1 Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
2 Center for Health Policy Analysis and Rural Health Research, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
Public Health Rep. 2018 May/Jun;133(3):250-256. doi: 10.1177/0033354918754542. Epub 2018 Apr 13.
Public health accreditation is intended to improve the performance of public health departments, and quality improvement (QI) is an important component of the Public Health Accreditation Board process. The objective of this study was to evaluate the QI maturity and accreditation readiness of local health departments (LHDs) in Nebraska during a 6-year period that included several statewide initiatives to progress readiness, including funding and technical assistance.
We used a mixed-methods approach that consisted of both online surveys and key informant interviews to assess QI maturity and accreditation readiness. Nineteen of Nebraska's 21 LHDs completed the survey in 2011 and 2013, 20 of 20 LHDs completed the survey in 2015, and 19 of 20 LHDs completed the survey in 2016. We facilitated a large group discussion with staff members from 16 LHDs in 2011, and we conducted key informant interviews with staff members from 4 LHDs in 2015.
Both QI maturity and accreditation readiness improved from 2011 to 2016. In 2011, of 19 LHDs, only 6 LHD directors agreed that their LHD had a culture that focused on QI, but this number increased every year up to 12 in 2016. The number of LHDs that had a high capacity to engage in QI efforts improved from 3 in 2011 to 8 in 2016. The number of LHDs with a QI plan increased from 3 in 2011 to 10 in 2016. The number of LHDs that were confident in their ability to obtain Public Health Accreditation Board accreditation improved from 6 in 2011 to 13 in 2016. Although their QI maturity generally increased over time, LHDs interviewed in 2015 still faced challenges adopting a formal QI system. External financial and technical support helped LHDs build their QI maturity and accreditation readiness.
Funding and technical assistance can improve LHDs' QI maturity and accreditation readiness. Improvement takes time and sustained efforts by LHDs, and support from external partners (eg, state health departments) helps build LHDs' QI maturity and accreditation readiness.
公共卫生认证旨在提高公共卫生部门的绩效，而质量改进（QI）是公共卫生认证委员会流程的重要组成部分。本研究的目的是评估内布拉斯加州地方卫生部门（LHD）在 6 年期间的 QI 成熟度和认证准备情况，该期间包括了多项全州范围的准备工作，包括资金和技术援助。
我们使用了一种混合方法，包括在线调查和关键知情人访谈，以评估 QI 成熟度和认证准备情况。2011 年和 2013 年，内布拉斯加州的 21 个 LHD 中有 19 个完成了调查，2015 年，20 个 LHD 完成了调查，2016 年，19 个 LHD 完成了调查。我们于 2011 年与 16 个 LHD 的工作人员进行了一次大型小组讨论，并于 2015 年与 4 个 LHD 的工作人员进行了关键知情人访谈。
QI 成熟度和认证准备情况从 2011 年到 2016 年都有所提高。2011 年，在 19 个 LHD 中，只有 6 个 LHD 主任同意他们的 LHD 有一种注重 QI 的文化，但这一数字每年都在增加，到 2016 年增加到 12 个。有能力进行 QI 工作的 LHD 数量从 2011 年的 3 个增加到 2016 年的 8 个。有 QI 计划的 LHD 数量从 2011 年的 3 个增加到 2016 年的 10 个。对自己获得公共卫生认证委员会认证能力有信心的 LHD 数量从 2011 年的 6 个增加到 2016 年的 13 个。尽管 LHD 的 QI 成熟度总体上随时间推移而提高，但 2015 年接受采访的 LHD 仍面临采用正式 QI 系统的挑战。外部财务和技术支持有助于 LHD 提高 QI 成熟度和认证准备情况。
资金和技术援助可以提高 LHD 的 QI 成熟度和认证准备情况。改进需要 LHD 付出时间和持续努力，外部合作伙伴（例如，州卫生部门）的支持有助于建立 LHD 的 QI 成熟度和认证准备情况。
