tool for evaluating the delivery of personal health care services and for examining population-based activities addressing the health of the public (see Chapter 4). Although many performance monitoring activities are focused on specific health care organizations, there is a growing appreciation of their importance from a population-based perspective. Only at the population level is it possible to examine the effectiveness of health promotion and disease prevention activities and to determine whether the needs of all segments of the community are being addressed.

If a community's resources are to be mobilized for a continuing effort to improve its own health, potential participants must know what values they have in common and develop a clear and shared vision of what can be achieved. Based on its review of the determinants of health, of the forces in the community that can influence them, and of community experience with performance monitoring, the committee finds that a community health improvement process that includes performance monitoring, as outlined in this report, can be an effective tool for developing a shared vision and supporting a planned and integrated approach to improve community health. The committee's recommendations for operationalizing a CHIP are based on a variety of theoretical and practical models for community health improvement, continuous quality improvement, quality assurance, and performance monitoring in health care, public health, and other settings. However, the specifies of the committee's proposal have never been tested, in toto, in community settings. Thus, the final section in this chapter identifies a number of ways in which the process that the committee proposes can be evaluated and developed.

The committee suggests that a CHIP should include two principal interacting cycles based on analysis, action, and measurement. The problem identification and prioritization cycle focuses on identification and prioritization of health problems in the community, and the analysis and implementation cycle on a series of processes intended to devise, implement, and evaluate the impact of health improvement strategies to address the problems (see Figure 6-1).

In developing a health improvement program, every commu-