摘要：Objectives. We identified the characteristics of local health departments (LHDs) that intended to seek accreditation, and also examined the association between that intent and a complete community health assessment (CHA), community health improvement plan, agency strategic plan, or other specific accreditation requirements. Methods. We analyzed data from the 2010 profile survey of LHDs conducted by the National Association of County and City Health Officials (n = 267). Results. Those LHDs that conducted a CHA (adjusted odds ratio [AOR] = 0.62; 95% confidence interval [CI] = 0.38, 1.00; P = .05) and developed a strategic plan (AOR = 0.30; 95% CI = 0.12, 0.74; P = .01) were less likely to have an intent to pursue accreditation in the first 2 years of the program. By contrast, those LHDs that were engaged in quality improvement (QI) activities were approximately 2.6 times more likely to pursue accreditation compared with those LHDs that did not have any QI activities ( P < .001). Conclusions. Based on our findings, national public health accreditation might be the vehicle LHDs could use to improve their operating environments, better manage their resources, and reap the rewards associated with meeting national industry standards. A variety of events in public health have focused attention on the need to improve public health agency performance. The 1988 Institute of Medicine report, “The Future of Public Health,” characterized public health as a “system in disarray.” In 2002, the Institute of Medicine released a second major report, “The Future of Public Health in the 21st Century,” that recommended exploration of public health accreditation as a means of improving performance and accountability for governmental public health departments. In September 2011, the Public Health Accreditation Board (PHAB) launched the first voluntary accreditation system with consensus standards and measures for state, local, and tribal public health agencies in the United States. 1,2 The mission of PHAB is to promote and protect the health of communities by advancing quality and performance of all public health departments in the United States. 1,3,4 National public health accreditation domains, standards, and measures are structured around the 10 Essential Public Health Services (EPHSs). 5 Each of the 10 EPHSs encompasses a PHAB Domain (1–10) under which standards and measures provide guidance to local health departments (LHDs) for meeting the intent of each essential public health service. 1 Additional PHAB domains include Domain 11 (Administrative and Management Capacity) and Domain 12 (Engagement of the Public Health Governing Entity). 1 With the release of these standards and the measures grounded in quality improvement (QI), 6,7 LHDs, for the first time, have a QI mechanism upon which to benchmark performance nationally. 8 Previous studies identified the potential benefits of QI through accreditation, including reduction of costs and increased ability to meet specific customer demands, increased profits, improved efficiency, and productivity and survivability. 9,10 However, because difficult economic times (particularly during the recent 2008–2010 economic recession) forced health departments to adjust services and staffing levels, public health has become strained under the increasing pressures of infectious and chronic diseases, emergency preparedness concerns, and the loss of essential services. 11–14 At this time in the history of public health in the United States, the mission of PHAB “to promote and protect the health of communities by advancing the quality and performance of all public health departments in the US.” 1,3,4 has become increasingly relevant. Therefore, by providing a national mechanism for QI through benchmarking performance against PHAB standards and measures, public health accreditation provides governmental public health “a roadmap for its QI journey.” 8 (p57) Combined with investments and training in QI activities, this roadmap can be particularly valuable for those LHDs that have not implemented QI initiatives in the past. 15,16 Governmental public health agencies, specifically LHDs seeking accreditation, must satisfy PHAB prerequisites for accreditation by completing a community health assessment (CHA), a community health improvement plan (CHIP), and an agency strategic plan. 1 The CHA, addressed in PHAB Domain 1, is a systematic, collaborative method to assess the health needs of a community. 17,18 The CHIP is a long-term, systematic plan for addressing those needs, 18 and the strategic plan is the result of a deliberative decision-making process that defines the agency’s direction through the identification of a mission and vision with goals and objectives 19 ; both are addressed in PHAB Domain 5. 1 Accreditation also requires LHDs to adhere to standards for each of the PHAB domains, such as public health investigations (Domain 2), education and prevention activities (Domain 3), QI (Domain 9), financial management (Domain 11), and governance (Domain 12). 1 Beaudry et al. 7 outlined opportunities for QI that are evident in the completion of the 3 prerequisites and satisfaction of the standards and measures of each PHAB domain; however, Shah et al. 20 also identified perceived LHD barriers to PHAB national voluntary accreditation that included time and effort exceeding benefits. We sought to identify the characteristics of LHDs that indicated in the 2010 National Association of County and City Health Officials (NACCHO) survey that they intended to seek accreditation in the first 2 years of voluntary national accreditation, and to determine if an association existed between that intent and the LHD having already completed a CHA, CHIP, agency strategic plan, or other specific accreditation standards mapped to the 10 EPHSs. In this study, we used “intent to pursue accreditation in the first two years” as a proxy for accreditation. We hypothesized that those LHDs that managed activities according to the 10 EPHSs before accreditation and that widely used management functions (e.g., planning, organization of resources, QI, and adherence to goals and objectives) 21,22 would be among the first to apply for, and potentially receive, national voluntary public health accreditation quickly because of their previous work.
