Health Districts as Quality Improvement Collaboratives and Multijurisdictional Entities

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.