Accreditation Seeking Decisions in Local Health Departments
Kate E. Beatty, PhD, Tyler Carpenter, BS, Ross
Brownson, PhD, Paul Erwin, DrPH
Disclosures
• No conflicts of interest to disclose
Objective
Upon completion of this educational activity, you will be able to:• Identify factors associated with
accreditation seeking behaviors in LHDs• Identify differences in behaviors by rurality
Educational Need/Practice Gap
Investigation of rural local health department accreditation is limited.
Overview of the Presentation
• Background• Research Question• Data Sources• Methods• Results• Conclusion
Background
• Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure.
• Rural LHDs face many challenges including lower levels of staffing and funding than LHDs serving metropolitan or urban areas. – Their populations experience health disparities related to risky
health behaviors, health outcomes, and access to medical care.
• Through accreditation, rural LHDs can become better equipped to meet the needs of their communities.
Research Question
• To identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs.
• What is the effect of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB)?
Data Sources
• 2013 NACCHO National Profile of Local Health Departments Study (2013 Profile Study)– Core Questionnaire and Module 1
• Rural Urban Commuting Area (RUCA) Codes
Outcome Variable
• Which of the following best describes your LHD with respect to participation in the PHAB’s accreditation program for LHDs?
– Seeking PHAB Accreditation • Submitted an application for accreditation• Submitted a Statement of Intent
– Not Seeking PHAB Accreditation• Undecided• Decided NOT to apply for accreditation• The SHA is pursuing accreditation on behalf of my LHD
Predictor Variables
• Rurality – Rural– Micropolitan– Urban
• Governance (state, local or shared)• Local Board(s) of Health • Workforce
– Employ Epidemiologist – Employ Public Health Physician – Employ Information Systems Specialists
• Per Capita Revenue• Agency-wide strategic plan
Analytic Approach
• Univariate descriptive statistics
• Bivariate analysis– Mann Whitney-U, Cramer’s V, Kendall’s Tau
• Binary logistic regression– Seeking PHAB accreditation (yes/no)
BIVARIATE FINDINGS
Accreditation Seeking
• Sample size N=306– Rural n=101 – Micropolition n=64– Urban n=141
• Accreditation seeking – 10.5% (n=32) are seeking PHAB accreditation
Total Seeking Not Seeking0%
20%
40%
60%
80%
100%
33%
3%
37%
21%
6%
23%
46%
91%
41%
Accreditation Seeking by Rurality
Rural Micropolitan Urban
p<0.001
Seeking
Accreditation
Total Yes No SigAgency-wide strategic plan (Yes) 152 (47.8%) 31 (91.2%) 121 (42.6%) 0.001
Governance NS
Shared 34 (10.6%) 3 (8.8%) 31 (10.8%)
State 72 (22.5%) 5 (14.7%) 67 (23.2%)
Local 214 (66.9%) 26 (76.5%) 118 (65.7%)Local Board(s) of Health (Yes) 214 (67.5%) 27 (79.4%) 187 (66.1%) 0.01
Epidemiologist (Yes) 107 (44.4%) 23 (69.7%) 84 (40.4%) 0.001Public Health Physician (Yes) 129 (51.0%) 19 (57.6%) 110 (50.0%) 0.05Information Systems Specialists (Yes) 104 (43.0%) 24 (75.0%) 80 (38.1%) 0.001
MULTIVARIATE FINDINGS
Adjusted Odds Ratio 95% CI
Per Capita Revenue 1.02 (1.01, 1.02)Agency-wide strategic plan (reference=no) 14.7 (6.7, 32.2)
Rurality (reference=Rural)Micropolitan 2.6 (0.8, 8.5)
Urban 30.6 (10.1, 93.2)Governance (reference=Shared)
State 6.1 (1.9, 19.8)
Local 5.3 (2.1, 13.0)Local Board(s) of Health (reference=none) 3.5 (1.6, 7.7)
Employ Epidemiologist (reference=no) 2.4 (1.2, 4.9)Employ Public Health Physician (reference=no) 0.9 (0.5, 1.6)
Employ Information Systems Specialists (reference=no) 1.6 (0.8, 3.2)
Conclusion
• Rural LHDs are less likely to seek accreditation.
• Other organization factors such as LBOH, having a strategic plan, and employing an epidemiologist were associated with seeking behaviors
• Trends in seeking behaviors should be explored overtime
Limitations
• Small sample size– Questions asked in Module, not Core
• PHAB accreditation was only 2 years old at time of survey
Implications
• Rural LHD lower likelihood of seeking accreditation likely relates to a myriad of challenges – lower levels of staffing and funding
• Simultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care.
• Efforts should be made to increase accreditation seeking in rural LHDs
Contact information
For additional information about this study contact:
Kate Beatty at [email protected] or
423-439-4482
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