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Objectives. We examined local health department (LHD) preparedness capacities in the context of participation in accreditation and other performance improvement efforts.
Methods. We analyzed preparedness in 8 domains among LHDs responding to a preparedness capacity instrument from 2010 through 2012. Study groups included LHDs that (1) were exposed to a North Carolina state-based accreditation program, (2) participated in 1 or more performance improvement programs, and (3) had not participated in any performance improvement programs. We analyzed mean domain preparedness scores and applied a series of nonparametric Mann-Whitney Wilcoxon tests to determine whether preparedness domain scores differed significantly between study groups from 2010 to 2012.
Results. Preparedness capacity scores fluctuated and decreased significantly for all study groups for 2 domains: surveillance and investigation and legal preparedness. Significant decreases also occurred among participants for plans and protocols, communication, and incident command. Declines in capacity scores were not as great and less likely to be significant among North Carolina LHDs.
Conclusions. Decreases in preparedness capacities over the 3 survey years may reflect multiple years of funding cuts and job losses, specifically for preparedness. An accreditation program may have a protective effect against such contextual factors. (Am J Public Health. 2014;104:2233-2238. doi:10.2105/ AJPH.2014.302159)
Federal, state, and local public health agencies have made substantial investments in improving state and local health department (LHD) preparedness capacities and capabilities to effectively prevent, detect, or respond to public health emergencies.1 A lack of valid and reliable data collection instruments as well as evolving preparedness standards has made it difficult to determine the impact of these investments.2,3 As recently as 2011, the Centers for Disease Control and Prevention released 15 public health preparedness capabilities designed to serve as national public health preparedness standards to assist state health departments and LHDs with strategic planning.4 In addition, few studies have examined the impact of LHD contextual factors and participation in improvement efforts on the performance of preparedness capacities.5 We examined LHD preparedness capacities in the context of participation in performance improvement efforts over a 3-year period using a validated survey instrument.6
LHDs are essential to emergency preparedness and response activities. They have statutory authority to perform key functions including community health assessments and epidemiologic investigations, enforcement of health laws and regulations, and coordination of the...
