North Carolina public health agency accreditation and performance: the climb from good to extraordinary

The objective of this study was to determine how local public health agency accreditation impacts public health performance. Survey data collected in October 2008 from 80 local health agencies in North Carolina compared accredited and non-accredited local public health agency performance on three domains: policy development and implementation, community engagement, and leadership behavior. Secondary data analysis using performance data from the NC Center for Health Statistics compared North Carolina counties served by accredited and non-accredited local public health agencies on 13 performance indicators. Finally, key informant interviews with health directors and management team members from high performing local public health agencies supplemented findings from the surveys and performance indicator data. A cross-sectional survey design was used to assess local public health agency performance on key activities associated with the NC Local Health Department Accreditation Program. Descriptive analyses were conducted consisting of question-specific frequency distributions with p-values used to determine whether there were significant differences in scores for each domain based on the accreditation status of the responding agency. Time-series comparisons of performance improvement in accredited and non-accredited local public health agencies were conducted to describe patterns of variation in performance improvement across accredited and non-accredited agencies. A thematic analysis of transcripts from key informant interviews was conducted using across-case matrices derived from within-case summaries. Findings indicated that accredited and non-accredited local public health agencies in North Carolina differed with respect to the degree to which they demonstrated policy development and implementation and community engagement, with accredited local public health agencies demonstrating higher scores on these domains. These findings may provide valuable information to North Carolina public health leaders and the national voluntary accreditation efforts regarding ways to ensure that local public health agency accreditation drives high performance

Building the Evidence for Decision-Making: The Relationship Between Local Public Health Capacity and Community Mortality

Objectives. We examined associations between local health department (LHD) spending, staffing, and services and community health outcomes in North Carolina. Methods. We analyzed LHD investments and community mortality in North Carolina from 2005 through 2010. We obtained LHD spending, staffing, and services data from the National Association of City and County Health Officials 2005 and 2008 profile surveys. Five mortality rates were constructed using Centers for Disease Control and Prevention mortality files, North Carolina vital statistics data, and census data for LHD service jurisdictions: heart disease, cancer, diabetes, pneumonia and influenza, and infant mortality. Results. Spending, staffing, and services varied widely by location and over time in the 85 North Carolina LHDs. A 1% increase in full-time-equivalent staffing (per 1000 population) was associated with decrease of 0.01 infant deaths per 1000 live births (P < .05). Provision of women and children’s services was associated with a reduction of 1 to 2 infant deaths per 1000 live births (P < .05). Conclusions. Our findings, in the context of other studies, provide support for investment in local public health services to improve community health

An Examination of the Perceived Importance and Skills Related to Policies and Policy Making Among State Public Health Injury Prevention Staff

The purpose of this research is to use the Public Health Workforce Interests and Needs Survey to assess in greater detail state injury prevention staff perceptions of policy development and related skills and their awareness and perception of “Health in All Policies” (HiAP)

Information-Seeking Behaviors and Other Factors Contributing to Successful Implementation of Evidence-Based Practices in Local Health Departments

The objective of this article is to describe factors which contribute to successful translation of science into evidence-based practices and their implementation in public health practice agencies, based on a review of the literature and evidence from a series of case studies. The case studies involved structured interviews with key informants in four health departments and with four corresponding partners from academic institutions. Interviews were recorded and transcribed, coded by two independent, trained coders, using a standard codebook. A thematic analysis of codes was conducted. Coding was entered into Atlas TI software for further analysis

Effects of Maternity Care Coordination on Pregnancy Outcomes: Propensity-Weighted Analyses

Care coordination services that link pregnant women to health-promoting resources, avoid duplication of effort, and improve communication between families and providers have been endorsed as a strategy for reducing disparities in adverse pregnancy outcomes, however empirical evidence regarding the effects of these services is contradictory and incomplete. This study investigates the effects of maternity care coordination on pregnancy outcomes in North Carolina

Consolidated Framework for Collaboration Research derived from a systematic review of theories, models, frameworks and principles for cross-sector collaboration.

Cross-sector collaboration is needed to address root causes of persistent public health challenges. We conducted a systematic literature review to identify studies describing theories, models, frameworks and principles for cross-sector collaboration and synthesized collaboration constructs into the Consolidated Framework for Collaboration Research (CFCR). Ninety-five articles were included in the review. Constructs were abstracted from articles and grouped into seven domains within the framework: community context; group composition; structure and internal processes; group dynamics; social capital; activities that influence or take place within the collaboration; activities that influence or take place within the broader community; and activities that influence or take place both in the collaboration and in the community. Community engagement strategies employed by collaborations are discussed, as well as recommendations for using systems science methods for testing specific mechanisms of how constructs identified in the review influence one another. Researchers, funders, and collaboration members can use the consolidated framework to articulate components of collaboration and test mechanisms explaining how collaborations function. By working from a consolidated framework of collaboration terms and using systems science methods, researchers can advance evidence for the efficacy of cross-sector collaborations

Building the Evidence for Decision-Making: The Relationship Between Local Public Health Capacity and Community Mortality

Objectives. We examined associations between local health department (LHD) spending, staffing, and services and community health outcomes in North Carolina. Methods. We analyzed LHD investments and community mortality in North Carolina from 2005 through 2010. We obtained LHD spending, staffing, and services data from the National Association of City and County Health Officials 2005 and 2008 profile surveys. Five mortality rates were constructed using Centers for Disease Control and Prevention mortality files, North Carolina vital statistics data, and census data for LHD service jurisdictions: heart disease, cancer, diabetes, pneumonia and influenza, and infant mortality. Results. Spending, staffing, and services varied widely by location and over time in the 85 North Carolina LHDs. A 1% increase in full-time-equivalent staffing (per 1000 population) was associated with decrease of 0.01 infant deaths per 1000 live births (P < .05). Provision of women and children’s services was associated with a reduction of 1 to 2 infant deaths per 1000 live births (P < .05). Conclusions. Our findings, in the context of other studies, provide support for investment in local public health services to improve community health

Effects of Maternity Care Coordination on Pregnancy Outcomes: Propensity-Weighted Analyses

BACKGROUND: Care coordination services that link pregnant women to health-promoting resources, avoid duplication of effort, and improve communication between families and providers have been endorsed as a strategy for reducing disparities in adverse pregnancy outcomes, however empirical evidence regarding the effects of these services is contradictory and incomplete. This study investigates the effects of maternity care coordination on pregnancy outcomes in North Carolina. METHODS: Birth certificate and Medicaid claims data were analyzed for 7,124 women delivering live infants in North Carolina from October 2008 through September 2010, of whom 2,255 received Maternity Care Coordination (MCC) services. Propensity-weighted analyses were conducted to reduce the influence of selection bias in evaluating program participation. Sensitivity analyses compared these results to conventional OLS analyses. RESULTS: The unadjusted preterm birth rate was lower among women who received MCC services (7.0 percent compared to 8.3 percent among controls). Propensity-weighted analyses demonstrated that women receiving services had a 1.8 percentage point reduction in preterm birth risk; p<0.05). MCC services were also associated with lower pregnancy weight gain (p=0.10). No effects of MCC were seen for birthweight. CONCLUSIONS: These findings suggest that coordination of care in pregnancy can significantly reduce the risk of preterm delivery among Medicaid-enrolled women. Further research evaluating specific components of care coordination services and their effects on preterm birth risk among racial/ethnic and geographic subgroups of Medicaid enrolled mothers could inform efforts to reduce disparities in pregnancy outcome