Impact of North Carolina Local Public Health Agency Accreditation on Public Health Performance

The objective of this study is 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 compares accredited and nonaccredited 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 State Center for Health Statistics compares North Carolina counties served by accredited and nonaccredited local public health on 13 performance indicators. Finally, key informant interviews with health directors and management team members from high performing local public health agencies supplements 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 nonaccredited local public health agencies were conducted to describe patterns of variation in performance improvement across accredited and nonaccredited agencies. A thematic analysis of transcripts from key informant interviews was conducted using across-case matrices derived from within-case summaries.

Preliminary findings indicate that accredited and nonaccredited local public health agencies in North Carolina differ with respect to the degree to which they demonstrate policy development and implementation and community engagement, with accredited local public health agencies demonstrating higher scores on these domains. These findings will provide valuable information to North Carolina public health leaders and the national voluntary accreditation efforts regarding ways to ensure that public health agency accreditation drives high performance.