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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.
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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.
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Copyright 1999 by the National Academy of Sciences. All rights reserved.
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
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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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. |
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
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
