Influence of Local Health Department Structure on Quality, Process, and Priorities of Community Health Assessment and Health Improvement Planning

Purpose: Investigate the variations of Community Health Assessment (CHA) and Community Health Improvement Planning (CHIP) process, quality, and outcomes based on structural organization of Local Health Departments (LHD), including LHD type; jurisdictional size; region; and LHD resources. Compare process, quality, and outcomes of joint jurisdictional CHAs and CHIPs with single jurisdiction process. Methods: Comparative case study utilizing mixed methods.  The adapted CHIPP Quality Measurement Tool was used to analyze the quality of CHIP/CHA process in all 124 Ohio LHDs.  The LHDs with the highest quality process for CHA (4) and CHIP (4) were surveyed and interviewed. Results: Regardless of structural issues, LHD demonstrated a high degree of CHA/CHIP quality. Structural differences included:  County departments were less likely to progress from CHA to CHIP, involve stakeholders, or establish guiding principles. City departments were less likely to identify measurable objectives and time framed targets. There were no significant differences in CHA/CHIP quality or process based on Board of Health or on jurisdictional size. Lower budget health departments performed with similar quality to higher budget programs, with more use of guiding principles, but less use of measurable objectives. The largest structural differences were geographic. There were distinct regional differences in CHA/CHIPs quality and process. Conclusion: Despite enormous differences in size, staffing, and resources diverse health departments showed more similarities than difference. Differences in quality based on budget and region raise concern about disparities in community health improvement. Quality differences based on LHD structure are identified to encourage eliminating these structural differences.