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--> Using Performance Monitoring to Improve Community Health: Conceptual Framework and Community Experience Workshop Summary Committee on Using Performance Monitoring to Improve Community Health Ellen M. Weissman, Editor Board on Health Promotion and Disease Prevention Institute of Medicine NATIONAL ACADEMY PRESS Washington, D.C. 1996
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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Funding for this project was provided by the Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services (contract no. 282-94-0032); The Robert Wood Johnson Foundation (grant no. 024336); and the National Academy of Sciences. The views presented in this report are those of the Committee on Using Performance Monitoring to Improve Community Health and of the participants in the workshop and are not necessarily those of the funding organizations. International Standard Book Number: 0-309-05594-6 Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP on-line bookstore at http://www.nap.edu/bookstore. Copyright 1996 by the National Academy of Sciences. All rights reserved. Printed in the United States of America
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--> Committee on Using Performance Monitoring to Improve Community Health BOBBIE A. BERKOWITZ* (Cochair), Deputy Secretary, Washington State Department of Health, Olympia, Washington THOMAS S. INUI** (Cochair), Professor and Chair, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts ALAN W. CROSS (Vice Chair), Director, Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina LARRY W. CHAMBERS, Epidemiology Consultant, Hamilton–Wentworth Regional Public Health Department, and Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada THOMAS W. CHAPMAN,*** Chief Executive Officer, George Washington University Hospital, and Senior Vice President for Network Development, George Washington University Medical Center, Washington, D.C. ELLIOTT S. FISHER, Associate Professor of Medicine and Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire JAMES L. GALE, Professor, Department of Epidemiology, School of Public Health, and Director, Northwest Center for Public Health Practice, University of Washington, Seattle; Health Officer, Kittitas County, Washington KRISTINE GEBBIE** (Liaison, Board on Health Promotion and Disease Prevention), Assistant Professor of Nursing, Columbia University School of Nursing, New York, New York FERNANDO A. GUERRA, Director of Health, San Antonio Metropolitan Health District, San Antonio, Texas GARLAND H. LAND, Director, Center for Health Information Management and Epidemiology, Missouri Department of Health, Jefferson City, Missouri SHEILA LEATHERMAN, Executive Vice President, United Health Care Corporation, Minneapolis, Minnesota JOHN R. LUMPKIN, Director, Illinois Department of Public Health, Springfield, Illinois WILLIAM J. MAYER, Vice President, Medical Affairs, Kellogg Company, Battle Creek, Michigan ANA MARIA OSORIO, Chief, Occupational Health Branch, California Department of Health Services, Berkeley, California SHOSHANNA SOFAER, Associate Professor and Associate Chair for Research, Department of Health Care Sciences, George Washington University Medical Center, Washington, D.C.
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--> DEBORAH KLEIN WALKER, Assistant Commissioner, Bureau of Family and Community Health, Massachusetts Department of Public Health, Boston, Massachusetts JOHN E. WARE, Jr.,*** Senior Scientist, The Health Institute, New England Medical Center, Boston, Massachusetts RICHARD A. WRIGHT, Director, Community Health Services, Denver Department of Health and Hospitals, Denver, Colorado Study Staff Linda A. Bailey, Senior Program Officer (Co–Study Director) Jane S. Durch, Program Officer (Co–Study Director) Stephanie Y. Smith, Project Assistant Michael A. Stoto, Director, Division of Health Promotion and Disease Prevention Marissa Fuller, Research Associate Sarah H. Reich, Project Assistant Susan Thaul, Senior Program Officer Workshop Consultant Ellen M. Weissman, Johns Hopkins School of Hygiene and Public Health * As of July 1, 1996, Deputy Director, Turning Point Program, University of Washington School of Public Health and Community Medicine, Seattle. ** Member, Institute of Medicine. *** Served through December 1995.
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--> Contents Introduction 1 The Committee's Charge 1 The Workshop 2 Background 2 Determinants of Health 4 Health Field Model 4 Social Environment 5 Genetic Endowment 7 Physical Environment 7 Behavior 7 Health Care 8 Linking the Determinants 8 Interventions to Improve Health 8 Community Interventions 9 Targets for Intervention 9 Implications for Performance Monitoring 10 Community Experience with Performance Monitoring 12 McHenry County Project for Local Assessment of Need 13 City of Escondido Health Care and Community Services Project 14 North Shore Community Health Network Area 15 Arizona Partnership for Infant Immunization 16 Calhoun County Health Improvement Program 17 Discussion 17 Identification of Stakeholders 18
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--> Selecting Health Issues and Performance Indicators 18 Should Performance Indicators Be Standardized? 19 Role of Performance Indicators in Stakeholder Accountability 20 Community Responses to Performance Indicators 20 Implementation: What Does It Take? 21 Social Change and Accountability 21 Models of Change 21 Change in Health Care: Case Study of Alberta, Canada 22 Commentary 24 Concluding Observations 26 References 29 Appendix A Workshop Agenda 32 Appendix B Workshop Speakers and Guests 34