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Using Performance Monitoring to Improve Community Health: Exploring the Issues: Workshop Summary
TABLE 1 Ten Basic Practices in the Core Functions of Public Health
Assess the health needs of the community.
Investigate the occurrence of health effects and health hazards in the community.
Analyze the determinants of identified health needs.
Policy Development Practices
Advocate for public health, build constituencies, and identify resources in the community.
Set priorities among health needs.
Develop plans and policies to address priority health needs.
Manage resources and develop organizational structures.
Evaluate programs and provide quality assurance.
Inform and educate the public.
SOURCE: Adapted from Roper et al., 1992, and Turnock et al., 1994b.
of 10 practices have been linked to the core public health functions of assessment, policy development, and assurance (see Table 1).
Using sources such as APEXPH: Assessment Protocol for Excellence in Public Health (NACHO, 1991) and Healthy Communities 2000: Model Standards (American Public Health Association et al., 1991), the University of Illinois at Chicago project selected an initial set of public health practice indicators and sent them to a panel of local health officials for review. After revisions, the indicators were sent to a national sample of local health departments for comments on issues such as whether the indicators were important descriptors of local public health practice and whether proposed measures were appropriate. A more detailed study in five states looked at potential sources of data and factors that might affect access to data or willingness to share data.
The most recent step has been to develop and test a merged set of 20 indicators that bring together the results of the work at the University of Illinois at Chicago and the University of North Carolina. (See Table 2.) The indicators reflect standards for both performance and capacity to perform. For example, for assessment practices the selected indicators include whether there is a community health needs assessment process and whether adequate laboratory facilities are available to meet diagnostic and surveillance needs. For some purposes, broadly framed indicators might be broken into more specific components (e.g., does the needs assessment include morbidity information).