Through examination of LHDs’ performance score in PHAB accreditation standards, we were able to demonstrate use of individual PHAB standards as an instrument to measure and compare LHDs’ performance, and support the existing evidence that accreditation is fostering LHDs’ quality improvement in public health systems for capacity to promote population health.

In our article “Local Health Departments’ Characteristics and Their Performance Scores in PHAB Accreditation Standards,” we (Betty Bekemeier, Abraham Flaxman, Butch de Castro, and I) explored the relationship between the local public health agencies’ characteristics and their performance scores in the public health accreditation (PHAB) assessment. We examined the variation in local health department’s (LHD) PHAB accreditation scores with respect to their organizational and jurisdiction characteristics, to understand how LHD characteristics relate to their performance.

We used cross-sectional data from 250 LHDs from 38 states that participated in PHAB accreditation assessments during 2013-2020 and had also participated in the 2016 National Association of County and City Health Officials (NACCHO) Profile. Using exploratory cluster analysis, we identified clusters of LHDs with similar performance scores in PHAB accreditation standards. We were then able to characterize each LHD cluster based on common organizational structures, jurisdiction characteristics, and activity levels on core public health functions.

WHAT DID WE FIND?

We found 3 clusters of LHDs with respect to PHAB accreditation performance scores. These clusters showed subtle differences in organizational and jurisdiction characteristics across clusters, especially in population size of the jurisdictions served. We noted that LHDs in our Cluster 1 tended to have the highest performance scores and served larger populations (eg, 250,000 or more). Also, we noted that LHDs serving smaller population (eg, less than 20,000 population size) exhibited relatively lower performance than other LHDs and may require more targeted supports to close the gap in their performance score. Our findings suggest that there are LHD characteristics that may predict PHAB performance scores and that can serve as a means for guiding specific performance improvement supports.

THE KEY TAKEAWAYS AND THE IMPLICATIONS FOR POLICY AND PRACTICES

Our analysis looked beyond accreditation status as an indicator for LHDs’ capacity to provide essential services. Through examination of LHDs’ performance score in PHAB accreditation standards, we were able to demonstrate use of individual PHAB standards as an instrument to measure and compare LHDs’ performance, and support the existing evidence that accreditation is fostering LHDs’ quality improvement in public health systems for capacity to promote population health.

In addition, our analysis revealed performance score differences that exist among LHDs that participated in PHAB accreditation, with some LHDs seemingly needing more help to meet specific accreditation standards— especially LHDs serving less than 20,000 population size.

Looking closely at PHAB standard areas in which agencies have lower and higher scores and examining how their characteristics are related to performance scores, can guide the type of interventions that will be most effective for agencies in meeting PHAB standards.

Likewise, since PHAB accreditation reports are not publicly available to individual LHDs for peer-to-peer comparison, we believe this cross-sectional evaluation of the performance scores highlights the potential to identify specific opportunities for system-based interventions to achieve equitable performance in the public health system. Thus, implications of our findings include:

• Comparisons of LHDsʼ PHAB accreditation performance scores may allow for identifying opportunities for system-level interventions to achieve equitable performance in the public health system.
• Understanding aggregate PHAB performance scores across agencies can provide insights to guide LHD assistance for meeting the accreditation criteria.
• Effective public health system-level support and interventions are needed that can go beyond individual LHDsʼ efforts to attain accreditation.
• An examination of the specific PHAB standards achieved across LHDs can reveal areas where LHDs lack proficiency and where targeted interventions are most needed.

Learn More:

• Local Health Departments’ Characteristics and Their Performance Scores in PHAB Accreditation Standards