1. Accreditation Seeking Decisions in Local Health Departments Kate E. Beatty, PhD, Tyler Carpenter, BS, Ross Brownson, PhD, Paul Erwin, DrPH

2. Disclosures No conflicts of interest to disclose

3. Objective Upon completion of this educational activity, you will be able to: Identify factors associated with accreditation seeking behaviors in LHDs Identify differences in behaviors by rurality

4. Educational Need/Practice Gap Investigation of rural local health department accreditation is limited.

5. Overview of the Presentation Background Research Question Data Sources Methods Results Conclusion

6. Background Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure. Rural LHDs face many challenges including lower levels of staffing and funding than LHDs serving metropolitan or urban areas. –Their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural LHDs can become better equipped to meet the needs of their communities.

7. Research Question To identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs. What is the effect of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB)?

8. Data Sources 2013 NACCHO National Profile of Local Health Departments Study (2013 Profile Study) –Core Questionnaire and Module 1 Rural Urban Commuting Area (RUCA) Codes

9. Outcome Variable Which of the following best describes your LHD with respect to participation in the PHAB’s accreditation program for LHDs? –Seeking PHAB Accreditation Submitted an application for accreditation Submitted a Statement of Intent –Not Seeking PHAB Accreditation Undecided Decided NOT to apply for accreditation The SHA is pursuing accreditation on behalf of my LHD

10. Predictor Variables Rurality –Rural –Micropolitan –Urban Governance (state, local or shared) Local Board(s) of Health Workforce –Employ Epidemiologist –Employ Public Health Physician –Employ Information Systems Specialists Per Capita Revenue Agency-wide strategic plan

11. Analytic Approach Univariate descriptive statistics Bivariate analysis –Mann Whitney-U, Cramer’s V, Kendall’s Tau Binary logistic regression –Seeking PHAB accreditation (yes/no)

12. BIVARIATE FINDINGS

13. Accreditation Seeking Sample size N=306 –Rural n=101 –Micropolition n=64 –Urban n=141 Accreditation seeking –10.5% (n=32) are seeking PHAB accreditation

14. p<0.001

15. Seeking Accreditation TotalYesNoSig Agency-wide strategic plan (Yes)152 (47.8%)31 (91.2%)121 (42.6%)0.001 GovernanceNS Shared34 (10.6%)3 (8.8%)31 (10.8%) State72 (22.5%)5 (14.7%)67 (23.2%) Local214 (66.9%)26 (76.5%)118 (65.7%) Local Board(s) of Health (Yes)214 (67.5%)27 (79.4%)187 (66.1%)0.01 Epidemiologist (Yes)107 (44.4%)23 (69.7%)84 (40.4%)0.001 Public Health Physician (Yes)129 (51.0%)19 (57.6%)110 (50.0%)0.05 Information Systems Specialists (Yes)104 (43.0%)24 (75.0%)80 (38.1%)0.001

16. MULTIVARIATE FINDINGS

17. Adjusted Odds Ratio95% CI Per Capita Revenue1.02(1.01, 1.02) Agency-wide strategic plan (reference=no) 14.7(6.7, 32.2) Rurality (reference=Rural) Micropolitan 2.6 (0.8, 8.5) Urban30.6(10.1, 93.2) Governance (reference=Shared) State6.1(1.9, 19.8) Local5.3(2.1, 13.0) Local Board(s) of Health (reference=none) 3.5(1.6, 7.7) Employ Epidemiologist (reference=no)2.4(1.2, 4.9) Employ Public Health Physician (reference=no) 0.9(0.5, 1.6) Employ Information Systems Specialists (reference=no)1.6(0.8, 3.2)

18. Conclusion Rural LHDs are less likely to seek accreditation. Other organization factors such as LBOH, having a strategic plan, and employing an epidemiologist were associated with seeking behaviors Trends in seeking behaviors should be explored overtime

19. Limitations Small sample size –Questions asked in Module, not Core PHAB accreditation was only 2 years old at time of survey

20. Implications Rural LHD lower likelihood of seeking accreditation likely relates to a myriad of challenges –lower levels of staffing and funding Simultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Efforts should be made to increase accreditation seeking in rural LHDs

21. Contact information For additional information about this study contact: Kate Beatty at beattyk@etsu.edu or 423-439-4482