Measuring Health Performance in the Public Sector

A Summary of Two Reports

Panel on Performance Measures and Data for Public Health Performance Partnership Grants

Committee on National Statistics

Commission on Behavioral and Social Sciences and Education

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.



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Measuring Health Performance in the Public Sector A Summary of Two Reports Panel on Performance Measures and Data for Public Health Performance Partnership Grants Committee on National Statistics Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C.

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NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council. The study was supported by Contract No. 282-95-0034 between the National Academy of Sciences and the U.S. Department of Health and Human Services. Support of the work of the Committee on National Statistics is provided by a consortium of federal agencies through a grant from the National Science Foundation (No. SBR-9709489). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-06583-6 Additional copies of this summary are available from National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area). This report is also available on line at http://www.nap.edu Printed in the United States of America Copyright 1999 by the National Academy of Sciences. All rights reserved.

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PANEL ON PERFORMANCE MEASURES AND DATA FOR PUBLIC HEALTH PERFORMANCE PARTNERSHIP GRANTS EDWARD B. PERRIN (Chair), Department of Health Services, School of Public Health and Community Medicine, University of Washington JOHN C. BAILAR, III, Department of Health Studies, University of Chicago THOMAS J. BARRETT, Mental Health Services, Colorado Department of Human Services DAVID W. FLEMING, Center for Disease Prevention and Epidemiology, Oregon Health Division V. JOSEPH HOTZ, Departments of Economics and Policy Studies, University of California, Los Angeles IRA R. KAUFMAN, University of Medicine and Dentistry of New Jersey, Department of Environmental and Community Medicine, Robert Wood Johnson Medical School JOHN R. LUMPKIN, Illinois Department of Public Health WILLIAM A. MORRILL, Mathtech, Inc., Princeton, New Jersey R. HEATHER PALMER, Center for Quality of Care Research and Education, Harvard School of Public Health J. SANFORD SCHWARTZ, School of Medicine and the Wharton School, University of Pennsylvania MARY E. STUART, Maryland Collaboratory for Business and Health, Department of Sociology and Anthropology, University of Maryland, Baltimore County CYNTHIA P. TURNURE, Minnesota Department of Health PAUL J. WIESNER, DeKalb County Board of Health, Decatur, Georgia GAIL R. WILENSKY, Project Hope, Bethesda, Maryland JANE S. DURCH, Study Director JEFFREY J. KOSHEL, Study Director (through December 1997) SUSAN M. SKILLMAN, Senior Research Associate TELISSIA M. THOMPSON, Senior Project Assistant

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COMMITTEE ON NATIONAL STATISTICS 1998–1999 JOHN E. ROLPH (Chair), Department of Information and Operations Management, University of Southern California JOSEPH G. ALTONJI, Department of Economics, Northwestern University JULIE DaVANZO, RAND, Santa Monica, California WILLIAM F. EDDY, Department of Statistics, Carnegie Mellon University WILLIAM KALSBEEK, Department of Biostatistics, University of North Carolina RODERICK J.A. LITTLE, School of Public Health, University of Michigan THOMAS A. LOUIS, School of Public Health, University of Minnesota CHARLES F. MANSKI, Department of Economics, Northwestern University WILLIAM NORDHAUS, Department of Economics, Yale University JANET L. NORWOOD, Urban Institute, Washington, D.C. EDWARD B. PERRIN, Department of Health Services, School of Public Health and Community Medicine, University of Washington PAUL R. ROSENBAUM, Department of Statistics, Wharton School, University of Pennsylvania FRANCISCO J. SAMANIEGO, Division of Statistics, University of California, Davis RICHARD L. SCHMALENSEE, Sloan School of Management, Massachusetts Institute of Technology ANDREW A. WHITE, Acting Director

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CONTENTS     Preface   vii     From Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health         Executive Summary   1     Introduction and Framework (from Chapter 1)   5     Contents   11     From Health Performance Measurement in the Public Sector: Principles and Policies for Implementing an Information Network         Executive Summary   15     Potential Health Outcome and Risk Status Measures (Appendix A)   29     Contents   35

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Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. E.B. Perrin and J.J. Koshel, eds. Panel on Performance Measures and Data for Public Health Performance Partnership Grants, Committee on National Statistics, National Research Council. Washington, D.C.: National Academy Press (1997). Health Performance Measurement in the Public Sector: Principles and Policies for Implementing an Information Network. E.B. Perrin, J.S. Durch, and S.M. Skillman, eds. Panel on Performance Measures and Data for Public Health Performance Partnership Grants, Committee on National Statistics, National Research Council. Washington, D.C.: National Academy Press (1999). Copies of both reports are available from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan areas). These reports are also available on line at http://www.nap.edu.

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PREFACE This document brings together summary materials from two reports prepared by the Panel on Performance Measures and Data for Public Health Performance Partnership Grants of the Committee on National Statistics. The panel was originally created to examine and report on the technical issues involved in establishing performance measures in ten substantive program areas. Such measures were to be required as part of a proposed Performance Partnership Grants (PPG) Program, under which each state was to negotiate with the U.S. Department of Health and Human Services (DHHS) an action plan with performance objectives that would be specific in terms of outcomes, processes, and capacity to be achieved within a 3-to 5-year period. Although formal legislation mandating PPGs was not adopted, various DHHS programs and a growing number of states and communities are moving to monitor and analyze health outcomes on their own. Moreover, there appears to be a growing consensus in the public sector about the value of performance measurement. Indeed, many people believe that the case for increasing, or even maintaining, public funding for health programs will depend on documented program performance. The panel's first report, Assessment of Performance Measures for Public Health, Substance Abuse and Mental Health (National Academy Press, Washington, D.C., 1997), provides an analytic framework for use by states and the federal government in assessing the appropriateness of outcome, process, and capacity measures for use in federal-state performance agreements. It also examines the technical issues involved in the development of performance measures in specific program areas and reviews the advantages and limitations of potential measures

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and data sources that can support them. The report includes examples of potential outcome performance measures in the areas of chronic diseases, sexually transmitted diseases, HIV infection, tuberculosis, immunization, mental health, substance abuse, sexual assault, disabilities, and emergency medical services. The second report, Health Performance Measurement in the Public Sector: Principles and Policies for Implementing an Information Network (National Academy Press, Washington, D.C., 1999) turns to data and information system issues at the federal, state, and local levels, and proposes building on existing health data and information resources to develop a broad national health information network that can support performance measurement, as well as other health information needs. The panel's recommendations address the policy framework for selecting performance measures and using performance measurement, operational principles related to data and data systems that support performance measurement, essential investments in data systems and in training and technical assistance, and research needed to improve performance measures and performance measurement. With this summary of the two reports, the panel hopes to acquaint a larger audience with a set of scientific, policy, and operational issues that must be addressed if performance measurement is to be used effectively across a variety of health programs, and with the panel's conclusions and recommendations. The materials included in the summary have been selected to provide readers with an overview of the reports' essential points. Readers are encouraged to consult the full reports for a more extensive discussion of these matters. Those interested in the performance measurement issues addressed by the Panel on Performance Measures and Data for Public Health Performance Partnership Grants should also note the availability of related reports from other National Academy of Sciences studies. Improving Health in the Community: A Role for Performance Monitoring (National Academy Press, Washington, D.C., 1997), from the Institute of Medicine, explores the use of performance measurement and the development of performance indicators for community-level health improvement activities. Managing Managed Care: Quality Improvement in Behavioral Health (National Academy Press, Washington, D.C., 1997), also from the Institute of Medicine, presents a framework for developing, using, and evaluating performance indicators for managed behavioral health care. Evaluating Federal Research Programs: Research and the Government Performance and Results Act (National Academy Press, Washington, D.C., 1999), produced by the Committee on Science, Engineering, and Public Policy, addresses the challenges of applying performance measurement requirements to federal research programs. EDWARD B. PERRIN, CHAIR PANEL ON PERFORMANCE MEASURES AND DATA FOR PUBLIC HEALTH PERFORMANCE PARTNERSHIP GRANTS

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ASSESSMENT OF PERFORMANCE MEASURES FOR PUBLIC HEALTH, SUBSTANCE ABUSE, AND MENTAL HEALTH

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