Health Performance Measurement in the Public Sector Principles and Policies for Implementing an Information Network (1999) / Chapter Skim
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5 Strategies for Supporting Performance Measurement Through a National Information Network
5 Strategies for Supporting Performance Measurement Through a National Information Network
Pages 132-160
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From page 132... ...
Department of Health and Human Services, 1997; Public Health Foundation, 1998~. This final chapter reviews the panel's essential conclusions regarding performance partnership agreements, outlines its vision for a national health information network to facilitate performance measurement for publicly funded health programs, and recommends steps that can and should be taken to realize that vision.
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From page 133... ...
for health programs has led the panel to a set of general principles that it believes should guide further performance partnership efforts. First, the panel concludes that those who are affected by decisions resulting from the application of performance measures must share fully in the creation and selection of those measures, and, where possible, the measurement process.
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From page 134... ...
Such investments have, however, been beyond the reach of many state and local health agencies. The panel recognizes that developing a truly comprehensive information network of national scope is a massive, potentially overwhelming endeavor.
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Successful development of information systems for performance measurement in the public or private sectors will require both time and financial investment from a variety of sources, as well as commitment and persistence. ESSENTIAL FEATURES OF A HEALTH INFORMATION NETWORK TO SERVE DIFFERENT LEVELS OF DECISION MAKING Given the complexity and scope of the task of developing the envisioned health information network, the panel believes that a clear vision of the intended long-term goal is required if the effort is to stay on course amid the vast amount of detail, variation, and difficult choices involved.
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From page 136... ...
The network should be able to serve the information needs of managers, planners, health care providers, evaluators, policy makers, and the public at the national, state, and local levels. For example, data systems operated by states and communities can provide essential geographic detail and flexibility in data collection and analysis that are often not available from federal data systems, whereas federal data systems provide the broad national information that guides federal policy making and can serve as a reference point for assessing progress by individual states and communities.
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Efficient and Effective Use of Resources The envisioned national health information network will require sufficient resources to operate effectively and support a wide range of users, but it should be organized efficiently to minimize its consumption of resources and any competition for resources with health programs and services. One consideration is efficient data collection.
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From page 138... ...
Although the proposal to transform significant portions of DHHS grant funding to states into PPGs specifically addressed a federal-state relationship, performance measurement requires a much broader collaborative partnership across federal, state, and local governments if it is to succeed. The panel sees opportunities to strengthen health-related performance measurement efforts through collaborative efforts that would enable all parties to learn from each other and would promote consensus regarding health outcome, process, and capacity measures that are appropriate at the federal, state, and local levels.
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From page 139... ...
1. Federal, state, and local governments should commit to a com mon and national strategic goal of incorporating performance mea surement into the practices of publicly funded health programs.
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Collaborative efforts must extend across the federal, state, and local levels and will require the participation of a multiplicity of stakeholders from each level to ensure that all important issues are addressed. Discussions at the national level among organizations representing the range of officials who will need to participate in performance monitoring efforts can help promote a shared national vision of and commitment to performance monitoring.
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From page 141... ...
DHHS will be a key participant and may be an essential catalyst for this process, but must act as a partner with state and local stakeholders. Because many points of view must be considered fully and fairly, one approach might be to identify an interested party without a direct stake in the outcomes (e.g., a foundation, a university, a unit of the National Academy of Sciences)
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Thus while this survey meets the needs of many federal programs, it is currently of little direct use to state health programs. The federal partners can also make important contributions to states and local entities in the planning and maintenance of performance monitoring systems.
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, especially data related to health care services. However, the categorical nature of much of the federal funding for state and local health-related programs has often encouraged both a fragmented approach to health problems and the development of programspecific data systems and reporting requirements.
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6. DHHS, in collaboration with state and local partners, should review restrictions on the use of grant funds to determine whether they represent a significant barrier to progress in the development of integrated health information systems.
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The information revolution is proceeding at such a rapid pace that many state and local health agencies cannot remain current. In addition, standardization is a key feature of successful integration and interoperability of data systems.
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Although few existing data systems have been designed specifically for performance measurement, they nonetheless provide an essential base from which to build an information network that can meet a broad range of health information needs, including performance data. Use of existing data systems to the extent feasible would provide an important efficiency in the establishment of a performance measurement system.
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The panel supports efforts to make the data systems in a health information network as efficient and effective as possible. As noted in conjunction with recommendation 8, an information network should also provide access to data systems that are beyond the purview of health agencies but contain data valuable for tracking health risks and outcomes.
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10. DHHS, in partnership with state and local stakeholders, should lead the implementation of a process for ongoing development and review of performance measures to be used in conjunction with state and local health programs.
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Efforts by private nonprofit groups to identify measures suitable for outcomes research in health care (e.g., the Medical Outcomes Trust) might serve as models for a process for assembling sets of performance measures for publicly funded health programs.
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Comparability of Data and Data Collection Methods While specific applications of performance measurement may vary, common definitions are critical for any communication and comparison of results. Similarly, while various data collection methods may be used to obtain performance data, standards for each method should be promoted in all cases to enhance data quality and promote comparability.
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From page 151... ...
The advantages of this harmonization of measures and data collection practices for comparability and efficiency should not, however, be allowed to obscure the need for continued critical assessment of their appropriateness in general or for specific applications. Data Quality Data systems that support performance measurement must ensure adequate quality and appropriate handling of the data that are collected.
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REQUIRED INVESTMENT FOR AN INFORMATION NETWORK Performance measurement activities can be expected to impose new demands (e.g., additional data collection, data system development, and analysis of performance data) on those whose performance is being assessed.
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A positive sign is the Maternal and Child Health Bureau's State Systems Development Initiative, which specifically allows states to apply for grants of up to $100,000 that can be used for such purposes as the development of integrated information systems or the collection of data for performance measures for the Maternal and Child Health Services Block Grant (Maternal and Child Health Bureau, 1998~. Other important sources of state and local data that require adequate support include public health surveillance systems, such as vital records, notifiable disease systems, and registries for cancers, immunizations, and birth defects.
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From page 154... ...
All participants in this effort will have some stake in existing information systems and may be reluctant to accept changes in those systems. However, successful development of a broader national health information network that can support performance measurement and other operational, managerial, and analytic activities will require coordination and compromise, as well as a broad, long-term commitment by the participants.
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From page 155... ...
Other opportunities for state and local training and capacity building should also be explored. For example, university medical centers and schools of public health could develop collaborative programs that would provide state and local health departments with access to training and academic expertise in data collection and analysis while providing faculty and students with opportunities for field experience and research.
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From page 156... ...
In the current highly competitive market for information technology personnel, many state and local agencies are at a disadvantage because their salaries tend to be relatively low. One example of work DHHS is already doing along these lines is the preparation of an investment analysis guide for states that want to combine categorical grant funds for the development of integrated health information systems (Centers for Disease Control and Prevention and Health Resources and Services Administration, 1998~.
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From page 157... ...
Resources are needed to support comprehensive reviews and rigorous analyses of the relevant scientific evidence and to produce evidence-based reports describing the scientific foundation applicable to the development of performance measures for use in publicly funded health programs. AHCPR currently sponsors a program to develop, use, and evaluate evidence-based tools and information related to clinical health care.
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From page 158... ...
The participants must be partners in seeking benefits from and sharing responsibility for the effective management and operation of a broader health information network. The information network envisioned by the panel should enhance the capacity of federal, state, and local health programs to meet performance measurement obligations and to use performance data and other information to achieve desired health outcomes.
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From page 159... ...
Hummel 1996 Health Information Systems and Their Role in Rural Health Services: Issues and Recommendations. Report to the Agency for Health Care Policy and Research (Contract #282-93-0036-4)
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Stroup 1994 Future directions for comprehensive public health surveillance and health information systems in the United States. American Journal of Epidemiology 140:383-397.
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