Objectives: To assess the current deployment of quality improvement (QI) approaches within local health departments (LHDs) and gain a better understanding of the depth and intensity of QI activities.
Methods: A mixed quantitative and qualitative approach was employed to determine the current status of QI utilization within LHDs. All respondents from the 2005 NACCHO Profile QI module questionnaire who indicated that their LHD was involved in some kind of QI activity received a follow-up Web-based survey in 2007. A smaller convenience sample of 30 LHDs representing all groups of respondents was selected for the follow-up interview to validate and expound upon survey data.
Results: Survey response rate was 62 percent (181/292). Eighty-one percent of LHDs reported QI programmatic activities, with 39 percent occurring agency-wide. Seventy-four percent of health departments had staff trained in QI methods. External funding sources for QI were infrequent (28%). LHDs that were serving large jurisdictions and LHDs that were subunits of state health agencies (centralized states) were more likely to engage in most QI activities. However, interview responses did not consistently corroborate survey results and noted a need for shared definitions.
Conclusion: Multiple factors, including funders and accreditation, may be driving the increase of QI for public health. Additional research to confirm and validate these findings is necessary. A common QI vocabulary is also recommended.
This article discusses the progress, pitfalls, and potential of a mixed quantitative and qualitative approach for assessing the quality improvement utilization in local health departments.
Carolyn Leep, MS, MPH, is Director of Research and Evaluation, National Association of County and City Health Officials, Washington, DC.
Leslie M. Beitsch, MD, JD, is Professor of Health Policy and Director of the Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee.
Grace Gorenflo, MPH, RN, is Project Director, National Association of County and City Health Officials, Washington, DC.
Jessica Solomon, MCP, is Program Manager, National Association of County and City Health Officials, Washington, DC.
Robert G. Brooks, MD, MBA, MPH, is Associate Dean for Health Affairs, Florida State University College of Medicine, Tallahassee.
Corresponding Author: Leslie M. Beitsch, MD, JD, Florida State University College of Medicine, Center for Medicine and Public Health, 1115 W Call St, Tallahassee, FL 32306 (firstname.lastname@example.org)
The authors thank Claudine Martin, Penney Davis, and Stacy Baker for their contributions to the manuscript. Ms Martin conducted the telephone interviews to collect the qualitative data that are a key component of the study, and Ms Davis was an insightful reviewer. Ms Baker contributed to the development of the survey instrument. We also express our appreciation to the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation for providing funding support for the collection of data reported herein.