Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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6 Conclusions and Recommendations
6 Conclusions and Recommendations
Pages 166-180
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From page 166... ...
The community health improvement process (CHIP) described in this report offers one approach for a community to address this collective responsibility and to marshal resources of specific, accountable entities to improve the health of its members.
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From page 167... ...
Based on its review of the determinants of health, of the forces in the community that can influence them, and of community experience with performance monitoring, the committee finds that a community health improvement process that includes performance monitoring, as outlined in this report, can be an effective tool for developing a shared vision and supporting a planned and integrated approach to improve community health. The committee's recommendations for operationalizing a CHIP are based on a variety of theoretical and practical models for community health improvement, continuous quality improvement, quality assurance, and performance monitoring in health care, public health, and other settings.
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168 IMPROVING HEALTH IN THE COMMUNITY Form Community Prepare and Analyze Health Coalition Community Health Profiles Problem Identification and Prioritization Cycle Identify Critical Health Issues Health Issue Health Issue Health Issue Analyze Health Issue Monitor Process Inventory Resources and Outcomes Analysis and Implementation Implement Cycle Develop Health Strategy Improvement Strategy Develop Identify Indicator Set Accountability FIGURE 6-1 The community health improvement process (CHIP)
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Given the different perspectives and activities of personal health service, public health, and other organizations that can contribute to the health of communities and given differing views of the meaning of "health" in the community context, the committee recommends that • communities should base a health improvement process on a broad definition of health and a comprehensive conceptual model of how health is produced within the community. In the committee's view, the field model, as elaborated by Evans and Stoddart (1994)
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To encourage full participation in the health improvement process, the selected performance measures should be balanced across the interests and contributions of the various accountable entities in the community, including those whose primary mission is not health specific. Selecting indicators also requires careful consideration of how to gain insight into progress achieved in the health improvement process.
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The proposed health improvement process and performance monitoring activities will require that communities have a sustainable organization or system that represents all major stakeholders and accountable entities. Thus, the committee recommends that • community coalitions guiding CHIPs should strive for strategic inclusiveness, incorporating individuals, groups, and organizations that have an interest in health outcomes, can take actions necessary to improve community health, or can contribute data and analytic capabilities needed for performance monitoring.
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Strategies for improving the effectiveness of community coalitions for health improvement are discussed in Chapter 3. ENABLING POLICY AND RESOURCES Federal, state, and local public health agencies and boards of health are all stakeholders in a community's health and capable of taking action to improve it.
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For the CHIP to be effective, communities need certain resources, especially data for community health profiles and performance measures. Since all parties share in the goal of improving community health, it is reasonable that public and private resources be combined to support the data collection and analysis needed for communities to obtain health profile information, to conduct health status assessments and communicate results, and to sustain performance monitoring programs.
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can assist communities by facilitating access to relevant data held by the private sector. In particular, the committee recommends that • states and the federal government, through health departments or other appropriate channels, should require that health plans, indemnity insurers, and other private entities report standard data on the characteristics and health status of their enrolled populations, on services provided, and on outcomes of those services, as necessary for performance monitoring in the community health improvement process.
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The overall community health improvement process, its performance monitoring component, and the indicator sets should be tested and improved over time. Thus, the committee recommends that • the CHIP concept developed in this report should be implemented in a variety of communities across the country, and these efforts should be carefully documented and independently assessed.
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The goals of these "natural experiments" would be to learn how local circumstances, including opportunities and barriers experienced, affect the way the CHIP is adapted by different communities; to identify the "necessary and desirable conditions" for implementation of the CHIP; and to assess whether or not the CHIP indeed results in a refocusing of attention on root causes of health problems and, ultimately, in important improvements in community health. The current evaluations of community health interventions ought to inform this field through their findings on specific interventions to address health problems, on the community intervention process itself, and on the analytic techniques to apply to community studies.
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Thus, the committee recommends that • the Public Health Service, in conjunction with state and local health agencies, national professional organizations, and foundations, should develop workbooks, seminars, and other forms of technical assistance to catalog and convey to communities information on best CHIP practices, specific model performance measures for a variety of health issues and ways to interpret changes in these measures, and available data resources. Universities can, in a variety of activities and through a variety of disciplines, play an important role in helping communities implement a CHIP and in developing and sharing technical expertise.
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These programs should introduce the concept of CHIP as a way of thinking about the application of a group of academic disciplines (epidemiology, biostatistics, environmental health, health behavior, and so on) to the practice of community health improvement.
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1993. Activating Communities for Health Promotion: A Process Evaluation Method.
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