摘要：Objectives . We sought to identify the incentives most likely to encourage voluntary participation in the national public health accreditation model. Methods . We reviewed existing incentives, held meetings with key informants, and conducted a survey of state and local public health agency representatives. The survey was sent to all state health departments and a sample of local health departments. Group-specific differences in survey responses were examined. Results . Survey response rates were 51% among state health department representatives and 49% among local health department representatives. Both state health department and local health department respondents rated financial incentives for accredited agencies, financial incentives for agencies considering accreditation, and infrastructure and quality improvement as important incentives. State health department respondents also indicated that grant administration and grant application would encourage their participation in the national accreditation model, and local health department respondents also noted that technical assistance and training would encourage their participation. Conclusions . Incentives to encourage participation of state and local agencies in the national voluntary accreditation model should include financial support as well as support for agency infrastructure and quality improvements. Several initiatives are already under way to support agency infrastructure and quality improvement, but financial support incentives have yet to be developed. The Institute of Medicine's 2003 report The Future of the Public's Health in the 21st Century called for increased accountability by state and local public health agencies in performing the core public health functions (assessment, policy development, and assurance) and the 10 essential public health services (e.g., monitoring health status, diagnosing and investigating health problems). An accreditation program was identified as 1 possible method of achieving this goal, 1 and the recent establishment of the Public Health Accreditation Board (PHAB) represents an important step in the process. The PHAB was established to provide state and local health departments with a process through which they could assess their capacities against recognized standards and apply for accreditation by a national entity. The PHAB model and the proposed standards are based heavily on the outcomes of the Exploring Accreditation Project (EAP). The EAP assessed the feasibility of the national voluntary public health accreditation model, which was designed to assess state and local health departments' capacity and performance against national standards. 2 The EAP was supported by funding from the Centers for Disease Control and Prevention (CDC) and the Robert Wood Johnson Foundation, and work on the project was led by the Association of State and Territorial Health Officials (ASTHO), the National Association of Local Boards of Health, the National Association of County and City Health Officials (NACCHO), and the American Public Health Association. These organizations are providing continuing support to the PHAB. Given this investment of time and resources, it is critical to ensure that the conditions that will allow the national accreditation model to be successful are in place. As a means of informing the development of the public health accreditation model, Mays conducted a review of accreditation programs from a variety of service industries. 3 That review showed that accreditation programs with strong and visible incentives (e.g., increased eligibility for funding) encourage organizations to participate and are more likely to function successfully. For example, in the health care industry, eligibility for participation in Medicare has served as a strong incentive for hospitals to take part in the Joint Commission on Accreditation of Healthcare Organizations process. EAP surveys of state and local agency personnel have identified quality and performance improvements, consistency among health departments, and recognition by peers as the most important incentives associated with accreditation. Another incentive that has been identified is access to the resources and services necessary to complete the accreditation process. 2 The EAP Finance and Incentives Work Group has concluded that the most feasible incentives would be those that provide financial support in the process of applying or preparing for accreditation, improve the efficiency of programs, and provide new grant funding to accredited health departments. 4 The EAP Steering Committee and the Finance and Incentives Workgroup has recommended that incentives for public health accreditation be uniformly positive. Types of incentives not recommended include coercive or restrictive incentives, such as loss of funding for health departments that do not participate in accreditation; incentives that could create real or perceived conflicts of interest, such as access to special training; and incentives that could exacerbate problems for health departments with few resources, such as small or rural health departments. Although these principles and survey results informed the EAP process, there has been no effort to systematically explore the incentives most likely to encourage voluntary participation in the national public health accreditation model. The EAP data collection efforts were limited by incomplete identification of potential incentives, and data were collected primarily from convenience samples. Also informing the research described here were evaluations of the North Carolina Local Health Department Accreditation Program; these evaluations identified several key benefits (e.g., eligibility for additional funding) as potential incentives for participating in that accreditation program. 5 We sought to identify additional accreditation incentives and to determine those most likely to encourage voluntary participation by state and local health officials in the proposed national public health accreditation model.
