This project will use a mapping study to assess the status of accreditation laws, policies and regulations in 20 states that have been identified as having or making progress towards accreditation, followed by a mechanism study involving process tracing in six case study states to examine how and why states developed, adopted, and implemented a particular legal structure.

The mechanism study will also utilize the conceptual framework of public health system and services research (PHSSR) to explore the impact that legal structure has on the organizational capacity, functions, and outputs of resulting accreditation programs. Deliverables for this project include a "legal supplement" to The Accreditation Road Map, a tool aimed at assisting states in the creation of a successful accreditation program. The legal supplement will be disseminated electronically to all study participants, states participating in the Multistate Learning Collaborative, and others to guide agency accreditation activities.