Investigating the effects of partnerships on local health departments preparedness

OBJECTIVES: The purpose of this study was quantitative evaluation of the effects of partnerships on the preparedness of local health departments (LHDs).

METHODS: We used propensity-scores-matching methodology (PSCORE routine in STATA9) to conduct quasi-experimental assignment of LHDs into pairs of cases and controls comparable by their observable characteristics (LHD expenditures, population in jurisdiction, number of employees, etc). The effects of LHD partnerships were estimated by calculating the difference in outcome variables between cases and controls. The five preparedness activities (outcomes) were: 1) develop or update a written emergency plan, 2) review relevant legal authorities 3) participate in drills or exercises, 4) assess emergency preparedness competencies of staff, and 5) provide emergency preparedness training to staff. Data was obtained from the 2005 NACCHO survey of 440 LHD.

FINDINGS: LHDs were more likely to develop or update a written emergency plan if they partnered with emergency responders (30% point difference, t=3.30), community organizations (20%, t=2.68), doctors (15%, t=2.98), businesses (14%, t=2.97) and schools (16%, t=1.79). Partnerships with businesses seemed to induce LHDs to review legal authorities (20% point difference, t=2.70). LHD participation in drills was more likely if they partnered with emergency responders (25% point difference, t=2.60), community organizations (19%, t=2.51), or physicians (9%, t=1.84). LHDs more frequently assessed emergency competencies of staff if they partner with hospitals (31% difference, t=2.97), emergency responders (30%, t=2.61, physicians (23%, t=3.21), or businesses (15, t=2.11). LHDs tended to provide more training if they partnered with hospitals (21%, t=2.27), emergency responders (19%, t=2.01), or community organizations (17%, t=1.95). No statistically significant effects of partnerships with community heath centers, insurers, economic development agencies, faith based organizations and universities on LHD preparedness activities were observed.

CONCLUSIONS: This study suggests that LHD partnerships with emergency responders, doctors, community organizations, hospitals and businesses may have beneficial effects on preparedness activities