Quality Improvement Efforts of Local Health Departments: Findings from the 2005 National Profile of LHDs Study

2005 National Profile of Local Health Departments Study Collaboration with CDC Fourth in the Profile series Prior studies in 1989, , and Census design – includes all LHDs in U.S. First National Profile to be conducted as Web-based survey Source of all data in this presentation

Topics in Profile Core Governance Population served Finances Characteristics of top executive LPHA workforce Activities and services provided Community health assessment & improvement Information technology

Topics in Profile Modules Detailed information on: Finances LPHA workforce Community health assessment & improvement Information technology Additional Topics: Performance improvement Emergency preparedness Partnerships Policy-making and advocacy Addressing health inequities

Descriptive Statistics from 2005 Profile of LHDs Community Health Assessment (core) Community Health Improvement Planning (core) Performance Improvement (module) Accreditation (module)

Community Health Assessment Definition: A community health assessment is the process whereby a local health agency and its community engage in assessing the health needs of their community and investigate adverse health effects and health hazards to create a snap-shot of a communitys health.

LHD Participation in Community Health Assessment (CHA) CHA completion or plans Percentage Completed CHA in past three years51% Plans to complete CHA in next three years65% Either completed CHA in past three years or plans to complete in next three years 79% Both completed CHA in past three years and plans to complete in next three years 38%

Participation in CHA: Comparison with 1999 Study Population size All LHDs55%51% <25,00044%42% 25,000 – 49,99963%53% 50,000 – 99,99965%57% 100,000 – 499,99966%61% 500, %67%

Community Health Improvement Planning Definition: a series of timely and meaningful action steps that define and direct the distribution of health services and resources to improve your communitys health, or definite strategic action steps to improve health status in the community HP 2010 Target: 80% of LHDs have a health improvement plan

LHD Participation in Community Health Improvement Planning (CHIP) Percentage Participated in CHIP54% CHIP based results of CHA*86% CHIP linked to states health improvement plan* 68% Participation in past three years *Of those LHDs that have participated in CHIP

Participation in CHIP: Comparison with 1999 Study Population size All LHDs53%54% <25, ,000 – 49, ,000 – 99, ,000 – 499, ,

Participation in CHA by State: Version 1 % completed CHA in last 3 years

Participation in CHA by State: Version 2 % completed CHA in last 3 years OR plan to complete in next 3 years

Participation in CHA by State: Version 3 % completed CHA in last 3 years OR plan to complete in next 3 years

LHD Participation in Quality or Performance Improvement Efforts Population sizePercentage All LHDs71% <25,00063% 25,000 – 49,99967% 50,000 – 99,99973% 100,000 – 499,99973% 500, % n=423; involvement in past three years

Performance Management Components Has LHD established Performance Standards? Does the LHD use Performance Measures? Does the LHD Report Progress? Does the LHD have a Quality Improvement Process?

LHD Performance Management Activities n=427

Components of LHD Performance Management Activities Combination of Elements Area of Focus All four components QI process only Performance standard only Report progress only Standard, measure, report Human resources development 4221 Data and information systems Financial management Management practices Customer focus and orientation Public health capacity Health status

LHD Use of Performance Standards and Performance Measures

Percentage of LHD Programs with Evaluation or QI Efforts n=228 to 418

LHD Participation in Accreditation Programs Population sizePercentage All LHDs16% <25,0007% 25,000 – 49,99912% 50,000 – 99,99925% 100,000 – 499,99930% 500, % n=420

LHD Participation in Specific Accreditation Programs Accreditation programPercentage State-established accreditation program9% Laboratory accreditation program9% JCAHO (Joint Commission on Accreditation for Healthcare Organizations) 2% n=395

Relationships among Activities

What do LHDs mean by Quality Improvement? Probably a lot of different things! NACCHO plans to explore this in a survey about LHD quality improvement efforts Directed to all LHDs who reported some PI/QI activity in the last three years on the 2005 Profile survey

Follow-up QI Survey Topics Frameworks for performance improvement Resources for performance improvement Extent of QI activities (Agency-wide? Several program areas?) Proactive initiative or grant requirement? Elements of QI programs Training for LHD staff

For more information: Carolyn Leep, Senior Analyst National Association of County & City Health Officials 2005 Profile Web site: