Angela L. Carman

Quality Improvement Activities of Local Health Departments during the 2008-2010 Economic Recession

BACKGROUND A review of the work of researchers in the field of quality reveals a connection between the use of quality improvement (QI) concepts and improved financial performance. The disconnect between the expanding role of public health and the levels of per capita spending to support this role suggests that local health departments with a change in funding might benefit by employing QI to increase service delivery efficiency. PURPOSE To examine the relationship between changes in local health department (LHD) total revenue during the 2008-2010 economic recession and changes in LHD quality improvement activities during the same period. METHODS A matched-pairs study assessed change in revenue and associated change in QI activities at two points of time, 2008 and 2010. The study was completed in 2013. A proportional odds regression model estimated the adjusted ORs, measuring the association between change in QI activities and total revenue change, controlling for demographics, leadership QI training, and accreditation intention. RESULTS Neither changes in revenue nor changes in expenses predicted change in QI activities in LHDs. Enhanced QI activities were found in LHDs led by a director with a masters degree, led by directors trained in QI, or those serving medium-sized (50,000-499,000) jurisdictions. CONCLUSIONS This study revealed that neither changes in revenue nor changes in LHD expenses predict enhanced QI activities. Rather, improvements appear to be more related to characteristics of local health department leaders, which suggests areas to focus on for future efforts in public health services improvement.

Designing for Dissemination: Lessons in Message Design From “1-2-3 Pap”

Despite a large number of evidence-based health communication interventions tested in private, public, and community health settings, there is a dearth of research on successful secondary dissemination of these interventions to other audiences. This article presents the case study of “1-2-3 Pap,” a health communication intervention to improve human papillomavirus (HPV) vaccination uptake and Pap testing outcomes in Eastern Kentucky, and explores strategies used to disseminate this intervention to other populations in Kentucky, North Carolina, and West Virginia. Through this dissemination project, we identified several health communication intervention design considerations that facilitated our successful dissemination to these other audiences; these intervention design considerations include (a) developing strategies for reaching other potential audiences, (b) identifying intervention message adaptations that might be needed, and (c) determining the most appropriate means or channels by which to reach these potential future audiences. Using “1-2-3 Pap” as an illustrative case study, we describe how careful planning and partnership development early in the intervention development process can improve the potential success of enhancing the reach and effectiveness of an intervention to other audiences beyond the audience for whom the intervention messages were originally designed.

Public health accreditation: rubber stamp or roadmap for improvement.

OBJECTIVES We identified the characteristics of local health departments (LHDs) that intended to seek accreditation, and also examined the association between that intent and a complete community health assessment (CHA), community health improvement plan, agency strategic plan, or other specific accreditation requirements. METHODS We analyzed data from the 2010 profile survey of LHDs conducted by the National Association of County and City Health Officials (n = 267). RESULTS Those LHDs that conducted a CHA (adjusted odds ratio [AOR] = 0.62; 95% confidence interval [CI] = 0.38, 1.00; P = .05) and developed a strategic plan (AOR = 0.30; 95% CI = 0.12, 0.74; P = .01) were less likely to have an intent to pursue accreditation in the first 2 years of the program. By contrast, those LHDs that were engaged in quality improvement (QI) activities were approximately 2.6 times more likely to pursue accreditation compared with those LHDs that did not have any QI activities (P < .001). CONCLUSIONS Based on our findings, national public health accreditation might be the vehicle LHDs could use to improve their operating environments, better manage their resources, and reap the rewards associated with meeting national industry standards.

Collective Impact through Public Health and Academic Partnerships: A Kentucky Public Health Accreditation Readiness Example

In the ever-changing, resource-limited public health environment, the use of partners found in the faculty and students of Colleges of Public Health can provide training, consultation, and technical assistance needed to increase local health department (LHD) workforce capacity to meet new public health demands including national public heath accreditation. This manuscript describes the provision of the backbone support activities of facilitation, data management, and project management by University of Kentucky’s College of Public Health to Kentucky’s LHDs seeking national public health accreditation.

The journey toward voluntary public health accreditation readiness in local health departments: leadership and followership theories in action

Local health department directors’ intent on getting their organizations ready for accreditation must embrace the blurring of leader/follower lines and create an accreditation readiness team fueled not by traditional leader or follower roles but by teamship.

Cross Jurisdictional Boundaries to Build a Health Coalition: A Kentucky Case Study

Cross-jurisdictional sharing is accomplished through collaboration across jurisdictional boundaries to deliver essential public health services and solve problems that cannot be easily addressed by single organizations or jurisdictions. Partners across 10 counties and three public health jurisdictions of the Barren River Area Development District (BRADD) convened as Barren River Initiative to Get Healthy Together (BRIGHT), a community health improvement coalition. Focus groups and interviews with BRIGHT members indicate that the use of effective strategies to focus collaborative health improvement efforts fosters a cohesive coalition even when the group is populated by individuals from across public health jurisdictional boundaries. Focusing strategies identified included: the importance of organizing workgroups so members can draw upon expertise, adoption of a community engagement model for health assessment and improvement; and use of a facilitator, who offers guidance and administrative support to groups and focuses members on accomplishing goals.

Facilitating Community Health Improvement Capacity Through Nongovernmental Public Health Partners

The purpose of this study was to evaluate the effectiveness of the Facilitating the Community Health Improvement Process training in increasing the capacity of nongovernmental public health partners to serve as facilitators and supporters of community health improvement coalitions. Ten members of WellCare Advocacy and Community-Based Program teams (CommUnity Advocates) serving communities across the country were identified to participate in the pilot training group. They completed pre- and posttraining surveys to evaluate knowledge of community health improvement process models and facilitation techniques, as well as qualitative interviews to assess use of training material 6 months after the training. Results of the project revealed successful use of content from the training, which enhanced the impact of nongovernmental public health partners as facilitators of community health improvement planning and implementation.

Adaptation of an Evidence-Based Intervention to Improve Preventive Care Practices in a Federally Qualified Health Center in Appalachian Kentucky

University collaboration with a federally qualified health center resulted in adaptation and implementation of an evidenced-based intervention promoting preventive care, including cancer screening. Here, we focus on strategic planning, formative research, staff commitment, patient perceptions, data refinements, and organizational investments; successes, lessons learned, and challenges are also discussed.