in evaluating performance in subpopulations, such as high-risk populations. Such populations can be defined demographically, such as minorities, children, or elderly persons; by conditions, such as the lack of health insurance or homelessness; or by geographic area, such as central cities, high-risk neighborhoods, or rural communities. Specific sets of target populations can vary across states. Rather than trying to anticipate multiple submeasures that can be developed for each potential measure, the panel chose to develop broad population measures that can be tailored by each state to focus on its specific population group priorities. Clearly, validity, sample size, and other statistical issues need to be examined separately for every subpopulation.

The health outcome measures presented in this report are not meant as a mandated list. Few states are likely to have data necessary to support all of them. Furthermore, state agencies have major priorities in addition to those indicated by the outcome measures listed here (e.g., injury prevention, oral health, hearing and vision, environmental health) and are responsible for administering major programs relevant to public health (e.g., Medicaid) that are not covered by this panel's mandate. Therefore, the health outcome measures presented in this report should be considered an important subset, but not an exhaustive listing, of those that will be of interest to state agencies. Indeed, it is the panel's hope that performance measure evaluation will evolve so that new health outcome measures are continuously defined, studied, and adopted.

Similarly, the process and capacity measures presented in this report are for illustrative purposes only. Since states can pursue many reasonable strategies to improve health outcomes, a prohibitively long list of process and capacity measures would be required to cover all of their reasonable program options. The panel concluded, therefore, that the most useful approach would be to provide good, representative examples of relevant process and capacity measures in each program area. In order to illustrate the myriad strategies available to attain a single health outcome or risk status objective, Table 3-1 provides a list of possible program strategies and corresponding process measures aimed at reducing the incidence of smoking.

A major goal of this report is to provide an analytic framework for use by the states and DHHS in assessing the appropriateness of specific outcome, process, and capacity measures proposed for PPG agreements in the future. It is anticipated that many of the measures described in this report can, in time, be modified or replaced by others that meet the panel's selection guidelines.

Although the panel began its work with expectations that it would identify a set of core measures to support the PPG process in all the states, the panel has concluded that such a set of measures cannot be selected at this time. This conclusion is based on two findings. First, data sets to generate comparable state-level estimates exist for only a few health outcome measures; for the most part, data are not comparable across states. Second, as noted above, there are many reasonable process and capacity measures that states could adopt for PPG purposes



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