Health Performance Measurement in the Public Sector Principles and Policies for Implementing an Information Network (1999) / Chapter Skim
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1 Introduction
1 Introduction
Pages 15-29
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From page 15... ...
A system of performance measurement promises improved documentation of the contributions of public and private agencies, and can serve as a quality improvement tool by drawing attention to practices shown to contribute to desired outcomes and by identifying areas needing improvement. In fact, many people who are well informed about public health, health policy, health economics, and related matters believe that we cannot expect public funding to increase or even be maintained at current levels without better documentation of the return on program investments.
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From page 16... ...
Performance Partnership Grants States receive DHHS grant funds in support of various health programs. Seeking a way to increase state flexibility in the use of these funds while enhancing accountability for progress toward program goals, DHHS proposed that formal legislative changes be made for some of these grant programs to mandate the implementation of PPG arrangements between states and the federal government.
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From page 17... ...
Nevertheless, the idea of performance partnerships based on negotiated federal-state agreements regarding program objectives and measures remains viable and is being implemented for certain grant programs (e.g., the Maternal and Child Health Block Grant; see Maternal and Child Health Bureau, 1997~. Other Influences Perhaps the most direct antecedent to the PPG proposal is the Government Performance and Results Act (GPRA)
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(See Appendix A for a list of the health outcome and risk status measures proposed in the panel's first report.) Related process and capacity measures were also suggested.
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Even with such studies, the panel cautions against using performance measures as the sole basis for causal inferences regarding program performance because of the diversity of factors beyond program activities that affect most health outcomes. See Chapter 2 for additional discussion of the characteristics and uses of performance measurement.
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From page 20... ...
With GPRA, for example, the Congress has created a requirement that the executive branch agencies develop performance plans with appropriate performance measures. Under the kinds of performance partnership agreements represented by the PPG proposal, however, states incur an obligation to report on performance by accepting federal grant funding, but they are recognized as partners with whom some of the terms of an agreement are negotiated rather than dictated.
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From page 21... ...
For example, a state with a goal of reducing its mortality rate from breast cancer could seek to reduce the risk of death by increasing the number of mammograms provided to women aged 50 and over. The mammography rate could then be used as a risk status measure.
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From page 22... ...
Recognizing that data resources and measurement methods need improvement, the panel recommended in its first report that DHHS continue to work with states and local areas toward several infrastructure goals: developing common definitions and measurement methods; encouraging efficient development of data resources that would support multiple public health, mental health, and substance abuse needs; incorporating state and local data priorities in national infrastructure development efforts; and promoting state and local data collection and analytic capabilities. These issues are addressed more thoroughly in the present report.
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From page 23... ...
that are smoke free (have limited smoking to separately ventilated areas) Proportion of elementary, junior high, and high schools with age-appropriate smoking prevention activities and comprehensive curricula Proportion of current tobacco smokers visiting a health care provider during the past 12 months who received advice to quit Proportion of managed care organizations (or schools or obstetric and gynecological service providers)
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From page 24... ...
A second important limitation on the sole use of outcome measures to monitor program effectiveness, noted earlier, is the impractical delay involved in observing certain outcomes of interest, such as the length of time required for many cancers to become detectable. A third limitation is the rarity of some important outcomes, such as major outbreaks of food- or water-borne illness.
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From page 25... ...
For example, the federal mental health block grant represents only about 4 percent of state mental health agency budgets, with state general revenues, private insurance, Medicaid, and local sources making up the balance. Because those federal funds do not buy specific services, it appears unlikely that a change in any statewide measure of mental health outcomes could be attributed unequivocally to a mental health block grant.
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From page 26... ...
The panel therefore recommended viewing the use of performance measures to assess the effectiveness of public health, substance abuse, and mental health programs as an ongoing, long-term public administration effort that requires a strong commitment by the federal government to providing technical assistance and infrastructure support to its partners at the state and local levels. Inadvisability of Using Performance Measures Alone for Resource Allocation Purposes Although there is considerable value in using performance measurement to enhance the effectiveness and accountability of publicly funded programs, the development and use of performance measures, particularly for comparisons across states, is not yet and may never be a precise scientific process.
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From page 27... ...
Rather than pursue a strictly technical assessment of program-specific measures, data collection methods, or analytic techniques, the panel judged it important to put performance measurement in a broader data context and to emphasize the commonalities across programs, while still taking note of some special concerns in specific program areas. The study's second phase continued to focus largely on the public sector, but the panel looked beyond the federal-state relationship that defined the PPG proposal to consider a more general notion of performance partnership agreements that can encompass state and local interests as well.
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From page 28... ...
A specialized data system for performance measurement is generally not an efficient or cost-effective goal. Because health needs, program priorities, and resources differ throughout the country and change over time, an information network useful for performance measurement must be adaptable to these differences and changes.
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From page 29... ...
Chapter 4 explores factors in the current data and information system environment that must be addressed to advance the use of performance measurement. In Chapter 5, the panel outlines its vision of a national health information network that would effectively support performance measurement as well as other objectives, and makes recommendations to further the development and implementation of such a network.
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