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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