Measuring Accreditation Activity and Progress: Findings from a survey of Indiana local health departments

Background: Public health accreditation is an important frontier for local health departments nationwide, as it will likely improve the quality and policy standing. Even as the system itself is relatively new, an increasing number of health departments are seeking accreditation. Understanding accreditation progress requires valid and meaningful measures that have yet to be fully developed and tested.

Methods: A 2013 survey among 71 of 93 Indiana local health jurisdictions measured accreditation activity and progress. Reported activities were categorized into accreditation stages using the Public Health Accreditation Board’s accreditation ‘steps’ as a guiding framework. Survey data were matched with the 2010 NACCHO Profile for longitudinal analyses with 76.1% of respondents.

Findings: 59.2% of jurisdictions reported pursuing accreditation. Half (50.0%) were categorized at initial stage of accreditation, and 42.9% were categorized at prerequisite stage. Receiving technical assistance was associated with reporting accreditation activity generally, and being at the prerequisite stage was associated with receipt of technical assistance by universities, the state health department and contractors. Three characteristics from 2010 were found to be associated with 2013 accreditation pursuit and/or progress: jurisdictions reporting accreditation activities in 2010 (CHA, CHIP, QI (yes), Strategic Plan) tended to report 2013 accreditation progress; those jurisdictions who in 2010 reported discussion about accreditation with their health departments, boards of health and others were more likely report pursuing accreditation in 2013; and those jurisdictions with female health directors in 2010 also tended to report accreditation pursuit in 2013.

Conclusion: This study offers a framework to conceptualize accreditation progress. Findings confirm the importance of targeted accreditation investment for accreditation progress, and point toward the investigation of organizational, resources and leadership characteristics. Evaluation of potential predictors of accreditation pursuit and progress should continue with 2013 Profile data and later, given the timing of national accreditation implementation.