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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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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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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Improving Health in the Community: A Role for Performance Monitoring 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