Respondents also reported a decrease in a QI process
in 2010 compared with 2007 for most levels of QI
implementation except for QI partially implemented
for specific programs (Table 1). Possible reasons for the reported decrease in a QI process may include an improved understanding ofQI and thus more accurate reporting, use of a slightly revised definition of QI in 2010 compared with 2007 and/or limited staff to perform QI due to the recession.When comparing the same survey question in 2007 to 2010, a self-reported QI process in place decreased from82.4% to 76.5%. In 2010, however, the number of formal QI projects was assessed and based on response to this question, 84.3% of respondents
had implemented at least 1 formal QI project in
the past 12 months indicating a presence (albeit limited)
of a QI process at the agency. The survey question regarding the number of formal QI projects implemented at the agency was among several new QI-related questions asked on the 2010 survey. These additional survey questions allow for greater exploration of the presence of organizational QI and alternate ways to assess the construct. The results indicate that the measurement of QI at public health departments needs continued enhancement and refinement on the profile surveys. Despite relatively high levels of self-reported QI or PM activities by health departments, it remains difficult to identify widespread QI practices or measurable outcomes
related to those activities. Moreover, this bolsters
the prior suggestion that our reporting may overestimate current efforts.24 Whether a reported QI process by respondents is 76.5% or 84.3% (ie, based on the implementation of at least 1 QI project), the result (similar to the 2007 findings) continues to lie somewhere between the 61.7% reported by Beitsch et al25 and 88% reported by Mays et al.26