and federal agencies (DHHS, 1990, 1992). Regular reports are issued to describe national progress toward meeting the objectives.

In 1995, DHHS began a process of establishing performance measures and objectives in anticipation of block grants legislation in public health, mental health, and substance abuse (NRC, 1997). A national initiative known as performance partnership grants is under way to improve the capacity of health departments and other public agencies to monitor and report on the health status of the U.S. population (NRC, 1997). DHHS also sponsored another IOM effort to examine performance measures for public health, which resulted in the development of prototypical sets of indicators for specific public health concerns that can be used by communities to monitor the performance of public agencies, private organizations delivering personal health services, and others (IOM, 1997b).

The scope of performance measurement on aspects of children's health and health care spans federal, state, and local governments; independent and university-based policy research organizations; provider organizations; and many other sources.

At the federal level, the agencies that follow use, produce, and advance performance measures in their role or responsibility with regard to children's access to care, health status, and health outcomes.

• U.S. Department of Health and Human Services:

• Agency for Health Care Policy and Research,
• Centers for Disease Control and Prevention,
• Food and Drug Administration,
• Health Care Financing Administration—Medicaid,
• Health Care Financing Administration—Disabled,
• Health Resources and Services Administration,
• Indian Health Service,
• National Institutes of Health, and
• Substance Abuse and Mental Health Services Administration;

• U.S. Department of Agriculture (nutrition programs);
• U.S. Department of Commerce (Current Population Survey);
• U.S. Department of Defense (Comprehensive Health and Medical Programs of the Uniformed Services);
• U.S. Department of Labor (employer and workforce statistics);
• U.S. Department of Treasury (tax policy); and
• Social Security Administration—Social Security Income;

At the state level, the following agencies use, produce, or advance performance measures for children's health care, insurance, access to care and for quality assurance:

• Medicaid agency,
• health department (often decentralized to include local agencies),
• human services department (often decentralized to counties),
• insurance department, and
• professional licensure and credentialing boards.

Private-sector organizations with specific interest in performance measures for children's health include: