Beatty Kate E, Mayer Jeffrey, Elliott Michael, Brownson Ross C, Wojciehowski Kathleen
Departments of Health Management and Policy (Dr Beatty), Behavioral Science and Health Education (Dr Mayer), and Biostatistics (Dr Elliott), Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri; Brown School and Division of Public Health Sciences and Alvin J. Siteman Cancer Center, School of Medicine, Washington University in St. Louis, Saint Louis, Missouri (Dr Brownson); and Missouri Institute for Community Health, Jefferson City, Missouri (Dr Wojciehowski).
J Public Health Manag Pract. 2015 Mar-Apr;21(2):116-25. doi: 10.1097/PHH.0000000000000089.
The Healthy People 2020 goal for the public health system is "to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services." To address this goal, Missouri established the first statewide, voluntary accreditation program of local health departments (LHDs) and began accrediting the LHDs in 2003. The purpose of this study was to identify organizational, structural, and workforce factors related to accreditation status of LHDs in Missouri.
Using data from the National Association of County & City Health Officials (2010) and the Missouri Department of Health & Senior Services (2012), binary logistic regression analysis was performed to predict accreditation status of LHDs. Likelihood ratio tests were used to examine whether the addition of each predictor added significantly to the model compared with a model including total revenues alone. Adjusted odds ratios (aORs), 95% confidence intervals, the significance level of the likelihood ratio test, and the overall Nagelkerke pseudo-R for each model are reported.
Having a community health improvement plan (aOR = 6.2), a strategic plan (aOR = 7.9), evaluating programs (aOR = 3.6), being in a region with a high proportion of accredited LHDs (aOR = 5.5), and participating in multijurisdictional collaborations (aOR = 6.4) all increased the likelihood of accreditation. Barriers of time (aOR = 0.1) and cost (aOR = 0.3) were negatively associated with accreditation.
Accredited LHDs were more likely to have completed the prerequisites for accreditation and collaborate with other LHDs. These activities help LHDs meet the accreditation standards. In addition, with shrinking budgets, LHDs will need additional financial and technical support to achieve accreditation. Assisting LHDs to find ways to increase the staff is important. Through collaborations with other LHDs, regional or multicounty positions can be created. Also collaborations with universities, specifically colleges or schools of public health, can provide opportunities for internships at LHDs giving practical experience while providing important assistance to LHDs.
“健康人民2020”针对公共卫生系统的目标是“确保联邦、州、部落和地方卫生机构拥有有效提供基本公共卫生服务所需的基础设施”。为实现这一目标，密苏里州建立了首个全州范围内针对地方卫生部门（LHDs）的自愿认证计划，并于2003年开始对地方卫生部门进行认证。本研究的目的是确定与密苏里州地方卫生部门认证状况相关的组织、结构和劳动力因素。
利用美国县市卫生官员协会（2010年）和密苏里州卫生与老年服务部（2012年）的数据，进行二元逻辑回归分析以预测地方卫生部门的认证状况。似然比检验用于检验与仅包含总收入的模型相比，每个预测变量的加入是否能显著增加模型的解释力。报告每个模型的调整比值比（aORs）、95%置信区间、似然比检验的显著性水平以及整体Nagelkerke伪R值。
拥有社区健康改善计划（aOR = 6.2）、战略计划（aOR = 7.9）、评估项目（aOR = 3.6）、所在地区认证地方卫生部门比例高（aOR = 5.5）以及参与多辖区合作（aOR = 6.4）均增加了获得认证的可能性。时间障碍（aOR = 0.1）和成本障碍（aOR = 0.3）与认证呈负相关。
获得认证的地方卫生部门更有可能完成认证的先决条件并与其他地方卫生部门合作。这些活动有助于地方卫生部门达到认证标准。此外，随着预算的缩减，地方卫生部门需要额外的财政和技术支持以实现认证。协助地方卫生部门找到增加工作人员的方法很重要。通过与其他地方卫生部门合作，可以设立区域或多县职位。与大学，特别是公共卫生学院或学校的合作，可以为地方卫生部门提供实习机会，在提供实践经验的同时为地方卫生部门提供重要帮助。
