Date of Award

Spring 2021

Document Type


Degree Name

Master of Public Health (MPH)


Public Health


Bright Spots are counties that are experiencing better-than-expected health outcomes. There have been a limited number of analyses exploring this concept. There are two research reports that have identified Bright Spots at the county level. The Institute for Healthcare Improvement (IHI) identified 17 counties nationally as Bright Spots. The “Creating a Culture of Health in Appalachia” initiative identified 15 urban counties and 27 rural counties as Bright Spots. In this study we reviewed these findings, and applied the methods used in these reports in an analysis of the Northeast Region of the US.

The IHI published a summary report (Counties of Interest) for a 90-day research and development project in 2011. This summary report identified counties that were experiencing better health outcomes than predicted by social and economic factors in 2010. Counties of interest were identified as Bright Spots if their deleted t residual (the standardized difference between the expected vs. observed health outcome) was statistically significant (at the 90% significance level) based on a linear regression model using all counties in the same state (IHI, 2011, p. 7). The summary report identified 17 counties with better-than-expected health outcomes in the United States. No national comprehensive analysis has been done since the publication of this report.

The research initiative “Creating a Culture of Health in Appalachia” published a statistical analysis executive summary (Identifying Bright Spots in Appalachian Health) in 2018. In this executive summary, Bright Spots were identified as those counties which were experiencing better-than-expected health outcomes given characteristics and resources in 2016. Bright spots were identified if a county’s standardized health outcome was in the top decile (10%) (Holmes et al, 2018, p. 5). The executive summary identified 15 urban counties and 27 rural counties as Bright Spots with better-than-expected health outcomes in the Appalachian region. These results are not comparable between urban and rural areas (Holmes et al, 2018, p. 5). This analysis only explored counties in the Appalachian region.

There has not been an investigation of US counties with “better-than-expected” health outcomes (“Bright Spots”) since 2011. The aim of this Capstone was to update some of the information, by identifying Bright Spot counties as they now exist in the Northeastern region of the United States. Another goal of this Capstone analysis was to identify the top decile of metropolitan (urban) and nonmetropolitan (rural) counties with better-than-expected health outcomes for the Northeastern region. This Capstone’s analytical methods were developed based on the methods used in the IHI and Appalachian reports. The identification of Bright Spot counties in the Northeast region will allow future research to investigate the factors that drive health outcomes. The Capstone research can also be a resource for researchers who are interested in exploring the reasons or causes behind Bright Spot (i.e. health-outlier) counties.



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