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Potential Health Outcome and Risk Status Measures The health outcome and risk status measures in this appendix are presented to illustrate the types of measures that might be included in performance partnership grants (PPGs) between state agencies and the U.S. Department of Health and Human Services (DHHS). These measures were selected from among the many proposed to the panel by participants at four regional meetings sponsored by DHHS, as well as by professional health associations and private agencies and individuals. The panel chose the measures using the guidelines described in Chapter 1 of this report: a measure should be specific and results oriented; it should be meaningful and understandable; data should be adequate to support the measure; and the measure should be as valid, reliable, and responsive as possible. These health outcome and risk status measures are not meant to represent a mandated list. Few states are likely to have all of the data necessary to support all of these measures. In addition, state agencies may well have major priorities beyond those represented by the categories of outcome measures listed here (e.g., injury prevention, oral health, hearing and vision, environmental health) and are responsible for administering major programs relevant to public health that are not covered by this report (e.g., Medicaid). In addition, the panel did not attempt to identify all of the measures that might be relevant for specific important subpopulations (i.e., groups defined by demographic or risk categories). Consequently, the health outcome and risk status measures shown below should be considered an important subset, but not an exhaustive listing, of those that will be of interest to state agencies. A major goal of this report is to provide an analytic framework for use by the
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states and DHHS in assessing the appropriateness of specific outcome, process, and capacity measures proposed for PPG agreements in the future. The panel hopes that the field of performance measure evaluation will evolve as new health outcome measures are defined and studied and become available. It is anticipated that many of the measures described in this report can, in time, be modified or replaced by others that meet the selection guidelines cited above. Potential Measures: Overview Chronic Disease Tobacco Percentage of (a) persons aged 18-24 and (b) persons aged 25 and older currently smoking tobacco Percentage of persons aged 14–17 (grades 9–12) currently smoking tobacco Percentage of women who gave birth in the past year and reported smoking tobacco during pregnancy Percentage of employed adults whose workplace has an official policy that bans smoking Nutrition Percentage of persons aged 18 and older who eat five or more servings of fruits and vegetables per day1 Percentage of persons aged 14–17 (grades 9–12) who eat five or more servings of fruits and vegetables per day2 Percentage of persons aged 18 and older who are 20 percent or more above optimal body mass index3 Exercise Percentage of persons aged 18 and older who do not engage in physical activity or exercise Percentage of persons aged 14–17 (grades 9–12) who do not engage in physical activity or exercise 1 The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel. 2 See fn. 1. 3 See fn. 1.
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Screenings and Tests Percentage of persons aged 18 and older who had their blood pressure checked within the past 2 years4 Percentage of women aged 45 and older and men aged 35 and older who had their cholesterol checked within the past 5 years5 Percentage of women aged 50 and older who received a mammogram within the past 2 years6 Percentage of adults aged 50 and older who had a fecal occult blood test within the past 12 months or a flexible sigmoidoscopy within the past 5 years7 Percentage of women aged 18 and older who received a Pap smear within the past 3 years8 Percentage of persons with diabetes who had HbA1C checked within the past 12 months9 Percentage of persons with diabetes who had a health professional examine their feet at least once within the past 12 months10 Percentage of persons with diabetes who received a dilated eye exam within the past 12 months11 STDs, HIV Infection, and Tuberculosis Incidence rates of selected STDs Incidence rates of HIV infection Prevalence rates of selected STDs Prevalence rates of HIV infection Consumer satisfaction with STD, HIV, and tuberculosis treatment programs Rates of sexual activity among adolescents aged 14–17 Rates of sexual activity with multiple sex partners among people aged 18 and older Rates of condom use during last episode of sexual intercourse among sexually active adolescents aged 14–17 Rates of condom use during last episode of sexual intercourse by persons aged 18 and older with multiple sex partners 4 See fn. 1. 5 See fn. 1. 6 Cancer incidence by diagnosed stage may be a better alternative in cancer registry areas; see fn. 1. 7 See fns. 1 and 6. 8 See fns. 1 and 6. 9 See fn. 1. 10 See fn. 1. 11 See fn. 1.
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Rates of condom use during last episode of sexual intercourse among men having sex with men Rates of injection drug use among adolescents and adults Completion rates of treatment for STDs, HIV infection, and tuberculosis Mental Health Percentage of persons aged 18 and older receiving mental health services who experience reduced psychological distress Percentage of persons aged 18 and older receiving mental health services who experience increased level of functioning Percentage of persons aged 18 and older receiving mental health services who report increased employment (including volunteer time) Percentage of persons aged 18 and older with serious and persistent mental illness receiving mental health services who live in integrated, independent living situations or with family members Percentage of children aged 17 and younger with serious emotional disorders receiving mental health services who live in noncustodial living situations Percentage of persons aged 18 and older with serious mental illness who are in prisons and jails Percentage of children aged 17 and younger with serious emotional disorders who are in juvenile justice facilities Percentage of homeless persons aged 18 and older who have a serious mental illness Percentage of adolescents aged 14–17 or family members of children and adolescents or both who are satisfied with: (a) access to services, (b) appropriateness of services, and (c) perceptions of gain in personal outcomes Percentage of persons (aged 18 and older) or their family members or both who are satisfied with: (a) access to mental health services, (b) appropriateness of services, and (c) perceptions of gain in personal outcomes Immunization Reported incidence rate of representative vaccine-preventable diseases Age-appropriate vaccination rates for target age groups (children aged 2 years; children entering school at approximately 5 years of age; and adults aged 65 and older) for each major vaccine group Substance Abuse Death rate of persons aged 15–65 attributed to (a) alcohol, (b) other drug use, and (c) combined agents Percentage of emergency room encounters for alcohol or other drug-related causes
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Prevalence rate of substance abuse clients who report experiencing diminished severity of problems after completing treatment as measured by the Addiction Severity Index (ASI) or a similar measure12 Ratio of substance abuse clients involved with the criminal justice system before and after completing treatment Prevalence rate of adolescents aged 14–17 engaged in heavy drinking or other drug use13 Prevalence rate of persons aged 18 and older engaged in heavy drinking or other drug use14 Percentage of women who gave birth in the past year and reported using alcohol or other drugs during pregnancy Mean age at first use of ''gateway'' drugs (tobacco, marijuana, alcohol) Percentage of adolescents aged 14–17 stating disapproval of marijuana use Percentage of adolescents aged 14–17 who report parents or guardians who communicate non-use expectations Percentage of drug abuse clients who engage in risk behaviors related to HIV/AIDS after completing treatment plan Sexual Assault Prevention Incidence rate of sexual assault reported by females Disabilities Percentage of newborns with neural tube defects Percentage of persons aged 18–65 with disabilities who are in the workforce Percentage of children aged 6 or younger with blood lead greater that 10 micrograms per deciliter15 Percentage of women who gave birth in the past year and reported using alcohol, tobacco, or other drugs during pregnancy Emergency Medical Services Percentage of persons who suffer out-of-hospital cardiac arrest who survive 12 Although the estimated incidence rate would be a more appropriate measure for monitoring progress by the state substance abuse agencies, the currently available data source for this measure provides prevalence data. 13 See fn. 12. 14 See fn. 12. 15 See fn. 1.
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