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Dada OO, Bekemeier B, Flaxman A, de Castro B. Local Health Departments' Characteristics and Their Performance Scores in PHAB Accreditation Standards. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:375-383. [PMID: 35045009 DOI: 10.1097/phh.0000000000001458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Local health departments (LHDs) function to promote and protect population health by executing programs and activities through the 10 essential public health (PH) services in their operationalization of the core functions of PH systems-assessment, policy development, and assurance. PH accreditation supports LHDs by assessing their ability to promote community well-being through a set of standards and measures based on the 10 essential PH services. Prior studies show variation in LHD characteristics relative to their likelihood of participating in accreditation, but no studies have examined the variation in LHD accreditation scores to understand how LHD characteristics relate to performance improvement. OBJECTIVE This work examines variation in LHD accreditation scores relative to their organizational and jurisdiction characteristics. DESIGN Cross-sectional data were obtained from 250 LHDs from 38 states that underwent Public Health Accreditation Board (PHAB) accreditation review. ANALYSIS We used exploratory cluster analysis to identify and group LHDs with similar performance scores in PHAB accreditation standards. Descriptive analyses were undertaken to characterize each LHD cluster group's organizational structure, jurisdiction characteristics, and core PH function activity levels. We then employed multivariate regression analysis to confirm the cluster analysis results. RESULTS The analysis showed 3 clusters of PHAB accreditation performance scores (cluster 1 = 0.95; cluster 2 = 0.87; and cluster 3 = 0.71). Subtle differences in organizational and jurisdiction characteristics across clusters, notably in population size of the jurisdictions served, were observed. LHDs in cluster 3 tended to have jurisdictions with less than 250000 population size and serve more than 1 county. CONCLUSIONS Performance scores in PHAB accreditation can be a useful standardized metric for assessing LHD ability to promote community well-being. LHDs serving less than 20000 population size, which exhibit relatively lower performance than other LHDs, may require more targeted supports to close the gap in their performance score.
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Affiliation(s)
- Oluwatosin Omolara Dada
- University of Washington School of Nursing, Seattle, Washington (Drs Dada, Bekemeier, and de Castro); and University of Washington Department of Global Health, Seattle, Washington (Dr Flaxman)
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Dada OO, Bekemeier B, Flaxman A, de Castro AB. Associations Between Local Health Department Expenditures on Foundational Capabilities and PHAB Accreditation Standards Scores. Front Public Health 2022; 10:861587. [PMID: 35692346 PMCID: PMC9174657 DOI: 10.3389/fpubh.2022.861587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/27/2022] [Indexed: 02/03/2023] Open
Abstract
Context Foundational Capabilities (FC) are the public health (PH) infrastructure areas that are essential for local health departments (LHDs) to support a "minimum package" of programs and services that promote population health. Despite being a critical component of LHD programs, FC are chronically underfunded, and studies specific to the relationship between LHD FC expenditures and their performance-the LHDs' ability to provide essential PH programs and services to their community-have not been previously reported. Public Health Accreditation Board (PHAB) accreditation is a nationally recognized accreditation program for PH agencies. PHAB accreditation assesses LHDs' performance against sets of standards that are based on the 10 essential PH services. Alignment between FC and the PHAB standards presents a means for assessing LHD FC expenditures relative to their performance in PHAB accreditation standards. Objectives We examined the association between LHD total FC expenditures, as well as FC funding allocation patterns, and performance score on selected PHAB accreditation standards. Methods We used Bayesian regression methods to estimate the coefficients for the aggregate performance score, and performance scores on individual PHAB standards. Results Analyses showed that a dollar increase in total FC expenditures is associated with a 0.2% increase in the aggregate performance score in selected PHAB standards as well as the performance score on most of the standards examined. LHDs that allocated FC budgets more evenly across FC programs were found to be more likely to have higher scores. Conclusions Investment in FC could improve LHD performance scores in PHAB accreditation standards and support LHDs' capability for improving community health outcomes. Allocating available FC resources across the various FC programs could support better LHD performance, as indicated by accreditation scores. This study contributes to advancing the understanding of public health finances in relation to performance and could help guide effective LHD resource allocation.
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Affiliation(s)
- Oluwatosin O. Dada
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States,*Correspondence: Oluwatosin O. Dada
| | - Betty Bekemeier
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
| | - Abraham Flaxman
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States,Department of Global Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - A. B. de Castro
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
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Kovach KA, Lipnicky A. An Analysis of How Characteristics of Local Health Department Jurisdictions Influence Involvement in PHAB Accreditation: Implications for Health Equity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:449-458. [PMID: 33208717 DOI: 10.1097/phh.0000000000001248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore how characteristics of local health department (LHD) jurisdictions impact involvement in Public Health Accreditation Board (PHAB) accreditation and to characterize the implications for health equity. METHODS Data from the 2016 National Profile of LHDs survey were linked with data from the American Community Survey, National Center for Health Statistics, Behavioral Risk Factor Surveillance System, and the 2016 presidential election. Outcome measures included LHDs that were formally engaged in PHAB accreditation and LHDs that planned to apply for PHAB accreditation but were not formally engaged. Logistic regression was used to assess for the impact LHD jurisdictions' socioeconomic position, demographics, population health status, political ideology, and LHD organizational characteristics have on PHAB accreditation. RESULTS Approximately 37% of the participants were formally engaged (n = 297) and planned to apply (n = 337) for PHAB accreditation. Involvement in PHAB accreditation was equal among LHDs based on poverty and income inequality, but median household income was negatively associated. Diverse jurisdictions were more likely to be involved in PHAB accreditation but less likely to be involved after controlling for covariates. Jurisdictions with worse population health status were either as likely or more likely to be involved in PHAB accreditation. Jurisdictions with a greater conservative political ideology were less likely to be involved. CONCLUSION LHD involvement in PHAB accreditation varies by their jurisdiction's characteristics. This has implications for health equity based on socioeconomic, racial, and population health status. Policies and practices are needed to improve the uptake of PHAB accreditation in LHD jurisdictions impacted most by health inequities.
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Affiliation(s)
- Kevin A Kovach
- Population and Community Health Department, American Academy of Family Physicians, Leawood, Kansas (Dr Kovach); and Master of Public Health Program, University of Kansas Medical Center, Kansas City, Kansas (Ms Lipnicky)
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Maintaining a Competent Public Health Workforce: Lessons Learned From Experiences With Public Health Accreditation Domain 8 Standards and Measures. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 26:57-66. [PMID: 29324566 DOI: 10.1097/phh.0000000000000750] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Public health accreditation is an ongoing national movement to improve the quality of public health departments and the public health system in the United States; however, calls have been made for more evidence regarding best practices in the accreditation process. OBJECTIVE The purpose of this work is to provide evidence about best practices in the accreditation process, specifically within the workforce development domain. It is the first in-depth investigation into workforce development using data collected by Public Health Accreditation Board (PHAB). DESIGN Using deidentified accreditation application data from PHAB, this study employs a mixed-methods approach to examining practices, lessons learned, challenges, and strategies pertaining to workforce development planning for Domain 8. SETTING United States. PARTICIPANTS US state (n = 19) and local health departments (n = 115). MAIN OUTCOME MEASURES Public Health Accreditation Board assessment scores for the workforce measures and the relationship between the health department's approach to meeting a PHAB measure criteria and the PHAB assessment score. RESULTS Of the 9 different approaches identified as ways of encouraging the development of a sufficient number of qualified public health workers (version 1, measure 8.1.1), only 1 approach (local health department internship programs with schools of public health; B = 0.25, P < .03) was significantly related to higher scores. An opportunity for improvement identified for measure 8.2.1 was that plans missing a clear identification of the gap between current staff competencies and staff needs were associated with a 0.88-point decrease in the 4-point score (P < .001). CONCLUSIONS Findings suggest that there are approaches adopted for meeting PHAB domain 8 measures that will impact the overall conformance assessment and score of a health department pursuing accreditation. There are several opportunities for improvement that health departments might consider when planning for accreditation or assessing their activities.
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Leider JP, Kronstadt J, Yeager VA, Hall K, Saari CK, Alford A, Freeman LT, Kuehnert P. Application for Public Health Accreditation Among US Local Health Departments in 2013 to 2019: Impact of Service and Activity Mix. Am J Public Health 2021; 111:301-308. [PMID: 33351657 PMCID: PMC7811080 DOI: 10.2105/ajph.2020.306007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives. To examine correlates of applying for accreditation among small local health departments (LHDs) in the United States through 2019.Methods. We used administrative data from the Public Health Accreditation Board (PHAB) and 2013, 2016, and 2019 Profile data from the National Association of County and City Health Officials to examine correlates of applying for PHAB accreditation. We fit a latent class analysis (LCA) to characterize LHDs by service mix and size. We made bivariate comparisons using the t test and Pearson χ2.Results. By the end of 2019, 126 small LHDs had applied for accreditation (8%). When we compared reasons for not pursuing accreditation, we observed a difference by size for perceptions that standards exceeded LHD capacity (47% for small vs 22% for midsized [P < .001] and 0% for large [P < .001]).Conclusions. Greater funding support, considering differing standards by LHD size, and recognition that service mix might affect practicality of accreditation are all relevant considerations in attempting to increase uptake of accreditation for small LHDs.Public Health Implications. Overall, small LHDs represented about 60% of all LHDs that had not yet applied to PHAB.
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Affiliation(s)
- Jonathon P. Leider
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Jessica Kronstadt
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Valerie A. Yeager
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Kellie Hall
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Chelsey K. Saari
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Aaron Alford
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Lori Tremmel Freeman
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
| | - Paul Kuehnert
- Jonathon P. Leider is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Jessica Kronstadt, Chelsey K. Saari, and Paul Kuehnert are with the Public Health Accreditation Board (PHAB), Alexandria, VA. Valerie A. Yeager is with the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN. Kellie Hall, Aaron Alford, and Lori Tremmel Freeman are with the National
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The Relationship Between Health Department Accreditation and Workforce Satisfaction, Retention, and Training Needs. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25 Suppl 2, Public Health Workforce Interests and Needs Survey 2017:S113-S123. [PMID: 30720624 PMCID: PMC6519885 DOI: 10.1097/phh.0000000000000920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To improve quality and consistency of health departments, a voluntary accreditation process was developed by the Public Health Accreditation Board. Understanding accreditation's role as a mediator in workforce training needs, satisfaction, and awareness is important for continued improvement for governmental public health. OBJECTIVE To compare differences in training needs, satisfaction/intent to leave, and awareness of public health concepts for state and local health department staff with regard to their agency's accreditation status. DESIGN This cross-sectional study considered the association between agency accreditation status and individual perceptions of training needs, satisfaction, intent to leave, and awareness of public health concepts, using 2017 Public Health Workforce Interests and Needs Survey (PH WINS) data. Respondents were categorized on the basis of whether their agencies (at the time of survey) were (1) uninvolved in accreditation, (2) formally involved in accreditation, or (3) accredited. RESULTS Multivariate logistic regression models found several significant differences, including the following: individuals from involved state agencies were less likely to report having had their training needs assessed; staff from accredited and involved agencies identified more gaps in selected skills; and employees of accredited agencies were more aware of quality improvement. While state employees in accredited and formally involved agencies reported less job satisfaction, there were no significant differences in intent to leave or burnout. Differences were identified concerning awareness of various public health concepts, especially among respondents in state agencies. CONCLUSIONS While some findings were consistent with past research (eg, link between accreditation and quality improvement), others were not (eg, job satisfaction). Several self-reported skill gaps were unanticipated, given accreditation's emphasis on training. Potentially, as staff are exposed to accreditation topics, they gain more appreciation of skills development needs. Findings suggest opportunities to strengthen workforce development components when revising accreditation measures.
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Shah GH, Corso L, Sotnikov S, Leep CJ. Impact of Local Boards of Health on Local Health Department Accreditation, Community Health Assessment, Community Health Improvement Planning, and Strategic Planning. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:423-430. [PMID: 31348156 DOI: 10.1097/phh.0000000000000847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Local health departments (LHDs) are increasingly using national standards to meet the challenges presented by the complex environments in which these agencies operate. Local boards of health (LBoHs) might play an instrumental role in improving LHDs' engagement in activities to meet these standards. OBJECTIVES To assess the impact of LBoH performance of governance functions on LHDs having a current (completed within 5 years) community health assessment (CHA), community health improvement plan (CHIP), strategic plan, and level of engagement in the Public Health Accreditation Board (PHAB) accreditation program. METHODS Binary and multinomial logistic regression models were used to analyze linked data from 329 LHDs participating in both the 2015 Local Board of Health Survey and the 2016 National Profile of LHDs Survey. RESULTS Higher performance of LBoH governance functions, measured by an overall scale of LBoH taxonomy consisting of 60 items, had a significant positive effect on LHDs having completed CHA (P < .001), CHIP (P = .01), and strategic plan (P < .001). LHDs operating in communities with a higher score on the overall scale of LBoH taxonomy had significantly higher odds (P = .03) of having higher level of participation in the PHAB national voluntary accreditation program-that is, being accredited, having submitted application for accreditation, or being in the e-PHAB system (eg, by submitting a letter of intent). CONCLUSIONS LBoHs serve as governance bodies for roughly 71% of LHDs and can play a significant role in encouraging LHDs' participation in these practices. That positive influence of LBoHs can be seen more clearly if the complexity and richness of LBoH governance functions and other characteristics are measured appropriately. The study findings suggest that LBoHs are a significant component of the public health system in the United States, having positive influence on LHDs having a CHA, CHIP, strategic plan, and participation in accreditation.
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Affiliation(s)
- Gulzar H Shah
- Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Corso and Dr Sotnikov); and National Association of County & City Health Officials, Washington, District of Columbia (Ms Leep)
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Allen P, Mazzucca S, Parks RG, Robinson M, Tabak RG, Brownson R. Local Health Department Accreditation Is Associated With Organizational Supports for Evidence-Based Decision Making. Front Public Health 2020; 7:374. [PMID: 31921739 PMCID: PMC6928116 DOI: 10.3389/fpubh.2019.00374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/22/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction: Recent studies show that health department accreditation from the U.S. Public Health Accreditation Board (PHAB) drives performance management and quality improvement. PHAB standards call for agencies to use evidence in decision making. It is unknown whether accreditation is associated with organizational supports for evidence-based decision making (EBDM). Self-report data from a 2017 survey of U.S. local health departments were analyzed to test relationships of accreditation status with organizational supports for EBDM. Methods: A cross-sectional survey was conducted in this observational study. A total of 579 local health departments were invited to complete an online survey; 350 (60.4%) provided complete data for the present study. The dependent variables were six factors of organizational supports for EBDM previously validated through confirmatory factor analyses. Accreditation status (PHAB-accredited, preparing, not preparing) was the independent variable of interest. Logistic regression analyses controlled for governance (presence of a local board of health; state, local, or shared state and local governance) and jurisdiction population size. Results: PHAB-accredited health departments were more likely to report higher capacity for EBDM, resource availability for EBDM, and evaluation capacity than health departments that reported not yet preparing for accreditation. Health departments that reported preparing for PHAB accreditation showed a non-significant pattern of higher perceived supports for EBDM compared to departments not preparing for accreditation. Conclusion: PHAB standards and the accreditation process may help stimulate health department organizational supports for EBDM.
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Affiliation(s)
- Peg Allen
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Renee G Parks
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Mackenzie Robinson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Rachel G Tabak
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Ross Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States.,Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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Ellis Hilts K, Xia J, Yeager VA, Ferdinand AO, Menachemi N. Market characteristics associated with community health assessments by local health departments. Public Health 2018; 162:118-125. [PMID: 30029173 DOI: 10.1016/j.puhe.2018.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/18/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Community health assessments (CHAs) have been promoted as a strategy for population health. This study uses the resource dependence theory (RDT) to examine how external market characteristics are associated with CHAs conducted by local health departments (LHDs) and subsequent partnering with hospitals for CHAs in the United States. STUDY DESIGN The RDT was used to guide the conceptualization of the market in the context of local public health. RDT emphasizes that organizations are not in control of all the resources they need and, to some extent, must rely on the external environment to provide those necessary resources. Binary measures were used to examine whether LHDs conducted CHAs and whether they did so in partnership with a local hospital. Independent variables were identified to measure the RDT constructs of munificence (resource availability in the environment), complexity (level of heterogeneity), and dynamism (level of environmental turbulence). METHODS Bivariate (Chi-squared and t-tests) and multivariate (logistic regression) cross-sectional analyses were conducted using secondary data from the National Association of County and City Health Officials 2013 Profile Survey, the 2013 County Health Rankings data set, and the Health Resources and Services Administration's Area Health Resource File. RESULTS Two of three variables measuring munificence were positively associated with having conducted a CHA; one variable was also related to doing so in conjunction with a local hospital. One measure of market complexity was negatively associated with having conducted a CHA. No measure of dynamism was related to the dependent variables. CONCLUSIONS Study results provide partial support for the use of RDT in understanding the relationship between market factors and LHDs' activities around CHAs. Local hospitals as partners and other market factors should be considered by LHDs when conducting CHAs. Findings from this work will be of interest to public health practitioners, policy-makers, and researchers interested in public health and population health improvement.
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Affiliation(s)
- K Ellis Hilts
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA.
| | - J Xia
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
| | - V A Yeager
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
| | | | - N Menachemi
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
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Drivers and Barriers for Adopting Accreditation at Local Health Departments for Their Performance Improvement Effort. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:e25-e35. [PMID: 28492448 DOI: 10.1097/phh.0000000000000567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT A national system of voluntary public health accreditation for state, local, and tribal health departments (local health departments [LHDs]) is part of a movement that aims to improve public health performance with ultimate impact on population health outcomes. Indiana is a good setting for the study of LHD accreditation adoption because several LHDs reported de-adopting accreditation in a recent statewide survey and because 71% of Indiana counties serve populations of 50 000 or less. DESIGN A systematic method of analyzing qualitative data based on the Performance Improvement Model framework to expand our understanding of de-adoption of public health accreditation. SETTING/PARTICIPANTS In 2015, we conducted a key informant interview study of the 3 LHDs that decided to delay their engagement in the accreditation based on findings from an Indiana survey on LHD accreditation adoption. The study is an exploration of LHD accreditation de-adoption and of the contributions made to its understanding by the Performance Improvement Model. RESULT The study found that top management team members are those who champion accreditation adoption, and that organizational structure and culture facilitate the staff's embracing of the change. The Performance Improvement Model was found to enhance the elucidation of the inner domain elements of Consolidated Framework for Implementation Research in the context of de-adoption of public health accreditation. CONCLUSION Governing entities' policies and priorities appear to mediate whether the LHDs are able to continue accreditation pursuit. Lacking any of these driving forces appears to be associated with decisions to de-adoption of accreditation. Further work is necessary to discern specific elements mediating decisions to pursue accreditation. This study demonstrates the added knowledge of Performance Improvement Model (PIM) to the CFIR framework. A large scale study is called to further clarify and discern supports of specific to the needs of individual LHDs for their performance improvement effort.
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Public Health Agency Accreditation Among Rural Local Health Departments: Influencers and Barriers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 24:49-56. [DOI: 10.1097/phh.0000000000000509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rurality, Quality Improvement Maturity, and Accreditation Readiness: A Comparison Study of Colorado, Kansas, and Nebraska Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 24:E15-E22. [PMID: 29227416 DOI: 10.1097/phh.0000000000000678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare local health department (LHD) accreditation readiness (AR) and quality improvement (QI) maturity in 3 states, between LHDs with varying levels of rurality, and across an LHD staffing-level continuum. DESIGN This was a cross-sectional comparative study that included an online survey administered to LHD directors in Colorado, Kansas, and Nebraska. The survey included 10 questions assessed on a 5-point Likert scale covering 3 QI domains and 13 questions covering 5 AR domains. The median score for both QI maturity and AR was calculated by each state, by the number of full-time equivalent staff employed at the LHD, and by a measure of rurality and population density. SETTING AND PARTICIPANTS A total of 156 LHDs from the states of Colorado, Kansas, and Nebraska. MAIN OUTCOME MEASURE(S) QI maturity and AR scores. RESULTS A majority (59%) of the surveyed LHDs plan to apply or have already applied for Public Health Accreditation Board (PHAB) accreditation. The overall QI maturity and AR scores were highest in Nebraska, as was the intent to seek PHAB accreditation and current use of PHAB standards. Across levels of rurality and staffing, LHD QI maturity scores were similar; however, AR scores improved as LHD staffing levels increased and rurality decreased. CONCLUSIONS Small LHDs and rural LHDs have QI maturity levels that are comparable to larger, less rural LHDs, but their AR is much lower. As accreditation has been found to have positive benefits, it is important that all LHDs have the capacity and resources to meet the performance standards required of accredited LHDs. Small, rural LHDs may need additional resources and support in order to improve their ability to be accredited and/or certain accreditation requirements may need modification to make accreditation more accessible to small LHDs.
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Local Boards of Health Characteristics Influencing Support for Health Department Accreditation. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 24:263-270. [PMID: 28832430 DOI: 10.1097/phh.0000000000000623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Local boards of health (LBoHs) serve as the governance body for 71% of local health departments (LHDs). PURPOSE To assess the impact of LBoH governance functions and other characteristics on the level of LBoH support of LHD accreditation. METHODS Data from 394 LHDs that participated in the 2015 Local Boards of Health Survey were used for computing summative scores for LBoHs for domains of taxonomy and performing logistic regression analyses in 2016. RESULTS Increased odds of an LBoH directing, encouraging, or supporting LHD accreditation activities were significantly associated with (a) a higher overall combined score measuring performance of governance functions and presence of other LBoH characteristics (adjusted odds ratio [AOR] = 1.05; P < .001); (b) a higher combined score for the Governance Functions subscale (AOR = 1.06; P < .01); (c) the "continuous improvement" governance function (AOR = 1.15; P < .001); and (d) characteristics and strengths such as board composition (eg, LBoH size, type of training, elected vs nonelected members), community engagement and input, and the absence of an elected official on the board (AOR = 1.14; P = .02). CONCLUSIONS LBoHs are evenly split by thirds in their attention to Public Health Accreditation Board accreditation among the following categories: (a) encouraged or supported, (b) discussed but made no recommendations, and (c) did not discuss. This split might indicate that they are depending on the professional leadership of the LHD to make the decision or that there is a lack of awareness. The study findings have policy implications for both LBoHs and initiatives aimed at strengthening efforts to promote LHD accreditation.
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Shah GH, Sotnikov S, Leep CJ, Ye J, Van Wave TW. Creating a Taxonomy of Local Boards of Health Based on Local Health Departments' Perspectives. Am J Public Health 2016; 107:72-80. [PMID: 27854524 DOI: 10.2105/ajph.2016.303516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To develop a local board of health (LBoH) classification scheme and empirical definitions to provide a coherent framework for describing variation in the LBoHs. METHODS This study is based on data from the 2015 Local Board of Health Survey, conducted among a nationally representative sample of local health department administrators, with 394 responses. The classification development consisted of the following steps: (1) theoretically guided initial domain development, (2) mapping of the survey variables to the proposed domains, (3) data reduction using principal component analysis and group consensus, and (4) scale development and testing for internal consistency. RESULTS The final classification scheme included 60 items across 6 governance function domains and an additional domain-LBoH characteristics and strengths, such as meeting frequency, composition, and diversity of information sources. Application of this classification strongly supports the premise that LBoHs differ in their performance of governance functions and in other characteristics. CONCLUSIONS The LBoH taxonomy provides an empirically tested standardized tool for classifying LBoHs from the viewpoint of local health department administrators. Future studies can use this taxonomy to better characterize the impact of LBoHs.
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Affiliation(s)
- Gulzar H Shah
- Gulzar H. Shah is with Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Sergey Sotnikov and Timothy W. Van Wave are with the Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Carolyn J. Leep and Jiali Ye are with National Association of County and City Health Officials, Washington, DC
| | - Sergey Sotnikov
- Gulzar H. Shah is with Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Sergey Sotnikov and Timothy W. Van Wave are with the Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Carolyn J. Leep and Jiali Ye are with National Association of County and City Health Officials, Washington, DC
| | - Carolyn J Leep
- Gulzar H. Shah is with Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Sergey Sotnikov and Timothy W. Van Wave are with the Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Carolyn J. Leep and Jiali Ye are with National Association of County and City Health Officials, Washington, DC
| | - Jiali Ye
- Gulzar H. Shah is with Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Sergey Sotnikov and Timothy W. Van Wave are with the Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Carolyn J. Leep and Jiali Ye are with National Association of County and City Health Officials, Washington, DC
| | - Timothy W Van Wave
- Gulzar H. Shah is with Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Sergey Sotnikov and Timothy W. Van Wave are with the Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Carolyn J. Leep and Jiali Ye are with National Association of County and City Health Officials, Washington, DC
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Meyerson BE, King J, Comer K, Liu SS, Miller L. It's Not Just a Yes or No Answer: Expressions of Local Health Department Accreditation. Front Public Health 2016; 4:21. [PMID: 26909344 PMCID: PMC4754618 DOI: 10.3389/fpubh.2016.00021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/02/2016] [Indexed: 11/13/2022] Open
Abstract
The identification and exploration of moderators of health department accreditation remain limited by current dichotomous conceptualizations of pursuit.
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Affiliation(s)
- Beth E Meyerson
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington , Bloomington, IN , USA
| | - Jerry King
- Indiana Public Health Association , Indianapolis, IN , USA
| | - Karen Comer
- The Polis Center, Indiana University-Purdue University at Indianapolis , Indianapolis, IN , USA
| | - Sandra S Liu
- College of Health and Human Sciences, Purdue University , West Lafayette, IN , USA
| | - Laura Miller
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington , Bloomington, IN , USA
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