Application for Public Health Accreditation Among US Local Health Departments in 2013 to 2019: Impact of Service and Activity Mix

Abstract

Objectives. To examine correlates of applying for accreditation among small local health departments (LHDs) in the United States through 2019.Methods. We used administrative data from the Public Health Accreditation Board (PHAB) and 2013, 2016, and 2019 Profile data from the National Association of County and City Health Officials to examine correlates of applying for PHAB accreditation. We fit a latent class analysis (LCA) to characterize LHDs by service mix and size. We made bivariate comparisons using the t test and Pearson χ².Results. By the end of 2019, 126 small LHDs had applied for accreditation (8%). When we compared reasons for not pursuing accreditation, we observed a difference by size for perceptions that standards exceeded LHD capacity (47% for small vs 22% for midsized [P < .001] and 0% for large [P < .001]).Conclusions. Greater funding support, considering differing standards by LHD size, and recognition that service mix might affect practicality of accreditation are all relevant considerations in attempting to increase uptake of accreditation for small LHDs.Public Health Implications. Overall, small LHDs represented about 60% of all LHDs that had not yet applied to PHAB.

FIGURE 1—

Local Health Department Application Trends to the Public Health Accreditation Board, Cumulative, by Year and Population Size Served: United States, 2013–2019 Note. LHD = local health department; PHAB = Public Health Accreditation Board. LHDs within the states of Ohio and Florida are categorized separately; the former of which has a statute requiring application to PHAB and the latter of which saw all LHDs accredited at the same time as the state department of health. The numbers above the bars indicate the total number of LHDs that had applied to the PHAB, with the percentage of those among all LHDs for that bar in parentheses. Source. Public Health Accreditation Board application data.

FIGURE 2—

Per-Capita Spending Among Small Local Health Departments, by Public Health Accreditation Board Application Status and Year: United States, 2013–2019 Source. Public Health Accreditation Board and National Association of County and City Health Officials Profile data.

FIGURE 3—

Reasons for Not Pursuing Public Health Accreditation Board Accreditation Among Small Local Health Departments, by Year: United States, 2013–2019 Note. LHD = local health department; PHAB = Public Health Accreditation Board. Error bars represent 95% confidence intervals derived from analysis of design- and nonresponse-adjusted weighted data.

FIGURE 4—

Accreditation Uptake by Latent Class and Local Health Department Size: United States, Excluding Florida and Ohio, 2013–2019 Note. Clin. = clinical; ins./reg = inspection and regulation; PHAB = Public Health Accreditation Board; pop. based = population-based prevention and epidemiology.