title: Assessing the roles of brokerage: an evaluation of a hospital-based Public Health epidemiologist program in North Carolina.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Using a Gould-Fernandez brokerage analysis, this study examines communication among organizational actors and their dependence on third parties to broker information and knowledge.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: 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 NC 27599, USA. bevc@unc.edu
authors.forename: Christine A
authors.initials: CA
authors.lastname: Bevc
authors.forename: Milissa L
authors.initials: ML
authors.lastname: Markiewicz
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hegle
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Horney
authors.forename: Pia D M
authors.initials: PD
authors.lastname: MacDonald
mesh_terms: D004813:Epidemiology; D019538:Health Care Surveys; D006801:Humans; D033183:Interdisciplinary Communication; D009111:Local Government; D009657:North Carolina; D015397:Program Evaluation; D011635:Public Health Administration; D062486:Public Health Surveillance / Q000379:methods*; D060756:Social Networking; D000078329:Workforce