摘要：Objectives . I explored the structural and operational practices of the chronic disease prevention and control unit of a state health department and proposed a conceptual model of structure, function, and effectiveness for future study. Methods. My exploratory case study examined 7 elements of organizational structure and practice. My interviews with staff and external stakeholders of a single chronic disease unit yielded quantitative and qualitative data that I coded by perspective, process, relationship, and activity. I analyzed these for patterns and emerging themes. Results. Chi-square analysis revealed significant correlations among collaboration with goal ambiguity, political support, and responsiveness, and evidence-based decisions with goal ambiguity and responsiveness. Conclusions. Although my study design did not permit conclusions about causality, my findings suggested that some elements of the model might facilitate effectiveness for chronic disease units and should be studied further. My findings might have important implications for identifying levers around which capacity can be built that may strengthen effectiveness. Public health agencies struggle to identify optimal administrative and programmatic structures. Although public health effectiveness literature documents how a state health department should function to achieve the intended impact on population health, little is known about how organizational structure changes affect function, and ultimately, health. 1,2 Proposed guidelines for professional and organizational competencies exist, 3–5 but the role public health agency structure plays in effective functioning has not been definitively examined. 1,6–9 My case study examined the attributes (how an organization is structured) and practices (how an organization operates) of the chronic disease prevention and control unit of a state health department. My findings could inform a conceptual model for future empirical study and might assist state health departments in identifying levers of effectiveness. State-level public health agencies and funders, which are faced with difficult economic realities, seek administrative and programmatic efficiencies that maximize public health impact with the available resources. Three recent initiatives focused on state health department operations: state health department accreditation, 3 the National Prevention Strategy, 10 and Coordinated Chronic Disease funding from the Centers for Disease Control and Prevention (CDC). 11 The pressures of accreditation and coordinated chronic disease funding have resulted in small- and large-scale organizational changes, ranging from alterations in leadership to structural reorganization. 12,13 Despite a mandate to use evidence-based decision-making in public health practice, 10,14–16 and the broad uptake of evidence-based interventions for risk factor reduction, the evidence linking organizational structure and public health outcomes remains undeveloped. 1,9 State health departments have had very little evidence to apply in creating highly efficient organizational structures that maximize population health outcomes. 2,9 The assumption remains that an effectively run state health department with adequate resources and competent professional staff employing evidence-based decision-making will improve population health. 14,17,18
