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Improving Health in the Community: A Role for Performance Monitoring
Index
A
Academic health centers, 384
Access to health care
barriers, 43, 61, 331
community health profile indicators, 159, 161-162
interventions to improve, 430, 434
performance indicators, 362
uninsured persons, 159
Accountability
accreditation and, 81
approaches to, 5, 10, 64-66, 75, 99-100
community role, 64-66
concerns about, 62-64
establishing, 10, 65-66, 99-100, 437
market forces and, 99, 437
performance monitoring and, 5, 10, 29, 30, 86, 100, 146, 185-186, 378
private-sector role, 64-65, 83, 379
public-sector requirements, 64, 99-100, 397
reporting requirements, 64
social change and, 439-442
stakeholder, 3, 25, 42, 146, 437-438
state role, 64, 81
written agreements, 437
Accreditation, 81, 89, 109, 397
Accountable entities. See Stakeholders
Adolescents
births to, 161
interventions for, 54, 425-426, 433
smoking/tobacco use, 53, 141, 143, 300-307, 309
violence, 345-350, 353, 377
Advisory Committee on Immunization Practices, 279, 294, 437
Agency for Health Care Policy and Research, 394
Aid to Families with Dependent Children, 285, 292
AIDS, 160-161
Air quality, 138, 163
Alberta, Canada, 440-442
Alcohol and drug control programs, 46, 47, 431-432
Ambulatory care sensitive conditions, 266, 271, 362
American Academy of Family Physicians, 246
American Academy of Pediatrics, 246, 289
American Association of Retired Persons, 237
American Cancer Society, 196
American Hospital Association, 71-72, 269, 271
American Managed Behavioral Healthcare Association, 27, 86
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American Medical Association, 246, 269, 271
American Osteopathic Association, 269
American Public Health Association, 406
Analysis and implementation cycle. See Community health improvement process
Area Agency on Aging, 231, 235, 237
Arizona Partnership for Infant immunization (TAPII), 433-434, 435, 437
Assessment
of community health improvement process, 17-18, 105-106, 175-176
of community health needs, 4, 28, 84-85, 89-93, 389-392, 428-430, 443-444;
see also Community health profile
definition, 109, 418 n.3
function of public health departments, 28, 44, 89, 91, 108-109, 173 , 379-380
of interventions, 103-106;
see also Performance monitoring
public health practice, 4, 28, 379-382
quality of care, 82
Assessment Initiative, 135
Assessment Protocol for Excellence in Public Health (APEXPH)
analysis of health issues and resources, 95-97
approach, 84
capacity assessment, 113
environmental health addendum, 387
performance monitoring applications, 28, 142, 380, 381, 387, 406-407, 437
priority-setting with, 93
users, 85, 98, 381, 396, 428-429
workbook, 396-397, 406-407
Assurance
definition, 109, 418 n.3
function of public health departments, 44, 89, 99-100, 109
B
Behavior
adherence to treatment, 52
genetic influence, 52, 423
health status and, 8, 52, 56, 420, 423
individual, 158-163, 165, 264-265, 274
Behavior, as field model domain
breast and cervical cancer, 194-195, 203
community health profile indicators, 156-163, 165
depression, 212-214
infant health, 280-283
prototype performance indicators, 150, 194-195, 265-266, 274, 280-283, 303-304, 321, 327-330, 342, 348-350, 358
tobacco and health, 303-304
vaccine-preventable diseases, 327-330, 342
violence, 348-350, 358
Behavioral change
individual, 47
triggers for, 440
Behavioral Risk Factor Surveillance System (BRFSS), 131, 135-137, 139, 159, 162-165, 197, 198, 208, 209, 213, 216, 220, 235, 267, 270 , 293, 366
Births, to adolescents, 161
Block grants, reporting requirements, 29, 81, 86, 101, 138, 147, 175, 375, 393
Blueprint for a Healthy Community, 108, 111, 397
Breast and cervical cancer, prototype performance indicators
behavior, 194-195, 203
community health profile indicators, 160
data sources, 202-204
disease, 191-193, 202-203
genetic endowment, 194-195, 203
health care and, 191-193, 202-203
overview, 189-191
sample indicator set, 196-200, 202-204
social environment, 195-196, 204
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C
Calhoun County Health Improvement Program, 434-435
California, 46, 85, 176, 431-432
California Wellness Foundation Health Improvement Initiative, 378
Canada, 49, 138, 144 n.2, 440-442
Canadian Task Force on the Periodic Health Examination, 246
Cancer, 51, 97, 144, 160, 423;
see also Breast and cervical cancer
Cardiovascular diseases
mortality, 160
risk reduction, 52, 104-105, 107, 430, 442
Catholic Health Association, 72, 83
Center for Public Health Practice, 384
Center for Substance Abuse Prevention, 71
Center for the Advancement of Health, 378, 379
Centers for Disease Control and Prevention (CDC), 97, 105, 131, 158 , 159, 161, 176, 246, 247, 366, 380, 394, 407, 433
Cervical cancer. See Breast and cervical cancer
Change. See Social change
Children's health.
See also Infant health
abuse and neglect, 161, 283, 349-351
community health profile indicators, 158, 159-160, 161-162
data sources on, 136-137
family structure and, 50, 421
immunization, 80, 95, 96, 97, 116, 161-162, 324-325, 385, 425, 430 , 433-434, 437
lead poisoning, 242-244
monitoring, 85
socioeconomic status and, 158, 425
Civic Index, 96-97
Civic infrastructure, 109, 113
Clinic Assessment Software Application (CASA), 433
Clinical performance measures, 101 n.2, 375, 394
Clinical practice guidelines, 82, 145
Coalitions and coalition building
data collection and analysis, 91, 92-93
definition of, 70-71, 87
formation of, 87-89, 442
incentives to participate, 89, 391-392
inclusiveness, 14, 88, 171
leadership, 87-88
meetings, 94
organizational structure, 88
participants, 88-89;
see also Stakeholders
research on, 71-72
resource consumption by, 443-444
roles, 14-15, 75, 87-88, 91, 93, 110, 172, 445
Columbia Presbyterian Medical Center, 377
Columbia University, 377
Communicable diseases, 160, 430
Community
capacities, 34, 108-109
definition, 24-25, 59-60, 139
empowerment, 111
health centers, 44
outside influences on, 25-26
Community benefit, 83, 86, 89, 175, 385
Community Care Network, 71-72, 105
Community health improvement process (CHIP).
See also Community health profile;
Interventions to improve health;
Performance monitoring
accountability approaches, 5, 10, 99-100
administrative skills and resources, 112
analysis and implementation cycle, 5-11, 30-31, 32, 78-79, 95-103, 140-141, 167-168, 183
analysis of health issues, 8, 95-96
assessment of, 5, 17-18, 103-106, 117-118, 175-176
authority to act, 111
capacity building for, 106, 108-117
coalition building, 87-89
community empowerment, 111
components, 78-80
consumer role, 88
data collection and analysis, 30, 80-81, 89, 91-93, 102-103, 135-140, 153, 173-174
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evolutionary nature of, 5, 30, 80-81
expertise and skills, 96, 111-112, 153
federal role, 18-19, 81-82, 115, 139, 172-173, 174, 176-177
field model and, 11-12, 78, 86-87, 96, 116-117, 141-142, 166-167, 169
funding, 81, 85, 96-97, 102, 112
implementation resources, 90, 112
information systems, 112
leadership, 80, 87-89, 110-111
learning from, 103-106
motivation for participation, 36, 62, 83, 128, 385
operationalizing, 167-172
origins, 81-86
performance indicator development, 100-101, 169-170
performance monitoring, 102-104, 167
priority-setting, 93-95, 102, 111, 391
private-sector role, 83, 87, 89, 103, 173-174, 379, 384-386
problem identification and prioritization cycle, 5-7, 30-31, 78-79, 87-95, 126, 140, 167-168, 183
professional training, 116-117, 177-178
public health sector roles, 80, 84-85, 89, 91, 108-109, 173-174
resources for, 9, 35-36, 96-97
selecting indicators;
see Community health profile indicators;
Performance indicators
state role, 15-17, 18-19, 80, 81, 91-92, 173-175, 176-177
tools, 114-116, 176-177, 375
Community health profile
comparisons based on, 128
definition, 127
further development of, 137-140
privacy and confidentiality issues, 128
proposed indicators, 129-130, 156-165
role for, 7, 32, 91, 126-129, 140
size of community and, 139-140
updating, 128-129, 139
Community health profile indicators
access to health care, 127, 157, 161-162
and CDC consensus indicators, 130-131, 137, 138, 158, 159-161, 221
for children, 158-159, 161-162
communicable diseases, 160-161, 162
data sources, 127, 131-137
death rates, by leading causes, 160
demographic composition of population, 156-157
economic prosperity, 158-159
education, 157, 158
environmental quality, 163
family structure, 159
field model domains, 131-134, 138, 156-165
functional status, 9, 130, 134, 164
health resource use, 9, 127, 130, 134, 164
health risk factors, 9, 126-127, 130, 133, 161-163
health status, 8, 73, 85, 126, 127, 129, 133, 159-161, 164
immunization, 127, 161-162
infant mortality, 159-160
obesity, 163
as performance indicators, 128-129, 221
quality of life, 9, 127, 130, 131, 134, 135, 165
rate calculations, 137
selection of, 130-135, 138
smoking, 162-163
sociodemographic characteristics, 8, 126, 127, 129, 132, 156-159
standard measures, development of, 18-19, 27, 128, 176-177
unemployment rate, 159
uninsured persons, 159
uses, 7, 91, 93, 127-128, 139
Community Intervention Trial for Smoking Cessation, 85, 176
Community Mental Health Services Block Grant program, 81
Community-oriented primary care, 83
Community-wide Health Improvement Learning Collaborative, 106, 107
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Competition, and performance monitoring, 437, 443
Comprehensive health planning, 82
Confidentiality. See Privacy and confidentiality issues
Conflict theory, 439
Consumer Assessment of Health Plans Study, 394
Consumer satisfaction, 115
Continuous quality improvement. See Quality improvement
Core functions. See Public health agencies/system; specific functions
Coronary heart disease, 52, 85, 104-105, 176, 362, 424
Critical periods in human development, 50, 53, 54, 95, 144, 171, 421-422, 425
D
Data.
See also Behavioral Risk Factor Surveillance System;
Information systems;
Methodological issues;
Youth Risk Behavior Surveillance System
from administrative records, 367-368
availability of and access to, 135-137, 138, 146
breast and cervical cancer, 202-203
collection and analysis, 15-16, 33, 89, 91-93, 103, 116, 135-137, 143-144, 376, 389-390, 395, 397, 400
community health assessment, 377, 389-390
community health improvement process, 80-81, 89, 91-93, 103
for community health profile indicators, 131-137
comparative data/benchmark, 73, 93, 128, 138-139, 265, 268
costs of collection, 143-144, 395
environmental health, 386-387, 390
epidemiological, 93, 436, 443-444
geocoding, 15, 137, 174
immunization, 150-152
performance monitoring, 55, 74, 102-106, 146, 374, 376, 388, 445-446
privacy and confidentiality, 92, 111, 128, 149, 153, 174
private sector, 15-16, 92, 103, 174-175, 397
for prototype performance indicators, 202-204, 227-228, 240-241, 259-261, 274-275, 298-299, 321-323, 342-344, 358-359
and qualitative information, 11, 74, 94, 102-103, 390, 436
sharing, 15-16, 174-175
Demographic composition of population, 156-157
Depression, prototype performance indicators
behavior, 212-214
data sources, 227-228
disease, 207-209, 212, 227
genetic endowment and, 212
health and function, 209-211, 227
health care, 217-219, 228
overview, 205-207
physical environment, 212, 216-217
risk factors, 212
sample indicator set, 220-224, 227-228
social environment and, 212, 214-216, 227-228
stakeholders, 227-228
well-being, 209-211, 227
Determinants of health.
See also Field model of health determinants
biomedical construct, 43, 48, 55-56
conceptual model, 36, 47-48, 82
community-level, 53, 55, 62
critical periods in human development, 50, 53, 54, 95, 144, 421-422, 425
nature of, 42-43
research needs, 56
targeting interventions to, 53-54
Disease, as field model domain
breast and cervical cancer, 187, 191-193, 202-203
community health profile indicators, 158-163
depression, 207-209, 227
elderly people, 230-231, 240
infant health, 278-280, 298
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lead poisoning, 245-251, 259
prototype performance indicators, 150, 187, 191-193, 202-203, 230-231, 240, 245-251, 259, 278-280, 298, 302-303, 321, 326-327, 342, 347-348, 358
tobacco and, 302-303, 321
vaccine-preventable diseases, 326-327, 342
violence and, 347-348, 358
Disease, individual experience of, 40
Drugs. See Alcohol and drug control programs
Duke Endowment, 71
E
Economic analysis, 93, 97-98
Economic prosperity, as field model domain, 51, 54, 56, 157-165, 187, 231, 234, 241, 288-289, 308-309, 353, 422
Education.
See also Professional training
and health status, 50, 157, 421-422
indicators, 157, 158
maternal, 50, 157, 422
preschool, 50, 421-422
provider, 427, 433-434
Elder health, prototype performance indicators
data sources, 240-241
disease, 230-231, 240
economic prosperity, 231, 234, 241
health care, 230-231, 240
Kaiser Permanente Northern California Region performance measurement
areas, 231, 232-233
overview, 229-230
physical environment, 235, 241
sample indicator set, 235-241
social environment, 231, 234, 241, 424
stakeholders, 240-241
Employee Retirement Income Security Act, 153
End-stage renal disease, 362
England, 50, 421
Environmental health.
See also Lead poisoning;
Physical environment
air quality, 163
community health status indicators, 163
community-level focus, 53
data collection and analysis, 386-387, 390
interventions, 430
measures for, 93, 387, 397
model, 387
performance standards, 387
risk monitoring, 137
toxic substances, 51, 423
water quality, 163
Escondido Health Care and Community Services Project, 46, 47, 431-432, 437
Epidemiological data, use of, 93, 436, 443-444
F
Family structure and resources, 50, 96, 159, 277-278, 377, 421
Federal role, 16, 18-19, 81, 113, 115-116, 172-173, 174, 176-177
Field model of health determinants
and community health improvement process, 78, 82, 86-87, 96, 116-117, 141-142, 169
and community health profile indicators, 131-134, 138, 156-165
community-level factors, 53, 62
domains of model, 3, 24, 47-48, 49-52, 420-424;
see also specific domains (behavior, disease, economic prosperity, genetic endowment, health and function, health care, physical environment, social environment, well-being)
framework, 3, 47-53, 141, 166, 420-421, 425
importance of, 36, 42
interrelatedness of domains, 2-3, 24, 25, 48, 52-53, 56, 59, 420, 423, 424
and performance indicator selection, 100-101, 140, 141-142, 150-152, 183, 184, 187, 191-196, 202-204, 207-219, 227-228, 230-235, 240-241, 244-255, 259-261, 265-269,
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274-275, 278-291, 298-299, 302-311, 321-323, 326-334, 358-359, 347 -353, 358-359;
see also specific prototype performance indicators (breast and cervical cancer, depression, elder health, health care resource allocation, infant health, lead poisoning, tobacco and health, vaccine-preventable diseases, violence)
Florida, 91
Foundation for Accountability, 27, 65, 86, 147
Functional status
community health profile indicators, 9, 130, 134
Future of Public Health, The, 15-16, 28, 80, 113, 173, 379, 407
G
Genetic endowment, as field model domain, 51-52, 56, 131, 156-157, 160-161, 163, 184, 187, 194-195, 203, 283-284, 305, 327, 359, 423, 424
Genetic influences
on behavior, 52, 423
on health, 51-52, 423, 424
GOAL/QPC, 107
Government Performance and Results Act, 86
Great Britain
Whitehall study of civil servants, 50, 422
Group Health Cooperative of Puget Sound, 83, 89, 375, 384-386
H
Health. See also Determinants of health
as biomedical construct, 41, 43, 48
defining, 2, 24, 40, 41-47, 55-56
multidimensional nature, 42-43, 48-49, 53
Health and function, as field model domain
community health profile indicators, 158, 159, 160-165
depression, 209-211, 227
prototype performance indicators, 209-211, 227, 291, 311, 334, 347 -348, 358
tobacco and health, 311
vaccine-preventable diseases, 334
violence, 347-348, 358
Health Belief Model, 440
Health care
benchmarks, 265, 268-269
biomedical model of health and, 43
competing interests, 61-62
expenditures, 29, 60-61, 164, 262-264
inefficiencies, 262-263
legislation, 61
and life expectancy, 43, 52, 424
lost opportunities, 263
reform, 4, 60-62, 382-383, 388
satisfaction with, 164
Health care, as field model domain
breast and cervical cancer, 191-193, 202-203
community health profile indicators, 158, 159, 160-165
depression, 217-219, 228
elder health, 230-231, 240
infant health, 289-291, 299
lead poisoning, 245-251
prototype performance indicators, 151-152, 187, 191-193, 202-203, 228, 230-231, 240, 245-251, 259, 309-311, 323, 327-330, 332-334, 343-344, 350-351, 359
tobacco and health and, 309-311, 323
vaccine-preventable diseases, 327-330, 332-334, 343-344
violence and, 350-351, 359
Health Care Financing Administration, 164
Health care resource allocation, prototype performance monitors
benchmarked rates, 268-269
data sources, 274-275
individual behavior and, 265-266, 274
overview, 262-264
physical environment and, 266, 274
provision and utilization of services, 267-269, 274-275
public health capacity, 267-268
sample indicator set, 269-271, 274-275
social environment and, 266
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Health care sector, community health improvement initiatives, 81-83
Health care system
accountability in, 62-63
changing nature, 43-44, 440-442
Health data organizations, 153
Health improvement.
See also Community health improvement process
ecologic/systems theory approach, 47
social and political contexts for, 60-62
Health Insurance Portability and Accountability Act of 1996, 61
Health maintenance organizations. See Managed care organizations
Health Plan Employer Data and Information Set (HEDIS), 27, 33, 86, 101 n.2, 144, 147, 185, 186, 198, 217-218, 222, 264, 266, 290, 294 , 301, 310, 329, 335, 336, 338, 379, 388, 397-398, 406, 433, 437, 442
Health plans
capacity needs of, 108
coverage, 61
performance indicators, 27, 378-379
reporting, 375
Health promotion, 41, 45, 84, 440
Health Resources and Services Administration, 384
Health status
community health profile indicators, 8, 73, 85, 126, 127, 129, 133
self-reported, 164
Healthy Cities/Healthy Communities, 28, 84, 85, 105, 127, 425
Healthy Communities Handbook, 84
Healthy Communities 2000: Model Standards, 28-29, 84, 85, 101 n.2, 147, 185, 380, 396, 406, 407, 437
Healthy People 2000
for comparative data/benchmarks, 73, 93, 128
and indicator development, 85, 101 n.2, 127, 130-131, 138, 147, 185 , 221, 395
methodological and statistical issues, 360-371
objectives, 28-29, 147, 212-213, 243, 244, 251, 267, 276-277, 301, 310, 335, 337, 338, 360-371, 375, 380, 395, 396, 407
objectives, as performance measures, 185, 280, 368, 380, 381, 406, 407, 437
Performance Partnership Grants and, 393
and reporting requirements for block grants, 138
Hill-Burton program, 43
Homeless people, health care for, 157, 385
Homicide, 160, 345-347
Housing conditions, 51, 423
Hungary, 50, 421
I
Illinois
capacity assessment, 114
data systems and sources, 91, 135, 136
health improvement leadership, 80
McHenry County Project for Local Assessment of Need, 97, 98, 428-430
performance monitoring of local health departments, 81, 381-382
Project Health, 64
Immunization.
See also Vaccine-preventable diseases
analysis of issue, 96, 324-325
coalitions, 339
coverage, 80, 324-325
elderly people, 162
health profile indicators, 127, 161-162
interventions, 97, 385, 425, 430, 433-434
measurement issues, 328
performance indicators, 144, 150-152, 279, 437
recommended doses, 161-162, 290, 324
registries, 116, 137, 149, 162, 334, 339
Income
community health profile indicators, 158
and mortality rates, 51, 422
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Indicators. See Community health profile indicators; Measures; Performance indicator sets; Performance indicators
Infant health, prototype performance indicators
data sources, 298-299
disease, 278-280, 298
economic prosperity and, 288-289
genetic endowment, 283-284
health and function, 291
health care and, 289-291, 299
individual response, 280-283
overview, 276-278
physical environment and, 287-288, 299
sample indicator set, 291-295, 298-299
social environment and, 287-287, 298-299
stakeholders, 298-299
well-being and, 291
Information Network for Public Health Officials, 116
Information systems. See also Data
capacity, 33, 112, 135
clinical performance measures database, 101 n.2, 394
development of, 80, 115-116
and health profile indicators, 135-137, 139-140
infrastructure, 33
Internet, 91-92, 135
location identifiers, 137, 174
limitations, 33, 419
Medicaid/Medicare databases, 103 n.3
National Information Infrastructure project, 116, 392-393
private sector, 92, 103
public-private partnerships, 388
technical expertise, 112, 153
Injury, 238, 277, 287-288, 423, 430;
see also Violence
Input measures, definition, 426 n.6
Institute for Health Improvement, 107
Interventions to improve health.
See also Community health improvement process;
performance monitoring;
specific programs
barriers to success, 98-99
business role, 427-428
community-level, 53, 425, 434-435
cost-effectiveness, 93, 106
development, 9-10, 97, 99
evidence base for, 32, 78, 80, 97, 104-105, 145, 176, 186, 389, 399 , 425, 442, 443
funding, 430, 431-432, 434, 442
implementation, 10, 101-102
multidisciplinary approach, 2, 24, 42-43, 48, 54-55, 56, 72, 420, 425-426
needs assessment, 428-430
organization/institution role, 72-73, 426-427
performance-monitoring considerations, 144, 426-427
population effects, 4, 54, 425
staffing and resource utilization, 430
studies of, 93-94, 104-105, 176, 425
targets for, 53-54, 80, 85, 420, 425-426
''theory of change" in, 99
time frames, 13-14, 54, 171, 424-425
Iowa, 91
J
Joint Commission on Accreditation of Healthcare Organizations, 27, 101 n.2, 398-399, 406
Joint Council of Governmental Public Health Agencies, 397
K
Kaiser Family Foundation Community Health Promotion Grant Program, 85, 105, 176, 442
L
Lalonde Report, 47
Lead poisoning, prototype performance indicators
adults, 244
children, 242-244
data sources, 259-261
disease and, 245-251, 259
economic prosperity and, 424
health care and, 245-251, 259
physical environment and, 251-254, 259-261
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sample indicator set, 255-257, 259-261
social environment and, 254-255, 424
stakeholders, 259-261
Life expectancy, 43, 52, 424
M
Managed care organizations.
CDC activities with, 394-395
community health promotion activities, 55, 83, 431-432
"community" served by, 55, 427
growth, 44, 83
information tools, 427
Medicaid beneficiaries, 27, 81, 83, 333
performance monitoring, 26-28, 44, 147
provider education, 427, 433-434
Massachusetts
capacity assessment, 114
Community Health Network Areas, 71, 74, 80, 81, 94, 432-433
MassCHIP data system, 91, 135, 136, 139-140
North Shore Community Health Network Area, 432-433
McHenry County Project for Local Assessment of Need, 97, 98, 428-430
Measures.
See also Community health profile indicators;
Input measures;
Outcome measures;
Performance indicators;
Process measures
clinical performance, 101 n.2, 375, 394
of community health, 93, 130, 138-139
community-level, 139
development of, 65, 115, 380-381
diet and exercise, 139
environmental health, 387, 397
public health practice, 380-381
quality of life, 165
of satisfaction, 164, 165
of smoking initiation, 162
updating, 91, 138-139
Medicaid, 27, 43, 83, 89, 158, 175, 246, 294
Medical Outcomes Study, 209
Medical Outcomes Trust, 145 n.2
Medical practice patterns, 82
Medicare, 27, 43, 83, 89, 103 n. 3, 164, 264, 329, 331
Methodological issues
administrative records as data sources, 367-368
assessment of health improvement activities, 106
benchmarks, 93-94, 268, 364-366, 369
comparisons, 128
immunization rates, 328
interpretation of survey data, 363-364
local-level data, 366-367
small-area estimation, 370-371
specification of performance indicators, 101, 170-171, 361-362
standardization of rates, 369-370
units of analysis, 362-363
Michigan, 434-435
Migrants, 157
Minnesota, 85, 113, 135, 176
Missouri Community Health Assessment and Resource Team, 89, 90, 91
Models.
See also Field model of health determinants
biomedical, 43, 48
community development model of change, 440
environmental health factors, 387
Health Belief, 440
of health improvement, 444
PRECEDE-PROCEED, 440
of social change, 68-70, 439-440, 446
stages of change, 440
statistical, for small-area estimation, 370-371
Model Standards, 437;
see also Healthy Communities 2000: Model Standards
Monitoring. See Performance monitoring
Mortality
education and, 421
income and, 51, 422
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infant, 159-160, 385;
see also Infant health
social class and, 50, 422
N
National Association of County and City Health Officials, 396-397, 406
National Breast and Cervical Cancer Early Detection Program, 197
National Cancer Institute, 85, 176, 365
National Center for Health Statistics, 135, 137, 370, 395
National Civic League, 109, 111, 113, 138
National Committee for Quality Assurance (NCQA), 27, 64-65, 109, 144 n.2, 186, 263-264, 379, 397-398, 406
National Health and Nutrition Examination Survey, 368
National Health Interview Survey, 363-364, 395
National Heart, Lung, and Blood Institute, 85, 104-105, 176, 442
National Immunization Survey, 433
National Information Infrastructure project, 116, 392-393
National Institutes of Health, 43
New York City Washington Heights/Inwood neighborhood, 96, 375, 377
New York State, 91
Non-English-speaking populations, 157
North Shore Community Health Network Area, 432-433
Norway, 50, 421
O
Obesity, 163
Occupational Safety and Health Administration, 244, 246-247
Ontario, Canada, 138, 144 n.2
Organization for Economic Cooperation and Development, 51, 422
Organizations and institutions
expectations of, 55, 427
identification of stakeholders among, 427
internal monitoring, 427
model of social change, 440
Outcome measures
assessment instruments, 145 n.2
clinical, 388
definition, 142 n.1, 426 n.6
environmental health, 387
functional capacity and well-being, 48
intermediate, 426 n.6
Outcomes research, 82, 97-98, 425
P
Pacific Business Group on Health, 44, 45
Patient navigator program, 196
Performance indicator sets
breast and cervical cancer, 148, 196-200, 202-204
catalogs of, 101 n.2
data sources, 150-152, 202-204, 227-228, 240-241, 259-261
definition, 140
depression, 141, 148, 220-224, 227-228
development of, 10, 101, 183, 187, 374-375, 407
elder health, 142, 148, 235-241
field model domains of, 148, 150-152, 183, 184, 191-196, 202-204, 207-219, 227-228, 235-241, 244-255, 259-261, 264-269, 274-275, 278 -291, 298-299, 334-339, 342-344, 354-359
health care resource allocation, 148, 269-271, 274-275
health plan assessment, 27, 378-379
health status, 28-29, 85, 395, 432-433, 437, 443
Indicator Measurement System, 398-399
infant health, 148, 291-295
lead poisoning, 148, 257-261
mental health and chemical dependency services, 27
prototypes, 147-148, 150-152, 183-187
selecting, 141
stakeholder roles, 150-152, 183, 187
tobacco and health, 141, 148, 312-318, 408-409
uses, 81, 143, 147, 378, 406, 407, 443
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vaccine-preventable diseases, 13, 148, 150-152, 184, 334-339, 342-344
violence, 148, 354-359
Performance indicators
assessment of, 101
characteristics, 100, 419, 443
community health profile indicators as, 128-129
community responses to, 438
of cooperation among organizations, 100
criteria for selection, 13-14, 144-147, 184-185, 170-171
data availability, 146, 185
data collection and analysis costs, 143-144
definition, 140
development tools, 115, 177, 419
environmental health, 387
gaps in, 142, 379
health improvement links, 145, 184
health plan, 27, 378-379
health status indicators and, 73, 85, 432-433, 437, 443
immunization, 437
inclusion in other indicator sets, 146-147, 185
normative element, 378
operational issues, 143, 378
overall program evaluation distinguished from, 437
privacy and confidentiality issues, 149, 153
public health practice, 380-381
robustness and responsiveness to change, 146, 184-185
selection of, 12-13, 32, 42-43, 49, 99, 100-101, 142-147, 148, 170 -171, 184-186, 390-391, 408, 419, 420, 436-437, 445
sources, 100-101, 185
specification of, 361-362
stakeholders linked to, 12, 32, 146, 185, 170-171
standard measures, development of, 18-19, 27, 176-177, 186, 397, 436-437
strategic concerns, 171, 378
technical aspects, 177, 378
uses, 32, 430
validity and reliability, 145, 184, 362
Performance monitoring
and accountability, 5, 10, 29, 30, 86, 100, 145, 186, 378
barriers to, 34-35, 62
benchmarks, 93-94, 265, 268, 364-366
best practices, 96, 427
cultural competence, 72
data collection and analysis, 11, 72, 102-103, 376, 388, 426
definition, 4, 26, 418
federal role, 56, 64, 392-395
goals, 62, 397, 399, 418-419
identification of stakeholders, 142, 427, 432
implementation, 72-73, 409-410, 438
importance, 26-29, 63, 166-167, 416
leadership, 72, 438
measures, 55, 142, 186;
see also Input measures;
Outcome measures;
Performance indicator sets;
Performance indicators;
Process measures
participants, 56, 59, 72, 376, 435-436, 445;
see also Stakeholders
population-based perspective, 26, 105, 377, 419
priority setting, 72, 148
by private sector, 26-28, 55, 81, 86, 385, 386, 396-399, 443
by public sector, 28-29, 379-382
and qualitative information, 11, 27-28, 55, 74, 94, 102-103
"reinventing government," 26, 86
report cards, 27, 86, 397-398, 427
resource management, 36-37, 72
selection of health issues, 141-142, 436, 438
systems, 28-29, 68, 399-401, 419
time factors, 144
use of data from, 14-15, 27, 103-106, 374, 445-446
Performance Partnership Grants, 29, 81, 139, 175, 186, 393
Perry Preschool Study, 50, 421-422
Personal Responsibility and Work Opportunity Reconciliation Act, 285 n.1
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Pew Health Professions Commission, 109
Physical environment, as field model domain
community health profile indicators, 8, 157, 158, 159, 160, 162-163, 165
depression, 216-217
elder health, 235, 241
and health, 51, 52, 423
health care resource allocation, 266, 274
and infant health, 287-288, 299
lead poisoning, 251-254, 259-261
performance indicators, 216-217, 235, 241, 251-254, 259-261, 266, 274, 287-288, 299. 307-308, 322, 332, 353, 359
tobacco and health, 307-308, 322
vaccine-preventable diseases and, 332, 359
violence and, 353, 359
Plan-Do-Check-Act cycle, 82
Planned Approach to Community Health (PATCH), 28, 84, 96
Poverty. See Economic prosperity
PRECEDE-PROCEED model, 440
Privacy and confidentiality issues, 92, 111, 128, 149, 153, 174
Private sector.
See also Managed care organizations;
Organizations
and institutions
community health activities, 384-386
data for health assessments, 92, 103, 173-175
health assessment guide, 85
health care costs, 60
incentives for participation, 89
performance monitoring, 26-28, 55, 81, 86, 385, 386, 396-399, 443
public-sector partnerships with, 114
standardization of data, 16-17, 174
Problem identification and prioritization cycle. See Community health improvement process
Process measures
definition, 142 n.1, 426 n.6
environmental health, 387
public health practice, 380
Professional
competencies, 109
training, 19, 116-117, 177-178, 384
Project Health, 64
Prostate Patient Outcome Research Team, 262-263
Public health agencies/system
assessment of performance of, 379-382
capacity, 108-109, 113
core functions, 28, 44, 89, 91, 108-109, 113, 379-380, 404, 407, 418 n.3
essential services, 108, 267-268
health planning activities, 84-85
infrastructure database, 393
private-sector partnerships with, 113, 388
roles and responsibilities in community health improvement process , 15-16, 80, 88, 89-90, 93, 95-96, 99-100, 103, 112, 113, 172-175, 176-177, 375-376
Public Health Foundation, 366
Public Health sector, health improvement activities, 84-85
Public Health Service, 18-19, 176-177
Public hospitals, 44
Q
Quality assurance
definition, 418 n.3
private-sector systems, 44
public-sector role, 44, 82-83, 397
Quality improvement
and accreditation standards, 109
continuous (CQI), 4, 82, 102, 106, 107, 113, 332
definition, 418 n.3
indicator sets, 27-28, 101 n.2
internal, by health care organizations, 86
Quality of care, 27, 164
Quality of life, 18-19, 84, 115, 131, 135, 164, 165
R
Recommendations
assessment of community health improvement process (CHIP), 17-18, 175-176
coalitions, 14-15, 171-172
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community health profiles, 173-174, 176-177
data collection and analysis, 16-17, 173-174
defining health, 11-12, 169
development of CHIP, 17-19, 175-178
development of measurement tools, 18-19, 176-177
enabling policy and resources, 15-17, 172-175
implementation of CHIP, 17-18, 175
operationalizing CHIP concept, 11-15, 167-172
performance indicators, 12-14, 18-19, 169-170, 177
professional education, 19, 177-178
public health agency roles, 15-16, 172-173
stakeholder accountability, 11-12, 169-170, 175
timing of goals, 14, 171
Regional Municipality of Hamilton-Wentworth, Canada, 138, 144 n.2
Research
on coalition building, 71-72
on community health interventions, 105
on determinants of health, 56
on health outcomes, 82, 97-98, 425
on measurement techniques, 115
Rhode Island, 85, 176
Robert Wood Johnson Foundation, 46, 71, 375, 417
S
Satisfaction
with health care system, 18-19, 164, 264
with quality of life, 165
Seattle-King County, Washington, 73, 92-93, 375, 387, 389-392
Senior citizens. See Elder health
Sexually transmitted diseases, 143, 433
Single-parent families, 50, 159, 421
Smoking.
See also Tobacco and health
adolescents, 53
community health profile indicators, 162-163
genetic influences on, 52, 423
interventions, 53, 85, 425, 432-433
and lung cancer, 144
maternal, 96
measures of initiation, 162, 361-362
stages of change model, 440
workplace policies, 53
Social change
and accountability, 439-442
agents, 67
authoritarian model of, 68-69
community coalition building and, 70-72, 75
in health care, 440-442
individual level, 440
managing, 66-72
models of, 75, 439-440, 446
organizational level, 440
process of, 68-70
readiness for, 400-401
reallocation of resources, 68
resistance to, 67-68
stakeholder involvement, 3, 67-68
strategies and tactics, 70
willing compliance model of, 68, 69-70
Social class, and health, 50-51, 54, 422
Social environment, as field model domain
behavior and, 52, 423
breast and cervical cancer, 195-196, 204
community health profile indicators, 156-165
community-level focus, 53
depression, 214-216, 227-228
elder health, 231, 234, 241
epidemiology applied to, 436
and health, 8, 49-51, 52, 56, 421-422, 423
health care resource allocation, 266
infant health, 284-287, 298-299
lead poisoning, 254-255
prototype performance indicators, 150-151, 195-196, 204, 214-216, 227-228, 284-287, 298-299, 305-307, 321-322, 327-332, 342, 351-353, 359
tobacco and health and, 305-307, 321-322
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vaccine-preventable diseases and, 327-332, 342
violence and, 351-353, 359
Social networks, 50, 422
Social systems, health and, 45, 47
Socioeconomic status
and children's health, 424
Stages-of-change model, 440
Stakeholders.
See also Coalitions and coalition building
accountability, 3, 25, 32, 56, 59, 437-438
accountable entities, 12, 32, 56, 63-64, 66, 80, 88, 147, 169
collaboration/coordination among, 3, 36, 59, 74-75, 87-89, 433
definition of, 25, 63-64
depression, 227-228
development of performance indicators, 142, 183-184, 437
diversity of, 2, 25, 36, 56, 61-62, 187
elder health, 240-241
identification of, 75, 142, 427, 432, 433, 435-436, 445
infant health, 298-299
involvement in change process, 67-68
lead poisoning, 259-261
roles and responsibilities, 2-3, 25, 59, 65-66
tobacco and health, 321-323
vaccine-preventable diseases, 150-152, 342-344
Standards for Pediatric Immunization Practices, 332
State role.
See also individual states
in accountability, 64, 397
in community health improvement process, 15-17, 18-19, 80, 81, 91-92, 173-175, 176-177
in quality assurance, 397
Structural functionalism, 439
Substance Abuse Monitoring system, 135
Suicide, 160, 205, 209, 211, 348-349
Surgeon General's Workshop on Violence and Health, 347
Sustainable Development Indicators, 138, 144 n.2
Symbolic interactionism, 439
Syphilis, 160-161
T
Task Force on Community Preventive Services, 18, 97, 105, 176
Temporary Assistance to Needy Families, 285 n.1
Tobacco and health, prototype performance indicators
data sources, 321-323
disease, 302-303, 321
economic prosperity and, 308-309
genetic endowment, 305
health and function, 311
health care, 309-311, 323
individual response, 303-304, 321
overview, 300-302
physical environment and, 307-308, 322
sample indicator set, 312-318, 321-323
social environment and, 305-307, 321-322
stakeholders, 321-323
well-being and, 311
Tuberculosis, 160-161
U
U.S. Census Bureau, 366
U.S. Department of Health and Human Services, 29, 186, 375, 392-393, 417
U.S. Environmental Protection Agency, 163, 243, 249
U.S. Preventive Services Task Force, 97, 145, 246, 395
Unemployment, 51, 159, 422
Uninsured persons, 159
United States
social-class effects, 50-51, 422
University of
Florida, 380
Illinois at Chicago, 380, 381
Kansas, 105
North Carolina, 380
Washington School of Public Health, 375, 384
V
Vaccine-preventable diseases, prototype performance indicators
data sources, 150-152, 342-344
disease domain, 150, 326-327, 342
genetic endowment and, 327
health and function, 334
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health care and, 151-152, 327-330, 332-334, 343-344
individual behavior and, 150, 327-330, 342
physical environment and, 332, 359
sample indicator set, 13, 150-152, 334-339, 342-344
social environment and, 150-151, 327-332, 342
stakeholders, 150-152, 342-344
Violence, prototype performance indicators
data sources, 358-359
disease and, 347-348, 358
economic prosperity and, 353
genetic endowment and, 359
health and function, 347-348, 358
health care and, 350-351, 359
individual response, 348-350, 358
overview, 345-347
physical environment and, 353, 359
sample indicator set, 354-359
social environment and, 351-353, 359
well-being and, 346, 358
Voluntary Hospitals of America (VHA), 72, 83
W
W.K. Kellogg Foundation, 72, 434
Wales, 50, 421
Washington State, 73, 80, 92-93, 382-392
Washington State Public Health Improvement Plan, 114, 375, 382-383
Water quality, 163, 430
Well-being, as field model domain, 157, 159, 160-161, 163, 164, 165 , 166, 209-211, 227, 291, 311, 346, 358
Western Consortium for Public Health, 379
Whitehall study of British civil servants, 50, 422
WIC, 158, 285, 292, 331
Work-related factors, 51, 160, 422
World Health Organization
definition of health, 40
Health for All by the Year 2000 program, 84
and Healthy Cities/Healthy Communities, 84, 127
Y
Youth Risk Behavior Surveillance System (YRBSS), 136-137, 163, 208 , 209, 221
Representative terms from entire chapter:
performance indicators
