title: Health districts as quality improvement collaboratives and multijurisdictional entities.
abstract: BACKGROUND
  Local health departments are increasingly challenged to meet emerging health problems at the same time that they are being challenged with dwindling resources and the demands of accreditation.
  
  
  OBJECTIVE
  To assess the capacity of Multicounty health districts to serve as "Quality Improvement Collaboratives" and support local health departments to meet accreditation standards.
  
  
  METHODS
  The study used an online survey tool and follow-up phone calls with key informants in health districts and county health departments in Georgia. Data collection was primarily based on an instrument to measure Quality Improvement Collaboratives that was adapted and tested for use with public health agencies in Georgia.
  
  
  METHODS
  The Georgia PBRN conducted this study of health districts and county health departments. The Georgia Department of Public Health supports 18 health districts and 159 county health departments (GA DPH, 2011). The health districts range in county composition from 1 to 16 counties in each district.
  
  
  METHODS
  Key informants comprised district and county health department staff and county health department board members were identified by 13 participating health district offices.
  
  
  RESULTS
  Key opinion leaders from both the rural and nonrural counties agreed that the Districts were important for providing essential services and supporting quality improvement collaboration. Psychometric testing of the Quality Improvement Collaborative assessment public health instrument yielded high scores for validity and reliability.
  
  
  CONCLUSIONS
  Regionalization of local public health capacity is a critical emerging issue for public health accreditation and quality improvement. This study demonstrated the utility of regionalization across traditional local geopolitical boundaries.
authors.affiliation: Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA. wclivingood@georgiasouthern.edu
authors.forename: William
authors.initials: W
authors.lastname: Livingood
authors.forename: Nandi
authors.initials: N
authors.lastname: Marshall
authors.forename: Angela
authors.initials: A
authors.lastname: Peden
authors.forename: Ketty
authors.initials: K
authors.lastname: Gonzalez
authors.forename: Gulzar H
authors.initials: GH
authors.lastname: Shah
authors.forename: Dayna
authors.initials: D
authors.lastname: Alexander
authors.forename: Kellie
authors.initials: K
authors.lastname: Penix
authors.forename: Raymona
authors.initials: R
authors.lastname: Lawrence
authors.forename: Russell
authors.initials: R
authors.lastname: Toal
authors.forename: Lynn
authors.initials: L
authors.lastname: Woodhouse
mesh_terms: D000068:Accreditation; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D005845:Georgia; D019538:Health Care Surveys; D006801:Humans; D009111:Local Government; D058996:Quality Improvement / Q000592:standards*; D015203:Reproducibility of Results