RiverStone Health, Billings, Montana 59101, USA.
J Public Health Manag Pract. 2011 Jan-Feb;17(1):E14-21. doi: 10.1097/PHH.0b013e3181f54282.
This study's primary objective was to determine where the viewpoints of public health officials and county commissioners differed on interjurisdictional collaboration in public health service delivery.
After cataloging literature findings on interjurisdictional collaboration, an original questionnaire for 2 population groups within a cross-sectional design was developed.
The questionnaire was administered in a rural or frontier state (Montana) that operates a generally decentralized public health system.
Respondents (n = 83) were 29 lead local public health officials representing 34 counties, and 54 county commissioners representing 33 counties.
Sixteen reasons to collaborate, 13 barriers to collaboration, and 18 policy considerations that would lead respondents to support or oppose a collaborative system were assessed, along with perceptions of current and ideal levels of interjurisdictional collaboration using the 4-level National Association of County and City Health Officials scale.
Viewpoints of public health officials and county commissioners were found to differ significantly on 7 of 47 items. The potential benefit of improved surge capacity to manage large-scale events or emergencies was found by public health officials to be a more important reason to collaborate across jurisdictional lines. Long-standing commitment to home rule, current political climate, perceived threats to local elected officials, loss of local input into public health services and priorities, and lack of collaborative government and staffing models were all identified by public health officials as greater barriers to interjurisdictional collaboration. County commissioners were more likely to neither support nor oppose using existing disaster and emergency services district boundaries to define public health regional boundaries.
Public health officials and county commissioners seem to have similar viewpoints on reasons to collaborate and policy considerations, but different viewpoints on barriers to collaboration. Reconciling those key differences is critical to effecting system change.
本研究的主要目的是确定公共卫生官员和县级专员在公共卫生服务提供方面的跨辖区合作观点的分歧所在。
在对跨辖区合作文献进行分类后，设计了一种针对横向设计中两类人群的原始问卷。
该问卷在一个农村或边疆州（蒙大拿州）实施，该州实行一般分散的公共卫生系统。
受访者（n=83）包括 29 位代表 34 个县的地方主要公共卫生官员，以及 54 位代表 33 个县的县级专员。
对 16 个合作理由、13 个合作障碍和 18 个政策考虑因素进行评估，这些因素将导致受访者支持或反对合作系统，同时还评估了对当前和理想的跨辖区合作水平的看法，使用国家县和城市卫生官员协会的 4 级量表。
公共卫生官员和县级专员在 47 项中的 7 项上观点存在显著差异。公共卫生官员认为，改善应对大规模事件或紧急情况的应急能力是跨辖区合作的一个更重要的原因。长期以来对地方自治的承诺、当前的政治氛围、对地方当选官员的威胁、对公共卫生服务和优先事项的地方投入的丧失，以及缺乏合作的政府和人员配备模式，这些都被公共卫生官员视为跨辖区合作的更大障碍。县级专员更有可能既不支持也不反对使用现有的灾害和应急服务区边界来定义公共卫生区域边界。
公共卫生官员和县级专员在合作理由和政策考虑方面似乎观点相似，但在合作障碍方面观点不同。弥合这些关键分歧对于实现系统变革至关重要。
