Final recommendations for a voluntary national accreditation program for state and local health departments: steering committee report.

A recently released report of the Exploring Accreditation Project affirmatively answered the questions regarding the desirability and feasibility of establishing a national voluntary public health accreditation program. The report's recommendations were made after 10 months of inquiry from public health experts, elected officials, the general public health workforce, academicians, and other interested parties, more than 650 public health professionals in all. Recommendations regarding how such a program might be implemented insofar as its governance, principles for standards development, financing and incentives, and evaluation were included. The report provides a blueprint for establishing a national voluntary public health accreditation program. This article describes key aspects of the Steering Committee recommendations, with limited linkage to implementation strategies where relevant, in the four areas in which the project was designed. Details are provided in the final reports of the Steering Committee (www.exploringaccreditation.org) and in other articles in this issue.

Assessing perceived agency adherence to the values of community inclusion: implications for staff satisfaction.

Measures of staff members' knowledge (N = 518) of the values of community inclusion, perception of agency adherence to community inclusion, and satisfaction with relevant components of their jobs were developed. Staff represented 130 agencies in a state-wide program of individualized community living supports for adults with developmental and/or mental disabilities. Results suggest relatively high levels of knowledge about values of inclusion and perceived agency adherence to the inclusion philosophy among employees regarding the need to provide individuals who have disabilities with opportunities for engaging in community daily activities and their rights for services. Employees, however, had significantly less knowledge of and noted less agency adherence to activities intended to provide consumers with opportunities to make choices. Staff who perceived more agency adherence to the philosophy of inclusion were more satisfied with their jobs.

The California Hospital Outcomes Project: using administrative data to compare hospital performance.

BACKGROUND: The California Hospital Outcomes Project was created by an act of the state legislature in 1991. The California Office of Statewide Health Planning and Development (OSHPD) publishes annual reports on risk-adjusted hospital outcomes for medical, surgical, and obstetric patients. These outcomes indicators were chosen: in-hospital mortality within 30 days (acute myocardial infarction [AMI]), reported post-operative complications (diskectomy, delivery), post-operative length of stay (diskectomy), and readmission within 6 weeks (delivery). Project reports are based on discharge abstracts submitted by hospitals and edited by OSHPD. For each outcome, two risk adjustment models were used to estimate expected and risk-adjusted hospital outcome rates, along with p values representing the likelihood that the observed number of adverse outcomes occurred by chance. RESULTS: The first hospital outcomes report was distributed to hospitals in June 1993 and released to the public in December 1993. The total number of hospitals labeled as "better than expected" was 14 for AMI, 5 for cervical diskectomy, and 25 for lumbar diskectomy. The second hospital outcomes report was distributed to hospitals in June 1995. RESPONSE AND CONCLUSIONS: Letters submitted for 168 hospitals in response to the 1993 report demonstrated that hospitals had studied and used project results to evaluate their coding practices and quality of care. Media coverage of the 1993 report was balanced but sometimes critical of OSHPD's failure to identify "worse" hospitals. In response to providers' concerns, OSHPD has undertaken a validation study to explore whether differences in coding, unmeasured risk factors, or processes of care explain the reported differences in risk-adjusted outcome rates.

Capacity of state health agencies to meet nutrition objectives in maternal and child health.

Public health nutritionists in 54 official state health agencies were surveyed in 1987 to determine to what extent they were prepared to implement the Model State Nutrition Objectives developed by the Association of State and Territorial Public Health Nutrition Directors. Objectives related to services to the maternal and child health (MCH) population were the focus of one part of the survey. One half of all states have plans for nutrition services integrated into their state MCH plans. More than 75% of state agencies collect data on the nutritional status of pregnant and lactating women, infants, and preschool children. Fewer than half collect data on dietary intake patterns or nutrition knowledge. Thirty-one agencies reported a formal quality assurance program for one or more subsets of the MCH population. At least 75% of all states provide dietary intake recommendations, screening and assessment protocols, and policies concerning referrals to maternal and infant health programs. State health agencies are already involved in activities that will facilitate adoption of the model state nutrition objectives.

Moving the 'standards movement'.

Substantial variations found in state implementation of public health service standards were partially explained by information collected from State Health Departments. A number of structural factors, particularly the distribution of service and supervisory responsibilities between state and local agencies, produce role and tactical differences in the process of standards implementation. Patterns and philosophies of intergovernmental funding were also reported to be critical to the process. In that these and related factors have their roots in political decisions, attention to internal and external political constraints is believed to be important to progress on standards implementation. Finally, the extent of variation reported raises the issue of the degree to which a common paradigm of public health exists and guides practice in state and local communities.