Health Performance Measurement in the Public Sector Principles and Policies for Implementing an Information Network (1999) / Chapter Skim
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3 Performance Measurement Considerations for Publicly Funded Health Programs
3 Performance Measurement Considerations for Publicly Funded Health Programs
Pages 59-82
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From page 59... ...
For example, the control of food-borne disease outbreaks generally requires much more rapid response than do steps to control cancer, and such differences should be reflected in the performance measures used. Although program-specific issues must be considered, the panel emphasizes that a strictly programmatic perspective may discourage a more comprehensive approach to performance measurement that can capitalize on the complementary, 59
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From page 60... ...
Third, implementation of publicly funded health programs involves not only public-sector health agencies, but also agencies with other responsibilities (e.g., education, criminal justice, housing, transportation) and organizations and individuals in the private sector, such as hospitals, health plans, individual clinicians, and employers.
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From page 61... ...
Population Health Services Many publicly funded health programs fall within the realm of "public health," a designation based not on the source of funding or on the specific content of the services but on the population-based approach used to plan and provide those services. The defining features of public health are its emphasis on protecting and improving the health of the general public through preventionoriented population-based services, and its role in ensuring that key services reach individuals at risk.
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The distinctions between population and personal health services have implications for performance measurement and monitoring. For population health services, health outcomes and risk status are measured by overall changes for a population (or subgroup)
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A surveillance system includes a functional capacity for data collection, analysis, and dissemination linked to public health programs (Thacker and Berkelman, 1988: 1 64~. Plans for performance measurement in publicly funded health programs should build on the surveillance systems already in place.
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From page 64... ...
Performance measurement itself is readily encompassed as a responsibility of health agencies through both the assessment and assurance functions and at least two of the essential services: monitor health status to identify community health problems, and evaluate effectiveness, accessibility, and quality of personal and populationbased health services. The panel encourages states and communities to consider using performance measurement to monitor not only the programmatic aspects of public health services immunization programs, water treatment, and maternal and child health programs, for instance but also the infrastructure for these health programs as represented by activities related to the core functions and essential services.
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From page 65... ...
Although the panel supports implementing performance measurement to monitor public health services, additional groundwork will be needed to reach agreement on an approach to measurement and to identify suitable measures and data sources. Furthermore, research and evaluation remain necessary to determine the impact on health outcomes of the performance of activities related to the core functions and essential services of public health.
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From page 66... ...
Environmental Health Programs Environmental health services, such as ensuring clean air, safe water, and protection from other toxic exposures, are a classic component of public health programs, but they pose difficult challenges for performance measurement. Environmental threats to health and the services designed to control those threats are diverse.
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From page 67... ...
, with support from the National Center for Environmental Health at CDC, is working to develop methods for use by communities in assessing environmental health conditions. Environmental health data issues have also been the focus of various workshops (e.g., National Center for Environmental Health, 1996; Public Health Foundation, 1997~.
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From page 68... ...
Mental Health Programs Until the mid-1960s, most publicly funded mental health services were provided in institutional settings. Frequently, individuals with serious and persistent mental illness (e.g., schizophrenia and bipolar disorder)
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From page 69... ...
Increasingly, the emphasis is on the development of a common outcomeoriented framework for the evaluation of mental health programs (e.g., MHSIP Taskforce on a Consumer-Oriented Mental Health Report Card, 1996; Institute of Medicine, 1997b; Smith et al., 1997; National Association of State Mental Health Program Directors, 1998~. The Mental Health Statistics Improvement Program (MHSIP)
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From page 70... ...
The fourth area that will require attention if performance measures are to be used successfully is the further development of agreed-upon data collection tools and procedures and their integration into existing mental health program information systems. A recent study to test the ability of five states to use many of the measures identified in the MHSIP Report Card and the NASMHPD frameworkthe Five-State Feasibility Study found that fewer than half of the 28 measures tested could be reported by all five states and that differing definitions frequently limit the comparability of apparently similar measures (National Association of State Mental Health Program Directors Research Institute, 1998a)
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From page 71... ...
CDC is working with several researchers to explore whether questions on the annual, state-based Behavioral Risk Factor Surveys can be used to obtain valid assessments of the mental health status of the population (Centers for Disease Control and Prevention, 1998~. In summary, the growing demand for performance-based evaluations of publicly funded mental health programs is creating an urgent need to develop greater consensus on the overall framework for these evaluations.
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From page 72... ...
In October 1997, a workgroup organized by the National Association of State Alcohol and Drug Abuse Directors (NASADAD) proposed the adoption of a performance measurement framework based on the domains of efficiency, effectiveness, and structure (see National Association of State Alcohol and Drug Abuse Directors, 1998~.
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From page 73... ...
For example, the Treatment Outcomes and Performance Pilot Studies project has funded 14 states to test methods of monitoring the performance of publicly funded substance abuse treatment services. Another priority is the development of measures that can be used in managed care settings.
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From page 74... ...
Among the performance measures adopted for this goal are the prevalence of drug abuse and the number of chronic drug users. Examples of the measures for the objective on improving the drug treatment system are the rate of full-time employment among adults completing substance abuse treatment programs and the average waiting time to enter treatment.
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From page 75... ...
, first published in 1988, provides a rigorous assessment of evidence concerning the effectiveness of personal health services for disease prevention, such as screening, immunization, chemoprophylaxis, and health counseling, that are provided to individuals in clinical care settings. Between 1989 and 1996, the Agency for Health Care Policy and Research (AHCPR)
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From page 76... ...
Preventive Services Task Force, and other groups, often cover such topics as immunization and screening services that lie in the overlap between clinical care and public health. The development of guidelines and evidencebased reports for the population-based services that are at the heart of public health programs is just beginning.
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From page 77... ...
The community-based interventions that are part of many publicly funded health programs have proven particularly challenging to study (see, e.g., Koepsell et al., 1992; Connell et al., 1995~. For example, because communities are constantly affected by many factors other than the intervention of interest, it is difficult to identify an appropriate comparison (i.e., a control group or counterfactual)
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From page 78... ...
As the fruits of this research effort become available, it will become possible to design more effective health programs, as well as to design better systems for monitoring performance within these programs. CONCLUSIONS Publicly funded health programs cover a broad spectrum of programmatic areas and include a diverse mix of population-based and personal health services.
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From page 79... ...
Performance measurement draws attention to and establishes accountability for processes and intermediate outcomes that are more clearly under the control of health programs. Performance measurement may also promote the needed development of and adherence to evidence-based best practices to guide steps to achieve desired health outcomes, including a much-needed emphasis on defining standards of practice in public health program areas.
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From page 80... ...
Mittlemark, and H Blackburn 1996 Community education for cardiovascular disease prevention: Morbidity and mortality results from the Minnesota Heart Health Program.
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From page 81... ...
National Association of State Mental Health Program Directors Research Institute 1998a Five State Feasibility Study on State Mental Health Agency Performance Measures. Final Report.
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From page 82... ...
Richards 1994a Implementing and assessing organizational practices in local health departments. Public Health Reports 109:478-484.
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