Role of accreditation intent in local health departments' decision to collaborate with tax-exempt hospitals around the community health assessment

Background: Local health departments (LHDs) have conducted community health assessments (CHAs) for years. More recently, completing a CHA has also become a prerequisite for LHDs seeking accreditation by the Public Health Accreditation Board (PHAB). Similarly, under the Affordable Care Act, nonprofit hospitals are required to conduct periodic CHAs. Opportunities thus exist for LHDs to partner with nonprofit hospitals in their communities, yet it remains unclear whether interest in PHAB accreditation motivates LHDs to engage in such collaborations.

Research objective: We examined LHD-hospital collaborations around CHAs, including characteristics of LHDs involved in collaborations and the relationship between LHDs’ accreditation activities and their involvement in collaborations.  

Data and sample: Data came from the 2013 National Association of County and City Health Officials (NACCHO) Profile Study and the Area Resource File. The sample included 1,492 LHDs.

Analysis: Descriptive and multivariate regression analyses were conducted. In the multivariate analysis, the dependent variable was a binary indicator of LHDs’ involvement in collaborations with nonprofit hospitals. PHAB accreditation intent  - completion of a CHA, a community health improvement plan, and an agency-wide strategic plan - represented the primary independent variables.

Principal findings: LHDs that collaborated with hospitals were larger, more likely to be locally governed and to have a local board of health. The PHAB accreditation prerequisites were all significantly correlated with LHD-hospital collaborations. Accreditation intent also was an important factor in LHDs’ decisions to collaborate with hospitals around the CHA when controlling for other LHD, population, and community characteristics.  

Conclusions: Accreditation efforts may be a positive influence on LHD-hospital collaborations. LHDs need to conduct a CHA as a prerequisite for PHAB accreditation and these LHDs may thus be in a good position to engage in collaborations with hospitals. Incentivizing voluntary accreditation among LHDs may help policymakers to encourage greater collaboration around CHAs.