Dada Oluwatosin Omolara, Bekemeier Betty, Flaxman Abraham, de Castro Butch
University of Washington School of Nursing, Seattle, Washington (Drs Dada, Bekemeier, and de Castro); and University of Washington Department of Global Health, Seattle, Washington (Dr Flaxman).
J Public Health Manag Pract. 2022;28(4):375-383. doi: 10.1097/PHH.0000000000001458. Epub 2022 Jan 18.
Local health departments (LHDs) function to promote and protect population health by executing programs and activities through the 10 essential public health (PH) services in their operationalization of the core functions of PH systems-assessment, policy development, and assurance. PH accreditation supports LHDs by assessing their ability to promote community well-being through a set of standards and measures based on the 10 essential PH services. Prior studies show variation in LHD characteristics relative to their likelihood of participating in accreditation, but no studies have examined the variation in LHD accreditation scores to understand how LHD characteristics relate to performance improvement.
This work examines variation in LHD accreditation scores relative to their organizational and jurisdiction characteristics.
Cross-sectional data were obtained from 250 LHDs from 38 states that underwent Public Health Accreditation Board (PHAB) accreditation review.
We used exploratory cluster analysis to identify and group LHDs with similar performance scores in PHAB accreditation standards. Descriptive analyses were undertaken to characterize each LHD cluster group's organizational structure, jurisdiction characteristics, and core PH function activity levels. We then employed multivariate regression analysis to confirm the cluster analysis results.
The analysis showed 3 clusters of PHAB accreditation performance scores (cluster 1 = 0.95; cluster 2 = 0.87; and cluster 3 = 0.71). Subtle differences in organizational and jurisdiction characteristics across clusters, notably in population size of the jurisdictions served, were observed. LHDs in cluster 3 tended to have jurisdictions with less than 250000 population size and serve more than 1 county.
Performance scores in PHAB accreditation can be a useful standardized metric for assessing LHD ability to promote community well-being. LHDs serving less than 20000 population size, which exhibit relatively lower performance than other LHDs, may require more targeted supports to close the gap in their performance score.
地方卫生部门（LHDs）通过在公共卫生（PH）系统的核心功能——评估、政策制定和保障的实施过程中，执行10项基本公共卫生服务的项目和活动，来促进和保护人群健康。公共卫生认证通过一套基于10项基本公共卫生服务的标准和措施，评估地方卫生部门促进社区福祉的能力，从而为其提供支持。先前的研究表明，地方卫生部门的特征在参与认证的可能性方面存在差异，但尚无研究考察地方卫生部门认证分数的差异，以了解地方卫生部门的特征与绩效改进之间的关系。
这项工作考察了地方卫生部门认证分数相对于其组织和管辖特征的差异。
横断面数据来自38个州的250个接受公共卫生认证委员会（PHAB）认证审查的地方卫生部门。
我们使用探索性聚类分析来识别和分组在PHAB认证标准中具有相似绩效分数的地方卫生部门。进行描述性分析以描述每个地方卫生部门聚类组的组织结构、管辖特征和核心公共卫生功能活动水平。然后，我们采用多元回归分析来确认聚类分析结果。
分析显示PHAB认证绩效分数有3个聚类（聚类1 = 0.95；聚类2 = 0.87；聚类3 = 0.71）。观察到各聚类在组织和管辖特征上存在细微差异，特别是在所服务辖区的人口规模方面。聚类3中的地方卫生部门往往服务于人口规模小于25万且不止1个县的辖区。
PHAB认证中的绩效分数可以作为评估地方卫生部门促进社区福祉能力的有用标准化指标。服务人口规模小于2万的地方卫生部门，其绩效相对低于其他地方卫生部门，可能需要更有针对性的支持来缩小其绩效分数差距。
