Substantive Issues

Addition of Subpopulations in PPG Agreements. Several organizations urged the panel to take into consideration various subpopulations of interest for the measures contained in the draft report, e.g., children and adolescents, ethnic and racial minorities, and persons with multiple health conditions:

The failure to demonstrate the importance of ethnicity as variables throughout the health outcomes measures needs to be visited by the panel. I specifically request that services to Native Americans be included in the performance measures. There are no dual diagnosis measures proposed and there should be at least some process or capacity measures suggested. Measure smoking among 18–24 years of age in addition to all adults 18+. Percentage of school children who eat five or more servings of fruits and vegetables daily.

The comments convinced the panel that additional measures for children and youth were needed in a number of health areas covered in the report, as this group is at high-risk in virtually all states. As explained in the report, however, other populations of special interest to state health agencies can vary greatly across states; therefore, states should be encouraged to specify their own subpopulations of interest and focus their PPG efforts accordingly. The panel expects that specific priority populations will be a central element of performance agreements between states and DHHS.

Modifications to Draft Measures. Several organizations urged the panel to take into consideration modifications to the measures contained in the draft report. The majority of such comments asked the panel to consider making particular measures more specific; other comments asked for more standardization of measures across the health areas addressed in the report. Examples of the first type of comment included:

The outcome measures for Substance Abuse consistently refer to "alcohol and drug abuse." It is preferable to use the terminology "abuse of alcohol and other drugs."The EMS process measure "Percentage of trauma patients going to trauma centers'' needs elaboration and revision. "Trauma centers" need some definition since not every hospital that may describe itself as a trauma center meets criteria. Change the proposed measure of "percentage of children with blood lead greater than 15 micrograms per deciliter" to "the percentage of children under six years of age with blood lead of 10 micrograms per deciliter or greater."

Many of the suggestions for modifying the specific wording of measures



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