measures of interest for community health assessment (e.g., prevalence of smoking). Meeting the needs of health plans and employers will, however, remain HEDIS's principal role. NCQA questions what contribution health plans and HEDIS should be expected to make toward collecting data on community health and where responsibility should lie for paying costs health plans would incur in collecting the data.

A specific suggestion offered to the committee was to focus on performance measures for public agencies and institutions. The group was urged not to try to duplicate the work already being done in the private sector.

Joint Commission on Accreditation of Healthcare Organizations21

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) assesses the qualifications and performance of hospitals and numerous other types of health care facilities. Performance indicators are not considered sufficient by themselves since they can provide only an after-the-fact report. Standards for organization and operation, which are set with the expectation that they increase the likelihood of good outcomes, are also considered essential.

Among the Joint Commission activities related to the committee's work is the development of preventive services standards, which extends the scope of the continuum of care beyond JCAHO's traditional focus on diagnosis and treatment. Primary, secondary, and tertiary prevention services are all within the scope of the new standards. Work is beginning with health care networks, but JCAHO expects to extend these standards to other kinds of health care organizations over time.

The standards for these services call for health networks to provide preventive services that are appropriate for their mission, that are considered efficacious, that are appropriate to the needs of the population they serve, and that are provided in an effective manner. If prevention is seen as an appropriate network service, a network will be expected to define the role it plays in delivering that service in the community. It will also be expected to conduct a needs assessment in the community to determine what services should be provided. The importance of working with public health agencies and other community resources, including other health care organizations, will be emphasized. As this process moves forward various issues of accountability will need to be resolved. In a “capacity-building ” effort, JCAHO will be holding workshops in conjunction with the American Hospital Association and CDC to better inform hospitals and other clinically focused health care organizations about issues such as health promotion and preventive services,


This section is based on a presentation by Margaret VanAmringe.

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