Does Local Public Health Department Accreditation in North Carolina have a Positive Impact on Emergency Preparedness: Conclusions from the NACCHO Profiles

Local public health departments (LPHDs) occupy pivotal positions within the nation's emergency preparedness (EP) and response systems because of their statutory authority to perform public health (PH) functions and their ability to coordinate the PH actions of many other organizations. Accreditation of PH agencies is important because of its potential to promote consistency in PH practice. This study assesses the impact of the state-based PH accreditation program in North Carolina on local EP capabilities. The 2005/2008 NACCHO National Profiles, the Area Resource File, and locally collected information are the data sources. 80 of 85 NC LPHDs who responded to both the 2005-08 NACCHO profiles (10 accredited in/before 2005, and 43 in/before 2008) are compared to a national comparison group (n=247) selected using propensity-score matching techniques. EP outcomes include: Developing a plan; Legal review; Participation in drills; Assessing competencies; and Providing training. In 2005 NC-accredited LPHDs were more likely to have performed all EP activities and were significantly more likely to assess EP-competencies and have a legal review of the EP-plan (p < 0.05). Longitudinal results show preparedness decreasing for some measures. However, for the NC-LPHDs who were “not-accredited in 05 but would be accredited in 2008,” preparedness capabilities increased. Further, of eight EP-Composite-Measures, accredited NC-LPHDs had higher scores for most domains, including: Surveillance & Investigation, Plans & Protocols, and Workforce & Volunteers. While NACCHO measures of EP need to be augmented and variability exists, the results suggest the NC accreditation program has a positive impact on preparedness capabilities of LPHAs. Structural and organizational attributes of LPHAs that influence their preparedness capabilities and accreditation outcomes will be presented.