Classifying local health departments on the basis of the constellation of services they provide

Abstract

Objectives: We explored service variation among local health departments (LHDs) nationally to allow systematic characterization of LHDs by patterns in the constellation of services they deliver.

Methods: We conducted latent class analysis by using categorical variables derived from LHD service data collected in 2008 for the National Profile of Local Health Departments Survey and before service changes resulting from the national financial crisis.

Results: A 3-class solution produced the best fit for this data set of 2294 LHDs. The 3 configurations of LHD services depicted an interrelated set of narrow or limited service provision (limited), a comprehensive (core) set of key services provided, and a third class of core and expanded services (core plus), which often included rare services. The classes demonstrated high geographic variability and were weakly associated with expenditure quintile and urban or rural location.

Conclusions: This empirically derived view of how LHDs organize their array of services is a unique approach to categorizing LHDs, providing an important tool for research and a gauge to monitor how changes in LHD service patterns occur.

FIGURE 1—

Probabilities that a low, medium, or high range of service provision in each service category (individual or population-focused and basic, expanded, or specialized) is offered by each of the 3 local health department classes (a) limited, (b) core, and (c) core plus: 2008 National Association of County and City Health Officials’ US National Profile of Local Health Departments.

FIGURE 2—

Results of latent class analysis of local health department service provision from 2008 National Association of County and City Health Officials’ US National Profile of Local Health Departments, mapped to 2008 local health department jurisdictional boundaries. Note. LHD = local health department.