Local Health Department Engagement in Access to Mental Health Services and Mental Health Policy or Advocacy Activities.

CONTEXT: Mental health is a public health concern that requires national attention at the local level. Major issues facing local health departments (LHDs) to actively engage in mental health activities include inadequate surveillance data and limited resources. OBJECTIVE: To examine the levels of engagement in access to mental health services, as well as policy or advocacy activities, by LHDs characteristics. DESIGN: The study design is cross-sectional based on the national survey of LHDs. We analyzed the survey data from the National Association of County and City Health Officials' 2019 Profile study. Logistic regression was performed with 6 levels of engagement in mental health activities as the outcome measures. RESULTS: LHDs reported that a majority had assessed the gaps in access to mental health (57.69%), followed by other activities-had implemented strategies to increase access to mental health (48.77%), implemented strategies to target underserved populations (40.66%), evaluated strategies to target underserved populations (38.84%), engaged in policy/advocacy to address mental health (32.27%), and finally addressed gaps through provision of mental health (22.31%). LHDs' governance structure was strongly associated with engagement in all 6 mental health activities. LHDs that had performed improvement processes, had behavioral health staff, and had cross-jurisdictional sharing were more likely to be engaged in all 6 of the mental health activities. LHDs were also more likely to be engaged in 5 of the 6 mental health activities if they had some relationships with faith communities and in 4 of the 6 mental health activities if they had some relationships with community health centers. CONCLUSIONS: Levels of engagement in mental health policy or advocacy activities among LHDs were low and varied by LHD characteristics. Intervention strategies may include encouraging LHDs to actively engage in mental health activities, participating in Public Health Accreditation Board accreditation program, and incentivizing mental health workforce retention.

Turnover, COVID-19, and Reasons for Leaving and Staying Within Governmental Public Health.

BACKGROUND AND OBJECTIVES: Public health workforce recruitment and retention continue to challenge public health agencies. This study aims to describe the trends in intention to leave and retire and analyze factors associated with intentions to leave and intentions to stay. DESIGN: Using national-level data from the 2017 and 2021 Public Health Workforce Interests and Needs Surveys, bivariate analyses of intent to leave were conducted using a Rao-Scott adjusted chi-square and multivariate analysis using logistic regression models. RESULTS: In 2021, 20% of employees planned to retire and 30% were considering leaving. In contrast, 23% of employees planned to retire and 28% considered leaving in 2017. The factors associated with intentions to leave included job dissatisfaction, with adjusted odds ratio (AOR) of 3.8 (95% CI, 3.52-4.22) for individuals who were very dissatisfied or dissatisfied. Odds of intending to leave were significantly high for employees with pay dissatisfaction (AOR = 1.83; 95% CI, 1.59-2.11), those younger than 36 years (AOR = 1.58; 95% CI, 1.44-1.73) or 65+ years of age (AOR = 2.80; 95% CI, 2.36-3.33), those with a graduate degree (AOR = 1.14; 95% CI, 1.03-1.26), those hired for COVID-19 response (AOR = 1.74; 95% CI, 1.49-2.03), and for the BIPOC (Black, Indigenous, and people of color) (vs White) staff (AOR = 1.07; 95% CI, 1.01-1.15). The leading reasons for employees' intention to stay included benefits such as retirement, job stability, flexibility (eg, flex hours/telework), and satisfaction with one's supervisor. CONCLUSIONS: Given the cost of employee recruitment, training, and retention of competent employees, government public health agencies need to address factors such as job satisfaction, job skill development, and other predictors of employee retention and turnover. IMPLICATIONS: Public health agencies may consider activities for improving retention by prioritizing improvements in the work environment, job and pay satisfaction, and understanding the needs of subgroups of employees such as those in younger and older age groups, those with cultural differences, and those with skills that are highly sought-after by other industries.

Assessing Public Health Workforce Informatics Competencies: A Study of 3 District Health Departments in Georgia.

CONTEXT: Despite the increased recognition of the importance of having informatics-competent public health professionals, the competency level of the public health workforce in public health informatics (PHI) has not been examined extensively in the literature. OBJECTIVE: The purpose of this study was to assess public health workforce informatics competencies in select Georgia health districts and determine the correlates of PHI proficiency. METHODS: This study is based on a cross-sectional quantitative study design. We conducted an online self-administered survey of employees from 3 selected district health departments to assess proficiency in foundational PHI competency domains. Three hundred thirty-three respondents completed the survey, with a response rate of 32.5%. A gap score was calculated as a proxy to identify informatics training needs. A path analysis was conducted to assess the relationships among contextual factors and foundational PHI competency domains. RESULTS: The public health employees participating in this study reported relatively high proficiency in foundational PHI competency. Psychometric testing of the competency assessment instrument revealed 2 foundational informatics competency domains-effective information technology (IT) use and effective use of information. The effective use of IT mediated the relationship between employee-level factors of age and past informatics training and the effective use of information. CONCLUSION: The study highlights the importance of improving the ability of public health professionals to leverage IT and information to advance population health. Periodic assessment of staff PHI competencies can help proactively identify competency gaps and address needs for additional training. Short assessment tools, such as presented in this study, can be validated and used for such assessments.

Consequences of COVID-19 crisis for persons with HIV: the impact of social determinants of health.

BACKGROUND: With the indiscriminate spread of COVID-19 globally, many populations are experiencing negative consequences such as job loss, food insecurity, and inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative equipment. Some of the most disadvantaged in the COVID-19 era are people living with HIV/AIDS and other autoimmune diseases. DISCUSSION: As the number of new HIV infections decrease globally, many subpopulations remain at high risk of infection due to lack of or limited access to prevention services, as well as clinical care and treatment. For persons living with HIV or at higher risk of contracting HIV, including persons who inject drugs or men that have sex with men, the risk of COVID-19 infection increases if they have certain comorbidities, are older than 60 years of age, and are homeless, orphaned, or vulnerable children. The risk of COVID-19 is also more significant for those that live in Low- and Middle-Income Countries, rural, and/or poverty-stricken areas. An additional concern for those living the HIV is the double stigma that may arise if they also test positive for COVID-19. As public health and health care workers try to tackle the needs of the populations that they serve, they are beginning to realize the need for a change in the infrastructure that will include more efficient partnerships between public health, health care, and HIV programs. CONCLUSION: Persons living with HIV that also have other underlying comorbidities are a great disadvantage from the negative consequences of COVID-19. For those that may test positive for both HIV and COVID-19, the increased psychosocial burdens stemming from stress and isolation, as well as, experiencing additional barriers that inhibit access to care, may cause them to become more disenfranchised. Thus, it becomes very important during the current pandemic for these challenges and barriers to be addressed so that these persons living with HIV can maintain continuity of care, as well as, their social and mental support systems.

Community Characteristics and COVID-19 Outcomes: A Study of 159 Counties in Georgia, United States.

BACKGROUND: The COVID-19 pandemic affects population groups differently, worsening existing social, economic, and health inequities. PURPOSE: This study examined 159 counties within Georgia to identify community characteristics associated with county-level COVID-19 case, hospitalization, and death rates. METHODS: Data from the 2020 County Health Rankings, the 2010 US Census, and the Georgia Department of Public Health COVID-19 Daily Status Report were linked using county Federal Information Processing Standard codes and evaluated through multivariable linear regression models. RESULTS: The percentages of children in poverty, severe housing problems, and people not proficient in the English language were significant predictors associated with increases in case, hospitalization, and death rates. Diabetic prevalence was significantly associated with increases in the hospitalization and death rates; in contrast, the percentages of people with excessive drinking and female were inversely associated with hospitalization and death rates. Other independent variables showing an association with death rate included the percentages of people reporting fair or poor health and American Indian/Alaska Native. IMPLICATION: Local authorities' proper allocation of resources and plans to address community social determinants of health are essential to mitigate disease transmission and reduce hospitalizations and deaths associated with COVID-19, especially among vulnerable groups.

College Students' Experiences of Race-Related Bias or Hatred in Their Lifetimes and COVID-19 Era.

OBJECTIVE: The primary aim of this study was to investigate whether students in minority race categories are more likely to experience race-related bias and hatred in their lifetime and since the onset of COVID-19, after controlling the effect of demographic and other variables. METHODS: This quantitative study used primary data from the survey of 1249 college students at one of the universities in Georgia during April and May 2020. We performed multinomial logistic regression, computing 2 models for the 2 ordinal dependent variables concerning students' experience of race-related bias and hatred-(a) during their lifetime and (b) since the onset of COVID-19 in March 2020-both measured as "never," "rarely," "sometimes," and "fairly often or very often." RESULTS: During their lifetime, 47.5% of students had experienced some level of bias or hatred, ranging from "rarely" to "very often." Since the onset of COVID-19 on March 2 in Georgia, in a short period of 1 to 2 months, 17.6% of students reported experiencing race-related bias or hatred. Univariate statistics revealed substantial differences in race-related bias and hatred by race, experienced during students' lifetime as well as since the onset of COVID-19. Results of multinomial logistic regression showed that the odds of having experienced bias or hatred during their lifetime were significantly higher (P < .05) for the Black students than for White students (adjusted odds ratio [AOR] = 75.8, for very often or often vs never; AOR = 42 for sometimes vs never). Compared with White students, the odds of hatred and bias were also significantly higher for students who were Asian, multiple races, or another non-White race. The odds of having experienced race-related bias and hatred since the onset of COVID-19 were also higher for Black Asian, multiple races, and other non-White students. CONCLUSIONS: This study adds critical scientific evidence about variation in the perception of bias and hatred that should draw policy attention to race-related issues experienced by college students in the United States.

Local Health Departments' Engagement in Activities to Address Opioid Use and Abuse: The Influence of Surveillance Systems' Use.

AIMS: To examine the extent to which local health departments (LHDs) conduct activities to address opioid use and abuse. To test the hypothesis that (i) LHDs' access to data from an electronic syndromic surveillance system is associated with conducting activities to address opioid use and abuse, and (ii) among those LHDs with access to syndromic surveillance data, the use of syndromic and other surveillance data on opioid-related events is associated with LHDs' report of conducting activities to address opioid use and abuse. METHODS: Logistic regression was used to analyze data from the 2018 Forces of Change Survey of a statistically representative sample of 966 LHDs, of which 591 participated in the survey. RESULTS: The LHDs' access to a syndromic surveillance system was significantly associated with their report of conducting activities to address opioid use and abuse. Compared with LHDs that had no surveillance systems, odds of participating in activities to address the opioid use or abuse were higher for LHDs that managed their own surveillance systems (adjusted odds ratio, AOR = 3.022, P = .03) and those who had but did not manage their own surveillance systems (AOR = 1.920, P < .01). The LHDs' use of syndromic surveillance systems (AOR = 2.98, P = .01) or other surveillance systems (AOR = 2.21, P = .03) was also associated with higher odds to participate in activities to address the opioid use or abuse (vs no such use). CONCLUSION: The LHDs are strategically well positioned to play their role in addressing this multifaceted epidemic. Access to data or information from electronic syndromic surveillance systems that use hospital emergency department data might significantly improve LHDs' engagement in conducting activities to address opioid use and abuse within their communities while building their capacity to face the next epidemic.

An Analysis of Local Health Departments' Responsiveness to Community Segregation in Their Efforts to Address Health Disparities.

Recent studies have found that racial health disparities are a direct result of the residential segregation, racial differences in socioeconomic status, health care access, and other social determinants of health that affect segregated minority groups. This study analyzed local health departments' (LHDs') efforts to decrease health disparities in their communities by using negative binomial regression models to examine the relationship between residential segregation and LHD health disparity activity engagement from the 2016 National Profile of LHDs-National Association of County & City Health Officials (NACCHO) and the 2017 County Health Rankings (CHRs). Significant associations were found between the incident rate ratios of activities performed by LHDs and the nonwhite/white residential segregation index, use of CHRs, LHD governance, per capita expenditures, and race of LHD top executive. The findings will help improvement in collaborative efforts between community agencies and LHDs in order to improve health disparity responsiveness.

Local Boards of Health as Linkages Between Local Health Departments and Health Care and Other Community Organizations.

INTRODUCTION: Efficient provision of essential public health services may be influenced by collaborative capacity of local health departments (LHDs). Local boards of health (LBoHs) are well positioned to facilitate partnerships. OBJECTIVES: We examined the degree to which LBoHs serve as a linkage between LHDs and 2 types of community organizations, health care providers and local government agencies, and the LBoH characteristics associated with tendency of LBoHs to perform such linkage function. METHODS: We analyzed data from a recent cross-sectional survey, the 2015 National Survey of Local Boards of Health. This survey used a probability sample of 685 LHDs stratified by the state of LHD location and the population size of LHD jurisdiction, resulting in 394 responses for a response rate of 58%. We used multivariate logistic regression to pursue the study objectives. RESULTS: LHD respondents reported that LBoHs served as a linkage with hospitals or other health care providers for 20% of LHDs and with local government agencies for 19% of LHDs. Significant association of LBoHs' performance of governance functions existed with their chances of linking LHDs with hospitals or other health care providers (adjusted odds ratio [AOR] = 1.25; P < .001) and with local government agencies (AOR = 1.23; P < .001). Among the factors associated with LBoHs serving as the linkage, the governance function oversight was the strongest, followed by governance functions policy development, continuous improvement, and resource stewardship. Legal authority had weakest association with both types of linkages. A strong positive association existed between LBoHs seeking community input from elected officials and LBoHs' tendency of serving as the linkage with both health care providers and local government agencies. CONCLUSIONS: The role of LBoHs in linking with hospitals, other health care providers, and government agencies could be further maximized, particularly given the high proportion of LBoHs that include members who are health care professionals.

Association Between Accreditation Engagement and Using The Community Guide for Preventive Services by Local Health Departments.

BACKGROUND: Accreditation is one of the macro trends shaping the future of public health practice, and The Community Guide to Preventive Services is a decision-making tool used to select evidence-based interventions. Although local health departments (LHDs) seeking accreditation use The Community Guide, the relationship between the two remains unknown. The purpose of this study was to determine whether accreditation engagement is associated with the extent to which LHDs use The Community Guide. METHODS: Data from the National Association of County and City Health Officials' 2016 Profile of LHDs were examined for associations between accreditation engagement and the use of The Community Guide. RESULTS: Whereas 52.8% of LHDs used The Community Guide sometimes or consistently, only 21.5% were engaged in the accreditation process. Engaged LHDs were more likely to use The Community Guide consistently (adjusted odds ratios: 8.2; 95% confidence interval, 4.0-16.4) or sometimes (adjusted odds ratios: 3.6; 95% confidence interval, 2.4-5.3) than those not engaged at all. Local health departments serving a population of more than 50 000, organized with a county or mixed level of jurisdiction, and those having a top executive with a masters' or a doctoral degree, were more likely to report some use of The Community Guide. CONCLUSIONS: The extent that LHDs utilize The Community Guide is positively associated with the level of their accreditation engagement. Capacity building and policy measures could encourage LHDs to seek accreditation thereby increasing the use of The Community Guide for evidence-informed practice. Future studies should identify causal factors predicting the use of The Community Guide.

Employee Perceptions About Public Health Agencies' Desired Involvement in Impacting Health Equity and Other Social Determinants of Health.

CONTEXT: Despite a growing consensus in public health to address health inequities and leverage social determinants of health (SDoH), the level of public health practitioners' readiness to become the agents of change in promoting health equity and shaping SDoH is not well researched. OBJECTIVES: To examine (1) the level of public health agency employees' perceived desirability for impacting health equity and SDoH, and (2) the impact of employee characteristics such as a (PH WINS) public health degree and awareness of health in all policies on such desirability. METHODS: Data from the 2017 Public Health Workforce Interests and Needs Survey were used in examining the sense of desirability among agency employees for affecting health equity and SDoH in the agency jurisdictions. RESULTS: Fifty-seven percent of health agency employees believed that their agencies should be very involved in affecting health equity in their jurisdictions. Fairly smaller proportions of employees believed in the desirability of affecting SDoH, and the proportions who believed that the agency should be very involved in affecting specific SDoH were 17.8% for affecting the quality of transportation, 18.5% for affecting the economy, 22.2% for quality of housing, 22.4% for quality of the built environment, 25.4% for K-12 education system, and 34.5% for impacting the quality of social support systems. Agency employees without a public health degree had significantly lower odds (P < .05) of believing that the agency should be very involved in affecting health equity. CONCLUSIONS: With increasing efforts to reduce health inequities and leverage SDoH for improved population health, gaps exist in the public health workforce's perceived desirability for their agencies to be involved in such efforts. These gaps exist among employees regardless of their demographic characteristics, length of tenure, or agency setting. Policy and practice initiatives aimed to improve health equity might benefit from our findings positing a need for education regarding SDoH and health equity. Our study findings imply the need for interventions for improving alignment between employee beliefs and organizational priorities for an effective transformation to Public Health 3.0. Fostering cross-sector partnerships with a focus on Health in All Policies (HiAP), SDoH, and health equity must be a high priority for public health agencies, which can be formalized through organizational strategic plans.

Local Health Departments' Engagement in Addressing Health Disparities: The Effect of Health Informatics.

CONTEXT: Health disparities and health inequities can lead to poor health outcomes. However, health disparities continue to persist in communities across the United States, presenting a crucial public health challenge. Persisting budget cuts and workforce challenges tend to hinder local health departments' (LHDs') ability to assess and address health disparities. OBJECTIVES: To examine the extent to which LHDs' use of informatics effects their engagement in strategies and activities addressing health disparities. METHODS: Data from the 2016 Profile of LHDs were used in examining the association of informatics with 9 activities addressing health disparities/inequities. RESULTS: Fifty-nine percent of LHDs used data and described health disparities in their jurisdiction, and 12% conducted original research to link health disparities to differences in social or environmental conditions. Less than 40% of LHDs prioritized resources for the reduction of health disparities. LHDs that implemented information systems had increased odds of describing the disparities in their jurisdiction (P < .01) and having prioritized resources for the reduction of disparities (P < .01). Per capita expenditures, participation in a national accreditation program process, and a larger LHD population were also positively associated with 7 of 9 activities for addressing health disparities/inequities. CONCLUSIONS: As LHDs advance efforts to reduce health disparities and inequities, leadership will find informatics a useful strategy. National initiatives aimed to boost LHDs' engagement in the reduction of disparities might benefit from our findings, positing a positive influence of informatics.

Impact of Local Boards of Health on Local Health Department Accreditation, Community Health Assessment, Community Health Improvement Planning, and Strategic Planning.

INTRODUCTION: Local health departments (LHDs) are increasingly using national standards to meet the challenges presented by the complex environments in which these agencies operate. Local boards of health (LBoHs) might play an instrumental role in improving LHDs' engagement in activities to meet these standards. OBJECTIVES: To assess the impact of LBoH performance of governance functions on LHDs having a current (completed within 5 years) community health assessment (CHA), community health improvement plan (CHIP), strategic plan, and level of engagement in the Public Health Accreditation Board (PHAB) accreditation program. METHODS: Binary and multinomial logistic regression models were used to analyze linked data from 329 LHDs participating in both the 2015 Local Board of Health Survey and the 2016 National Profile of LHDs Survey. RESULTS: Higher performance of LBoH governance functions, measured by an overall scale of LBoH taxonomy consisting of 60 items, had a significant positive effect on LHDs having completed CHA (P < .001), CHIP (P = .01), and strategic plan (P < .001). LHDs operating in communities with a higher score on the overall scale of LBoH taxonomy had significantly higher odds (P = .03) of having higher level of participation in the PHAB national voluntary accreditation program-that is, being accredited, having submitted application for accreditation, or being in the e-PHAB system (eg, by submitting a letter of intent). CONCLUSIONS: LBoHs serve as governance bodies for roughly 71% of LHDs and can play a significant role in encouraging LHDs' participation in these practices. That positive influence of LBoHs can be seen more clearly if the complexity and richness of LBoH governance functions and other characteristics are measured appropriately. The study findings suggest that LBoHs are a significant component of the public health system in the United States, having positive influence on LHDs having a CHA, CHIP, strategic plan, and participation in accreditation.

Factors Associated With Continuous Improvement by Local Boards of Health.

BACKGROUND: The continuous improvement function, 1 of the 6 public health governance functions, can be usefully applied in the context of local boards of health (LBoHs) operations to target self-improvements. PURPOSE: The purpose of this study was to determine the engagement level of LBoHs in continuous improvement efforts and to identify factors associated with this function. METHODS: Negative binomial regression was performed to analyze data from the 2015 Local Board of Health National Profile. The LBoH taxonomy was used as the guiding model. The taxonomy includes 6 governance functions as structural domains and LBoHs' characteristics and strengths as the central or seventh domain. RESULTS: For the 17 items that comprise the continuous improvement domain, the mean of the dichotomous responses was 4.97 (SD = 3.41). The negative binomial regression analysis showed that the overall summary scale for the other 5 governance domains and the LBoHs' other strengths domain had a significant positive association with the governance domain continuous improvement domain (incidence rate ratio [IRR] = 1.05, P < .001). The 5 individual scales for the governance domains also had significant positive associations with the continuous improvement domain, which included the governance functions of policy development (IRR = 1.13, P < .001), resource stewardship (IRR = 1.18, P < .001), legal authorization (IRR = 1.09, P < .001, partnership engagement (IRR = 1.12, P < .001), and oversight (IRR = 1.29, P < .001). The scale for other characteristics and strengths also showed positive association with continuous improvement (IRR = 1.14, P < .001). CONCLUSION: The findings of this study revealed that there was room for improvement in LBoHs' engagement in the continuous improvement governance function. The results also identified other governance functions and LBoHs' characteristics as factors associated with their continuous improvement.

Local Boards of Health Characteristics Influencing Support for Health Department Accreditation.

BACKGROUND: Local boards of health (LBoHs) serve as the governance body for 71% of local health departments (LHDs). PURPOSE: To assess the impact of LBoH governance functions and other characteristics on the level of LBoH support of LHD accreditation. METHODS: Data from 394 LHDs that participated in the 2015 Local Boards of Health Survey were used for computing summative scores for LBoHs for domains of taxonomy and performing logistic regression analyses in 2016. RESULTS: Increased odds of an LBoH directing, encouraging, or supporting LHD accreditation activities were significantly associated with (a) a higher overall combined score measuring performance of governance functions and presence of other LBoH characteristics (adjusted odds ratio [AOR] = 1.05; P < .001); (b) a higher combined score for the Governance Functions subscale (AOR = 1.06; P < .01); (c) the "continuous improvement" governance function (AOR = 1.15; P < .001); and (d) characteristics and strengths such as board composition (eg, LBoH size, type of training, elected vs nonelected members), community engagement and input, and the absence of an elected official on the board (AOR = 1.14; P = .02). CONCLUSIONS: LBoHs are evenly split by thirds in their attention to Public Health Accreditation Board accreditation among the following categories: (a) encouraged or supported, (b) discussed but made no recommendations, and (c) did not discuss. This split might indicate that they are depending on the professional leadership of the LHD to make the decision or that there is a lack of awareness. The study findings have policy implications for both LBoHs and initiatives aimed at strengthening efforts to promote LHD accreditation.

Creating a Taxonomy of Local Boards of Health Based on Local Health Departments' Perspectives.

OBJECTIVES: To develop a local board of health (LBoH) classification scheme and empirical definitions to provide a coherent framework for describing variation in the LBoHs. METHODS: This study is based on data from the 2015 Local Board of Health Survey, conducted among a nationally representative sample of local health department administrators, with 394 responses. The classification development consisted of the following steps: (1) theoretically guided initial domain development, (2) mapping of the survey variables to the proposed domains, (3) data reduction using principal component analysis and group consensus, and (4) scale development and testing for internal consistency. RESULTS: The final classification scheme included 60 items across 6 governance function domains and an additional domain-LBoH characteristics and strengths, such as meeting frequency, composition, and diversity of information sources. Application of this classification strongly supports the premise that LBoHs differ in their performance of governance functions and in other characteristics. CONCLUSIONS: The LBoH taxonomy provides an empirically tested standardized tool for classifying LBoHs from the viewpoint of local health department administrators. Future studies can use this taxonomy to better characterize the impact of LBoHs.

Data, Staff, and Money: Leadership Reflections on the Future of Public Health Informatics.

CONTEXT: Health informatics can play a critical role in supporting local health departments' (LHDs') delivery of certain essential public health services and improving evidence base for decision support. However, LHDs' informatics capacities are below an optimum level. Efforts to build such capacities face ongoing challenges. Moreover, little is known about LHD leaders' desires for the future of public health informatics. OBJECTIVES: Conduct a qualitative analysis of LHDs' future informatics plans, perceived barriers to accomplishing those plans, and potential impact of future advances in public health informatics on the work of the public health enterprise. METHODS: This research presents findings from 49 in-depth key informant interviews with public health leaders and informatics professionals from LHDs, representing insights from across the United States. Interviewees were selected on the basis of the size of the population their LHD serves, as well as level of informatics capacity. Interviews were transcribed, verified, and double coded. RESULTS: Major barriers to doing more with informatics included staff capacity and training, financial constraints, dependency on state health agency, and small LHD size/lack of regionalization. When asked about the role of leadership in expanding informatics, interviewees said that leaders could make it a priority through (1) learning more about informatics and (2) creating appropriate budgets for integrated information systems. Local health department leaders said that they desired data that were timely and geographically specific. In addition, LHD leaders said that they desired greater access to clinical data, especially around chronic disease indicators. CONCLUSIONS: Local health department leadership desires to have timely or even real-time data. Local health departments have a great potential to benefit from informatics, particularly electronic health records in advancing their administrative practices and service delivery, but financial and human capital represents the largest barrier. Interoperability of public health systems is highly desirable but hardly achievable in the presence of such barriers.

The Methods Behind 2015 Informatics Capacity and Needs Assessment Study.

The 2015 Informatics Needs and Capacity of Local Health Departments (LHDs) survey is the most recent comprehensive source of quantitative data on LHD informatics. Conducted by the National Association of County & City Health Officials (NACCHO), this is the third nationally representative quantitative study of LHD informatics since 2009. The previous 2 comprehensive quantitative assessments were conducted by NACCHO in 2009-2010 and 2011. Given that public health informatics is rapidly evolving, the 2015 Informatics survey is a much-needed country-wide assessment of the current informatics needs and capacities of LHDs. This article outlines detailed methodology used in the 2015 Informatics survey, including instrument development, pretesting, sampling design and sample size, survey administration, and sampling weights. A 9-member advisory committee representing federal, state, and local health agency representatives guided the design and implementation of this study. The survey instrument was organized into 6 topic areas: demographics, physical infrastructure, skills and capacity available, public health workforce development needs, electronic health records, and health information exchange. The instrument was pretested with a sample of 20 LHDs and subsequently pilot-tested with 30 LHDs. The survey was administered via the Qualtrics survey software to the sample of 650 LHDs, selected using stratified random sampling. The survey was fielded for approximately 8 weeks and 324 usable responses were received, constituting a response rate of 50%. Statistical weights were developed to account for 3 factors: (a) disproportionate response rate by population size (using 7 population strata), (b) oversampling of LHDs with larger population sizes, and

Electronic Health Records and Meaningful Use in Local Health Departments: Updates From the 2015 NACCHO Informatics Assessment Survey.

BACKGROUND: Electronic health records (EHRs) are evolving the scope of operations, practices, and outcomes of population health in the United States. Local health departments (LHDs) need adequate health informatics capacities to handle the quantity and quality of population health data. PURPOSE: The purpose of this study was to gain an updated view using the most recent data to identify the primary storage of clinical data, status of data for meaningful use, and characteristics associated with the implementation of EHRs in LHDs. METHODS: Data were drawn from the 2015 Informatics Capacity and Needs Assessment Survey, which used a stratified random sampling design of LHD populations. Oversampling of larger LHDs was conducted and sampling weights were applied. Data were analyzed using descriptive statistics and logistic regression in SPSS. RESULTS: Forty-two percent of LHDs indicated the use of an EHR system compared with 58% that use a non-EHR system for the storage of primary health data. Seventy-one percent of LHDs had reviewed some or all of the current systems to determine whether they needed to be improved or replaced, whereas only 6% formally conducted a readiness assessment for health information exchange. Twenty-seven percent of the LHDs had conducted informatics training within the past 12 months. LHD characteristics statistically associated with having an EHR system were having state or centralized governance, not having created a strategic plan related to informatics within the past 2 years throughout LHDs, provided informatics training in the past 12 months, and various levels of control over decisions regarding hardware allocation or acquisition, software selection, software support, and information technology budget allocation. CONCLUSION: A focus on EHR implementation in public health is pertinent to examining the impact of public health programming and interventions for the positive change in population health.