The researchers explored the influence of accreditation among North Carolina’s local health departments (LHDs) on improvements in service delivery and health outcomes measures. Specifically, this study examined if accredited LHDs in North Carolina demonstrate greater improvements in service delivery outputs and health indicators when compared with non-accredited health departments, and examined other factors that could influence this relationship. It explored the extent and rate by which LHD accreditation influences service delivery and health indicators as well as factors that affect this influence, and key outcomes which are of interest in implementing an accreditation program. The objective of this project was to inform the development of the national public health accreditation model.