The performance of local health departments: a review of the literature.

Local health department (LHD) performance measurement provides an opportunity to link inputs, outputs, and outcomes in a manner that should facilitate quality improvement. Since inputs flow from LHDs that vary substantially in size, organization, funding, and other characteristics, it is Reasonable to assume that these variable inputs may affect LHD performance or outcomes. Documenting this is becoming increasingly important as LHD accreditation is being seen as one approach to standardization of inputs. This article provides a literature Review of LHD performance measurement and attempts to identify LHD inputs (or characteristics) that impact performance or outcomes. The literature Review identified 23 articles on LHD performance, published in peer-reviewed journals since the 1988 Report on the Future of Public Health. The most common findings Related to LHD size, jurisdictional size, and funding: LHDs with larger staffs, serving populations of more than 50 000 persons, and with higher funding per capita were more often higher performing. Other notable characteristics of higher-performing LHDs included greater community interaction, having a director with higher academic degrees, and leadership functioning within a management team. Prospective studies that examine the linkages among LHD performance measurement, accreditation, and outcomes will be important in achieving performance improvement over time.