农村地方卫生部门的公共卫生机构认证：影响因素与障碍
Public Health Agency Accreditation Among Rural Local Health Departments: Influencers and Barriers.
作者信息
Beatty Kate E, Erwin Paul Campbell, Brownson Ross C, Meit Michael, Fey James
机构信息
Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Beatty); Department of Public Health, College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, Tennessee (Dr Erwin); Brown School, Prevention Research Center in St Louis, Division of Public Health Sciences and Alvin J. Siteman Cancer Center, School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson); and NORC Walsh Center for Rural Health Analysis, NORC at the University of Chicago, Bethesda, Maryland (Messrs Meit and Fey).
出版信息
J Public Health Manag Pract. 2018 Jan/Feb;24(1):49-56. doi: 10.1097/PHH.0000000000000509.
OBJECTIVE
Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB).
DESIGN
Cross-sectional study using secondary data from the 2013 National Association of County & City Health Officials (NACCHO) National Profile of Local Health Departments Study (Profile Study).
SETTING
United States.
PARTICIPANTS
LHDs (n = 490) that responded to the 2013 NACCHO Profile Survey.
MAIN OUTCOME MEASURES
LHDs decision to seek PHAB accreditation.
RESULTS
Significantly more accreditation-seeking LHDs were located in urban areas (87.0%) than in micropolition (8.9%) or rural areas (4.1%) (P < .001). LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs (RLHDs). LHDs that had completed an agency-wide strategic plan were 8.5 times (95% CI, 4.0-17.9), LHDs with a local board of health were 3.3 times (95% CI, 1.5-7.0), and LHDs governed by their state health department were 12.9 times (95% CI, 3.3-50.0) more likely to seek accreditation. The most commonly cited barrier was time and effort required for accreditation application exceeded benefits (73.5%).
CONCLUSION
The strongest predictor for seeking PHAB accreditation was serving an urban jurisdiction. Micropolitan LHDs were more likely to seek accreditation than smaller RLHDs, which are typically understaffed and underfunded. Major barriers identified by the RLHDs included fees being too high and the time and effort needed for accreditation exceeded their perceived benefits. RLHDs will need additional financial and technical support to achieve accreditation. Even with additional funds, clear messaging of the benefits of accreditation tailored to RLHDs will be needed.
目的
卫生部门认证是加强公共卫生基础设施的一项关键策略。本研究的目的是调查与寻求认证行为相关的地方卫生部门（LHD）特征。本研究旨在确定农村地区对通过公共卫生认证委员会（PHAB）寻求认证可能性的影响。
设计
采用来自2013年全国县市卫生官员协会（NACCHO）地方卫生部门全国概况研究（概况研究）的二手数据进行横断面研究。
地点
美国。
参与者
对2013年NACCHO概况调查做出回应的地方卫生部门（n = 490）。
主要观察指标
地方卫生部门寻求PHAB认证的决定。
结果
寻求认证的地方卫生部门中，位于城市地区的比例（87.0%）显著高于微型城市地区（8.9%）或农村地区（4.1%）（P <.001）。居住在城市社区的地方卫生部门寻求PHAB认证的可能性是农村地方卫生部门（RLHDs）的16.6倍（95%置信区间[CI]，5.3 - 52.3），微型城市地区的地方卫生部门是其3.4倍（95% CI，1.1 - 11.3）。已完成全机构战略计划的地方卫生部门寻求认证的可能性是其8.5倍（95% CI，4.0 - 17.9），设有地方卫生委员会的地方卫生部门是其3.3倍（95% CI，1.5 - 7.0），由州卫生部门管理的地方卫生部门是其12.9倍（95% CI，3.3 - 50.0）。最常提到的障碍是认证申请所需的时间和精力超过了收益（73.5%）。
结论
寻求PHAB认证的最强预测因素是服务于城市辖区。微型城市地区的地方卫生部门比规模较小、通常人员不足且资金不足的农村地方卫生部门更有可能寻求认证。农村地方卫生部门确定的主要障碍包括费用过高以及认证所需的时间和精力超过了它们认为的收益。农村地方卫生部门需要额外的财政和技术支持来实现认证。即使有额外资金，也需要针对农村地方卫生部门量身定制关于认证益处的清晰信息。
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