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Improving Health in the Community: A Role for Performance Monitoring
viewed as encompassing facilitation of the overall intervention strategy in addition to responsibilities for specific services or activities.
Develop a Set of Performance Indicators
Accountability is operationalized in a CHIP through the adoption of concrete, specific, and quantitative performance indicators linked to accountable entities in the community that can contribute to health improvement. In contrast to a community health profile, which provides an overview of health status and community characteristics, performance indicators focus on a specific health issue and the activities undertaken as part of a health improvement strategy.
Because health issues have many dimensions and can be addressed by various sectors in the community, sets of indicators will be needed to make a meaningful assessment of overall performance. A set should include enough indicators to cover critical features of a health improvement effort but should not be so extensive that the details overwhelm the broader picture. As "indicators," these measures should be more than one dimensional, representing performance in important related areas (Sofaer, 1995).
Selecting indicators requires careful consideration of how to gain insight into progress achieved in the health improvement process. A set of indicators should be a balanced mix of population-based measures of risk factors and health outcomes and of health systems-based measures of services performed. An indicator set should include measures for the various accountable entities in the community, including those whose primary mission is not health specific. A balance is also necessary among indicators that reflect short-term gains and those that measure more fundamental long-term changes in community health.
Communities may also want to consider indicators of cooperation among organizations. The success of multiple organizations serving a particular community may depend on how well their services are coordinated. For example, senior citizens may be served by separate programs providing meals, transportation, outreach, and mental health services. Each program may be meeting its own goals, but if they are not working together, their overall impact may be diminished.
Communities will need criteria to guide the selection of indicators. In the committee's view, such criteria should include consis-