include a set for monitoring the incidence of vaccine-preventable disease and a set to be used to track vaccination rates for specific diseases. Most of the potential mental health measures focus on health outcomes for the treated population. Lack of data for measures of mental health outcomes in more general populations severely limits the number of potential measures the panel proposes. In substance abuse, the potential measures cover both treated and general populations for health status outcome, social functioning outcome, and risk status. For the three areas of prevention—sexual assault, disabilities, and emergency medical services—the narrowness of this charge to the panel and the general dearth of supporting data have resulted in a short list of potential measures.

Of course, use of even a large number of health outcome, process, and capacity measures may still result in less than conclusive evidence of agency or program performance in reducing multifaceted health problems. Therefore, the panel recommends that public health performance measures be considered as a central but not the only element of a continuous program of technical assistance. For example, if one measure or a combination of measures suggests that a given state is having unusual difficulty in making progress in meeting its performance objectives, such information should trigger an alert that some additional resources or technical assistance may be needed. The panel believes that this approach is consistent with the National Performance Review initiative at the federal level and with the total quality management activities that are being undertaken by state and local agencies around the country.

A major goal of this report is to provide an analytic framework for states and DHHS to use when assessing the appropriateness of specific outcome, process, and capacity measures for individual performance agreements. Recognizing that data resources and measurement methods need improvement, the panel recommends that DHHS continue to work with states toward several infrastructure goals: developing common definitions and measurement methods; encouraging efficient development of data resources that support multiple public health, mental health, and substance abuse needs; incorporating state data priorities in national infrastructure development efforts; and promoting states' data collection and analytic capabilities.

During the next stage of the study, the panel will examine the adequacy of existing databases to support improved health outcome measures, assess the quality of the empirical evidence of the effectiveness of specific interventions and the health outcomes discussed in this report, and suggest modifications to existing data sources or new databases necessary to support refined or new performance measures. Based on that assessment, the panel will recommend priority areas of research and data collection and infrastructure development for each of the health areas covered in this report, as well as for more general areas of public health concern.

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