title: Declining trends in local health department preparedness capacities.
abstract: OBJECTIVE
  We examined local health department (LHD) preparedness capacities in the context of participation in accreditation and other performance improvement efforts. MetHODS: We analyzed preparedness in 8 domains among LHDs responding to a preparedness capacity instrument from 2010 through 2012. Study groups included LHDs that (1) were exposed to a North Carolina state-based accreditation program, (2) participated in 1 or more performance improvement programs, and (3) had not participated in any performance improvement programs. We analyzed mean domain preparedness scores and applied a series of nonparametric Mann-Whitney Wilcoxon tests to determine whether preparedness domain scores differed significantly between study groups from 2010 to 2012.
  
  
  RESULTS
  Preparedness capacity scores fluctuated and decreased significantly for all study groups for 2 domains: surveillance and investigation and legal preparedness. Significant decreases also occurred among participants for plans and protocols, communication, and incident command. Declines in capacity scores were not as great and less likely to be significant among North Carolina LHDs.
  
  
  CONCLUSIONS
  Decreases in preparedness capacities over the 3 survey years may reflect multiple years of funding cuts and job losses, specifically for preparedness. An accreditation program may have a protective effect against such contextual factors.
authors.affiliation: Mary V. Davis and Anna P. Schenk are with the North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH). Anna P. Schenck is also with the Public Health Leadership Program, Gillings School of Global Public Health, UNC-CH. Christine A. Bevc is with the Research and Evaluation Unit, North Carolina Institute for Public Health, Gillings School of Global Public Health, UNC-CH.
authors.forename: Mary V
authors.initials: MV
authors.lastname: Davis
authors.forename: Christine A
authors.initials: CA
authors.lastname: Bevc
authors.forename: Anna P
authors.initials: AP
authors.lastname: Schenck
mesh_terms: D002959:Civil Defense / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends; D003625:Data Collection; D004189:Disaster Planning / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D009111:Local Government; D011635:Public Health Administration / Q000706:statistics & numerical data / Q000639:trends; D055872:Surge Capacity / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends; D014481:United States