in Chapter 4, communities will have to assemble a set of performance indicators to address the multiple dimensions of a health issue. Discussed here are factors that should be considered in selecting sets of indicators for issue-specific performance monitoring. Prototype indicator sets in Appendix A to this report illustrate how communities might use the committee's approach.

Assessing the Scope of an Issue

Almost any health issue will have many dimensions and present many possible opportunities to respond. As an initial step in the analysis and implementation cycle of a CHIP, a community will need to think broadly about the nature of the problem, what can be done, who can take action, and what indicators can track progress most effectively. The field model provides a helpful framework for accomplishing the kind of systematic review that is needed. To gain a clear understanding of the features of a particular health issue so that an effective intervention strategy can be developed, it may be useful to gather additional information from key stakeholder groups. A community that wants to reduce adolescent tobacco use, for example, will need information on topics such as the age at which use begins, how adolescents obtain tobacco products, and the kinds of school-based prevention programs available.

As a community moves on to the process of identifying potential performance indicators, it should specifically include consideration of (1) the domains of the field model that could be addressed by those indicators and (2) the potential to engage the interest and action of a variety of community stakeholders. A narrow focus on any one stakeholder group or health factor may limit opportunities for effective action. For example, efforts to reduce the adverse impact of depression that look only at the quality of care provided by mental health specialists will neglect the contributions that might be made by primary care providers or by activities based in settings such as schools and workplaces.

Considering the Health Field Model

A narrow view of health interventions might be limited to the diagnosis and treatment of disease. Examining an issue in the framework of the field model, which presents health and well-being as the product of a more complex mix of forces, can point to a broader array of possible interventions and related performance



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