Contents

Preface

ix

Executive Summary

1

1 Introduction

15

  Origins of the Study

16

    Performance Partnership Grants

16

    Other Influences

17

  Charge to the Panel

18

  Essential Definitions

19

    Performance Measurement and Related Concepts

19

    Categories of Performance Measures

20

  Phase I: Focus on Selection of Performance Measures

22

    Use of Measures of Process and Capacity as Well as Outcomes

22

    Guidelines for Selecting Performance Measures

24

    Limitations of a Program-Specific Approach to Performance Measurement

25

    Need to Strengthen State and Local Capacity for Data Collection and Analysis

26

    Inadvisability of Using Performance Measures Alone for Resource Allocation Purposes

26

  Phase II: Data and Information System Development to Support Performance Measurement

27

    A Vision for a National Health Information Network

27

    Critical Issues

28

  Structure of the Report

29

  References

29



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OCR for page 35
Contents Preface ix Executive Summary 1 1 Introduction 15   Origins of the Study 16     Performance Partnership Grants 16     Other Influences 17   Charge to the Panel 18   Essential Definitions 19     Performance Measurement and Related Concepts 19     Categories of Performance Measures 20   Phase I: Focus on Selection of Performance Measures 22     Use of Measures of Process and Capacity as Well as Outcomes 22     Guidelines for Selecting Performance Measures 24     Limitations of a Program-Specific Approach to Performance Measurement 25     Need to Strengthen State and Local Capacity for Data Collection and Analysis 26     Inadvisability of Using Performance Measures Alone for Resource Allocation Purposes 26   Phase II: Data and Information System Development to Support Performance Measurement 27     A Vision for a National Health Information Network 27     Critical Issues 28   Structure of the Report 29   References 29

OCR for page 35
2 Putting Performance Measurement in Context 30   Use of Performance Measurement in Accountability Systems 30     Performance-Based Accountability Systems 31     Operation of Performance-Based Systems 33     Applications of Performance Measurement 37   Examples of Performance Monitoring and Accountability Systems 40     Government Performance and Results Act 41     Use of Performance Measures in the Maternal and Child Health Services Block Grant Program 42     Reporting Requirements for the Temporary Assistance for Needy Families Program 44     State Developments in Performance-Based Budgeting 45     Health Care Performance Measurement in the Private Sector 48   Conclusions 52   References 55 3 Performance Measurement Considerations for Publicly funded Health Programs 59   Broad Array of Health-Related Services and Service Relationships 60   Measurement Considerations for Population-Based Health Services 61     Population Health Services 61     Monitoring Population Health Services 62     Monitoring the Infrastructure for Publicly Funded Health Programs 64   Some Performance Measurement Considerations Related to Program-Specific Matters 66     Environmental Health Programs 66     Mental Health Programs 68     Substance Abuse Programs 71   Process Guidelines as a Basis for Performance Measurement 74     Guidelines for Personal Health Services 75     Guidelines for Population-Based Health Services 76     Research Needs for Practice Guidelines and Performance Measurement 76   Conclusions 78   References 79 4 Data and Information Systems: Issues for Performance Measurement 83   Health Data Resources 84     Registries 85     Surveys 86     Patient Records and Related Clinical Encounter Data 87     Administrative Data 89     Claims Data 90     Linkage of Data Sets 91     Steps Toward Integration of Data Sets 93

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  Assuring the Quality of Data and Data Analysis 95     Random Variation and Bias 96     Data Management 97     Challenges in Data Analysis 98   Developing and Implementing Standards for Data and Data Systems 103     Standardization Activities 103     Balancing Standardization and Change 108   Enhancing Performance Measurement through Advances in Information Technology 109     Data Collection and Transmission Technologies 109     Data Management and Analysis 110     Computer-Based Patient Records 111     The Internet and the World Wide Web 111     Limits of Technology 114   Privacy, Confidentiality, and Security of Health Data 114   Investing in Health Data and Data Systems 116     Data and Information Systems 117     Technology 119     Training and Technical Assistance 120   Taking a Collaborative Approach to the Development of Health Data and Information Systems 122     Meeting the Needs of Many Data Users 123     Collaboration in the Design and Implementation of Data Systems 125   Conclusions 126   References 127 5 Strategies for Supporting Performance Measurement through a National Information Network 132   Conclusions Regarding Performance Partnership Agreements 133   A National Information Network for Health-Related Data 134   Essential Features of a Health Information Network to Serve Different Levels of Decision Making 135   Major Policy Actions Needed 138     National Collaboration 138     Integration of Data Systems 143     Technology Policy 144   Operational Principles 145     Involve a Broad Range of Public Agencies 145     Build on Existing Information Systems 146     Implementation Standards 147   Required Investment for an Information Network 152     Data Systems 152     Training and Technical Assistance 154   A National Research Agenda 156   Final Observations 157   References 158

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Appendices A Potential Health Outcome and Risk Status Measures 163 B Workshop Agenda 168 C Biographical Sketches 170