Dissertations / Theses: 'Local Heath Departments'

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Carpenter, Tyler, Kate E. Beatty, Ross Brownson, and Paul Erwin. "Accreditation Seeking Decisions in Local Health Departments." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6848.

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background: Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure. This study seeks to identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs. data sets and sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. . LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. “Micropolitan” includes census tracts with towns of 10,000 - 49,999 population and census tracts tied to these towns through commuting. “Rural” includes census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts. analysis: Binary logistic regression analysis was conducted to predict PHAB accreditation decision. Predictors included variables related to rurality, governance, funding, and workforce. findings: From a sample of 448, approximately 6% of LHDs surveyed had submitted their letter of intent or full accreditation application. Over two-thirds were not seeking accreditation or deferring to the state agency. LHDs located in urban communities were 30.6 times (95% CI: 10.1, 93.2) more likely to seek accreditation compared to rural LHDs. LHDs with a local board of health were 3.5 times (95% CI: 1.6, 7.7) more likely to seek accreditation (controlling for rurality). Additionally, employing an epidemiologist (aOR=2.4, 95% CI: 1.2, 4.9), having a strategic plan (aOR=14.7, 95% CI: 6.7, 32.2) were associated with higher likelihood of seeking PHAB accreditation. conclusions: Rural LHDs are less likely to seek accreditation. This lower likelihood of seeking accreditation likely relates to a myriad of challenges. Simultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural LHDs can become better equipped to meet the needs of their communities.

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Beatty, Kate, Tyler Carpenter, Ross Brownson, and Paul Erwin. "Accreditation Seeking Decisions in Local Health Departments." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6854.

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Background: Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure. Research Objective: To identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs. Of particular interest is the effect of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Data Sets and Sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study (2013 Profile Study). The 2013 Profile Study includes a core questionnaire (core,) that was sent to all LHDs, and two modules, sent to a sample. Variables were selected from the core and module one for this project. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes for the zip code of the LHD address. “Micropolitan” includes census tracts with towns of between 10,000 and 49,999 population and census tracts tied to these towns through commuting. “Rural” includes census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts. Both “micropolitan” and “rural” categories are considered rural by the Federal Office of Rural Health Policy. Study Design: Cross-sectional. Analysis: Binary logistic regression analysis was conducted to predict PHAB accreditation decision. The variable for PHAB accreditation decision was created from the 2013 Profile Study question, “Which of the following best describes your LHD with respect to participation in the PHAB’s accreditation program for LHDs?” LHDs that selected “My LHD has submitted an application for accreditation” or “My LHD has submitted a statement of Intent” were coded as “Seeking PHAB Accreditation.” LHDs that selected “My LHD has decided NOT to apply for accreditation” or “The state health agency is pursuing accreditation on behalf of my LHD” were coded as “Not Seeking PHAB Accreditation.” Predictors included variables related to rurality, governance, funding, and workforce. Findings: From a sample of 448, approximately 6% of LHDs surveyed had either submitted their letter of intent or full accreditation application. Over two-thirds were either not seeking accreditation or deferring to the state agency. LHDs located in urban communities were 30.6 times (95% CI: 10.1, 93.2) more likely to seek accreditation compared to rural LHDs. LHDs with a local board of health were 3.5 times (95% CI: 1.6, 7.7) more likely to seek accreditation (controlling for rurality). Additionally, employing an epidemiologist (aOR=2.4, 95% CI: 1.2, 4.9), having a strategic plan (aOR=14.7, 95% CI: 6.7, 32.2), and higher per capita revenue (aOR=1.02, 95% CI: 1.01, 1.02) were associated with higher likelihood of seeking PHAB accreditation. Conclusions: Specific geographic, governance, leadership, and workforce factors were associated with intention to seek accreditation. Implications: Rural LHDs are less likely to seek accreditation. This lower likelihood of seeking accreditation likely relates to a myriad of challenges (e.g., lower levels of staffing and funding). Simultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural LHDs can become better equipped to meet the needs of their communities.

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Robinson, Andrew. "The management of local authority environmental health departments." Thesis, Leeds Beckett University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261189.

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Harris, Jenine K., Kate E. Beatty, J. P. Leider, Alana Knudson, Britta L. Anderson, and Michael Meit. "The Double Disparity Facing Rural Local Health Departments." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6825.

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Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.

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Johnson, S., M. Belcher, M. Moody, and Megan Quinn. "Collaboration Between Local Health Department and College of Public Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6794.

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Beatty, Kate, Paul Campbell Erwin, Ross C. Brownson, Michael Meit, and James Fey. "Public Health Agency Accreditation among Rural Local Health Departments: Influencers and Barriers." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6822.

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Objective: Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Design: Cross-sectional study using secondary data from the 2013 National Association of County & City Health Officials (NACCHO) National Profile of Local Health Departments Study (Profile Study). Setting: United States. Participants: LHDs (n = 490) that responded to the 2013 NACCHO Profile Survey. Main Outcome Measures: LHDs decision to seek PHAB accreditation. Results: Significantly more accreditation-seeking LHDs were located in urban areas (87.0%) than in micropolition (8.9%) or rural areas (4.1%) (P < .001). LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs (RLHDs). LHDs that had completed an agency-wide strategic plan were 8.5 times (95% CI, 4.0-17.9), LHDs with a local board of health were 3.3 times (95% CI, 1.5-7.0), and LHDs governed by their state health department were 12.9 times (95% CI, 3.3-50.0) more likely to seek accreditation. The most commonly cited barrier was time and effort required for accreditation application exceeded benefits (73.5%). Conclusion: The strongest predictor for seeking PHAB accreditation was serving an urban jurisdiction. Micropolitan LHDs were more likely to seek accreditation than smaller RLHDs, which are typically understaffed and underfunded. Major barriers identified by the RLHDs included fees being too high and the time and effort needed for accreditation exceeded their perceived benefits. RLHDs will need additional financial and technical support to achieve accreditation. Even with additional funds, clear messaging of the benefits of accreditation tailored to RLHDs will be needed.

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Hale, Nathan, Tamar Klaiman, Kate E. Beatty, and Michael B. Meit. "Local Health Departments as Clinical Safety Net in Rural Communities." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6824.

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Introduction: The appropriate role of local health departments (LHDs) as a clinical service provider remains a salient issue. This study examines differences in clinical service provision among rural/urban LHDs for early periodic screening, diagnosis, and treatment (EPSDT) and prenatal care services. Methods: Data collected from the 2013 National Association of County and City Health Officials Profile of Local Health Departments Survey was used to conduct a cross-sectional analysis of rural/urban differences in clinical service provision by LHDs. Profile data were linked with the 2013 Area Health Resource File to derive other county-level measures. Data analysis was conducted in 2015. Results: Approximately 35% of LHDs in the analysis provided EPSDT services directly and 26% provided prenatal care. LHDs reporting no others providing these services in the community were four times more likely to report providing EPSDT services directly and six times more likely to provide prenatal care services directly. Rural LHDs were more likely to provide EPSDT (OR=1.46, 95% CI=1.07, 2.00) and prenatal care (OR=2.43, 95% CI=1.70, 3.47) services than urban LHDs. The presence of a Federally Qualified Health Center in the county was associated with reduced clinical service provision by LHDs for EPSDT and prenatal care. Conclusions: Findings suggest that many LHDs in rural communities remain a clinical service provider and a critical component of the healthcare safety net. The unique position of rural LHDs should be considered in national policy discussions around the organization and delivery of public health services, particularly as they relate to clinical services.

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Crescioni, Mabel. "CHARACTERISTICS OF LOCAL HEALTH DEPARTMENTS IN ARIZONA AND THEIR ASSOCIATION TO HEALTH OUTCOMES." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/202764.

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Local Health Departments (LHD) that aim to address the public health needs of growing populations require qualified professionals with management competencies. In Arizona, the majority of public health services are delivered by the county health departments, which are charged with assisting community members and monitoring and improving community health. These activities are funded with federal, state and local money, which varies across counties. This study provides a comprehensive understanding of the local public health system in Arizona, the distribution of public health services across counties and examines the association between health outcomes data and funding patterns for each county. National Association of City and County Health Officials (NACCHO) data from their 2008 survey was used to examine the activities performed at the local level. The majority of the activities in which the LHDs focus fall within the assurance function of public health. Interviews with all Arizona county health department directors (N=15) were conducted. Discussion focused on LHD activities, county and state political/policy climate and partnerships that contribute to LHDs activities. Responses varied significantly across the state due to differences in demographic and financial characteristics of the counties. Many political, socioeconomic and environmental barriers to provision of services were identified as well as the need for developing a stronger public health infrastructure.Finally, associations between several health outcomes and funding, workforce and demographic data of the 15 local health departments in Arizona were examined by conducting correlation analysis and linear regressions. This study found strong positive associations between LHD revenues, LHD expenditures, population size and number of LHD employees and HIV/AIDS incidence, low birth weight births and infant mortality rate. Positive associations were also found between revenues and number of women who received prenatal care and HIV/AIDS mortality rate as well as between number of LHD employees and diabetes mortality rate. This study represents a small step in better understanding the local public health system in Arizona, the distribution of public health services across counties and the political, financial and policy constraints faced by county health department directors.

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Johnson, Kendra, Kim K. Nguyen, Shimin Zheng, and Robin P. Pendley. "The Relationship between Quality Improvement and Health Information Technology Use in Local Health Departments." UKnowledge, 2013. https://uknowledge.uky.edu/frontiersinphssr/vol2/iss6/2.

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This research examined if there is a relationship between engagement in quality improvement (QI) and health information technology (HIT) for local health departments (LHDs) controlling for workforce, finance, population, and governance structure. This was a cross-sectional study that analyzed data obtained from the Core questions and Module 1 in the NACCHO 2010 Profile of LHDs. Descriptive statistics, bivariate analyses, and logistic regression analyses were conducted. Findings suggest that LHD engagement in QI has a relationship with utilization of HIT including electronic health records, practice management systems, and electronic syndromic surveillance systems. This study provides baseline information about the HIT use of LHDs. LHDs and their system partners (hospitals, federally qualified health centers, and primary care providers) that utilize HIT as part of their QI decision making may have an easier time of using data to support evidence-based decision making and implementing the provisions of the Patient Protection and Affordable Care Act of 2010 in order to achieve population health for all.

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Capps, Patricia A. "Assessing Lyme disease knowledge of Indiana local health department nurses." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1048370.

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Lyme disease is a multisystemic, infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. The CDC designated LD as a reportable disease in 1990 and evidence suggests underreporting of the disease in Indiana. Local health department nurses have a major role in the areas of disease recognition, reporting, and education about LD. The present study assessed local health department nurses' knowledge of LD to determine their competence as LD educators.The study consisted of 428 nurses in 92 counties and three cities with independent health departments who were mailed a questionnaire containing 30 multiple-choice and/or true/false questions. Twenty-four nurses participated in a pilot study to establish the reliability of the instrument.The results were: (1) nurses did not differ in knowledge regardless of their duties, (2) urban and rural counties did not differ in knowledge, (3) experience did not make a difference in knowledge, and (4) less educated nurses were more knowledgeable. The nurses were least knowledgeable about LD reporting criteria, late stage symptoms, and and description of EM and most knowledgeable about prevention. The following are some of the recommendations suggested: more research with nurses on vector- borne diseases, better dissemination of information from CDC and ISDH, inservice programs for nursing personnel, and educational materials to distribute to the public.
School of Nursing

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Beatty, Kate E., Jeffrey Mayer, Michael Elliott, Ross C. Brownson, Safina Abdulloeva, and Kathleen Wojciehowski. "Patterns and Predictors of Local Health Department Accreditation in Missouri." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6866.

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Background: The Healthy People 2020 goal for the public health system is “to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services.” To address this goal, Missouri established the first statewide, voluntary accreditation program of local health departments (LHDs) and began accrediting the LHDs in 2003. The purpose of this study was to identify organizational, structural, and workforce factors related to accreditation status of LHDs in Missouri. Methods: Using data from the National Association of County & City Health Officials (2010) and the Missouri Department of Health & Senior Services (2012), binary logistic regression analysis was performed to predict accreditation status of LHDs. Likelihood ratio tests were used to examine whether the addition of each predictor added significantly to the model compared with a model including total revenues alone. Adjusted odds ratios (aORs), 95% confidence intervals, the significance level of the likelihood ratio test, and the overall Nagelkerke pseudo-R2 for each model are reported. Results: Having a community health improvement plan (aOR = 6.2), a strategic plan (aOR = 7.9), evaluating programs (aOR = 3.6), being in a region with a high proportion of accredited LHDs (aOR = 5.5), and participating in multijurisdictional collaborations (aOR = 6.4) all increased the likelihood of accreditation. Barriers of time (aOR = 0.1) and cost (aOR = 0.3) were negatively associated with accreditation. Conclusions: Accredited LHDs were more likely to have completed the prerequisites for accreditation and collaborate with other LHDs. These activities help LHDs meet the accreditation standards. In addition, with shrinking budgets, LHDs will need additional financial and technical support to achieve accreditation. Assisting LHDs to find ways to increase the staff is important. Through collaborations with other LHDs, regional or multicounty positions can be created. Also collaborations with universities, specifically colleges or schools of public health, can provide opportunities for internships at LHDs giving practical experience while providing important assistance to LHDs.

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Beatty, Kate, Jeffrey Mayer, Michael Elliott, Ross C. Brownson, Safina Abdulloeva, and Kathleen Wojciehowski. "Barriers and Incentives to Rural Health Department Accreditation." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6826.

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Context: Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities. Objective: To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the RLHD perspective. Design: Qualitative analysis of semistructured key informant interviews with Missouri local health departments serving rural communities. Participants: Eleven administrators of RLHDs, 7 from accredited and 4 from unaccredited departments, were interviewed. Population size served ranged from 6400 to 52 000 for accredited RLHDs and from 7200 to 73 000 for unaccredited RLHDs. Results: Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed more incentives than their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation. Conclusions: There is a need for better documentation of measurable benefits in order for an RLHD to pursue voluntary accreditation. Those who pursue accreditation are likely to see benefits after the fact, but those who do not pursue do not see the immediate and direct benefits of voluntary accreditation. The finding from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.

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Beatty, Kate, Kristin D. Wilson, Amanda Ciecior, and Lisa Stringer. "Collaboration Among Missouri Nonprofit Hospitals and Local Health Departments: Content Analysis of Community Health Needs Assessments." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6827.

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Objectives. We identified the levels of joint action that led to collaboration between hospitals and local health departments (LHDs) using the hospital’s community health needs assessments (CHNAs). Methods. In 2014, we conducted a content analysis of Missouri nonprofit hospitals (n = 34) CHNAs, and identified hospitals based on previously reported collaboration with LHDs. We coded the content according to the level of joint action. A comparison sample (n = 50) of Missouri nonprofit hospitals provided the basic comparative information on hospital characteristics. Results. Among the hospitals identified by LHDs, 20.6% were “networking,” 20.6% were “coordinating,” 38.2% were “cooperating,” and 2.9% were “collaborating.” Almost 18% of study hospitals had no identifiable level of joint action with LHDs based on their CHNAs. In addition, comparison hospitals were more often part of a larger system (74%) compared with study hospitals (52.9%). Conclusions. The results of our study helped develop a better understanding of levels of joint action from a hospital perspective. Our results might assist hospitals and LHDs in making more informed decisions about efficient deployment of resources for assessment processes and implementation plans.

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Ransom, James Anthony. "The Role of Agency in Community Health Outcomes: Local Health Departments and Childhood Immunization Coverage Rates." Antioch University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1382849108.

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Stringer, Lisa, Kate E. Beatty, K. Wilson, and A. Ciecor. "From the Hospitals’ Perspective: Collaboration among Non-Profit Hospitals and Local Health Departments." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6851.

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Beatty, Kate, Kirstin Wilson, Amanda Ciecior, and Lisa Stringer. "From the Hospitals’ Perspective: Collaboration among Non-Profit Hospitals and Local Health Departments." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6856.

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Schaff, Katherine Anne. "Local Health Departments Engaging in Policy Change to Achieve Health Equity| An Examination of the Foreclosure Crisis." Thesis, University of California, Berkeley, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10086067.

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Early public health efforts in the United States addressed social conditions that contributed to poor health, with public health workers playing a role in large scale societal reforms, such as passing housing and sanitation laws, which led to diminishing deaths from infectious diseases. As chronic diseases became leading causes of death, public health research and practice became more focused on individual behaviors, widely thought to be the primary cause of chronic diseases. However, health inequities along the lines of place, race, class, and other forms or marginalization are still prevalent. A substantial body of research illustrates how social, political, economic, and environmental factors affect multiple health outcomes, including chronic diseases, and contribute to health inequities.

In public health practice, some local health departments (LHDs) and organizations that support their work have called for broader public health interventions that address social policies that contribute to health inequities in addition to providing direct services to individuals. With continued research and support, the approximately 2,800 LHDs nationwide can play a central role in reducing health inequities. However, engaging in this complex work necessitates new approaches, skills, frameworks, and organizational infrastructures for LHDs. The recent foreclosure crisis, which stands to increase racial and health inequities, provides a lens to examine whether and how LHDs can move from a rhetorical commitment to addressing social determinants of health (SDH) into actual public health interventions that reduce health inequities.

Through this dissertation, I examine LHDs’ role in the foreclosure crisis through three related papers. My aim is provide insight into how LHDs responded to the deep and fundamental shifts in access to stable and quality housing and wealth created by the foreclosure crisis that disproportionately impacted African-American, Latino, and some Asian/Pacific Islander communities. Through all three papers, I incorporate a focus on challenges and approaches to addressing the racialized causes and outcomes of the foreclosure crisis. My overall aim is to help advance local public health practice within LHDs to more effectively target the causes of health inequities, including gaining a better understanding of LHD approaches and needs related to addressing SDH through local policy.

In the first paper, A National Survey on Local Health Department Engagement in Addressing the Foreclosure Crisis, I describe the results of a national survey on LHD engagement in the foreclosure crisis, which includes LHD approaches to addressing foreclosure and barriers to engagement. Responses followed a diffusion of innovation pattern, with innovator, early adopter, early majority, late majority, and lagging LHDs. Respondents expressed a high level of interest in adopting innovative approaches to addressing SDH and described a need for models of how other LHDs are preventing or mitigating the impacts of foreclosure, especially through local policies.

In the second paper, Adopting an Innovative Public Health Practice to Address Foreclosure: A Case Study of Alameda County Public Health Department , and the third paper, Policy Entrepreneurs, Agenda-Setting, and Communication: An Exploration of How a Local Health Department Engaged in Addressing the Foreclosure Crisis, I describe findings from qualitative interviews with current and former ACPHD staff and partners. In the second paper, I identify factors that 1) differentiate ACPHD’s innovative approach from traditional LHD activities; and, 2) contributed to ACPHD being an innovator among LHDs.

Finally, in the third paper, I focus on ACPHD’s role as a policy entrepreneur in agenda-setting, including their communication approach. While the second paper focuses on how ACPHD developed into an innovative LHD in the area of local housing policy, the 3rd paper focuses on how in this role, ACPHD interacted in the local policymaking process. This case study also examines how the role of policy entrepreneur can be shared across two organizations (ACPHD and Causa Justa::Just Cause) and provides another way to conceive of entrepreneurism.

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Capwell, Ellen M. "Local health department use of Ohio Department of Health Assistance to plan and implement community programs directed toward smoking control among women /." The Ohio State University, 1991. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487687115924146.

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Reisenauer, Stacy Lee. "Screening for chlamydia in Spokane County : implications for a local public health department." Online access for everyone, 2006. http://www.dissertations.wsu.edu/Thesis/Spring2006/s%5Freisenauer%5F042606.pdf.

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Budnik, Aimee Helen. ""IDENTIFYING PREDICTORS FOR PRIMARY PREVENTION ACTIVITIES IN LOCAL HEALTH DEPARTMENTS: UNDERSTANDING THE ROLE OF CONSOLIDATION"." Kent State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=kent1543629941331548.

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Beatty, Kate E., Megan Heffernan, Nathan Hale, and Michael Meit. "Funding and Service Delivery in Rural and Urban Local US Health Departments in 2010 and 2016." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/6818.

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Objectives. To investigate differences in funding and service delivery between rural and urban local health departments (LHDs) in the United States. Methods. In this repeated cross-sectional study, we examined rural–urban differences in funding and service provision among LHDs over time using 2010 and 2016 National Association of County and City Health Officials data. Results. Local revenue among urban LHDs (41.2%) was higher than that in large rural (31.3%) and small rural LHDs (31.2%; P < .05). Small (20.9%) and large rural LHDs (19.8%) reported greater reliance on revenue from Center for Medicare and Medicaid Services than urban LHDs (11.5%; P < .05). All experienced decreases in clinical revenue between 2010 and 2016. Urban LHDs provided less primary care services in 2016; rural LHDs provided more mental health and substance abuse services (P < .05). Conclusions. Urban LHDs generated more revenues from local sources, and rural LHDs generated more from the Center for Medicare and Medicaid Services and clinical services. Rural LHDs tended to provide more clinical services. Given rural LHDs’ reliance on clinical revenue, decreases in clinical services could have disproportionate effects on them. Public Health Implications. Differences in financing and service delivery by rurality have an impact on the communities. Rural LHDs rely more heavily on state and federal dollars, which are vulnerable to changes in state and national health policy.

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Erwin, Paul Campbell Greene Sandra B. "How changes at the local health department level are associated with improvements in health outcomes at the state level." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2009. http://dc.lib.unc.edu/u?/etd,2467.

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Thesis (DrPH)--University of North Carolina at Chapel Hill, 2009.
Title from electronic title page (viewed Sep. 3, 2009). "... in partial fulfillment of the requirements for the degree of Doctor of Public Health in the Department of Health Policy and Management, School of Public Health." Discipline: Health Policy and Management; Department/School: Public Health.

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O'Quin, Jeanette M. "Prophylactic Animal Rabies Vaccination Requirements in Ohio and Involvement of Local Health Departments in Low Cost Rabies Vaccination Clinics." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1322617160.

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Beatty, Kate E., Nathan Hale, Michael Meit, Paula Masters, and Amal Khoury. "Clinical Service Delivery along the Urban/Rural Continuum." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6870.

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Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities. Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities. Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting Area codes. Bivariate analysis for clinical services was conducted by rural/urban status. For each service, the proportions of LHDs that directly performed the service, contracted with other organizations to provide the service, or reported provision of the service by independent organizations in the community was compared. Results: Analyses show significant differences in patterns of clinical services offered, contracted, or provided by others, based on rurality. LHDs serving rural communities, especially large rural LHDs, tend to provide more direct services than urban LHDs. Among rural LHDs, larger rural LHDs provided a broader array of services and reported more community capacity for delivery than small rural LHDs- particularly maternal and child health services. Implications: There are capacity differences between large and small rural LHDs. Limited capacity within small rural LHDs may result in providing less services, regardless of the availability of other providers within their communities. These findings provide valuable information on clinical service provision among LHDs, particularly in rural and underserved communities.

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Meadows, Alicia Elizabeth. "Partnerships Between Non-Profit Hospitals and Local Health Departments as a Cost-Effective Strategy for Reducing Cost of Care Associated with the Uninsured Population in Oklahoma County." Thesis, The University of Oklahoma Health Sciences Center, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10793182.

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Strategies to reduce uninsured utilization of Emergency Departments (EDs) such as improved access to primary care, care coordination and management, alternative roles and functions for navigation, and emerging health information technology, cannot be fully realized independent of one another. The call for hospital systems to implement and evaluate population health management strategies as a key component of the U.S. Healthcare system’s transition to value-based care provides both the need and opportunity to research cost effective strategies for reducing preventable ED visits and hospitalizations, and associated costs among the uninsured. The Oklahoma City-County Health Department (OCCHD) Community Health Worker (CHW) Program is a small cohort pilot project implementing care coordination and management, and alternative role and functions for navigation strategies, as a partnership between local public health and non-profit hospitals.

Utilizing a pre- and post-intervention design, this study used secondary data from the program. The project captured the impact of the intervention on selected health risk indicators, ED utilization and associated self-pay charges. Data include demographic information, financial self-pay charges, and ED visit records of all study participants for a twelve-month period prior to study enrollment and for a twelve-month period following intervention. The intervention resulted in reduced volume and costs associated with uninsured utilization of EDs and preventable hospital visits. The intervention did not result in improvement of selected health risk measures including blood pressure, non-fasting glucose and BMI. This study demonstrates partnership between local non-profit hospitals and the local health department CHW program in Oklahoma County is a cost-effective strategy for reducing Emergency Department (ED) costs and preventable ED visits and hospitalizations associated with care for uninsured adults between the ages of 18 and 64.

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Harris, Jenine, Leslie Hinyard, Kate E. Beatty, Jared B. Hawkins, Elaine O. Nsoesie, Raed Mansour, and John S. Brownstein. "Evaluating the Implementation of a Twitter-Based Foodborne Illness Reporting Tool in the City of St. Louis Department of Health." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6821.

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Foodborne illness is a serious and preventable public health problem affecting 1 in 6 Americans with cost estimates over $50 billion annually. Local health departments license and inspect restaurants to ensure food safety and respond to reports of suspected foodborne illness. The City of St. Louis Department of Health adopted the HealthMap Foodborne Dashboard (Dashboard), a tool that monitors Twitter for tweets about food poisoning in a geographic area and allows the health department to respond. We evaluated the implementation by interviewing employees of the City of St. Louis Department of Health involved in food safety. We interviewed epidemiologists, environmental health specialists, health services specialists, food inspectors, and public information officers. Participants viewed engaging innovation participants and executing the innovation as challenges while they felt the Dashboard had relative advantage over existing reporting methods and was not complex once in place. This study is the first to examine practitioner perceptions of the implementation of a new technology in a local health department. Similar implementation projects should focus more on process by developing clear and comprehensive plans to educate and involve stakeholders prior to implementation.

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Sreedhara, Meera. "A Mixed Methods Study of Local Policy, Systems, and Environmental Approaches Supportive of Healthy Eating and Physical Activity." eScholarship@UMMS, 2020. https://escholarship.umassmed.edu/gsbs_diss/1075.

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Background: Policy, systems and environmental (PSE) approaches can sustainably improve opportunities for healthy eating (HE) and active transportation (AT). PSEs require cross-sector collaboration. Adopting and implementing PSEs is complex and not well understood. Methods: First, using a national probability survey dataset of US local health departments (LHD), inclusion of HE and AT PSE strategies in local community health improvement plans (CHIPs) was examined. Next, a content analysis of current CHIP documents provided data for multilevel latent class analyses to identify classes of CHIPs based on patterns of PSE-strategy alignment with six key activities that facilitate change. Lastly, semi-structured interviews informed a qualitative exploration of early stage Complete Streets policy implementation in Worcester, Massachusetts. Results: Less than half of US LHDs reported developing a CHIP containing any HE policy (32%) or AT (46%) strategies. Two classes of CHIPs were identified: CHIPs in Class A (HE: 71%; Physical Activity (PA): 79%) simply identified a PSE solution; Class B CHIPs (HE: 29%; PA 21%) mostly included PSE strategies that comprehensively addressed multiple key activities. Six themes emerged as factors for early Complete Streets implementation. Conclusions: This mixed methods study provides a novel understanding of the status, development and implementation of PSE strategies in relation to collaborative strategic health improvement planning efforts. CHIPs are underutilized to promote PSE strategies and few CHIPs in our study developed strategies that comprehensively address the process of PSE-change. Among other factors, CHIPs may provide a guiding structure for policy adoption and implementation.

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Frimpong, K. O. "Professionalising counter fraud specialists (fraud investigators) in the UK public sector : a focus upon Department for Work and Pensions, National Health Service and the Local Authority." Thesis, Nottingham Trent University, 2013. http://irep.ntu.ac.uk/id/eprint/307/.

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This thesis seeks to examine and explore the professionalisation initiatives of the UK public sector counter fraud specialists (fraud investigators), with a focus upon the Department for Work and Pensions (DWP), National Health Service (NHS) and Local Authority (LA). The conceptual framework used to underpin the study was functionalist / “traits” theory of a profession and professionalisation. The main research question for the thesis concerns the issue of whether counter fraud specialism is a profession or not. Thus the question here is: “Is counter fraud specialism a profession or not?”. Additionally, the thesis seeks to answer the question on how to develop a profession of counter fraud specialists. Thus, the question here is “If we want to develop a profession of counter fraud specialists (CFS), how do we do it?”. Fraud is a growing problem in UK which affects the government, businesses, individuals and society as a whole, and much more than would be assumed by anyone suggesting it to be a victimless crime. Despite this, the reputation of UK public sector fraud investigators had in the past gained negative images resulting from the use of questionable investigative practices, together with the lack of appropriate mechanism for evaluating the training of fraud investigators, and the ease of defrauding the welfare system. This became a great concern for UK politicians/parliamentarians since the 1970’s, resulting in the introduction of government initiatives, which emphasised the need to professionalise and introduce professionalism into anti-fraud work. The professionalisation initiatives led to the creation of a new breed of fraud investigators, otherwise known as “Counter Fraud Specialists” charged with the responsibilities of protecting the public purse and safeguarding it against fraud. In spite of the introduction of those initiatives and the positive contribution by Counter Fraud Specialists in protecting the public purse coupled with the ongoing austerity measures in the UK public sector, there has not been any major academic study assessing those initiatives. The study is important to the researcher because findings from the study will help inform the debate on professionalisation agenda for the UK public sector counter fraud specialists. Additionally, it will contribute to the academic research on the subject, given that, the literature on fraud and professionalisation on Counter Fraud Specialists has failed to address this. The study was undertaken by applying mixed-methods approaches involving the use of survey questionnaires and semi-structured interviews with a selected number of counter fraud practitioners in the UK public sector. In addition, documentary analysis was also undertaken. Generally, the study revealed developments enhancing the status of UK public sector counter fraud specialists as a result of the professionalisation initiatives/agenda. Nonetheless, the strength of the quality of developments remained arguable given identified weaknesses in the “pillars of institution” such as normative, regulative and cultural-cognitive symbols that, together with associated activities and resources provide the bedrock for institutional transformation and professionalising occupations. The study provides recommendations on areas of improvement and future research. Therefore, my contribution to knowledge in this study is that, I have attempted to show how to develop a profession for counter fraud specialists in the UK public sector, mainly, the DWP, NHS and LA. In addition, the study has failed to find evidence that counter fraud meets what the literature says is a hallmark of a profession. The literatures on fraud and professionalisation of counter fraud specialists have failed to address this and this is my contribution to knowledge.

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Tjale, Malose Moses. "The impact of local economic development projects funded by the Department of Health and Social Development on poverty alleviation in Bakenberg area of Mogalakwena Municipality, Limpopo Province." Thesis, University of Limpopo (Turfloop campus), 2011. http://hdl.handle.net/10386/625.

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Thesis (M.Dev.) --University of Limpopo, 2011
The study investigates the impact of LED projects funded by the DHSD on poverty alleviation in the Bakenberg area of the Mogalakwena Municipality. The DHSD established more than ten different types of projects in the area to alleviate poverty in the local area. The Bakenberg area is part of the Mogalakwena Municipality and is characterized by high poverty rate and unemployment. It is also regarded as one of the rural areas of the Municipality. The study used a case study methodology and a mixture of quantitative and qualitative research designs. The stratified random sampling method with a sample size of sixty (60) was used to collect data from various projects in the six categories. Data were collected by using the unstructured face-to-face interview method. The data were then analysed using the Moonstats Windows 14.0 to describe frequency tables, plotted pie and bar graphs for the quantitative study and the thematic method of analysis for the qualitative study. The key findings of the study were based on core issues, such as the profiles of the respondents that indicated that the majority of the research participants were females. Most of the LED projects had a problem of marketing their products, and this needed urgent attention. LED projects make an impact on job creation, sustainable livelihoods and social capital among project members and their communities. The study recommends that committed individuals who take part in poverty alleviation should be considered for funding rather than to provide state grants only to groups of people. Resources such as transport should be provided to projects in local areas to access any type of market. LED projects should install palisade and electric security fences around projects to prevent theft within the projects. The study also recommends that a stipend of R500 should be paid to each youth who joins the LED projects to encourage the youth to participate in LED projects.

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Hamaamba, Tyson. "Training needs for municipal employees: a case study of Makana Municipality." Thesis, Rhodes University, 2005. http://hdl.handle.net/10962/d1007952.

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This study investigated the education and training needs for municipal employees in order to inform an education and training strategy that would address environmental management challenges in Makana local municipality in Grahamstown, Eastern Cape province. The research was conducted as a qualitative case study that made use of questionnaires, document analysis, focus group discussions and interviews as instruments for data generation. Samples of respondents were selected from Makana Municipality employees in top and middle management positions, professionals/technicians and workers, including elected councillors. The study was contextualised through establishing environmental management issues in Makana municipality; establishing organisational needs; development of a learner profile; and through a review of policies and recent trends in adult education. The study established that the Makana Municipality employees are most concerned with the following issues: sanitation; solid waste management; livestock management and fire management. These issues require primary environmental competences among all council employees (top and middle management, professionals and technicians, workers and councillors who work on part-time basis). The educational implications needed to respond to these issues also require an understanding of legislation. The study also established that technical education and training which includes planning, project management, and financial and budgeting competences are necessary amongst the management and professionals. These competences may enable them to develop capacity in environmental management. This study further established the need for social education which includes competences such as communication and social justice. These competences should be developed amongst members of the same group as they need to involve the community in management of the environment. This should enable the municipality to create job opportunities and help change negative attitudes.

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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.

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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.

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32

Wissell, Richard Allyn. "Factors influencing the provision of services by local health departments." 1992. http://books.google.com/books?id=jFJYAAAAMAAJ.

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Kuhr, Jeffrey G. "Modifying national public health performance standards for local public health department accreditation." 2009. http://proquest.umi.com/pqdweb?did=1708097971&sid=10&Fmt=2&clientId=14215&RQT=309&VName=PQD.

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Thesis (Ph.D.)--University of Nebraska-Lincoln, 2009.
Title from title screen (site viewed June 26, 2009). PDF text: 204 p. : ill. ; 2 Mb. UMI publication number: AAT 3352319. Includes bibliographical references. Also available in microfilm and microfiche formats.

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Sprau, Daniel Downey. "Extending the role of local health departments into occupational and industrial health attitudes of local, state, and federal environmental health professionals." 1985. http://books.google.com/books?id=UNY9AAAAMAAJ.

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Williams, Maureen N. Herbold John Moore Frank I. "A model for use by local public health departments to evaluate pandemic influenza plans." 2008. http://proquest.umi.com.www5.sph.uth.tmc.edu:2048/pqdweb?did=1564033941&sid=2&Fmt=2&clientId=92&RQT=309&VName=PQD.

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Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008.
Source: Masters Abstracts International, Volume: 47-01, page: . Adviser: John Herbold. Includes bibliographical references.

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"The Right Side of the Public Health Ledger: How Revenue Dynamics Influence LHD Finances and Operations." Tulane University, 2019.

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archives@tulane.edu
Public health finance is still a relatively young field and, as such, many questions have yet to be asked—and answered. To date, few have examine how specific revenue streams—alone or in combination—shape local health departments’ (LHD) resources and capacity to accomplish their public health missions. Given ongoing policy conversations about financing for public health, it’s important for researchers to rigorously examine the and the potential costs and benefits associated with different revenue sources. Introduction Chapter: The central thesis for the body of work encapsulated by this dissertation is simple: where money comes from matters. This chapter critically examines published evidence and theory linking public health financing mechanisms and their interactions to LHD operations, outputs, and even outcomes. The chapter also introduces situates the specific research questions addressed in this dissertation within a broader conceptual framework. Paper 1: The first paper examines the relationship between revenue diversification and revenue volatility among Washington State LHDs. Using fixed effects linear regression models and revenue data reported during 1998-2014 by all LHDs operating in Washington State, the paper finds little evidence to suggest revenue diversification is significantly associated with revenue volatility. Paper 2: The second paper evaluates whether available revenue sources differentially effected the scope of programs provided by Washington State LHDs between 2000 and 2011. Using two measures of program scope and both linear and non-linear fixed effects panel regression models, the paper finds that only funding received from federal Medicaid was consistently and significantly associated with both measures of program scope. Paper 3: The third paper examines changes in total LHD expenditures in Washington State between 2006 and 2013 following introduction of a new state funding program to support core public health services and infrastructure. Using a pre-post design regression model to evaluate changes in LHD expenditures, the paper finds overall spending among LHDs significantly increased with receipt of the new state funds in the first years of the program. However, those increases were not sustained over the longer term Conclusion Chapter: The final chapter reviews findings from the three papers and discusses their implications for public health policy, practice, finance, and research.
1
Abigail Hope Viall

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Chang, Yu-Min, and 張煜敏. "Research on the Relationships Among Work Stress, Coping Strategies, and Physical and Mental Health of Employees from a Local Health Department." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/ae8f9t.

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碩士
長庚科技大學
健康照護研究所
104
Background: The public and the society anticipate that the health agency is responsible for maintaining the health of the public, resulting in its employees to experience heavy work stress. When work stress exceeds the load that an individual can handle, the stress can lead to negative impacts physically and mentally. The quality of service provided by the employees will be then degraded thereby affecting the health of the civilians. Purpose: By understanding work stress of the health agency employees, this study can find the correlations between coping strategies and physical and mental health conditions. We hope that the findings of the study can health authorities and academic institutions to enhance the health of health care professionals in the future. Methods: This study adopted cross-sectional and descriptive research design using the questionnaire survey to the entire staff of a public health agency in Northern Taiwan. A total of 160 questionnaires were issued and 145 questionnaires (90.6%) were valid. The structured questionnaire was used and the content included demographic data, work stress scale, coping strategies scale, and physical and mental health scale. Descriptive statistics, independent sample t test, one-way analysis of variance, Pearson product moment correlation analysis were used to analyze the data. Result: The overall work stress of the health agency staff was moderate and the item of “carrying excessive work load” was the most reported complaint. The frequency of using coping strategies was medium to high. When facing stress, most participants would use “rational thinking to solve problems” and least would “delay handling”. The level of physical and mental health condition was medium-to-high where “anxiety reaction” was the most complaint. Of the social demographic variables, employment, age, and seniority showed significant differences in work stress. Seniority and physical and mental health achieved significant differences. Work stress showed significant positive correlations with coping strategies and physical and mental health. The greater the work stress, the higher the frequency of using of coping strategies and the poorer the physical and mental health condition. Conclusions and Recommendations: This study suggested that to reduce the stress of the health care agency employees, the agency can arrange for suitable manpower according to the type of tasks, to thereby reduce excessive workload. The agency can regularly provide professional education and training courses such as ways to relieve pressure and emotional management to enhance physical and mental health of the staff.

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Fetter, Helen Ann Robertson. "The utilisation of routine statistical data submitted to the Department of Health by local authority primary health care clinics in Kwazulu Natal." Diss., 1998. http://hdl.handle.net/10500/16781.

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The collection and utilisation of statistical data is an integral component of rendering primary health care services. This study aimed to assess the utilisation of statistics on certain statistical forms submitted regularly to the Department of Health, by professional nurses at local authority primary health care clinics. Results revealed the following important shortcomings: • Statistics on different forms are viewed in isolation, resulting in a lack of necessary comparisons being made to determine trends. • Several targeted issues in the Reconstruction and Development Programme received insufficient attention, for example, immunisations, teenage pregnancies, tuberculosis treatment, sexually transmitted diseases. • A general managerial inability to analyse, display and utilise collected data by professional nurses. Recommendations centred around increasing the knowledge regarding maternal health care, more focus on prioritised areas of the Reconstruction and Development Programme, appropriate training regarding analysis and utilisation of collected statistics at local primary health care level.
Health Studies
M.A. (Nursing)

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Dissertations / Theses on the topic 'Local Heath Departments'

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