Rodriguez Hector P, McCullough Jeffrey Mac, Hsuan Charleen
University of California, Berkeley,
Arizona State University,
Front Public Health Serv Syst Res. 2014 Oct;3(4):7.
Local health departments (LHDs) can more effectively develop and strengthen community health partnerships when leaders focus on building partnership collaborative capacity (PCC), including a multisector infrastructure for population health improvement. Using the 2008 National Association of County and City Health Officials (NACCHO) Profile survey, we constructed an overall measure of LHD PCC comprised of the five dimensions: outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages. We conducted a series of regression analyses to examine the extent to which LHD characteristics and contextual factors were related to PCC. The most developed PCC dimension was vision-focus balance, while infrastructure development and community linkages were the least developed. In multivariate analyses, LHDs that were locally governed (rather than governed by the state), LHDs without local boards of health, and LHDs providing a wider range of clinical services had greater overall PCC. LHDs serving counties with higher uninsurance rates had lower overall PCC. LHDs with lower per capita expenditures had less developed partnership infrastructure. LHD discontinuation of clinical services may result in an erosion of collaborative capacity unless LHD partnerships also shift their foci from services delivery to population health improvement.
当地方卫生部门（LHDs）的领导者专注于建立伙伴关系协作能力（PCC）时，包括建立一个用于改善人群健康的多部门基础设施，他们就能更有效地发展和加强社区卫生伙伴关系。利用2008年全国县市卫生官员协会（NACCHO）概况调查，我们构建了一个LHD PCC的综合指标，该指标由五个维度组成：基于结果的倡导、愿景与重点的平衡、系统导向、基础设施发展和社区联系。我们进行了一系列回归分析，以检验LHD特征和背景因素与PCC的关联程度。最发达的PCC维度是愿景与重点的平衡，而基础设施发展和社区联系则是最不发达的。在多变量分析中，由地方治理（而非由州治理）的LHDs、没有地方卫生委员会的LHDs以及提供更广泛临床服务的LHDs总体PCC更高。服务于未参保率较高县的LHDs总体PCC较低。人均支出较低的LHDs伙伴关系基础设施发展较差。LHD停止临床服务可能会导致协作能力的削弱，除非LHD伙伴关系也将重点从服务提供转向人群健康改善。
