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Using Performance Monitoring to Improve Community Health: Exploring the Issues: Workshop Summary INTRODUCTION In recent years, performance monitoring has gained increasing attention as a tool for evaluating the delivery of personal health care services and for examining population-based activities addressing the health of the public. The attention to performance monitoring is linked to concerns about ensuring the most effective use of health care dollars in providing high quality care and achieving the best possible outcomes. Another factor has been the wider recognition that the health of the population depends on many services beyond medical care. Also important has been a heightened interest in accountability, fostered by various health care reform proposals and by the broader efforts to “reinvent government.” An interest in understanding how health care and public health activities might be coordinated and directed toward improving the health of entire communities is the basis of a study by the Institute of Medicine 's (IOM) Committee on Using Performance Monitoring to Improve Community Health. The study is being funded by the U.S. Department of Health and Human Services and by The Robert Wood Johnson Foundation. Study Plans The committee is considering the individual and interrelated roles that public health agencies, health care providers in the private sector, and other stakeholders play in influencing community-wide health and how the performance of those roles can be monitored in a systematic manner. It will also examine how a performance monitoring system can be used to foster collaboration among stakeholders and promote improvements in health status for all members of the community. Those stakeholders include various public agencies, employers and other purchasers of health services, insurers and other
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Using Performance Monitoring to Improve Community Health: Exploring the Issues: Workshop Summary payers, and a broad array of other groups in the community. A statement of the committee's vision for such a system appears in Appendix A. The committee intends to address an organizational and policy context for performance monitoring that unites the interests and authorities of local, state, and national entities in both the public and private sectors. The study will also explore ways in which a performance monitoring system can adapt to accommodate emerging health priorities. Presenting definitions of important concepts in performance monitoring will be essential to ensure that the committee's meaning is clear. 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. Selection of the health issues for which indicator sets will be developed will depend on factors such as the extent to which health improvements can be linked to specific interventions and whether relevant data are available. Each indicator set is expected to include a range of potential measures of and responses to the particular health problem. The committee will also examine the information infrastructure that will need to be developed to provide adequate support for performance monitoring efforts. It will be necessary to have the capability to monitor diverse phenomena in the various sectors that contribute to the health of populations, including clinical care, environmental services, individual and public education, community social services, and public policy promoting behavioral change, among others. As envisioned by the committee, the information infrastructure also would need to employ more sophisticated measurement strategies than those currently in use; provide information on the health status of a community, including threats to its future health; inform decisions about how to improve the health of the public; and document change in community health and in performance of health-related functions. The committee intends to consider both measurement issues that need further study and resources that communities may be able use to obtain needed technical capabilities. Questions that have emerged from the committee's deliberations and that will influence its future work are: Who needs to measure whose performance for whom? What are the uses of health-related performance monitoring activities for political processes, for analytic tools, or for community concerns beyond health? What might be unanticipated effects of performance monitoring activities? and What are performance monitoring's connections to processes of social change?
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