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Health Districts as Quality Improvement Collaboratives and Multijurisdictional Entities

Livingood, William PhD; Marshall, Nandi MPH, CHES, DrPH(c); Peden, Angela MPH; Gonzalez, Ketty MD, MS; Shah, Gulzar H. PhD, MStat, MS; Alexander, Dayna MSPH, CHES; Penix, Kellie MS; Lawrence, Raymona DrPH, MPH; Toal, Russell MPH; Woodhouse, Lynn MEd, EdD, MPH

Journal of Public Health Management & Practice: November/December 2012 - Volume 18 - Issue 6 - p 561–570
doi: 10.1097/PHH.0b013e31825b89fd
Original Articles

Context: Local health departments are increasingly challenged to meet emerging health problems at the same time that they are being challenged with dwindling resources and the demands of accreditation.

Objective: To assess the capacity of Multicounty health districts to serve as “Quality Improvement Collaboratives” and support local health departments to meet accreditation standards.

Design: The study used an online survey tool and follow-up phone calls with key informants in health districts and county health departments in Georgia. Data collection was primarily based on an instrument to measure Quality Improvement Collaboratives that was adapted and tested for use with public health agencies in Georgia.

Setting: The Georgia PBRN conducted this study of health districts and county health departments. The Georgia Department of Public Health supports 18 health districts and 159 county health departments (GA DPH, 2011). The health districts range in county composition from 1 to 16 counties in each district.

Participants: Key informants comprised district and county health department staff and county health department board members were identified by 13 participating health district offices.

Results: Key opinion leaders from both the rural and nonrural counties agreed that the Districts were important for providing essential services and supporting quality improvement collaboration. Psychometric testing of the Quality Improvement Collaborative assessment public health instrument yielded high scores for validity and reliability.

Conclusions and Implications: Regionalization of local public health capacity is a critical emerging issue for public health accreditation and quality improvement. This study demonstrated the utility of regionalization across traditional local geopolitical boundaries.

This article demonstrates the utility of regionalization across traditional local geopolitical boundaries. An online survey tool and follow-up phone calls with key informants in health districts and county health departments in Georgia were used to assess the capacity of multicounty health districts to serve as “Quality Improvement Collaboratives” and support local health departments to meet accreditation standards.

Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Drs Livingood, Shah, Lawrence, and Woodhouse, Mss Marshall, Peden, Alexander, and Penix, and Mr Toal); University of Florida College of Medicine, Jacksonville, Florida (Dr Livingood); and District 6: East Central, Augusta, Georgia (Dr Gonzalez).

Correspondence: William Livingood, PhD, Center for Health Equity & Quality Research, 580 West 8th St, Tower II, 6th Floor, Jacksonville, FL 32209 (wclivingood@georgiasouthern.edu).

This project was funded by a Quick Strike grant through the Public Health Practice-Based Research Networks (PBRN) Program, a national program of the Robert Wood Johnson Foundation.

The authors thank the Georgia Department of Health, specifically Dr Beatrice Frazier, for her support, advice, and participation. The authors also thank all the members of GAPHPBRN for their feedback and participation. Finally, without the participation of the Georgia practice community this study would not have been possible. The authors thank the County Health Department staff, Board of Health members, and health district staff from the participating Georgia health districts.

This research project was reviewed by the IRB at Georgia Southern University and determined to be “exempt from full review” under the B2 exemption category.

The authors declare no conflicts of interest.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.