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Suggested Citation:"Contents." National Research Council. 1999. Measuring Health Performance in the Public Sector: A Summary of Two Reports. Washington, DC: The National Academies Press. doi: 10.17226/9603.
×

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

Suggested Citation:"Contents." National Research Council. 1999. Measuring Health Performance in the Public Sector: A Summary of Two Reports. Washington, DC: The National Academies Press. doi: 10.17226/9603.
×

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

Suggested Citation:"Contents." National Research Council. 1999. Measuring Health Performance in the Public Sector: A Summary of Two Reports. Washington, DC: The National Academies Press. doi: 10.17226/9603.
×

  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

Suggested Citation:"Contents." National Research Council. 1999. Measuring Health Performance in the Public Sector: A Summary of Two Reports. Washington, DC: The National Academies Press. doi: 10.17226/9603.
×

Appendices

A Potential Health Outcome and Risk Status Measures

163

B Workshop Agenda

168

C Biographical Sketches

170

Suggested Citation:"Contents." National Research Council. 1999. Measuring Health Performance in the Public Sector: A Summary of Two Reports. Washington, DC: The National Academies Press. doi: 10.17226/9603.
×
Page 35
Suggested Citation:"Contents." National Research Council. 1999. Measuring Health Performance in the Public Sector: A Summary of Two Reports. Washington, DC: The National Academies Press. doi: 10.17226/9603.
×
Page 36
Suggested Citation:"Contents." National Research Council. 1999. Measuring Health Performance in the Public Sector: A Summary of Two Reports. Washington, DC: The National Academies Press. doi: 10.17226/9603.
×
Page 37
Suggested Citation:"Contents." National Research Council. 1999. Measuring Health Performance in the Public Sector: A Summary of Two Reports. Washington, DC: The National Academies Press. doi: 10.17226/9603.
×
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The Panel on Performance Measures and Data for Public Health Performance Partnership Grants was established at the request of the U.S. Department of Health and Human Services (DHHS). Its charge is to examine the state of the art in performance measurement for public health and to recommend measures that could be used to monitor the Performance Partnership Grant agreements to be negotiated between each state and the federal government. The panel was asked to consider performance measures in ten areas, which are clearly a subset of the full range of traditional public health concerns: chronic diseases; sexually transmitted diseases (STDs), human immunodeficiency virus (HIV) infection, and tuberculosis; mental health; immunization; substance abuse; and three areas of prevention of special interest to DHHS-sexual assault, disabilities, and emergency medical services. This report focuses on measures that states and the federal government can use over the next 3 to 5 years to negotiate agreements and monitor performance in these areas. A later report will examine additional measures that might be developed from new research findings on program effectiveness or as improvements are made to state and federal surveys and data systems.

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