Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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INDEX 463 Index Academic health centers, 384 Adolescents Access to health care births to, 161 barriers, 43, 61, 331 interventions for, 54, 425-426, 433 community health profile smoking/tobacco use, 53, 141, 143, indicators, 159, 161-162 300-307, 309 interventions to improve, 430, 434 violence, 345-350, 353, 377 performance indicators, 362 Advisory Committee on Immunization uninsured persons, 159 Practices, 279, 294, 437 Accountability Agency for Health Care Policy and accreditation and, 81 Research, 394 approaches to, 5, 10, 64-66, 75, 99- Aid to Families with Dependent 100 Children, 285, 292 community role, 64-66 AIDS, 160-161 concerns about, 62-64 Air quality, 138, 163 establishing, 10, 65-66, 99-100, 437 Alberta, Canada, 440-442 market forces and, 99, 437 Alcohol and drug control programs, performance monitoring and, 5, 10, 46, 47, 431-432 29, 30, 86, 100, 146, 185-186, Ambulatory care sensitive conditions, 378 266, 271, 362 private-sector role, 64-65, 83, 379 American Academy of Family public-sector requirements, 64, 99- Physicians, 246 100, 397 American Academy of Pediatrics, 246, reporting requirements, 64 289 social change and, 439-442 American Association of Retired stakeholder, 3, 25, 42, 146, 437-438 Persons, 237 state role, 64, 81 American Cancer Society, 196 written agreements, 437 American Hospital Association, 71-72, Accreditation, 81, 89, 109, 397 269, 271 Accountable entities. See American Managed Behavioral Stakeholders Healthcare Association, 27, 86 463
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29, 81, 86, 101, 138, 147, 175, analysis of health issues and 375, 393 resources, 95-97 Blueprint for a Healthy Community, approach, 84 108, 111, 397 capacity assessment, 113 Breast and cervical cancer, prototype environmental health addendum, performance indicators 387 behavior, 194-195, 203 performance monitoring community health profile applications, 28, 142, 380, 381, indicators, 160 387, 406-407, 437 data sources, 202-204 priority-setting with, 93 disease, 191-193, 202-203 users, 85, 98, 381, 396, 428-429 genetic endowment, 194-195, 203 workbook, 396-397, 406-407 health care and, 191-193, 202-203 Assurance overview, 189-191 definition, 109, 418 n.3 sample indicator set, 196-200, 202 function of public health 204 departments, 44, 89, 99-100, social environment, 195-196, 204 109
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From page 465... ...
. See also abuse and neglect, 161, 283, 349- Community health profile; 351 Interventions to improve health; community health profile indicators, Performance monitoring 158, 159-160, 161-162 accountability approaches, 5, 10, data sources on, 136-137 99-100 family structure and, 50, 421 administrative skills and resources, immunization, 80, 95, 96, 97, 116, 112 161-162, 324-325, 385, 425, analysis and implementation cycle, 430, 433-434, 437 5-11, 30-31, 32, 78-79, 95-103, lead poisoning, 242-244 140-141, 167-168, 183 monitoring, 85 analysis of health issues, 8, 95-96 socioeconomic status and, 158, 425 assessment of, 5, 17-18, 103-106, Civic Index, 96-97 117-118, 175-176 Civic infrastructure, 109, 113 authority to act, 111 Clinic Assessment Software capacity building for, 106, 108-117 Application (CASA)
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From page 466... ...
466 INDEX evolutionary nature of, 5, 30, 80-81 Community health profile indicators expertise and skills, 96, 111-112, access to health care, 127, 157, 153 161-162 federal role, 18-19, 81-82, 115, and CDC consensus indicators, 139, 172-173, 174, 176-177 130-131, 137, 138, 158, 159 field model and, 11-12, 78, 86-87, 161, 221 96, 116-117, 141-142, 166-167, for children, 158-159, 161-162 169 communicable diseases, 160-161, funding, 81, 85, 96-97, 102, 112 162 implementation resources, 90, 112 data sources, 127, 131-137 information systems, 112 death rates, by leading causes, 160 leadership, 80, 87-89, 110-111 demographic composition of learning from, 103-106 population, 156-157 motivation for participation, 36, 62, economic prosperity, 158-159 83, 128, 385 education, 157, 158 operationalizing, 167-172 environmental quality, 163 origins, 81-86 family structure, 159 performance indicator development, field model domains, 131-134, 138, 100-101, 169-170 156-165 performance monitoring, 102-104, functional status, 9, 130, 134, 164 167 health resource use, 9, 127, 130, priority-setting, 93-95, 102, 111, 134, 164 391 health risk factors, 9, 126-127, private-sector role, 83, 87, 89, 103, 130, 133, 161-163 173-174, 379, 384-386 health status, 8, 73, 85, 126, 127, problem identification and 129, 133, 159-161, 164 prioritization cycle, 5-7, 30-31, immunization, 127, 161-162 78-79, 87-95, 126, 140, 167- infant mortality, 159-160 168, 183 obesity, 163 professional training, 116-117, 177- as performance indicators, 128 178 129, 221 public health sector roles, 80, 84- quality of life, 9, 127, 130, 131, 85, 89, 91, 108-109, 173-174 134, 135, 165 resources for, 9, 35-36, 96-97 rate calculations, 137 selecting indicators; see Community selection of, 130-135, 138 health profile indicators; smoking, 162-163 Performance indicators sociodemographic characteristics, state role, 15-17, 18-19, 80, 81, 91- 8, 126, 127, 129, 132, 156-159 92, 173-175, 176-177 standard measures, development of, tools, 114-116, 176-177, 375 18-19, 27, 128, 176-177 Community health profile unemployment rate, 159 comparisons based on, 128 uninsured persons, 159 definition, 127 uses, 7, 91, 93, 127-128, 139 further development of, 137-140 Community Intervention Trial for privacy and confidentiality issues, Smoking Cessation, 85, 176 128 Community Mental Health Services proposed indicators, 129-130, 156- Block Grant program, 81 165 Community-oriented primary care, 83 role for, 7, 32, 91, 126-129, 140 Community-wide Health Improvement size of community and, 139-140 Learning Collaborative, 106, 107 updating, 128-129, 139
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See also Behavioral Risk Factor health and function, 209-211, 227 Surveillance System; Information health care, 217-219, 228 systems; Methodological issues; overview, 205-207 Youth Risk Behavior physical environment, 212, 216-217 Surveillance System risk factors, 212 from administrative records, 367- sample indicator set, 220-224, 227 368 228 availability of and access to, 135- social environment and, 212, 214 137, 138, 146 216, 227-228 breast and cervical cancer, 202-203 stakeholders, 227-228 collection and analysis, 15-16, 33, well-being, 209-211, 227 89, 91-93, 103, 116, 135-137, Determinants of health. See also Field 143-144, 376, 389-390, 395, model of health determinants 397, 400 biomedical construct, 43, 48, 55-56 community health assessment, 377, conceptual model, 36, 47-48, 82 389-390 community-level, 53, 55, 62 community health improvement critical periods in human process, 80-81, 89, 91-93, 103 development, 50, 53, 54, 95, for community health profile 144, 421-422, 425 indicators, 131-137 nature of, 42-43 comparative data/benchmark, 73, research needs, 56 93, 128, 138-139, 265, 268 targeting interventions to, 53-54 costs of collection, 143-144, 395 Disease, as field model domain environmental health, 386-387, 390 breast and cervical cancer, 187, epidemiological, 93, 436, 443-444 191-193, 202-203 geocoding, 15, 137, 174 community health profile immunization, 150-152 indicators, 158-163 performance monitoring, 55, 74, depression, 207-209, 227 102-106, 146, 374, 376, 388, elderly people, 230-231, 240 445-446 infant health, 278-280, 298
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See also Professional Federal role, 16, 18-19, 81, 113, 115 training 116, 172-173, 174, 176-177 and health status, 50, 157, 421- Field model of health determinants 422 and community health indicators, 157, 158 improvement process, 78, 82, maternal, 50, 157, 422 86-87, 96, 116-117, 141-142, preschool, 50, 421-422 169 provider, 427, 433-434 and community health profile Elder health, prototype performance indicators, 131-134, 138, 156 indicators 165 data sources, 240-241 community-level factors, 53, 62 disease, 230-231, 240 domains of model, 3,24, 47-48, 49 economic prosperity, 231, 234, 241 52, 420-424; see also specific health care, 230-231, 240 domains (behavior, disease, Kaiser Permanente Northern economic prosperity, genetic California Region performance endowment, health and function, measurement areas, 231, 232- health care, physical 233 environment, social overview, 229-230 environment, well-being) physical environment, 235, 241 framework, 3, 47-53, 141, 166, sample indicator set, 235-241 420-421, 425 social environment, 231, 234, 241, importance of, 36, 42 424 interrelatedness of domains, 2-3, stakeholders, 240-241 24, 25, 48, 52-53, 56, 59, 420, Employee Retirement Income Security 423, 424 Act, 153 and performance indicator End-stage renal disease, 362 selection, 100-101, 140, 141England, 50, 421 142, 150-152, 183, 184, 187, Environmental health.
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From page 469... ...
See also Determinants of health Health care resource allocation, prototype performance monitors as biomedical construct, 41, 43, 48 benchmarked rates, 268-269 defining, 2, 24, 40, 41-47, 55-56 multidimensional nature, 42-43, data sources, 274-275 individual behavior and, 265-266, 48-49, 53 274 Health and function, as field model domain overview, 262-264 physical environment and, 266, 274 community health profile provision and utilization of services, indicators, 158, 159, 160-165 depression, 209-211, 227 267-269, 274-275 public health capacity, 267-268 prototype performance indicators, sample indicator set, 269-271, 274 209-211, 227, 291, 311, 334, 347-348, 358 275 social environment and, 266
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From page 470... ...
See Housing conditions, 51, 423 Managed care organizations Hungary, 50, 421 Health Plan Employer Data and Information Set (HEDIS) , 27, 33, Illinois 86, 101 n.2, 144, 147, 185, 186, capacity assessment, 114 198, 217-218, 222, 264, 266, data systems and sources, 91, 135, 290, 294, 301, 310, 329, 335, 136 336, 338, 379, 388, 397-398, health improvement leadership, 80 406, 433, 437, 442 McHenry County Project for Local Health plans Assessment of Need, 97, 98, capacity needs of, 108 428-430 coverage, 61 performance monitoring of local performance indicators, 27, 378-379 health departments, 81, 381-382 reporting, 375 Project Health, 64 Health promotion, 41, 45, 84, 440 Immunization.
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From page 471... ...
See also Data "theory of change" in, 99 capacity, 33, 112, 135 time frames, 13-14, 54, 171, 424 clinical performance measures 425 database, 101 n.2, 394 Iowa, 91 development of, 80, 115-116 and health profile indicators, 135- Joint Commission on Accreditation of 137, 139-140 Healthcare Organizations, 27, infrastructure, 33 101 n.2, 398-399, 406 Internet, 91-92, 135 Joint Council of Governmental Public location identifiers, 137, 174 Health Agencies, 397 limitations, 33, 419 Medicaid/Medicare databases, 103 Kaiser Family Foundation Community n.3 Health Promotion Grant National Information Infrastructure Program, 85, 105, 176, 442 project, 116, 392-393 private sector, 92, 103 public-private partnerships, 388 Lalonde Report, 47 Lead poisoning, prototype performance technical expertise, 112, 153 Injury, 238, 277, 287-288, 423, 430; indicators adults, 244 see also Violence children, 242-244 Input measures, definition, 426 n.6 Institute for Health Improvement, data sources, 259-261 disease and, 245-251, 259 107 economic prosperity and, 424 Interventions to improve health. See also Community health health care and, 245-251, 259 physical environment and, 251-254, improvement process; 259-261 performance monitoring; specific programs
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From page 472... ...
See also Community health biomedical, 43, 48 profile indicators; Input community development model of measures; Outcome measures; change, 440 Performance indicators; Process environmental health factors, measures 387 clinical performance, 101 n.2, 375, Health Belief, 440 394 of health improvement, 444 of community health, 93, 130, 138- PRECEDE-PROCEED, 440 139 of social change, 68-70, 439-440, community-level, 139 446 development of, 65, 115, 380-381 stages of change, 440 diet and exercise, 139 statistical, for small-area environmental health, 387, 397 estimation, 370-371 public health practice, 380-381 Model Standards, 437; see also quality of life, 165 Healthy Communities 2000: of satisfaction, 164, 165 Model Standards of smoking initiation, 162 Monitoring. See Performance updating, 91, 138-139 monitoring Medicaid, 27, 43, 83, 89, 158, 175, Mortality 246, 294 education and, 421 Medical Outcomes Study, 209 income and, 51, 422
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INDEX 473 infant, 159-160, 385; see also clinical, 388 Infant health definition, 142 n.1, 426 n.6 social class and, 50, 422 environmental health, 387 functional capacity and well-being, National Association of County and City 48 Health Officials, 396-397, 406 intermediate, 426 n.6 National Breast and Cervical Cancer Outcomes research, 82, 97-98, 425 Early Detection Program, 197 National Cancer Institute, 85, 176, 365 Pacific Business Group on Health, 44, National Center for Health Statistics, 45 135, 137, 370, 395 Patient navigator program, 196 National Civic League, 109, 111, 113, Performance indicator sets 138 breast and cervical cancer, 148, National Committee for Quality 196-200, 202-204 Assurance (NCQA) , 27, 64-65, catalogs of, 101 n.2 109, 144 n.2, 186, 263-264, data sources, 150-152, 202-204, 379, 397-398, 406 227-228, 240-241, 259-261 National Health and Nutrition definition, 140 Examination Survey, 368 depression, 141, 148, 220-224, National Health Interview Survey, 363- 227-228 364, 395 development of, 10, 101, 183, 187, National Heart, Lung, and Blood 374-375, 407 Institute, 85, 104-105, 176, 442 elder health, 142, 148, 235-241 National Immunization Survey, 433 field model domains of, 148, 150National Information Infrastructure 152, 183, 184, 191-196, 202 project, 116, 392-393 204, 207-219, 227-228, 235National Institutes of Health, 43 241, 244-255, 259-261, New York City Washington Heights/ 264-269, 274-275, 278-291, Inwood neighborhood, 96, 375, 298-299, 334-339, 342-344, 377 354-359 New York State, 91 health care resource allocation, Non-English-speaking populations, 157 148, 269-271, 274-275 North Shore Community Health health plan assessment, 27, 378 Network Area, 432-433 379 Norway, 50, 421 health status, 28-29, 85, 395, 432 433, 437, 443 Obesity, 163 Indicator Measurement System, Occupational Safety and Health 398-399 Administration, 244, 246-247 infant health, 148, 291-295 Ontario, Canada, 138, 144 n.2 lead poisoning, 148, 257-261 Organization for Economic Cooperation mental health and chemical and Development, 51, 422 dependency services, 27 Organizations and institutions prototypes, 147-148, 150-152, 183 expectations of, 55, 427 187 identification of stakeholders selecting, 141 among, 427 stakeholder roles, 150-152, 183, internal monitoring, 427 187 model of social change, 440 tobacco and health, 141, 148, 312Outcome measures 318, 408-409 assessment instruments, 145 n.2 uses, 81, 143, 147, 378, 406, 407, 443
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From page 474... ...
474 INDEX vaccine-preventable diseases, 13, validity and reliability, 145, 184, 148, 150-152, 184, 334-339, 362 342-344 Performance monitoring violence, 148, 354-359 and accountability, 5, 10, 29, 30, Performance indicators 86, 100, 145, 186, 378 assessment of, 101 barriers to, 34-35, 62 characteristics, 100, 419, 443 benchmarks, 93-94, 265, 268, 364 community health profile indicators 366 as, 128-129 best practices, 96, 427 community responses to, 438 cultural competence, 72 of cooperation among organizations, data collection and analysis, 11, 72, 100 102-103, 376, 388, 426 criteria for selection, 13-14, 144- definition, 4, 26, 418 147, 184-185, 170-171 federal role, 56, 64, 392-395 data availability, 146, 185 goals, 62, 397, 399, 418-419 data collection and analysis costs, identification of stakeholders, 142, 143-144 427, 432 definition, 140 implementation, 72-73, 409-410, development tools, 115, 177, 419 438 environmental health, 387 importance, 26-29, 63, 166-167, gaps in, 142, 379 416 health improvement links, 145, 184 leadership, 72, 438 health plan, 27, 378-379 measures, 55, 142, 186; see also health status indicators and, 73, Input measures; Outcome 85, 432-433, 437, 443 measures; Performance indicator immunization, 437 sets; Performance indicators; inclusion in other indicator sets, Process measures 146-147, 185 participants, 56, 59, 72, 376, 435 normative element, 378 436, 445; see also Stakeholders operational issues, 143, 378 population-based perspective, 26, overall program evaluation 105, 377, 419 distinguished from, 437 priority setting, 72, 148 privacy and confidentiality issues, by private sector, 26-28, 55, 81, 86, 149, 153 385, 386, 396-399, 443 public health practice, 380-381 by public sector, 28-29, 379-382 robustness and responsiveness to and qualitative information, 11, 27 change, 146, 184-185 28, 55, 74, 94, 102-103 selection of, 12-13, 32, 42-43, 49, "reinventing government," 26, 86 99, 100-101, 142-147, 148, 170- report cards, 27, 86, 397-398, 427 171, 184-186, 390-391, 408, resource management, 36-37, 72 419, 420, 436-437, 445 selection of health issues, 141-142, sources, 100-101, 185 436, 438 specification of, 361-362 systems, 28-29, 68, 399-401, 419 stakeholders linked to, 12, 32, 146, time factors, 144 185, 170-171 use of data from, 14-15, 27, 103 standard measures, development of, 106, 374, 445-446 18-19, 27, 176-177, 186, 397, Performance Partnership Grants, 29, 436-437 81, 139, 175, 186, 393 strategic concerns, 171, 378 Perry Preschool Study, 50, 421-422 technical aspects, 177, 378 Personal Responsibility and Work uses, 32, 430 Opportunity Reconciliation Act, 285 n.1
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From page 475... ...
, 4, 82, 102, 106, health assessment guide, 85 107, 113, 332 health care costs, 60 definition, 418 n.3 incentives for participation, 89 indicator sets, 27-28, 101 n.2 performance monitoring, 26-28, 55, internal, by health care 81, 86, 385, 386, 396-399, 443 organizations, 86 public-sector partnerships with, 114 Quality of care, 27, 164 standardization of data, 16-17, 174 Quality of life, 18-19, 84, 115, 131, Problem identification and 135, 164, 165 prioritization cycle. See Community health improvement Recommendations process assessment of community health Process measures improvement process (CHIP)
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From page 476... ...
See also Tobacco and health 216, 227-228, 284-287, 298 adolescents, 53 299, 305-307, 321-322, 327 community health profile 332, 342, 351-353, 359 indicators, 162-163 tobacco and health and, 305-307, genetic influences on, 52, 423 321-322
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From page 477... ...
See also individual states social-class effects, 50-51, 422 in accountability, 64, 397 University of in community health improvement Florida, 380 process, 15-17, 18-19, 80, 81, Illinois at Chicago, 380, 381 91-92, 173-175, 176-177 Kansas, 105 in quality assurance, 397 North Carolina, 380 Structural functionalism, 439 Washington School of Public Substance Abuse Monitoring system, Health, 375, 384 135 Suicide, 160, 205, 209, 211, 348-349 Vaccine-preventable diseases, Surgeon General's Workshop on prototype performance indicators Violence and Health, 347 data sources, 150-152, 342-344 Sustainable Development Indicators, disease domain, 150, 326-327, 342 138, 144 n.2 genetic endowment and, 327 Symbolic interactionism, 439 health and function, 334 Syphilis, 160-161
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From page 478... ...
, Youth Risk Behavior Surveillance 72, 83 System (YRBSS)
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