BOX 2-1

On Scorecards

The term scorecards is sometimes used to refer to health-indicator sets that provide a snapshot of an area’s health (for example, How is X County compared with a national standard, compared with Y County in a given state, or compared with last year?). However, the term’s specific meaning in the business, education, and clinical care settings—as a tool for internal performance evaluation (for example, balanced scorecards)—is different from the meaning and purpose of many health-indicator sets. The committee struggled with achieving clarity about the seemingly overlapping meanings of the terms used in measurement and recognized that the purposes of performance measurement, public reporting, and mobilization are not necessarily independent or neatly separate from one another. The lack of semantic exactness regarding health indicators has led to a conflation of two primary meanings: “measures of health” and “measures of performance on health.” Many public health or population health data sets (as opposed to data sets used in the clinical care context) called scorecards or report cards are not, in fact, intended for or capable of measuring the performance of public health agencies in a county or state, of other organizations, or of communities in general. The committee discusses this difficulty with use of the term scorecard further in Chapter 4, “Measurement and Accountability.”

quarterly measure of gross domestic product. In this chapter and throughout much of the report, the committee will use the term indicators to denote components of data sets that convey information (comparative or ranked) about the health status of the country, states, and counties. Indicators will also refer to a variety of existing and potential metrics used to inform, mobilize, and advocate and in the context of a later discussion of measurement in accountability (in Chapter 4).3 The term scorecards is used to refer to some of these efforts and their indicator sets (see Box 2-1 and Chapter 4 for a discussion of this term).


On the difference between performance measures and outcome measures: The two types of measures may overlap in terminology and operationally. In ideal circumstances, it would be easy to draw a straight line between cause and effect in population health, elucidating a clear causal relationship between system inputs, such as programs or policies, and system outputs, such as health outcomes. Sufficient resources and other capabilities would be deployed in interventions supported by evidence, best practices, or strong theoretical arguments and would move public health agencies and their partners in the direction of achieving desired outcomes. However, health is the result of complex and dynamic interactions, data on which are often lacking. Because the evidence needed to elucidate the pathway from specific inputs to a given output is often incomplete, decisions as to which data to collect are challenging, and it is often difficult to collect the needed data. This is a topic in which research and analysis, including predictive and systems modeling, can help to elucidate the causal pathways, fill gaps in knowledge, and inform a variety of decision-making and policy-making.

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