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What Predicts Local Public Health Agency Performance Improvement? A Pilot Study in North Carolina

Hajat, Anjum MPH; Cilenti, Dorothy MPH, MSW; Harrison, Lisa M. MPH; MacDonald, Pia D.M. PhD, MPH; Pavletic, Denise MPH; Mays, Glen P. PhD, MPH; Baker, Edward L. MD, MPH

Journal of Public Health Management & Practice: March/April 2009 - Volume 15 - Issue 2 - p E22–E33
doi: 10.1097/01.PHH.0000346022.14426.84
Article

Local public health agencies (LPHAs) are faced with many challenges in their role as an integral part of the public health system. It is important to better understand the demands on and the capacity of LPHAs to respond to these challenges. Determining what factors can improve LPHA performance is critical to helping LPHAs face their challenges.

The objective of this study was to determine what factors are associated with LPHA performance improvement in North Carolina from 1999 to 2004. In North Carolina, several data sources regarding predictors of LPHA performance, including LPHA workforce, LPHA characteristics, public health expenditures, and population characteristics, are available. Improvement in LPHA performance was measured by nine indicators across diverse services that were collected over multiple years. Linear regression was used to evaluate the significance of predictor variables.

Our findings indicate that workforce characteristics such as occupational classification and experience of the workforce, LPHA characteristics such as number of full-time employees, as well as population characteristics are important predictors of LPHA performance.

This study provides insight into what is needed to better address LPHA performance improvement. More importantly, study findings indicate which workforce characteristics can be targeted to enhance LPHA performance improvement over time.

This study focuses on the factors that are associated with LPHA performance improvement in North Carolina from 1999 to 2004. This study provides insight into what is needed to better address LPHA performance improvement and indicates which workforce characteristics can be targeted to enhance LPHA performance improvement over time.

Anjum Hajat, MPH, is Doctoral Student with Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill.

Dorothy Cilenti, MPH, MSW, is Deputy Director for Management and Operations, North Carolina Institute for Public Health, School of Public Health, University of North Carolina, Chapel Hill.

Lisa M. Harrison, MPH, is Director of Southeast Public Health Leadership Institute and the North Carolina Public Health Incubator Collaboratives, North Carolina Institute for Public Health, School of Public Health, University of North Carolina, Chapel Hill.

Pia D.M. MacDonald, PhD, MPH, is Director of the North Carolina Center for Public Health Preparedness, North Carolina Institute for Public Health, and Research Assistant Professor with Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill.

Denise Pavletic, MPH, is Head of the Performance Improvement and Accountability Unit Administrative, Local and Community Support Section at the North Carolina Division of Public Health, Raleigh, North Carolina.

Glen P. Mays, PhD, MPH, is Associate Professor and Chair, Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock.

Edward L. Baker, MD, MPH, is Director of North Carolina Institute for Public Health, and Research Professor with Department of Health Policy and Administration, School of Public Health, University of North Carolina, Chapel Hill.

Corresponding Author: Anjum Hajat, MPH, North Carolina Center for Public Health Preparedness, University of North Carolina, School of Public Health, Campus Box 8165, Chapel Hill, NC 27599 (anjum@unc.edu).

The authors thank the local public health performance measurement committee, which includes local health directors and representatives of the North Carolina Division of Public Health, Administrative, Local and Community Support Section, and the local health department accountability workgroup. A special thanks to Joy Reed, Paul Buescher, and the State Center for Health Statistics for assistance with data acquisition, and to Leah Devlin for granting permission to use the data. Lastly, we thank the Robert Wood Johnson Foundation for funding this work.

© 2009 Lippincott Williams & Wilkins, Inc.