Community Health Assessment and Improved Public Health Decision-Making: A Propensity Score Matching Approach.

Abstract

We analyzed the likelihood of chronic disease prevention activities delivery, as a proxy measure of public health decision-making and actions, given that local health agencies (LHAs) implemented a community health assessment and improvement plan in their communities. Using a propensity score matching approach, we linked data from the 2010 National Association of County and City Health Officials profile of LHAs and the 2010 County Health Rankings to create a statistically matched sample of implementation and comparison LHAs. Implementation LHAs were those that implemented a community health assessment and improvement plan. We estimated the odds of chronic disease prevention activities delivery and the average treatment effect on the treated. Implementation group LHAs were 2 times as likely (95% confidence interval = 1.60, 2.64) to deliver population-based chronic disease prevention programs than comparison group LHAs. Furthermore, chronic disease prevention activities were more likely to be delivered among implementation group LHAs (6.50-19.02 percentage points higher) than in comparison group LHAs. Our results signal that routine implementation of a community health assessment and improvement plan in LHAs leads to improved public health decision-making and actions.