Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States.
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States.
Front Public Health. 2022 May 25;10:861587. doi: 10.3389/fpubh.2022.861587. eCollection 2022.
Foundational Capabilities (FC) are the public health (PH) infrastructure areas that are essential for local health departments (LHDs) to support a "minimum package" of programs and services that promote population health. Despite being a critical component of LHD programs, FC are chronically underfunded, and studies specific to the relationship between LHD FC expenditures and their performance-the LHDs' ability to provide essential PH programs and services to their community-have not been previously reported. Public Health Accreditation Board (PHAB) accreditation is a nationally recognized accreditation program for PH agencies. PHAB accreditation assesses LHDs' performance against sets of standards that are based on the 10 essential PH services. Alignment between FC and the PHAB standards presents a means for assessing LHD FC expenditures relative to their performance in PHAB accreditation standards.
We examined the association between LHD total FC expenditures, as well as FC funding allocation patterns, and performance score on selected PHAB accreditation standards.
We used Bayesian regression methods to estimate the coefficients for the aggregate performance score, and performance scores on individual PHAB standards.
Analyses showed that a dollar increase in total FC expenditures is associated with a 0.2% increase in the aggregate performance score in selected PHAB standards as well as the performance score on most of the standards examined. LHDs that allocated FC budgets more evenly across FC programs were found to be more likely to have higher scores.
Investment in FC could improve LHD performance scores in PHAB accreditation standards and support LHDs' capability for improving community health outcomes. Allocating available FC resources across the various FC programs could support better LHD performance, as indicated by accreditation scores. This study contributes to advancing the understanding of public health finances in relation to performance and could help guide effective LHD resource allocation.
基础能力（FC）是公共卫生（PH）基础设施的重要组成部分，对于地方卫生部门（LHD）支持促进人口健康的“基本一揽子”计划和服务至关重要。尽管 FC 是 LHD 计划的重要组成部分，但它们长期资金不足，而且关于 LHD FC 支出与其绩效（即 LHD 为其社区提供基本 PH 计划和服务的能力）之间关系的研究尚未报道。公共卫生认证委员会（PHAB）认证是一项针对 PH 机构的全国认可的认证计划。PHAB 认证根据十项基本 PH 服务的标准评估 LHD 的绩效。FC 与 PHAB 标准的一致性为评估 LHD 在 PHAB 认证标准中的 FC 支出与其绩效提供了一种手段。
我们研究了 LHD 总 FC 支出以及 FC 资金分配模式与选定 PHAB 认证标准绩效得分之间的关联。
我们使用贝叶斯回归方法估计总 FC 支出的综合绩效得分以及各个 PHAB 标准的绩效得分的系数。
分析表明，FC 总支出增加 1 美元与选定 PHAB 标准的综合绩效得分以及大多数所检查标准的绩效得分增加 0.2%相关。我们发现，在 FC 计划中更平均地分配 FC 预算的 LHD 更有可能获得更高的分数。
对 FC 的投资可以提高 LHD 在 PHAB 认证标准中的绩效得分，并支持 LHD 改善社区健康结果的能力。在各种 FC 计划中分配可用的 FC 资源可以支持更好的 LHD 绩效，这反映在认证分数上。这项研究有助于深入了解公共卫生财务与绩效的关系，并可以为有效的 LHD 资源分配提供指导。
