Quality Improvement Efforts of

Local Health Departments: Findings from the

2005 National Profile of LHDs Study

2005 National Profile of Local Health Departments Study

Collaboration with CDC Fourth in the Profile series• Prior studies in 1989, 1992-3, and 1996-7

Census design – includes all LHDs in U.S. First National Profile to be conducted

as Web-based survey Source of all data in this presentation

Topics in Profile Core

Governance Population served Finances Characteristics of top

executive LPHA workforce

Activities and services provided

Community health assessment & improvement

Information technology

Topics in Profile Modules

Detailed information on: Finances LPHA workforce Community health

assessment & improvement Information technology

Additional Topics: Performance improvement Emergency preparedness Partnerships Policy-making and advocacy Addressing health inequities

Descriptive Statistics from 2005 Profile of LHDs

Community Health Assessment (core) Community Health Improvement Planning (core) Performance Improvement (module) Accreditation (module)

Community Health Assessment

Definition: A community health assessment is the process whereby a local health agency and its community engage in assessing the health needs of their community and investigate adverse health effects and health hazards to create a “snap-shot” of a community’s health.

LHD Participation in Community Health Assessment (CHA)

CHA completion or plans Percentage

Completed CHA in past three years 51%

Plans to complete CHA in next three years 65%

Either completed CHA in past three years or plans to complete in next three years

79%

Both completed CHA in past three years and plans to complete in next three years

38%

Participation in CHA: Comparison with 1999 Study

Population size 1999 2005

All LHDs 55% 51%

<25,000 44% 42%25,000 – 49,999 63% 53%

50,000 – 99,999 65% 57%

100,000 – 499,999 66% 61%

500,000 + 72% 67%

Community Health Improvement Planning

Definition: a series of timely and meaningful action steps that define and direct the distribution of health services and resources to improve your community’s health, or definite strategic action steps to improve health status in the community

HP 2010 Target: 80% of LHDs have a health improvement plan

LHD Participation in Community Health Improvement Planning (CHIP)

Percentage

Participated in CHIP 54%

CHIP based results of CHA* 86%

CHIP linked to state’s health

improvement plan*

68%

Participation in past three years*Of those LHDs that have participated in CHIP

Participation in CHIP: Comparison with 1999 Study

Population size 1999 2005

All LHDs 53% 54%

<25,000 41 45

25,000 – 49,999 59 55

50,000 – 99,999 68 59

100,000 – 499,999 69 61

500,000 + 76 68

Participation in CHA by State: Version 1

% completed CHA in last 3 years

ID

AZ

UT

MT

WY

NM

CO

AL

FL

SC

TN

KY

INOH

NC

SD

KS

NE

MN

WI

IA

IL

MO

AR

MS

OK

ND

OR

CA NV

WA

TX

WV

PA

M E

VA

NY

United S tates of Am erica

LA

GA

MIRI

VT N

H

M D

CT

HI

D E

N J

AK

M A

>75%

50 - 75%

25 - 49%

<25%n=2280

Participation in CHA by State: Version 2

ID

AZ

UT

MT

WY

NM

CO

AL

FL

SC

TN

KY

INOH

NC

SD

KS

NE

MN

WI

IA

IL

MO

AR

MS

OK

ND

OR

CA NV

WA

TX

WV

PA

M E

VA

NY

LA

GA

MIRI

VT N

H

M D

CT

HI

D E

N J

AK

M A

n=2,280

>75%50 - 75%25-49%<25%

% completed CHA in last 3 years OR plan to complete in next 3 years

Participation in CHA by State: Version 3

% completed CHA in last 3 years OR plan to complete in next 3 years

ID

AZ

UT

MT

WY

NM

CO

AL

FL

SC

TN

KY

INOH

NC

SD

KS

NE

MN

WI

IA

IL

MO

AR

MS

OK

ND

OR

CA NV

WA

TX

WV

PA

M E

VA

NY

LA

GA

MIRI

VT N

H

M D

CT

HI

D E

N J

AK

M A

n=2,280

90 - 100 %80-89%70 - 79% %50 - 69%25% - 49%<25%

LHD Participation in Quality or Performance Improvement Efforts

Population size PercentageAll LHDs 71%

<25,000 63%

25,000 – 49,999 67%

50,000 – 99,999 73%

100,000 – 499,999 73%

500,000 + 89%

n=423; involvement in past three years

Performance Management Components

Has LHD established Performance Standards? Does the LHD use Performance Measures? Does the LHD Report Progress? Does the LHD have a Quality Improvement

Process?

LHD Performance Management Activities

34%

35%

35%

37%

37%

41%

48%

7%

8%

8%

10%

9%

12%

12%

0% 10% 20% 30% 40% 50%

Data and information systems

Human resource development

Financial systems

Management practices

Public health capacity

Health status

Customer focus and satisfaction

Any component All four components

n=427

Components of LHD Performance Management Activities

Combination of Elements

Area of FocusAll four

components

QI process

only

Performance standard

only

Report progress

only

Standard, measure,

report

Human resources development 42 21 21    

Data and information systems 38 22 23    

Financial management 42   26 21  

Management practices 47 17 30    

Customer focus and orientation 60 24 21    

Public health capacity 48   27 20  

Health status 64   22 29 22

LHD Use of Performance Standards and Performance Measures

0 20 40 60 80 100 120 140 160 180

Number of Responses

Data and information systems

Financial systems

Human resource development

Public health capacity

Management practices

Health status

Customer focus and satisfaction

63

70

70

69

74

97

97

33

38

31

36

35

29

32

22

20

32

28

33

30

49

Performance standards & measuresPerformance standards onlyPerformance measures only

Percentage of LHD Programs with Evaluation or QI Efforts

14%

17%

26%

38%

40%

64%

0% 10% 20% 30% 40% 50% 60% 70%

Indoor air quality

Land use planning

Obesity

Influenza

Tobacco use prevention

Emergency preparedness

n=228 to 418

LHD Participation in Accreditation Programs

Population size Percentage

All LHDs 16%

<25,000 7%

25,000 – 49,999 12%

50,000 – 99,999 25%

100,000 – 499,999 30%

500,000 + 47%n=420

LHD Participation in Specific Accreditation Programs

Accreditation program Percentage

State-established accreditation program 9%

Laboratory accreditation program 9%

JCAHO (Joint Commission on Accreditation for Healthcare Organizations)

2%

n=395

Relationships among Activities

79%84%

26%

56%

Community Health Improvement Plan

Quality Improvement Activities

0%

20%

40%

60%

80%

100%

Per

cen

tag

e o

f L

HD

s

Completed CHADid not complete CHA

What do LHDs mean by “Quality Improvement”?

Probably a lot of different things! NACCHO plans to explore this in a survey about

LHD quality improvement efforts Directed to all LHDs who reported some PI/QI

activity in the last three years on the 2005 Profile survey

Follow-up QI Survey Topics

Frameworks for performance improvement Resources for performance improvement Extent of QI activities (Agency-wide? Several

program areas?) Proactive initiative or grant requirement? Elements of QI programs Training for LHD staff

For more information:

Carolyn Leep, Senior AnalystNational Association of County & City Health Officials

cleep@naccho.org

2005 Profile Web site:http://www.naccho.org/topics/infrastructure/2005Profile.cfm