Topology of local health officials' advice networks: mind the gaps.

OBJECTIVE To determine how a health officials' advice network might contribute to a high-performing public health systems by facilitating diffusion of innovation and best practices. DESIGN A secondary analysis of cross-sectional data obtained from the National Association of County and City Health Officials 2010 Profile of local health departments (LHDs) using network analysis. SETTING The Profile survey is distributed biannually to all 2565 LHDs in the United States. In 2010, it included a network question: "In thinking about your peers who lead other local health departments in the U.S., list the five LHDs whose leaders you communicate with most frequently about administrative, professional, and leadership issues in public health." PARTICIPANTS The network question was answered only by the top executive. The subjects are 1522 health officials who answered the network question plus 477 named as contacts (n = 1999). MAIN OUTCOME MEASURES Measurements to assess network topology were density, centralization, transitivity, and reciprocity. At the node level, average centrality, clustering, effective network size, and clique count were measured. The convergence of iterated correlations algorithm was used to detect subgroups. RESULTS : A sparsely connected core periphery network exhibited minimal evidence of unified communication. Mutually connected small groups tend to clump within state boundaries suggesting gaps in information flow. The pattern persisted at the regional level with an average health official having an effective network of only 2 others. CONCLUSIONS Communication between peers may not be the primary way professional information diffuses among local health officials. National groups involved in performance improvement may wish to consider strategies to increase the diffusion of best practices and innovations through this network.