Using Performance Monitoring to Improve Community Health: Exploring the Issues

SUMMARY

Performance monitoring is being used as a tool for evaluating the delivery of personal health care services and for examining population-based public health activities. The Institute of Medicine's Committee on Using Performance Monitoring to Improve Community Health is exploring how such efforts might be coordinated and directed toward improving the health of entire communities. The committee is considering the individual and interrelated roles that public health agencies, health care providers in the private sector, and various other stakeholders play in influencing community-wide health; how the performance of those roles can be monitored in a systematic manner; and how a performance monitoring system can foster collaboration among stakeholders and promote improvements in health status for all members of the community. An important task for the committee will be developing prototypical sets of indicators that communities can use to monitor specific health issues and the role that public health agencies, personal health care organizations, and other entities with a stake in these matters could be expected to play in addressing those issues. The study is funded by the U.S. Department of Health and Human Services and by The Robert Wood Johnson Foundation.

This report summarizes the proceedings of a May 1995 workshop, which reviewed a variety of public and private activities in health-related performance monitoring. An opening presentation focused on the experiences in conducting and using an assessment of health status in New York City's Washington Heights/Inwood neighborhood. The subsequent presentation explored characteristics and limitations of health plan performance indicators and how they might be applied in a broader community context. The final presentation in this portion of the workshop reviewed the development of measures of public health practice for assessing the performance of local health departments and Illinois' application of such assessments in certification of its local health departments.



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Using Performance Monitoring to Improve Community Health: Exploring the Issues: Workshop Summary Using Performance Monitoring to Improve Community Health: Exploring the Issues SUMMARY Performance monitoring is being used as a tool for evaluating the delivery of personal health care services and for examining population-based public health activities. The Institute of Medicine's Committee on Using Performance Monitoring to Improve Community Health is exploring how such efforts might be coordinated and directed toward improving the health of entire communities. The committee is considering the individual and interrelated roles that public health agencies, health care providers in the private sector, and various other stakeholders play in influencing community-wide health; how the performance of those roles can be monitored in a systematic manner; and how a performance monitoring system can foster collaboration among stakeholders and promote improvements in health status for all members of the community. An important task for the committee will be developing prototypical sets of indicators that communities can use to monitor specific health issues and the role that public health agencies, personal health care organizations, and other entities with a stake in these matters could be expected to play in addressing those issues. The study is funded by the U.S. Department of Health and Human Services and by The Robert Wood Johnson Foundation. This report summarizes the proceedings of a May 1995 workshop, which reviewed a variety of public and private activities in health-related performance monitoring. An opening presentation focused on the experiences in conducting and using an assessment of health status in New York City's Washington Heights/Inwood neighborhood. The subsequent presentation explored characteristics and limitations of health plan performance indicators and how they might be applied in a broader community context. The final presentation in this portion of the workshop reviewed the development of measures of public health practice for assessing the performance of local health departments and Illinois' application of such assessments in certification of its local health departments.

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Using Performance Monitoring to Improve Community Health: Exploring the Issues: Workshop Summary The next set of presentations focused specifically on Washington State and Seattle–King County. They included discussions of the state health department's focal role in public health policy; links between the University of Washington School of Public Health and the state 's local health departments; the community-oriented approach being taken by the private nonprofit Group Health Cooperative of Puget Sound; efforts to bring a health outcomes perspective to assessments of environmental health activities; the state's voluntary public–private collaboration in the development of health data systems; and an overview of the health assessment and monitoring program in Seattle–King County. The final round of presentations reviewed activities related to performance monitoring being conducted by several federal agencies and national organizations, including work on clinical performance measures and health plan reporting; the national health promotion and disease prevention objectives of Healthy People 2000; tools to help communities and local health departments assess health needs and set objectives for improvement; and proposals for linking federal block grants in specific health areas to state performance commitments. Several important points emerged from the presentations and discussion. It will be valuable to learn from the range of existing activities related to performance monitoring. Critical to communities' acceptance of performance monitoring is bringing together the various groups who have an interest in and can contribute to efforts to improve community health. Identifying shared interests that can promote collaboration in meeting health needs will be important. Throughout the workshop, consulting with the community was emphasized as an important means of learning about areas of concern, gaining a better understanding of the data collected, and building support within the community for the monitoring process. Public health agencies can often play a valuable role in initiating and sustaining community collaboration. To apply performance monitoring to community health issues, it is necessary to have population-based data at the community level. Working with a determinants-of-health framework helps demonstrate the need for information not only on clinical services but also on environmental health and other factors such as education and social services that have an impact on health. In the private sector, health plans are potentially valuable sources of information about portions of the community. Assembling data from a variety of sources avoids duplication of effort in data collection and provides the most complete picture possible. Some communities will need to expand their capacity for data collection and analysis. A significant issue for performance monitoring is the need for more and better data on the impact of many community health interventions on health status. Currently, there is only limited evidence on the effectiveness of many interventions. Schools of public health may be to able to make several

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Using Performance Monitoring to Improve Community Health: Exploring the Issues: Workshop Summary contributions to performance monitoring efforts by conducting research on the effectiveness of interventions, providing analytic training for public health practitioners, and serving as source of expert advice for communities. Any effort to propose a model for a performance monitoring system must take into account the social, political, economic, and organizational differences among states and communities, all of which influence capacity and willingness to address community health. An assessment of how well private sector health plans are serving their members and the community is seen by many as an appropriate element of the community monitoring process. Questions arise, however, about the extent to which health plans can and should be held accountable for the health status of all residents in the community. Another important issue is understanding how to achieve constructive change in communities. The differences across communities and among the participants and audiences within communities emphasize the need for the committee to discuss performance monitoring in a way that is understandable from many perspectives.