Kate E Beatty PhD Tyler Carpenter BS Ross Brownson PhD Paul Erwin DrPH Disclosures No conflicts of interest to disclose Objective Upon completion of this educational activity you will be able to ID: 808992
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Slide1
Accreditation Seeking Decisions in Local Health Departments
Kate E. Beatty, PhD, Tyler Carpenter, BS, Ross Brownson, PhD, Paul Erwin, DrPH
Slide2Disclosures
No conflicts of interest to disclose
Slide3Objective
Upon completion of this educational activity, you will be able to:Identify factors associated with accreditation seeking behaviors in LHDsIdentify differences in behaviors by rurality
Slide4Educational Need/Practice Gap
Investigation of rural local health department accreditation is limited.
Slide5Overview of the Presentation
BackgroundResearch QuestionData SourcesMethodsResultsConclusion
Slide6Background
Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure. Rural LHDs face many challenges including lower levels of staffing and funding than LHDs serving metropolitan or urban areas. Their
populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care.
Through
accreditation, rural
LHDs can
become better equipped to meet the needs of their communities
.
Slide7Research Question
To identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs. What is the effect of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB)?
Slide8Data Sources
2013 NACCHO National Profile of Local Health Departments Study (2013 Profile Study)Core Questionnaire and Module 1Rural Urban Commuting Area (RUCA) Codes
Slide9Outcome Variable
Which of the following best describes your LHD with respect to participation in the PHAB’s accreditation program for LHDs?
Seeking PHAB
Accreditation
Submitted an application for accreditation
Submitted a Statement of Intent
Not Seeking PHAB
Accreditation
Undecided
Decided NOT to apply for accreditation
The SHA is pursuing accreditation on behalf of my LHD
Slide10Predictor Variables
Rurality RuralMicropolitanUrbanGovernance (state, local or shared)
Local
Board(s) of Health
Workforce
Employ
Epidemiologist
Employ
Public Health Physician
Employ
Information Systems
Specialists
Per Capita Revenue
Agency-wide strategic plan
Slide11Analytic Approach
Univariate
descriptive statistics
Bivariate analysis
Mann Whitney-U, Cramer’s V, Kendall’s Tau
Binary logistic regression
Seeking PHAB accreditation (yes/no)
Slide12Bivariate Findings
Slide13Accreditation Seeking
Sample size N=306Rural n=101 Micropolition n=64Urban n=141Accreditation seeking 10.5% (n=32) are seeking PHAB accreditation
Slide14p<0.001
Slide15Seeking
Accreditation
Total
Yes
No
Sig
Agency-wide strategic plan (Yes)
152 (47.8%)
31 (91.2%)
121 (42.6%)
0.001
Governance
NS
Shared
34 (10.6%)
3 (8.8%)
31 (10.8%)
State
72 (22.5%)
5 (14.7%)
67 (23.2%)
Local
214 (66.9%)
26 (76.5%)
118 (65.7%)
Local Board(s) of Health (Yes)
214 (67.5%)
27 (79.4%)
187 (66.1%)
0.01
Epidemiologist (Yes)
107 (44.4%)
23 (69.7%)
84 (40.4%)
0.001
Public Health Physician (Yes)
129 (51.0%)
19 (57.6%)
110 (50.0%)
0.05
Information Systems Specialists (Yes)
104 (43.0%)
24 (75.0%)
80 (38.1%)
0.001
Slide16Multivariate Findings
Slide17Adjusted Odds
Ratio
95% CI
Per Capita Revenue
1.02
(1.01, 1.02)
Agency-wide strategic plan (reference=no)
14.7
(
6.7, 32.2
)
Rurality
(reference=Rural)
Micropolitan
2.6
(
0.8, 8.5)
Urban
30.6
(
10.1, 93.2)
Governance (reference=Shared)
State
6.1
(
1.9, 19.8)
Local
5.3
(
2.1, 13.0)
Local Board(s) of Health (reference=none)
3.5
(
1.6, 7.7)
Employ Epidemiologist (reference=no)
2.4
(
1.2, 4.9)
Employ Public Health Physician (reference=no)
0.9
(
0.5
,
1.6)
Employ Information Systems Specialists (reference=no)
1.6
(
0.8, 3.2)
Slide18Conclusion
Rural LHDs are less likely to seek accreditation.Other organization factors such as LBOH, having a strategic plan, and employing an epidemiologist were associated with seeking behaviorsTrends in seeking behaviors should be explored overtime
Slide19Limitations
Small sample sizeQuestions asked in Module, not CorePHAB accreditation was only 2 years old at time of survey
Slide20Implications
Rural LHD lower likelihood of seeking accreditation likely relates to a myriad of challenges lower levels of staffing and fundingSimultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care.
Efforts should be made to increase accreditation seeking in rural LHDs
Slide21Contact information
For additional information about this study contact:Kate Beatty at beattyk@etsu.edu or 423-439-4482