Local Health Department Accreditation Is Associated With Organizational Supports for Evidence-Based Decision Making

The aim of evidence-based decision-making in public health involves the integration of science-based interventions with community preferences to improve population health. Although considerable literature is available on the development and adoption of evidence-based guidelines and barriers to their implementation, the evidence base specific to public health administration is less developed. This article reviews the literature from public health and related disciplines to identify administrative evidence-based practices (A-EBPs; i.e., agency-level structures and activities that are positively associated with performance measures). A "review of reviews" was carried out to assess the evidence for the effectiveness of A-EBPs covering the time frame January 2000 through March 2012. The following steps were used: (1) select databases; (2) determine search parameters and conduct the search; (3) screen titles and abstracts; (4) obtain selected documents; (5) perform initial synthesis; (6) abstract data; and (7) synthesize evidence. In both the reviews and original empiric studies, the most common outcome reported was performance of the local health department or local public health system. On the basis of a synthesis of data from 20 reviews, a total of 11 high-priority A-EBPs were identified (i.e., practices that local public health systems potentially can modify within a few years). The A-EBPs covered five major domains of workforce development, leadership, organizational climate and culture, relationships and partnerships, and financial processes. As the body of practice-based research continues to grow and the ability to measure administrative evidence-based practices improves, this initial list can be further developed and improved. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Background Preparing the public health workforce to practice evidence-based decision making (EBDM) is necessary to effectively impact health outcomes. Few studies report on training needs in EBDM at the national level in the United States. We report competency gaps to practice EBDM based on four U.S. national surveys we conducted with the state and local public health workforce between 2008 and 2013. Methods We compared self-reported data from four U.S. national online surveys on EBDM conducted between 2008 and 2013. Participants rated the importance of each EBDM competency then rated how available the competency is to them when needed on a Likert scale. We calculated a gap score by subtracting availability scores from importance scores. We compared mean gaps across surveys and utilized independent samples t tests and Cohen’s d values to compare state level gaps. In addition, participants in the 2013 state health department survey selected and ranked three items that “would most encourage you to utilize EBDM in your work” and items that “would be most useful to you in applying EBDM in your work”. We calculated the percentage of participants who ranked each item among their top three. Results The largest competency gaps were consistent across all four surveys: economic evaluation, communicating research to policymakers, evaluation designs, and adapting interventions. Participants from the 2013 state level survey reported significantly larger mean importance and availability scores (p <0.001, d =1.00, and p <0.001, d = .78 respectively) and smaller mean gaps (p <0.01, d = .19) compared to the 2008 survey. Participants most often selected “leaders prioritizing EBDM” (67.9%) among top ways to encourage EBDM use. “EBDM training for specific areas” was most commonly ranked as important in applying EBDM (64.3%). Conclusion Perceived importance and availability of EBDM competencies may be increasing as supports for EBDM continue to grow through trends in funding, training, and resources. However, more capacity building is needed overall, with specific attention to the largest competency gaps. More work with public health departments to both situate trainings to boost competency in these areas and continued improvements for organizational practices (leadership prioritization) are possible next steps to sustain EBDM efforts.