ASTHO and NACCHO Profiles Feb. 11 2010 CPH 950 F.D. Scutchfield, M.D. Peter P. Bosomworth Professor of Health Services Research and Policy University of KentuckyCenter for Public Health Systems & Services Research
Association of State and Territorial Health Officials (ASTHO)• ASTHO Profile of State Public Health, Volume One (2009) (pdf)• With support from the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention, ASTHO surveyed state and territorial health agencies about their responsibilities, organization and structure, planning and quality improvement activities, workforce, and much more. All 50 states and the District of Columbia completed the survey.
ASTHO – Vision and MissionVISION:• Healthy people thriving in a nation free of preventable illness and InjuryMISSION:• To transform public health within states and territories to help members dramatically improve health and wellness
State public health is the focal point for population health activities in states, public health system oversight, management of federal funds targeted to unmet needs, state health surveillance, and is the final arbiter of health policy in states.
4 Main Sections of ASTHO Profile1. Public Health Responsibilities2. Organization and Structure3. State Health Planning and Quality Improvement4. State Health Agency Workforce
1. Public Health Responsibilities• Wellness• Policy Development• Vital Statistics• Prevention Services• Immunization Services• Preparedness• Access to Care• Registry Maintenance• Maternal and Child Health Services• Epidemiology and Surveillance• Regulation, Inspection and Licensing• Environmental Health• Professional Licensing
State Health Agency (SHA) Top Activities • Leadership development • Adoption of National Public Health • Performance Standards • Implementation of the Public Health • Improvement Project • Workforce development / core competencies • Coordination with partners in the public health system • Support for local public health agencies • Data driven management.
2. Organization and StructureThis section looks at issues such as the influence of state legislatures on SHAs and the relationships between SHAs and other entities, such as local public health agencies and private organizations.
3. State Health Planning and QualityImprovementTo varying degrees, SHAs have drawn from several tools developed to help them achieve higher standards in their organizations and programs. Among the most prominent:• Turning Point, a network of 23 state partners and five National Excellence Collaboratives initiated by the Robert Wood Johnson Foundation to strengthen the public health system in the U.S.• National Public Health Performance Standards Program (NPHPSP), a CDC National Partnership initiative that sets forth standards for state and local public health systems.
SHA Health Improvement Plan QI and Performance Management
4. State Health Agency Workforce Although a majority of state health officials hold a medical doctor degree, others have earned degrees in a variety of disciplines. About a third hold a master’s in public health degree.
State Health Agency StaffNumber of Full-time Equivalents (FTEs) Number and Type of SHA EmployeesEmployed by SHAs
National Association of County and City Health Officials (NACCHO)NACCHO is the national organization representing local health departments. NACCHO support efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.
Purpose of National Profile of LHDsTo advance and support the development of a database for LHDs to describe and understand their structure, function, and capacities.
Operational Definition ofa Functional Local Health Department
Total Number of LHDs in StudyPopulation, Number of LHDsCompletingQuestionnaire, and Response Rates,for All LHDs and by State
Main Sections of NACCHO Profile1. Jurisdiction and Governance2. Financing3. LHD Leaders4. LHD Workforce5. Emergency Preparedness6. LHD Activies7. Community Health and Health Disparities8. Quality Improvement and Accreditation9. Information Technology and Management
1. Jurisdiction and Governance LHD Governance Type, by State
Local Boards of Health Functions• adopting public health regulations,• setting and imposing fees,• approving the LHD budget• hiring or firing the top agency administrator• requesting a public health levy
2. Financing • What Were LHD Total Annual Expenditures? • What Were the Average Expenditures of LHDs? • What Were per Capita Expenditures for LHDs? • Did LHD per Capita Expenditures Differ by State? • What Were the Sources of LHD Revenues? • Did Revenue Sources Vary by the Size of the Population Served • by the LHD? • What Were the LHD Revenue Sources for Each State?
LHD Total Annual Expenditures Forty-two percent had expenditures of less than $1 million, 30 percent had expenditures of $1 to $4.9 million, and 17 percent had expenditures of $5 million or more. Data on this item were unreported for 11 percent of LHDs.
3. LHD Leaders • What Were the Demographic Characteristics of LHD • Top Agency Executives? • Did Characteristics of Top Executives Change Between 2005 and 2008? • How Old Were Most LHD Top Executives? • What Was the Education Level of LHD Top Executives? • How Long Have Top Executives Worked at LHDs? • Were New Top Executives Different from Experienced Top Executives?
Percentage of Top Agency Distribution of Top Agency Executives,Executives by Selected Characteristics by Highest Degree Obtained
4. LHD Workforce • How Many FTE Positions Were Employed by LHDs? • Did the Average Numbers of Employees and FTEs Vary by Size • of the Population Served by the LHD? • What Were the Demographic Characteristics of LHD Staff? • What Kinds of Job Functions Were Most Often Included at LHDs?
LHD Workforce • Did Occupations at the LHD Vary by the Size of the Population Served? • What Were the Average Numbers of Staff Persons at LHDs? • What Were the Typical Staffing Patterns of LHDs? • Has the Workforce Size and Composition Changed Between 2005 and 2008? • What Was the Overall Distribution of the LHD Workforce?
Distribution of FTE Positions at Distribution of Occupations inLHDs the LHD Workforce
5. Emergency Preparedness• What Kinds of Centers for Disease Control and Prevention (CDC) Funding• Did LHDs Receive for Emergency Preparedness Activities?• Did Funding Vary by the Size of the Population Served by the LHD?• What Was the Funding per Capita for Emergency Preparedness Activities• in LHD Jurisdictions?• What Were the per Capita Levels of CDC Funding to LHDs for Emergency• Preparedness by State?• How Many LHDs Had Staff Salaries Paid with Emergency• Preparedness Funding?• What Kinds of Emergency Preparedness Planning Activities Were• Conducted by LHDs?• What Were the Reasons for Activating an Emergency Operations• Center (EOC)?• What Percentage of LHDs Responded to Specific Emergency Events?
Kinds of Emergency Preparedness PlanningActivities Were Conducted by LHDs
6. LHD Activities10 Most Frequent Activities and Services Available Through LHDs Directly
7. Community Health and HealthDisparities • Did LHDs Participate in Community Health Planning Activities? • What Roles Did LHDs Have in the Development of Community • Health Assessments? • Did Community Health Assessments and Community Health Improvement • Planning Activities Differ According to the Size of the Population Served • by the LHD? • What Resources Did LHDs Use for CHAs and CHIP?
Community Health and HealthDisparities • What Were LHD Activities Related to Health Disparities? • Did Activities to Address Health Disparities Differ by the Size of • the Population Served by the LHD? • What Kinds of Collaborations Were Conducted by LHDs? • How Did LHDs Relate to Academic Institutions? • What Were LHD Activities Regarding Public Health Policy? • What Were LHD Activities Regarding Access to Healthcare Services?
Community Health Assessments (CHAs) • More than 60 percent of respondents reported that a CHA had been completed in the last three years • A lower proportion (49%) reported that community health improvement planning had been conducted in the last three years; within this group, more than 90 percent of all CHIPs were based on community health assessments.
8. Quality Improvement andAccreditation • Did LHDs Participate in Formal Quality or Performance Improvement Activities? • What Were the Focus Areas for LHD Performance Improvement Activities? • Did LHDs Have Management with Training in Quality Improvement? • What Strategies or Approaches Did LHDs Use for Quality Improvement? • How Was the Operational Definition Used at LHDs? • Were Respondents Aware of the Developing Voluntary National • Accreditation Program? • What Was the Interest Level in LHD Accreditation? • Did Interest in a Voluntary National Accreditation Program Differ by the Size • of the Population Served by the LHD?
Percentage of LHDs with Participation in a Formal Performance ImprovementActivity, for All LHDs and by Size of Population Served
Percentage of LHDs, by Level of Agreement with Statements on SeekingVoluntary National Accreditation in Unspecified Time, by Size of PopulationServed
9. Information Technology andManagement • What Kinds of Information Technology Did LHDs Use? • How Were Records Kept in Specific LHD Programs? • What Types of Information Were Available to LHDs? • Did Most LHDs Have Web Sites? • What Types of Information Were Available on LHD Web Sites? • What Kinds of Promotional Strategies Were Used by LHDs? • Did LHDs Share Resources with Other LHDs? • In What Types of Programs Were LHD Resources Shared?
Percentage of LHDs, by Level of Implementation of Selected InformationTechnologies
Percentage of LHDs, by Availability of Data Sources
Data Harmonization• The Robert Wood Johnson Foundation (Princeton, NJ) –Data Harmonization• U.S. Centers for Disease Control and Prevention –Profiles (ASTHO and NACCHO)
The Profiles• ASTHO: Association of State & Territorial Health Officials (DC)• NACCHO: National Association of City & County Health Officials (DC)• NALBOH: National Association of Local Boards of Health (Bowling Green, OH)
Data Harmonization Outcome: Part AEach of the three Profiles surveys are using the same Geographic and Demographic questions (what we are calling Part A)
Data Harmonization Outcome: Part BEach of the three Profiles surveys, however, focus on different topics. Each survey has a distinct, different Part B with questions of interest for each organization.Even in these individualized Part Bs, however, there has been a concerted effort to align questions on similar topics by using shared or parallel language in the questions.Knowing what the other surveys are gathering, associations have been able to shorten their surveys somewhat.
Data Harmonization Outcome: Part CEach of the three Profiles surveys are using the similar cross-thematic questions addressing key areas of focus for RWJF initiatives (what we are calling Part C)
Teamwork• Interactive colleagues in parallel positions at all three associations• Profiles Work Groups at all three associations• ASTHO and NACCHO gathering information on local boards of health to assist NALBOH
References:• ASTHO - Profile of State Public Health Vol. 1 http://www.astho.org/Display/AssetDisplay.aspx?id=2882• NACCHO – National Profile of Local Health Departments• The Data Harmonization Project – Jeff Jones, PhD. Keeneland Conference, 2010
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