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 beattyk@etsu.edu or

423-439-4482