In addition to the interest of DHHS and some members of Congress in applying performance measures to public health programs, several other factors seem to account for the growing interest in performance measurement systems. Such systems promise improved documentation of the achievements of public and private agencies and also serve to identify areas needing improvement. In fact, many people in public health believe that funding cannot be expected to increase or even be maintained at current levels without better documentation of the return on program investments. Performance measurement can also complement and extend on-going public health monitoring efforts, including Healthy Cities, Healthy Communities, and Healthy People 2000 and 2010, as well as state benchmarking activities and state efforts to develop systems to monitor managed care providers. Finally, the Government Performance and Results Act (GPRA) requires the federal government to measure the performance of all federal programs. As a result, some administrators of health programs at the federal, state, and local levels are concerned that the implementation process for the GPRA may become dominated by concerns of fiscal management unless good public health measures are available to evaluate program effectiveness.

As articulated by DHHS, the PPG concept envisions that DHHS, in consultation with states, public health professionals, private organizations, public agencies, and citizens, will develop a broad menu of performance measures that can be used in one or more of the following ten areas: chronic diseases; sexually transmitted diseases (STDs), human immunodeficiency virus (HIV) infection, and tuberculosis; mental health; immunization; substance abuse; and three sub-categories of prevention of special interest to DHHS—sexual assault, disabilities, and emergency medical services. Each state-federal PPG agreement would specify performance measures as a basis for monitoring the program objectives selected for that state. DHHS has proposed that a small set of measures be designated as "core" measures of health problems or opportunities of national importance. Although these core measures would be monitored in each state, not all states would necessarily be required to address them as program priorities, since not every problem of national importance is a problem or priority in every state. A key element of the PPG concept is that progress toward the programmatic objectives is monitored through data regularly reported by the state.

To assist DHHS in developing the plan for the PPG program, the panel was charged with the following tasks: (1) to identify measurable objectives that states and other interested parties might want to achieve through PPG agreements that can be monitored at the state and national level, either now or with small modifications to existing data systems; (2) to identify measures relevant to PPG agreements that cannot be assessed but that are important to states and the federal government and therefore require further development; and (3) to recommend improvements to state and federal surveys and data systems to facilitate future collection of information for both existing and developmental measures. Task 1 is the subject of this report; tasks 2 and 3 will be the subject of a subsequent



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