Mary V. Davis

The Association of Changes in Local Health Department Resources With Changes in State-Level Health Outcomes

We explored the association between changes in local health department (LHD) resource levels with changes in health outcomes via a retrospective cohort study. We measured changes in expenditures and staffing reported by LHDs on the 1997 and 2005 National Association of County and City Health Officials surveys and assessed changes in state-level health outcomes with the Americas Health Rankings reports for those years. We used pairwise correlation and multivariate regression to analyze the association of changes in LHD resources with changes in health outcomes. Increases in LHD expenditures were significantly associated with decreases in infectious disease morbidity at the state level (P = .037), and increases in staffing were significantly associated with decreases in cardiovascular disease mortality (P = .014), controlling for other factors.

Development and implementation of a public health workforce training needs assessment survey in North Carolina

Assessing the training needs of local public health workers is an important step toward providing appropriate training programs in emergency preparedness and core public health competencies. The North Carolina Public Health Workforce Training Needs Assessment survey was implemented through the collaboration of several organizations, including the North Carolina Center for Public Health Preparedness at the North Carolina Institute for Public Health, the outreach and service unit of the University of North Carolina School of Public Health, the Office of Public Health Preparedness and Response in the North Carolina Division of Public Health Epidemiology Section, and local health departments across the state.

Examining the impact of a distance education MPH program: a one-year follow-up survey of graduates.

This article addresses the critical issue of measuring impact of a distance education Master of Public Health degree program on public health practitioners. It is based on an online survey of the 49 graduates of the Public Health Leadership Program at the School of Public Health of the University of North Carolina at Chapel Hill. The survey was carried out 1-year postgraduation and had a 73% response rate. Results indicated that graduates continued to have a high level of satisfaction with the program; 97% of respondents indicated they would recommend the program to others, and 75% said that their overall opinion about the program had increased since graduation. On a scale of 1 to 10, 79% of respondents rated the program with a score of 8 or higher in terms of the impact of the program on their ability to do their current job. Regarding new opportunities, 75% of respondents reported that they had new professional affiliations or service commitments, and 31% had job promotions since graduating. The methodology and results reported here may be a model for assessing the impact of a distance learning degree program for mid-career professionals. These results support the viability of a distance-education format for providing necessary training at the masters level for the public health workforce.

Informing the National Public Health Accreditation Movement: Lessons From North Carolina's Accredited Local Health Departments

To advance understanding of public health accreditation, we analyzed data on the North Carolina Local Health Department Accreditation program. We surveyed accredited health departments on barriers to and supports of accreditation preparation, performance on accreditation standards, and benefits and improvements after accreditation. All 48 accredited agencies responded to the survey. All agencies improved policies to prepare for accreditation and met most accreditation standards. Forty-six percent received local funds for accreditation preparation. The most common barrier to accreditation preparation was time and schedule limitations (79%). Fifty percent of agencies acted on suggestions for improvement, and 67% conducted quality improvement activities. Benefits of accreditation included improvements in local partnerships. Agencies of all sizes conducted accreditation activities, were successfully accredited, and experienced benefits resulting from accreditation.

Incentives to Encourage Participation in the National Public Health Accreditation Model: A Systematic Investigation

OBJECTIVES We sought to identify the incentives most likely to encourage voluntary participation in the national public health accreditation model. METHODS We reviewed existing incentives, held meetings with key informants, and conducted a survey of state and local public health agency representatives. The survey was sent to all state health departments and a sample of local health departments. Group-specific differences in survey responses were examined. RESULTS Survey response rates were 51% among state health department representatives and 49% among local health department representatives. Both state health department and local health department respondents rated financial incentives for accredited agencies, financial incentives for agencies considering accreditation, and infrastructure and quality improvement as important incentives. State health department respondents also indicated that grant administration and grant application would encourage their participation in the national accreditation model, and local health department respondents also noted that technical assistance and training would encourage their participation. CONCLUSIONS Incentives to encourage participation of state and local agencies in the national voluntary accreditation model should include financial support as well as support for agency infrastructure and quality improvements. Several initiatives are already under way to support agency infrastructure and quality improvement, but financial support incentives have yet to be developed.

The NC accreditation learning collaborative: partners enhancing local health department accreditation.

North Carolina (NC) is one of several states that have developed an accreditation system for local public health agencies. The NC Collaborative, composed of the NC Association of Local Health Directors, the NC Division of Public Health, and the NC Institute of Public Health, conducted several initiatives to enhance the NC accreditation system and contribute to the Multi-state Learning Collaborative. Two of these projects, benefits of accreditation and the Accreditation Road Map, are of potential national interest and can inform the proposed national, voluntary accreditation model. Benefits of accreditation from the perspectives of various system participants were explored through the ongoing evaluation of the NC accreditation system. The development of the Accreditation Road Map and its intended uses are described. Implications for the proposed national model and public health systems research are discussed.

Teaching Practical Public Health Evaluation Methods

Human service fields, and more specifically public health, are increasingly requiring evaluations to prove the worth of funded programs. Many public health practitioners, however, lack the required background and skills to conduct useful, appropriate evaluations. In the late 1990s, the Centers for Disease Control and Prevention (CDC) created the Framework for Program Evaluation in Public Health to provide guidance and promote use of evaluation standards by public health professionals. The emphasis of the Framework is utilization-focused evaluation for program improvement or to assess program impact. This article presents the use of the CDC Framework for Program Evaluation in Public Health to create and teach practical evaluation methods to master’s of public health students. The article includes the teaching approach, semester-long syllabus for students, and course evaluation data; suggests supplementary materials; and discusses implementation issues.

Opportunities to advance quality improvement in public health.

The concepts and use of quality improvement are not new to public health, but precise enumeration of quality improvement activities in public health has been problematic.1,2 Further, the context for, and advancement of, quality improvement in public health is still being defined.3 Nevertheless, quality improvement, along with voluntary accreditation, is critical to improving the performance of state and local public health agencies.4,5 Public health quality improvement initiatives have occurred or are under way at the national, state, and local levels, using a variety of quality improvement processes.6 In some cases, local health departments have conducted specific initiatives based on assessment results from the Operational Definition of a Local Health Department or the National Public Health Performance Standards local assessment instrument. Other local health departments have a culture of quality improvement that permeates all efforts of the organization. Several state health departments, such as those of Virginia, Washington, Florida, and South Carolina, have statewide performance management and assessment systems that drive measurement and performance improvement processes. Finally, there have been several multisite applications of quality improvement efforts at state and local levels, including PREPARE for Pandemic Influenza and the Multi-State Learning Collaboratives I, II, and III. The following factors appear to facilitate the adoption and success of public health quality improvement efforts: (1) cultivating public health leaders who support, facilitate, and provide resources for quality improvement and performance management and empower employees to innovate in their agencies; (2) teaching, training, and providing opportunities

Effectiveness of public health quality improvement training approaches: Application, application, application

CONTEXT Quality improvement (QI) has been identified as a key strategy to improve the performance of state and local public health agencies. Quality improvement training effectiveness has received little attention in the literature. OBJECTIVES To evaluate the effectiveness of 3 QI training types: webinars, workshops, and demonstration site activities on improving participant knowledge, skill, and ability to conduct QI through a questionnaire conducted after training participation. DESIGN We used a natural experimental design hypothesizing that demonstration site participants would have the greatest gains on outcomes of interest compared with webinar and workshop participants. Bivariate and multivariate models were used to examine outcome differences between questionnaire respondents who participated in various training types. PARTICIPANTS Local health department employees who participated in the 3 training strategies. MAIN OUTCOME MEASURES Measures included knowledge and skill gain, skill application, QI receptivity, and ability to successfully participate in a QI project. RESULTS Two hundred eighty-four unique individuals who work in 143 health departments completed the questionnaire for a 59% response rate. The majority of these health departments serve midsize populations. Demonstration site respondents had significantly greater gains in knowledge and skills, skill application, and ability to successfully participate in a QI project. Webcast training participants had significantly higher QI receptivity in adjusted models. Respondents who participated in both webcast and demonstration site trainings had higher mean scores on all outcomes when compared with demonstration site single training participants, these differences were significant in unadjusted models. CONCLUSION Our findings suggest that QI training for public health agency employees should include both didactic training on QI content and opportunities for QI application. Future research should examine if this approach can effectively increase successful participation in QI projects for staff in LHDs of all sizes.

Early evaluation results from a statewide quality improvement training program for local public health departments in North Carolina.

CONTEXT Many state and local public health agencies have developed accreditation systems and are utilizing quality improvement (QI) methods and tools to improve the public health infrastructure. Development of strategies to support and build the capacity of the public health workforce to apply QI can help advance these efforts. OBJECTIVE This article describes the adaptation and creation of a standardized QI training program for local health departments (LHDs), explores the effectiveness of the program in increasing the confidence of the LHD staff to apply QI methods and tools, and discusses lessons learned from the first cohort of the program. METHODS An existing program designed for health care professionals was pilot tested, adapted, and used in 8 LHDs. A formative evaluation of the new public health QI training program was conducted through a hybrid internal and external evaluation model. Pre/postsurveys were used to measure participant satisfaction and the capacity of LHD staff to conduct QI. RESULTS Staff from 8 LHDs successfully completed the program and 94% of participants reported that they were satisfied with the overall training program. Seventy percent of participants reported a higher perceived confidence in conducting a QI project, and all participants reported sharing QI tools and methods with their coworkers. CONCLUSION These findings suggest that QI training programs using methods and tools previously applied in health care and other industries can be successfully adapted to public health. Although additional studies are needed to validate the results, this training model can be used to inform future work in developing a standardized QI training program in public health.