Patterns and predictors of local health department accreditation in Missouri.
BACKGROUND
The Healthy People 2020 goal for the public health system is "to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services." To address this goal, Missouri established the first statewide, voluntary accreditation program of local health departments (LHDs) and began accrediting the LHDs in 2003. The purpose of this study was to identify organizational, structural, and workforce factors related to accreditation status of LHDs in Missouri.


METHODS
Using data from the National Association of County & City Health Officials (2010) and the Missouri Department of Health & Senior Services (2012), binary logistic regression analysis was performed to predict accreditation status of LHDs. Likelihood ratio tests were used to examine whether the addition of each predictor added significantly to the model compared with a model including total revenues alone. Adjusted odds ratios (aORs), 95% confidence intervals, the significance level of the likelihood ratio test, and the overall Nagelkerke pseudo-R for each model are reported.


RESULTS
Having a community health improvement plan (aOR = 6.2), a strategic plan (aOR = 7.9), evaluating programs (aOR = 3.6), being in a region with a high proportion of accredited LHDs (aOR = 5.5), and participating in multijurisdictional collaborations (aOR = 6.4) all increased the likelihood of accreditation. Barriers of time (aOR = 0.1) and cost (aOR = 0.3) were negatively associated with accreditation.


CONCLUSIONS
Accredited LHDs were more likely to have completed the prerequisites for accreditation and collaborate with other LHDs. These activities help LHDs meet the accreditation standards. In addition, with shrinking budgets, LHDs will need additional financial and technical support to achieve accreditation. Assisting LHDs to find ways to increase the staff is important. Through collaborations with other LHDs, regional or multicounty positions can be created. Also collaborations with universities, specifically colleges or schools of public health, can provide opportunities for internships at LHDs giving practical experience while providing important assistance to LHDs.
Departments of Health Management and Policy (Dr Beatty), Behavioral Science and Health Education (Dr Mayer), and Biostatistics (Dr Elliott), Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri; Brown School and Division of Public Health Sciences and Alvin J. Siteman Cancer Center, School of Medicine, Washington University in St. Louis, Saint Louis, Missouri (Dr Brownson); and Missouri Institute for Community Health, Jefferson City, Missouri (Dr Wojciehowski).
Kate E
KE
Beatty
Jeffrey
J
Mayer
Michael
M
Elliott
Ross C
RC
Brownson
Kathleen
K
Wojciehowski
D000068:Accreditation / Q000592:standards*; D006801:Humans; D009111:Local Government; D008923:Missouri; D011635:Public Health Administration / Q000379:methods* / Q000592:standards*; D015980:Public Health Practice; D058996:Quality Improvement / Q000458:organization & administration