, thereby accelerating the progress of PHSSR.
Beginning with this issue, the American Journal of Public Health (AJPH) will extend the reach of PHSSR studies by regularly publishing the abstracts of Frontiers articles along with full-text links. This partnership will allow both journals to play active roles in accelerating PHSSR production and application. AJPH’s wide reach to and credibility with the public health profession, combined with Frontier’s nimbleness in disseminating early and preliminary PHSSR evidence, makes this arrangement a high-value collaboration. The fruits of this collaboration, we believe, will help to transform the US public health system into a rapid-learning system in which research continually informs practice and practice continually motivates research.15 The result will be a continuously improving US public health system that seeks ever-better ways of deploying its resources for a healthier, safer, and more equitable nation.
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