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A 2013 survey of Indiana local health departments (LHDs) measured accreditation activity and progress. Reported activities were categorized using the Public Health Accreditation Board's (PHAB's) accreditation steps as a guiding framework and matched with selected sociodemographic, organizational, and technical assistance variables. Findings indicated that 42 (59.2%) of responding Indiana LHDs reported pursuing accreditation. Of LHDs pursuing accreditation, 21 were at the initial introductory step, 18 were at the prerequisite step, one reported submitting an application to PHAB, and two reported no activity, yet intent to pursue accreditation. Reported receipt of technical assistance was associated with accreditation progress (p50.01) and, specifically, with being at the prerequisite step. Facilitating the pursuit of LHD accreditation in states with low public health investment is possible with targeted accreditation resources. Finding meaningful measures of accreditation progress will help advance the study of factors associated with LHD accreditation on a broad scale and for the long term.

Context A national system of voluntary public health accreditation for state, local and tribal health departments (LHD) is part of a movement that aims to improve public health performance with ultimate impact on population health outcomes. Indiana is a good setting for the study of LHD accreditation adoption because several LHDs reported de-adopting accreditation in a recent statewide survey, and because 71% of Indiana counties serve populations of ≤ 50,000. Design A systematic method of analyzing qualitative data based on the performance improvement model (PIM) framework to expand our understanding of de-adoption of public health accreditation. Setting/Participants In 2015, we conducted a key informant interview study of the three LHDs that decided to delay their engagement in the accreditation based on findings from an Indiana survey on LHD accreditation adoption. The study is an exploration of LHD accreditation de-adoption, and of the contributions made to its understanding by the Performance Improvement Model (PIM). Result The study found that top management team members are those who champion accreditation adoption, and that organizational structure and culture facilitate the staff’s embracing of the change. The PIM was found to enhance the elucidation of the inner domain elements of CFIR in the context of de-adoption of public health accreditation. Conclusion Governing entities’ policies & priorities appear to mediate whether the LHDs are able to continue accreditation pursuit. Lacking any of these driving forces appears to be associated with decisions to de-adoption of accreditation. Further work is necessary to discern specific elements mediating decisions to pursue accreditation.

The identification and exploration of moderators of health department accreditation remain limited by current dichotomous conceptualizations of pursuit.MethodsA 2015 survey measured Indiana local health department (LHD) accreditation pursuit and progress, classifying respondents by progress evidence. Covariates included attitudes about the future impact of accreditation on funding and performance, health department size, geography, health outcome ranking, and quality improvement (QI) programing.ResultsFour classifications of accreditation pursuit emerged and were found to have greater association with covariates than standard dichotomous measures. “Active Pursuit” was associated with formal QI programing and a belief that accreditation will impact future funding and performance. “Intent Only” was associated with no QI programing and no completion of accreditation prerequisites. “Discontinued” was associated with the belief that accreditation will not impact future performance. “Not Pursuing” was associated with no interest or plan to complete prerequisites and reported belief that accreditation will not impact future health department funding or performance.ConclusionMore granular characterizations of accreditation pursuit may improve understanding of influential factors. This measurement framework should be validated in studies of LHDs in other states.