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Improving Health in the Community: A Role for Performance Monitoring
that setting. If possible, this indicator should be measured at the population rather than the institutional level. In addition, communities may want to examine the utilization of hospitals and ICUs for specific diagnoses.
Underuse of generic pharmaceutical agents. The growing availability of computerized pharmacy records will make it possible to monitor the proportion of eligible prescriptions that are written for generic drugs of generally equal effectiveness but substantially lower cost (Walzak et al., 1994).
Benchmarked supply of hospital beds, specialists, and primary care providers. Existing data from the American Hospital Association and physician organizations such as the American Medical Association (AMA) and the American Osteopathic Association can be used to determine the local supply of beds and physicians, while Medicare data or a state's hospital discharge data set can be used to adjust for border crossing and differences in age and sex across areas. A recently published analysis by researchers at Dartmouth provides such data for 1993 for all regions of the United States (Wennberg, 1996). Such analyses provide a potential source of data for benchmarking the level of personal health care resources within a community to numerous other communities that may achieve similar health outcomes with fewer resources.
SAMPLE SET OF INDICATORS
The 13 measures listed below represent a set of sample indicators that can be compiled by many communities throughout the United States:
Percentage of inpatients age 65 and over who die without an advance directive.
This measure would require a review of selected medical charts. The existence of an advance directive should be noted in the chart of patients with terminal conditions.
Percentage of health plan enrollees who smoke.
This measure would require a review of medical charts as well. Surveys at the community level may exist or could be developed.