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Using Performance Monitoring to Improve Community Health: Exploring the Issues: Workshop Summary
The PPG should combine the benefits of specificity and accountability in categorical grant programs with the flexibility of block grants, and avoid some of the problems in each of those funding mechanisms. The program will preserve funding specifically for surveillance and evaluation. It can also encourage states to integrate data systems that may originally have developed for specific categorical programs.
For each funding area, the proposal calls for states to reach an agreement with DHHS on specific targets for improvement and the degree of improvement sought. The mix of objectives and targets will vary among states. For each funding area, a menu of health status objectives from which states can choose will be developed in a collaborative effort organized by DHHS. Possible objectives will be identified through regional meetings and work with national associations representing state and local health agencies with responsibilities in the areas to be covered by the PPGs. A National Research Council panel will review technical measurement issues and areas where data system improvements may be needed.
Several factors will be considered in selecting PPG objectives: links to Healthy People 2000 (USDHHS, 1991); issues that are important and understandable to policymakers and the public; aspects of health status on which states can be expected to have an impact and for which change can be measured during the grant period; a focus on results with measures for outcomes and for processes and capacities with clear links to outcomes; clearly specified measures; and the timely availability of sound and comparable data to all grantees at reasonable cost. The menu of PPG objectives is expected to change as the capabilities of data systems improve.
National information infrastructure Another important activity (see Lasker et al., 1995) is bringing public health interests into the National Information Infrastructure (NII) initiative, which is promoting the enhancement of the nation 's computing and telecommunications infrastructure. Public health professionals are bringing to these discussions a familiarity with and interest in data issues that has not always been found in work with the health care community. Through its participation in the NII initiative, the public health community is gaining knowledge of and access to computing resources that often are not available to public agencies. Trying to bring a broad range of interests together around the NII may help identify common needs and more cost-effective solutions than could be achieved individually.
Information on the public health infrastructure The lack of, and need for, comprehensive information on the nation 's public health infrastructure became clear during the development of health care reform proposals in 1993 and 1994. DHHS is funding a project to assemble a database on public health resources at the national, state, and local levels (e.g., organization, services provided,