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Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health (1997)

Chapter: APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES

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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Appendix C Potential Health Outcome and Risk Status Measures

The health outcome and risk status measures in this appendix are presented to illustrate the types of measures that might be included in performance partnership grants (PPG) between state agencies and the U.S. Department of Health and Human Services (DHHS). These measures were selected from among the many proposed to the panel by participants at four regional meetings sponsored by DHHS, as well as by professional health associations and private agencies and individuals. The panel chose the measures—listed in the first section of this appendix and detailed in the second section—using the guidelines described in Chapter 1 of this report: a measure should be specific and results oriented; it should be meaningful and understandable; data should be adequate to support the measure; and the measure should be as valid, reliable, and responsive as possible.

These health outcome and risk status measures are not meant to represent a mandated list. Few states are likely to have all of the data necessary to support all of these measures. In addition, state agencies may well have major priorities in addition to those represented by the categories of outcome measures listed here (e.g., injury prevention, oral health, hearing and vision, environmental health, etc.) and are responsible for administering major programs relevant to public health that are not covered by this report (e.g., Medicaid). In addition, the panel did not attempt to identify all of the measures that might be relevant for specific important subpopulations (i.e., groups defined by demographic or risk categories). Consequently, the health outcome and risk status measures described below should be considered an important subset, but not an exhaustive listing, of those that will be of interest to state agencies.

A major goal of this report is to provide an analytic framework for use by the

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

states and DHHS in assessing the appropriateness of specific outcome, process, and capacity measures proposed for PPG agreements in the future. The panel hopes that the field of performance measure evaluation will evolve, as new health outcome measures are defined, studied, and become available. It is anticipated that many of the measures described in this report can, in time, be modified or replaced by others that meet the selection guidelines listed above.

Potential Measures: Overview

Chronic Disease

Tobacco
  • Percentage of (a) persons aged 18–24 and (b) persons aged 25 and older currently smoking tobacco
  • Percentage of persons aged 14–17 (grades 9–12) currently smoking tobacco
  • Percentage of women who gave birth in the past year and reported smoking tobacco during pregnancy
  • Percentage of employed adults whose workplace has an official policy that bans smoking
Nutrition
  • Percentage of persons aged 18 and older who eat five or more servings of fruits and vegetables per day1
  • Percentage of persons aged 14–17 (grades 9–12) who eat five or more servings of fruits and vegetables per day2
  • Percentage of persons aged 18 and older who are 20 percent or more above optimal body mass index3
Exercise
  • Percentage of persons aged 18 and older who do not engage in physical activity or exercise
  • Percentage of persons aged 14–17 (grades 9–12) who do not engage in physical activity or exercise

1  

The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel.

2  

See fn. 1.

3  

See fn. 1.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×
Screenings and Tests
  • Percentage of persons aged 18 and older who had their blood pressure checked within past 2 years4
  • Percentage of women aged 45 and older and men aged 35 and older who had their cholesterol checked within past 5 years5
  • Percentage of women aged 50 and older who received a mammogram within past 2 years6
  • Percentage of adults aged 50 and older who had a fecal occult blood test within past 12 months or a flexible sigmoidoscopy within past 5 years7
  • Percentage of women aged 18 and older who received a Pap smear within past 3 years8
  • Percentage of persons with diabetes who had HbA1C checked within past 12 months9
  • Percentage of persons with diabetes who had a health professional examine their feet at least once within past 12 months10
  • Percentage of persons with diabetes who received a dilated eye exam within past 12 months11

STDs, HIV Infection, and Tuberculosis

  • Incidence rates of selected STDs
  • Incidence rates of HIV infection
  • Prevalence rates of selected STDs
  • Prevalence rates of HIV infection
  • Consumer satisfaction with STD, HIV, and tuberculosis treatment programs
  • Rates of sexual activity among adolescents aged 14–17
  • Rates of sexual activity with multiple sex partners among people aged 18 and older
  • Rates of condom use during last episode of sexual intercourse among sexually active adolescents aged 14–17
  • Rates of condom use by persons aged 18 and older with multiple sex partners during last episode of sexual intercourse

4  

See fn. 1.

5  

See fn. 1.

6  

Cancer incidence by diagnosed stage may be a better alternative in cancer registry areas; see fn. 1.

7  

See fns 1 and 6.

8  

See fns. 1 and 6.

9  

See fn. 1.

10  

See fn. 1.

11  

See fn. 1.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×
  • Rates of condom use during last episode of sexual intercourse among men having sex with men
  • Rates of injection drug use among adolescents and adults
  • Completion rates of treatment for STDs, HIV infection, and tuberculosis

Mental Health

  • Percentage of persons aged 18 and older receiving mental health services who experience reduced psychological distress
  • Percentage of persons aged 18 and older receiving mental health services who experience increased level of functioning
  • Percentage of persons aged 18 and older receiving mental health services who report increased employment (including volunteer time)
  • Percentage of persons aged 18 and older with serious and persistent mental illness receiving mental health services who live in integrated, independent living situations or with family members
  • Percentage of children aged 17 and younger with serious emotional disorders receiving mental health services who live in noncustodial living situations
  • Percentage of persons aged 18 and older with serious mental illness who are in prisons and jails
  • Percentage of children aged 17 and younger with serious emotional disorders who are in juvenile justice facilities
  • Percentage of homeless persons aged 18 and older who have a serious mental illness
  • Percentage of adolescents aged 14–17 or family members of children and adolescents or both who are satisfied with: (a) access to services, (b) appropriateness of services, and (c) perceptions of gain in personal outcomes
  • Percentage of persons (aged 18 and older) or their family members or both who are satisfied with: (a) access to mental health services, (b) appropriateness of services, and (c) perceptions of gain in personal outcomes

Immunization

  • Reported incidence rate of representative vaccine-preventable diseases
  • Age-appropriate vaccination rates for target age groups (children aged 2 years; children entering school at approximately 5 years of age; and adults aged 65 and older) for each major vaccine group

Substance Abuse

  • Death rate of persons aged 15–65 attributed to (a) alcohol, (b) other drug use, and (c) combined agents
  • Percentage of emergency room encounters for alcohol or other drug-related causes
Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×
  • Prevalence rate of substance abuse clients who report experiencing diminished severity of problems after completing treatment as measured by the Addiction Severity Index (ASI) or a similar measure12
  • Ratio of substance abuse clients involved with the criminal justice system before and after completing treatment
  • Prevalence rate of adolescents aged 14–17 engaged in heavy drinking or other drug use13
  • Prevalence rate of persons aged 18 and older engaged in heavy drinking or other drug use14
  • Percentage of women who gave birth in the past year and reported using alcohol or other drugs during pregnancy
  • Mean age at first use of ''gateway" drugs (tobacco, marijuana, alcohol)
  • Percentage of adolescents aged 14–17 stating disapproval of marijuana use
  • Percentage of adolescents aged 14–17 who report parents or guardians who communicate non-use expectations
  • Percentage of drug abuse clients who engage in risk behaviors related to HIV/AIDS after completing treatment plan

Sexual Assault Prevention

  • Incidence rate of sexual assault reported by females

Disabilities

  • Percentage of newborns with neural tube defects
  • Percentage of persons aged 18–65 with disabilities who are in the workforce
  • Percentage of children aged 6 or younger with blood lead greater that 10 micrograms per deciliter15
  • Percentage of women who gave birth in the past year and reported alcohol, tobacco, or other drugs during pregnancy

Emergency Medical Services

  • Percentage of persons who suffer out-of-hospital cardiac arrest who survive

12  

Although the estimated incidence rate would be a more appropriate measure for monitoring progress by the state substance abuse agencies, the currently available data source for this measure provides prevalence data.

13  

See fn. 12.

14  

See fn. 12.

15  

See fn. 1.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

POTENTIAL MEASURES

Measure Type:

Chronic disease risk status

Measure:

Percentage of (a) persons aged 18–24 and (b) persons aged 25 and older currently smoking tobacco.

Numerator:

All adults in each age group smoking tobacco (either statewide or in selected subgroups).

Denominator:

All adults in each age group (in the selected subgroup).

Rationale for Measure:

Use of smoking tobacco is the leading preventable cause of death in this country and a major cause of a wide range of chronic diseases. (This measure corresponds to Healthy People 2000 Objective 3.4.)

Limitations of Measure:

Tobacco use by a state's population can be affected by many factors, including exposure to advertising, availability of vending machines, and other factors that may not be under the direct control of the state health agencies.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS).

Limitations of Data:

The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of persons aged 14–17 (grades 9–12) currently smoking tobacco.

Numerator:

Young adults aged 14–17 currently smoking tobacco (either statewide or in selected subgroup).

Denominator:

Young adults aged 14–17 (in the selected subgroup).

Rationale for Measure:

Use of smoking tobacco is the leading preventable cause of death in this country and a major cause of a wide range of chronic diseases. Use generally begins during youth. (This measure corresponds to Healthy People 2000 Objective 3.5.)

Limitations of Measure:

Tobacco use by a state's population can be affected by many factors, including exposure to advertising, availability of vending machines, and other factors that may not be under the direct control of the state health agencies. A school-based measure misses dropouts who may be at an increased risk for tobacco use, so supplemental surveys of dropouts and absentees are needed for the most accurate measurement.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Youth Risk Behavior Surveillance System (YRBSS).

Limitations of Data:

The methodology used to collect YRBSS data may vary significantly across states, making interstate comparisons with these data alone problematic. It should also be noted that YRBSS is currently conducted in fewer than half of all states and often does not involve a representative sampling of schools in a given state.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of women who gave birth in the past year and reported smoking tobacco during pregnancy.

Numerator:

All women who gave birth in the past year and reported smoking tobacco (either statewide or in selected subgroups).

Denominator:

All women giving birth (in selected subgroups).

Rationale for Measure:

Use of tobacco is the leading preventable cause of death in this country and a major cause of a wide range of chronic diseases. Use in pregnancy has deleterious effects on fetus and can raise the likelihood of one or more chronic diseases affecting the newborn. (This measure corresponds to Healthy People 2000 Objective 14.10.)

Limitations of Measure:

Tobacco use by a state's childbearing-age female population can be affected by many factors, including exposure to advertising, availability of vending machines, and other factors that may not be under the direct control of the state health agencies.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

 

Numerator:

Birth certificate data; states with alternative methods for measuring tobacco use during pregnancy (for example, PRAMS) may opt to use these data instead.

Denominator:

Official state population estimate.

Limitations of Data:

It is widely understood that birth certificate data may understate the actual use of tobacco by pregnant women. Nevertheless, this should not be a problem in examining trends over time or making interstate comparisons if the reporting bias is consistent from one time period to another or across jurisdictions.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of employed adults whose workplace has an official policy that bans smoking.

Numerator:

All employed persons in worksites with tobacco policies (either statewide or in selected subgroups).

Denominator:

All employed persons (in selected subgroups).

Rationale for Measure:

Exposure to tobacco smoke by nonsmokers is a significant cause of chronic disease, including lung cancer.

Limitations of Measure:

Policies that limit tobacco use by a state's working population can be affected by many factors that may not be under the direct control of the state health agencies.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Current Population Survey (CPS), tobacco risk supplement.

Limitations of Data:

While the general CPS only provides state-level estimates for approximately ten states, data from the tobacco risk supplement to the CPS can be used to produce annual state level estimates for all states.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of persons aged 18 and older who eat five or more servings of fruits and vegetables per day.*

Numerator:

Persons aged 18 and older who eat five or more servings of fruits and vegetables per day (either statewide or in selected subgroups).

Denominator:

All persons aged 18 and older (in the selected subgroup).

Rationale for Measure:

Eating five or more servings of fruits and vegetables per day is an important strategy for reducing dietary fat content, reducing obesity, and increasing the consumption of fiber and other nutrients, leading to reduced heart disease, colon cancer, and other diseases. (This measure corresponds to Healthy People 2000 Objective 2.6.)

Limitations of Measure:

Although diet has been demonstrated to have a causal link in reducing heart disease and some cancers, other factors, such as heredity, are known to affect the incidence of these diseases.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS).

Limitations of Data:

The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of persons aged 14–17 (grades 9–12) who eat five or more servings of fruits and vegetables per day.*

Numerator:

Persons aged 14–17 who eat five or more servings of fruits and vegetables per day (either statewide or in selected subgroups).

Denominator:

All persons aged 14–17 (in the selected subgroup).

Rationale for Measure:

Eating five or more servings of fruits and vegetables per day is an important strategy for reducing dietary fat content, reducing obesity, and increasing the consumption of fiber and other nutrients, leading to reduced heart disease, colon cancer, and other diseases. Dietary habits may be established during childhood or adolescence. (This measure corresponds to Healthy People 2000 Objective 2.6.)

Limitations of Measure:

Although diet has been demonstrated to have a causal link in reducing heart disease and some cancers, other factors, such as heredity, are known to affect the incidence of these diseases.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Youth Risk Behavior Surveillance System (YRBSS).

Limitations of Data:

The methodology used to collect YRBSS data may vary significantly across states, making interstate comparisons with these data alone problematic. It should also be noted that YRBSS is currently conducted in fewer than half of all states and often does not involve a representative sampling of schools in a given state.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of persons aged 18 and older who are 20 percent or more above optimal body mass index.*

Numerator:

All persons aged 18 and older who are 20 percent or more above optimal body mass index (either statewide or in selected subgroups).

Denominator:

All persons aged 18 and older (in the selected subgroup).

Rationale for Measure:

Obesity is a proxy measure for excess total calorie intake and insufficient exercise, an important cause of chronic disease.

Limitations of Measure:

Although diet and exercise have been demonstrated to have a causal link in reducing heart disease and some cancers, other factors, such as heredity, are known to affect the incidence of these diseases.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS).

Limitations of Data:

The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of persons aged 18 and older who do not engage in physical activity or exercise

Numerator:

Adults who do not engage in physical activity or exercise (either statewide or in selected subgroups).

Denominator:

All adults (in the selected subgroup).

Rationale for Measure:

Physical activity is a key determinant of overall wellness, and it reduces the risk of cardiovascular disease. (This measure corresponds to Healthy People 2000 Objective 1.3.)

Limitations of Measure:

Although exercise has been demonstrated to have a causal link in reducing heart disease and some cancers, other factors, such as heredity, are known to affect the incidence of these diseases.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS).

Limitations of Data:

The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of persons aged 14–17 (grades 9–12) who do not engage in physical activity or exercise

Numerator:

Persons aged 14–17 who do not engage in physical activity or exercise (either statewide or in selected subgroups).

Denominator:

All persons aged 14–17 (in the selected subgroup).

Rationale for Measure:

Physical activity is a key determinant of overall wellness, and it reduces the risk of cardiovascular disease. Exercise habits may be established during childhood or adolescence. (This measure corresponds to Healthy People 2000 Objective 1.3.)

Limitations of Measure:

Although exercise has been demonstrated to have a causal link in reducing heart disease and some cancers, other factors, such as heredity, are known to affect the incidence of these diseases.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Youth Risk Behavior Surveillance System (YRBSS).

Limitations of Data:

The methodology used to collect YRBSS data may vary significantly across states, making interstate comparisons with these data alone problematic. It should also be noted that YRBSS is currently conducted in fewer than half of all states and often does not involve a representative sampling of schools in a given state.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of persons aged 18 and older who had their blood pressure checked within past 2 years.*

Numerator:

Persons 18 and older having blood pressure checked within past 2 years (either statewide or in selected subgroups)

Denominator:

All persons 18 and older (in selected subgroups).

Rationale for Measure:

Hypertension is a key determinant of cardiovascular and cerebrovascular disease. A key public health component of prevention is screening. (This measure corresponds to Healthy People 2000 Objective 15.13.)

Limitations of Measure:

While decreasing hypertension has been shown to be a way of improving cardiovascular and cerebrovascular functioning, other factors are known to influence the incidence of cardiovascular and cerebrovascular disease.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS).

Limitations of Data:

The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of women aged 45 and older and men aged 35 and older who had their cholesterol checked within past 5 years.*

Numerator:

Persons 18 and older having cholesterol checked within past 5 years (either statewide or in selected subgroups).

Denominator:

All persons 18 and older (in selected subgroups).

Rationale for Measure:

Hypercholesterolemia is a key determinant of cardiovascular disease. A key public health component of prevention is screening. (This measure corresponds to Healthy People 2000 Objective 15.14.)

Limitations of Measure:

While decreasing hypercholesterolemia has been shown to improve cardiovascular functioning, other factors are known to influence the incidence of cardiovascular disease.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS).

Limitations of Data:

The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of women aged 50 and older who received a mammogram within past 2 years.*

Numerator:

Women aged 50 and older who received a mammogram within the previous two years (either statewide or in selected subgroups).

Denominator:

All women aged 50 and older (in selected subgroups).

Rationale for Measure:

Mammography is a primary strategy for early detection and thus more favorable treatment outcome for breast cancer. (This measure corresponds to Healthy People 2000 Objective 16.11.)

Limitations of Measure:

While early detection and treatment have been shown to improve outcomes for breast cancer, other factors can also influence mortality from this disease.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS).

Limitations of Data:

The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel. Breast cancer incidence by diagnosed stage may be a better alternative in cancer registry areas; this would be a health status outcome measure.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of adults aged 50 and older who had a fecal occult blood test within past 12 months or a flexible sigmoidoscopy within past 5 years.*

Numerator:

Adults aged 50 and older who have had a fecal occult blood test within past 12 months or a flexible sigmoidoscopy within past 5 years (either statewide or in selected subgroups).

Denominator:

All adults aged 50 and older (in the selected subgroup).

Rationale for Measure:

Fecal occult blood testing or periodic sigmoidoscopy are primary strategies for early detection and thus more favorable treatment outcome for colon cancer. (This measure corresponds to Healthy People 2000 Objective 16.13.)

Limitations of Measure:

While early detection has been shown to improve treatment outcomes for colon cancer, other factors can also influence the mortality of this disease.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS).

Limitations of Data:

The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel. Colon cancer incidence by diagnosed stage may be a better alternative in cancer registry areas; this would be a health status outcome measure.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of women aged 18 and older who received a Pap smear within past 3 years.*

Numerator:

Women aged 18 and older who received a Pap smear within past 3 years (either statewide or in selected subgroups).

Denominator:

All women aged 18 and older (in selected subgroups).

Rationale for Measure:

Pap smears are a primary strategy for early detection and thus more favorable treatment outcome for cervical cancer. (This measure corresponds to Healthy People 2000 Objective 16.12.)

Limitations of Measure:

While early detection and treatment have been shown to improve outcomes for cervical cancer, other factors can also influence mortality from this disease.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS).

Limitations of Data:

The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel. Invasive cervical cancer incidence by diagnosed stage is a better alternative in cancer registry areas; this would be a health status outcome measure.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of persons with diabetes who had HbA1C checked within past 12 months.*

Numerator:

Adult diabetics who receive HbA1C screening at least annually (either statewide or in selected subgroups).

Denominator:

All adult diabetics (in the selected subgroup).

Rationale for Measure:

HbA1C is a measure of blood glucose control. Good control of blood glucose has been shown to prevent secondary complications of diabetes. Routine testing of HbA1C can identify diabetics who need additional intervention to achieve optimal control.

Limitations of Measure:

While early detection of problems in controlling blood glucose levels has been shown to improve treatment outcomes for diabetes, other factors can also influence the morbidity and mortality caused by this disease.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS); Medicare Statistical Data System.

Limitations of Data:

The sample of diabetics identified through the BRFSS may be too small to obtain accurate estimates of those receiving HbA1C screening. Also, the methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons problematic. The Medicare population within the Medicare Statistical Data System is not representative of all diabetics, and it may not be representative of the Medicare diabetic population in some areas as it does not include encounter information from Medicare managed care services.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of persons with diabetes who had a health professional examine their feet at least once within past 12 months.*

Numerator:

Adult diabetics who have received a foot exam within past 12 months (either statewide or in selected subgroups).

Denominator:

All adult diabetics (in selected subgroups).

Rationale for Measure:

Diabetics are at risk for peripheral vascular disease and lower extremity amputation. Routine foot exams can identify at-risk patients early and lead to improved outcomes.

Limitations of Measure:

While early detection of circulatory problems has been shown to improve treatment outcomes for diabetes, other factors can also influence the morbidity and mortality caused by this disease.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS); Medicare Statistical Data System.

Limitations of Data:

The sample of diabetics identified through the BRFSS may be too small to obtain accurate estimates of those receiving HbA1C screening. Also, the methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic. The Medicare population within the Medicare Statistical Data System is not representative of all diabetics, and may not be representative of the Medicare diabetic population in some areas as it does not include encounter information from Medicare managed care services.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Chronic disease risk status

Measure:

Percentage of persons with diabetes who received a dilated eye exam within past 12 months.*

Numerator:

Adult diabetics who have received an eye exam in the past year (either statewide or in selected subgroups).

Denominator:

All adult diabetics (in the selected subgroup).

Rationale for Measure:

Diabetics are at risk for diabetic retinopathy and blindness. Routine eye exams can identify at-risk patients early and lead to improved outcomes. (This measure corresponds to Healthy People 2000 Objective 17.23.)

Limitations of Measure:

While early detection has been shown to improve treatment outcomes for diabetes, other factors can also influence the morbidity and mortality caused by this disease.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS); Medicare Statistical Data System.

Limitations of Data:

The sample of diabetics identified through the BRFSS may be too small to obtain accurate estimates of those receiving HbA1C screening. Also, the methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic. The Medicare population within the Medicare Statistical Data System is not representative of all diabetics, and may not be representative of the Medicare diabetic population in some areas as it does not include encounter information from Medicare managed care services.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

STD health status outcome

Measure:

Incidence rates of selected STDs: gonococcal urethritis in men; chlamydial urethritis in men; primary and secondary syphilis; congenital syphilis.

Numerator:

Number of reported cases.

Denominator:

Official state population estimates.

Rationale for Measure:

Used by CDC, states, and localities to track health status and overall STD prevention efforts. This is a useful measure because treatment of early acute conditions prevents the spread of new infections.

Limitations of Measure;

Useful information is limited to segments of the community whose health providers systematically report disease. Measure does not capture information from nonreporting sectors nor does it distinguish between cases from high-transmitting core groups and those from other groups. Factors other than program effects, such as poverty, health access, and substance abuse influence incidence. Variation in reported rates may be due to changes in the intensity of health department case finding and screening activities, rather than to true changes in disease incidence.

Use of Measure:

Disease specific measures of incidence have specific value in evaluating programs focused on these diseases. Changes in multiple incidence measures can be used to assess broader prevention efforts, e.g., those aimed at risk reduction or improving access to services. These outcome measures should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

National, state, and local STD surveillance systems.

Limitations of Data:

There is substantial variability in the diagnostic laboratory testing and reporting practices of providers. Shifts in populations at risk served by providers may not be reported in a timely manner because of this variability.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

HIV health status outcome

Measure:

Incidence rates of HIV infection: newly diagnosed cases of HIV infection; perinatally acquired HIV infection of infants.

Numerator:

Number of newly diagnosed cases of HIV infection in selected subgroups.

Denominator:

Official state population estimates.

Rationale for Measure:

Used by some states as a proxy measure for the occurrence of new HIV infection. Reducing new infection is the goal of prevention programs.

Limitations of Measure:

Useful information is limited to segments of the community whose health providers systematically report disease. The actual onset of the infection is not measured by this indicator; rather, the measure depends on screening frequencies, access to services, and trust between people and their providers. Many factors other than program activities influence new infection rates, including poverty, discrimination, and injection drug use.

Use of Measure:

Trends in the incidence of HIV infections are useful in measuring prevention efforts. This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

State-based HIV reporting systems.

Limitations of Data:

HIV reporting systems are available only in some states. Rates of diagnosis depend heavily on the level of case finding through screening. The selection of providers by at-risk populations may be influenced by the perceived likelihood of provider reporting. Major changes in HIV treatment and diagnostic criteria may influence the enumeration of cases.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

STD health status outcome

Measure:

Prevalence rates of selected STDs: gonococcal infection in women in defined populations; genital chlamydial infection in defined populations; syphilis in defined risk groups, e.g., pregnant women; rectal gonococcal infection in men.

Numerator:

Reported number of existing infections at specific monitoring site.

Denominator:

Population attending specific monitoring site.

Rationale for Measure:

Prevalent cases are the source of new infections in a community. Reducing the duration of prevalent infections contributes to STD prevention.

Limitations of Measure:

Monitoring is established only at defined sites, and the use of those sites by populations at risk will vary over time and location. The validity and reliability of the measure is dependent on the quality of the laboratory procedures.

Use of Measure:

Consistent trends in prevalence in well-defined populations, particularly when monitored at multiple locations in a state, can provide a reasonable estimate of whether true prevalence is changing. When used in conjunction with relevant process and capacity measures, the measure can assist in determining whether a state effort is having the desired impact.

Data Resources:

Special state-based programmatic surveys; publicly supported screening programs; Regional Infertility Prevention Project; several state and local STD programs.

Limitations of Data:

For a given state, the generalizability of data depends on the number of monitoring sites, how they are selected, and consistent assurance that either a complete or systematic sample is obtained at each site. Variations in these data collection procedures make cross-state comparisons problematic.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

HIV health status outcome

Measure:

Prevalence rates of HIV infection: seroprevalence of HIV infection in defined populations at high risk of infection, e.g., women of childbearing age.

Numerator:

Reported number of existing infections.

Denominator:

Populations attending specific monitoring site.

Rationale for Measure:

Prevalent cases are the source of new infections in a community.

Limitations of Measure:

Monitoring is established only at defined sites, and the use of those sites by populations at risk will vary over time and location. The validity and reliability of the measure is dependent on the quality of laboratory procedures.

Use of Measure:

Consistent trends in prevalence in well-defined populations, particularly when monitored at multiple locations in a state, can provide a reasonable estimate of whether true prevalence is changing. When used in conjunction with relevant process and capacity measures, the measure can assist in determining whether a state effort is having the desired impact.

Data Resources:

Special state-based programmatic surveys.

Limitations of Data:

For a given state, the generalizability of data depends on the number of monitoring sites, how they are selected, and consistent assurance that either a complete or systematic sample is obtained at each site. Variations in these data collection procedures make cross-state comparisons problematic.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

STD, HIV infection, and tuberculosis consumer satisfaction

Measure:

Rate of consumer satisfaction with STD, HIV infection, and tuberculosis treatment programs: satisfaction with (a) access to services; (b) appropriateness of services; and (c) perceptions of gain in personal outcomes.

Numerator:

Number of persons served by STD/HIV/TB clinical services satisfied with access and appropriateness of services and gain in personal outcomes.

Denominator:

All persons who use STD/HIV/TB services.

Rationale for Measure:

Satisfaction of the person who uses STD/HIV/TB clinical services is a critical measure of the viability of prevention programs. If consumers are not satisfied with services, they may not use services.

Limitations of Measure:

Variations in consumer satisfaction surveys across states make interstate comparisons problematic.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Special state surveys.

Limitations of Data:

Obtaining satisfaction surveys from the broad range of clinical providers is problematic. It is particularly difficult to assess consumer satisfaction among people who use services only episodically.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

STD and HIV risk status

Measure:

Rates of sexual activity among adolescents aged 14–17.

Numerator:

Number of sexually active adolescents who have engaged in sexual intercourse during the past 3 months.

Denominator:

Number of adolescents in population.

Rationale for Measure:

Once a person has become sexually active there are two definite actions they can take to reduce the risk of contracting STDs or HIV infection: abstain or reduce the frequency of sexual intercourse. (This measure corresponds to Healthy People 2000 Objective 5.5.)

Limitations of Measure:

Although high rates of sexual activity can increase the risk of contracting STDs or HIV, this measure does not take into account other factors that may play a role, including frequency of sexual activity, number of partners, and protection methods used.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

The Youth Risk Behavior Surveillance System (YRBSS) and other state-based population surveys.

Limitations of Data:

The methodology used to collect such data may vary significantly across states, making interstate comparisons problematic. The YRBSS is currently conducted in fewer than half of all states and often does not involve a representative sampling of schools in a given state. It also does not capture information about adolescents who are not attending school.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

STD and HIV risk status

Measure:

Rates of sexual activity with multiple sex partners among people aged 18 and older.

Numerator:

Number of persons aged 18 and older who have engaged in sexual intercourse with more than one partner during the past 12 months.

Denominator:

Number of persons aged 18 and older in the population who have ever been sexually active.

Rationale for Measure:

Once a person has become sexually active there are two definite actions they can take to reduce the risk of contracting STDs or HIV infection: abstain or reduce the frequency of sexual intercourse. (This measure corresponds to Healthy People 2000 Objective 5.5.)

Limitations of Measure:

Although high rates of sexual activity can increase the risk of contracting STDs or HIV, this measure does not take into account other factors that may play a role, including frequency of sexual activity, number of partners, and protection methods used.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

The Behavior Risk Factor Surveillance System (BRFSS) and other state-based population surveys.

Limitations of Data:

The methodology used to collect such data may vary significantly across states, making interstate comparisons problematic. BRFSS may not contain a sufficient sample of the high risk group of interest, unless states using this measure supplement the sample.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

STD and HIV risk status

Measure:

Rates of condom use during last episode of sexual intercourse among sexually active adolescents aged 14–17.

Numerator:

Number of sexually active adolescents aged 14–17 who used condoms during their last episode of sexual intercourse.

Denominator:

Number of adolescents aged 14–17 who have ever engaged in sexual intercourse.

Rationale for Measure:

If adolescents engage in sexual intercourse, the use of condoms reduces the likelihood of contracting or spreading HIV or STDs. (This measure corresponds to Healthy People 2000 Objective 5.6 for people aged 19 and younger.)

Limitations of Measure:

Although the use of condoms reduces the likelihood of contracting or spreading STDs or HIV, a person's behavior during the most recent episode of sexual intercourse may not be representative of regular behavior.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

The Youth Risk Behavior Surveillance System (YRBSS) and other state-based population surveys.

Limitations of Data:

The methodology used to collect such data may vary significantly across states, making interstate comparisons problematic. The YRBSS is currently conducted in fewer than half of all states and often does not involve a representative sampling of schools in a given state. It also does not capture information about adolescents who are not attending school.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

STD and HIV risk status

Measure:

Rates of condom use by persons aged 18 and older with multiple sex partners during last episode of sexual intercourse.

Numerator:

Number of persons aged 18 and older with multiple sex partners who used condoms during their last episode of sexual intercourse.

Denominator:

Number of persons aged 18 and older with multiple sex partners

Rationale for Measure:

Persons who engage in sexual intercourse with multiple partners are at increased risk of contracting or spreading STDs or HIV infection; the use of condoms reduces this risk. (This measure corresponds to Healthy People 2000 Objective 5.6 for people aged 19 and younger.)

Limitations of Measure:

Although the use of condoms reduces the likelihood of contracting or spreading STDs or HIV, a person's behavior during the most recent episode of sexual intercourse may not be representative of regular behavior.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

The Behavior Risk Factor Surveillance System (BRFSS) and other state-based population surveys.

Limitations of Data:

The methodology used to collect such data may vary significantly across states, making interstate comparisons problematic. BRFSS may not contain a sufficient sample of the high risk group of interest, unless states using this measure supplement the sample.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

STD and HIV risk status

Measure:

Rates of condom use during last episode of sexual intercourse among men having sex with men.

Numerator:

Number of men who have sex with men who used condoms during their last episode of sexual intercourse.

Denominator:

Number of men who have sex with men who have ever engaged in sexual intercourse.

Rationale for Measure:

The use of condoms reduces the likelihood of contracting or spreading HIV or STDs. (This measure corresponds to Healthy People 2000 Objective 5.6 for people aged 19 and younger.)

Limitations of Measure:

Although the use of condoms reduces the likelihood of contracting or spreading STDs or HIV, a person's behavior during the most recent episode of sexual intercourse may not be representative of regular behavior.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

The Behavior Risk Factor Surveillance System (BRFSS) and other state-based population surveys.

Limitations of Data:

The methodology used to collect such data may vary significantly across states, making interstate comparisons problematic. BRFSS may not contain a sufficient sample of the high risk group of interest, unless states using this measure supplement the sample.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

HIV/AIDS risk status

Measure:

Rates of injection drug use among adolescents and adults.

Numerator:

Number of adolescents and adults who have engaged in injection drug use.

Denominator:

Number of adolescents and adults.

Rationale for Measure:

A major known contributor to the transmission of HIV/AIDS is injection drug use. Because of the long time between exposure and onset of AIDS, it is recommended that states monitor the proportion of the population engaged in injection drug use.

Limitations of Measure:

This measure provides only a crude estimate of the frequency of injection drug use (i.e., past year for adults and any time in the past for adolescents).

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

The Behavior Risk Factor Surveillance System (BRFSS), the Youth Risk Behavior Surveillance System (YRBSS), and other state-based population surveys.

Limitations of Data:

The methodology used to collect such data may vary significantly across states, making interstate comparisons problematic. BRFSS and BRFSS may not contain a sufficient sample of the high risk group of interest, unless states using this measure supplement the sample. This is especially true for the BRFSS which is currently conducted in fewer than half of all states and often does not involve a representative sampling of schools in a given state.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

STD, HIV, and tuberculosis risk status

Measure:

Completion rates of treatment for STDs, HIV infection, and tuberculosis: standard treatment of individuals with STDs and their sex partners; standard antiviral treatment of HIV-infected pregnant women and their infants; standard treatment of tuberculosis cases, contacts, and skin test converters.

Numerator:

Number of cases of prescribed treatment completion for each disease.

Denominator:

Total number of cases of prescribed treatment for each disease.

Rationale for Measure:

Adequate treatment of curable infections is a primary strategy to prevent further spread in a community. There is direct evidence that adequate treatment directly reduces the risk of infection to others.

Limitations of Measure:

Treatment of cases in populations of high transmitters is more beneficial than the treatment of noncore groups.

Use of Measure:

The measure, when used in conjunction with measures of incidence and prevalence and the other relevant process and capacity measures, can be a useful measure of risk status in the community.

Data Resources:

State-specific treatment surveys.

Limitations of Data:

Treatment is poorly documented in some medical records. Whether data are collected depends on the existence of some form of disease reporting system or registry. Available data are likely to be biased toward higher rates of adequate treatment because sex partners not identified by the index patient, the provider, or the health department may be less likely to receive adequate treatment.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Mental health status outcome

Measure:

Percentage of persons aged 18 and older receiving mental health services who experience reduced psychological distress.

Numerator:

Change in psychological distress from beginning treatment to discharge.

Denominator:

Number of persons aged 18 and older admitted for services and then discharged.

Rationale for Measure:

Psychological distress (or symptom reduction) is one of the most widely accepted methods of evaluating the impact of mental health services.

Limitations of Measure:

Variations in assessment mechanisms across states make interstate comparisons problematic.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

 

Numerator:

Consumer or provider surveys, using one or more of the following instruments: NYCMH, Basis 32, SF 36, Multnomah Community Ability Scale, and Lehman Quality of Life.

Denominator:

State data systems.

Limitations of Data:

Surveys are not available in many states, and where available may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; nonresponse error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Mental health social functioning

Measure:

Percentage of persons aged 18 and older receiving mental health services who experience increased level of functioning.

Numerator:

Change in level of functioning from beginning treatment to discharge.

Denominator:

Number of persons aged 18 and older admitted for services and then discharged.

Rationale for Measure:

Increase in functioning is one of the most important means of determining whether positive change has occurred.

Limitations of Measure:

Variations in surveys across states make interstate comparisons problematic.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

 

Numerator:

Consumer or provider surveys using one or more of the following instruments: CAR, FARS, NYLOC.

Denominator:

State data systems.

Limitations of Data:

Surveys are not available in many states, and where available may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; nonresponse error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Mental health social functioning

Measure:

Percentage of persons aged 18 and older receiving mental health services who report increased employment (including volunteer time).

Numerator:

Number of consumers aged 18 and older reporting increased employment.

Denominator:

Total number of consumers aged 18 and older.

Rationale for Measure:

Consumers, providers, and funders consistently identify employment as one of the most critical measures of program success.

Limitations of Measure:

Variations in surveys across states make interstate comparisons problematic.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

 

Numerator:

Consumer surveys.

Denominator:

State data systems.

Limitations of Data:

Surveys are not available in many states, and where available may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; nonresponse error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Mental health social functioning

Measure:

Percentage of persons aged 18 and older with serious and persistent mental illness receiving mental health services who live in integrated, independent living situations or with family members.

Numerator:

All consumers aged 18 and older with serious and persistent mental illness who live in integrated, independent living situations or with family members.

Denominator:

All consumers aged 18 and older with serious and persistent mental illness.

Rationale for Measure:

Integrated, independent living or living with family members is the goal of many funding agencies and most consumers.

Limitations of Measure:

Significant variation in quality of living situations may occur among consumers living independently or with family members.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

State data systems.

Limitations of Data:

Surveys are not available in many states, and where available may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; nonresponse error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Mental health social functioning

Measure:

Percentage of children aged 17 and younger with serious emotional disorders receiving mental health services who live in noncustodial living situations.

Numerator:

Number of children aged 17 and younger with serious emotional disorders who are not in out-of-home placement.

Denominator:

Number of children aged 17 and younger with serious emotional disorders.

Rationale for Measure:

Some children need to be in out-of-home placements. However, many states identify a goal of reducing out-of-home placements as a measure of success of the mental health programs.

Limitations of Measure:

Significant variation in quality of living situations may occur among consumers in noncustodial living situations.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by state agencies are having the desired impact.

Data Resources

 

Numerator:

State mental health data systems; Medicaid data; child welfare data; juvenile justice data.

Denominator:

State mental health data system.

Limitations of Data:

Surveys are not available in many states, and where available may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; nonresponse error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Mental health social functioning

Measure:

Percentage of persons aged 18 and older with serious mental illness who are in prisons and jails.

Numerator:

Number of adults aged 18 and older with serious mental illness in jails and prisons.

Denominator:

Number of adults aged 18 and older with serious mental illness.

Rationale for Measure:

The number of adults with serious mental illness in jails and prisons is increasing. While some individuals with serious mental illness are appropriately in jails and prisons, others are there because there is no other facility providing services.

Limitations of Measure:

In many states the mental health agency does not have the responsibility for delivering or administering services to the jail and prison population. The measure can be affected by many factors that may not be under the direct control of the mental health agencies.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

State corrections data sets; state surveys of mentally ill persons.

Limitations of Data:

There are difficulties in obtaining valid and reliable data on prison and jail populations. The methodology required to accurately and meaningfully measure this subpopulation is not widely available or developed. In addition, it may be hard to obtain information on jails and prisons, and it is often difficult to coordinate data across agencies.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Mental health social functioning

Measure:

Percentage of children aged 17 and younger with serious emotional disorders who are in juvenile justice facilities.

Numerator:

Number of children aged 17 and younger with serious emotional disorders who are in juvenile justice facilities.

Denominator:

Number of children aged 17 and younger with serious emotional disorders.

Rationale for Measure:

Many states identify a goal of reducing the number in juvenile justice facilities as a measure of success of mental health programs.

Limitations of Measure:

In many states the mental health agency does not have responsibility for delivering or administering services to the juvenile justice facility population. The measure can be affected by many factors that may not be under the direct control of the mental health agencies.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

 

Numerator:

State data systems; child welfare and juvenile justice.

Denominator:

State data system.

Limitations of Data:

There are difficulties in obtaining valid and reliable data on juvenile justice facility populations. The methodology required to accurately and meaningfully measure this subpopulation is not widely available or developed.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Mental health social functioning

Measure:

Percentage of homeless persons aged 18 and older who have a serious mental illness.

Numerator:

Number of persons aged 18 and older with serious mental illness who are homeless.

Denominator:

Number of persons aged 18 and older who are homeless.

Rationale for Measure:

Homelessness is one of the most serious problems for many people with serious mental illness.

Limitations of Measure:

In many states the mental health agency does not have the responsibility for delivering or administering services to the homeless population. The measure can be affected by many factors that may not be under the direct control of the mental health agencies.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

 

Numerator:

Estimates of homeless populations from local surveys and shelter information.

Denominator:

State surveys of population-in-need estimates, based on new federal definitions.

Limitations of Data:

There are difficulties in obtaining valid and reliable data on the homeless population. The methodology required to accurately and meaningfully measure this subpopulation is not widely available or developed. In addition, it is nearly impossible to collect data on the homeless if they do not reach a shelter. These data are not available in many states.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Mental health consumer satisfaction

Measure:

Percentage of adolescents aged 14–17 or family members of children and adolescents or both who are satisfied with: (a) access to services, (b) appropriateness of services, and (c) perceptions of gain in personal outcomes.

Numerator:

All adolescents aged 14–17 or family members of children and adolescents or both who are surveyed and are satisfied with access to and appropriateness of services and gain in personal outcomes.

Denominator:

All adolescents aged 14–17 or family members surveyed or both who use services.

Rationale for Measure:

Satisfaction of the person using mental health services is a critical measure of the viability of service programs. If consumers are not satisfied with services, they may not use them.

Limitations of Measure:

Variations in consumer satisfaction surveys across states make interstate comparisons problematic.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

MHSIP Report Card Survey; state surveys.

Limitations of Data:

The MHSIP Report Card Survey is in early stages of state implementation and the availability of data may differ across states. State surveys may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; nonresponse error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Mental health consumer satisfaction outcome

Measure:

Percentage of persons (aged 18 and older) or their family members or both who are satisfied with: (a) access to mental health services, (b) appropriateness of services, and (c) perceptions of gain in personal outcomes.

Numerator:

All adults or family members of adults who are surveyed or both and are satisfied with access to and appropriateness of mental health services and gain in personal outcomes.

Denominator:

All adults or family members surveyed or both who use mental health services.

Rationale for Measure:

Satisfaction of the person using mental health services is a critical measure of the viability of service programs. If consumers are not satisfied with services, they may not use them.

Limitations of Measure:

Variations in consumer satisfaction surveys across states make interstate comparisons problematic.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

MHSIP Report Card Survey; state surveys.

Limitations of Data:

The MHSIP Report Card Survey is in early stages of implementation; the availability of the data may differ by states. State surveys may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; non-response error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Immunization health status outcome

Measure:

Reported incidence rate of representative vaccine-preventable diseases.

Numerator:

Number of reported cases (for each disease, age, or risk group).

Denominator:

Population estimate (for each age or risk group).

Rationale for Measure:

Key objective used by CDC, states, and Healthy People 2000. (This measure corresponds to Healthy People 2000 Objective 20.1.)

Limitations of Measure:

Incomplete coverage of population.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

 

Numerator:

State-based reportable disease registries.

Denominator:

Official state population estimate.

Limitations of Data:

Inconsistent validity and reliability; subject to selection and reporting bias; only some vaccine-preventable diseases are reported.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Immunization risk status

Measure:

Age-appropriate vaccination rates for target age groups (children aged 2 years; children entering school at approximately 5 years of age; and adults aged 65 and older) for each major vaccine group.

Numerator:

Number of people within each age group who are appropriately vaccinated.

Denominator:

Population estimate for each age group.

Rationale for Measure:

Used by CDC and states to monitor health status and best measure of achievement of immunization objectives. (This measure corresponds to Healthy People 2000 Objective 20.11.)

Limitations of Measure:

Incomplete coverage of population: does not include high-risk non-elderly adults or children aged 3–5 or high-risk subgroups (poor, underserved minorities, adolescents).

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

National Immunization Survey (NIS); retrospective school-based surveys; Medicare Statistical System; HEDIS managed care data; BRFSS.

Limitations of Data:

Only a small percentage of NIS immunization histories are confirmed, although many states have the ability to confirm most of them. Medicare data excludes those immunized in hospitals and HMOs, although HEDIS 3.0 calls for reporting on influenza immunizations for Medicare recipients.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse health status outcome

Measure:

Death rate of persons aged 15–65 attributed to (a) alcohol, (b) other drug use, and (c) combined agents.

Numerator:

Number of alcohol and other drug-related deaths.

Denominator:

Number of deaths of persons between 15 and 65 years of age.

Rationale for Measure:

Alcohol and other drug use contribute to a wide variety of deaths, including fatal accidents. (This measure corresponds to Healthy People 2000 Objective 4.1.)

Limitations of Measure:

Many personal and social factors can influence alcohol and drug use that are difficult for a state agency to measure in the short term. Traffic and highway drunk driving deaths may be affected by state and local enforcement of drunk driving laws. Some deaths may not occur for many years after use (e.g., cirrhosis).

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

Death records in National Vital Statistics Systems; Fatal Accident Reporting System; traffic fatality reports; Mortality, Multiple Cause of Death Data.

Limitations of Data:

Cause of death is not always accurately reported and may be collected differently in different states.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse health status outcome

Measure:

Percentage of emergency room encounters for alcohol or other drug-related causes.

Numerator:

Number of encounters that mention alcohol or other drugs.

Denominator:

Total emergency room encounters.

Rationale for Measure:

Emergency room encounters are good indicators of heavy alcohol and illicit drug use.

Limitations of Measure:

The causes reported for emergency room encounters may understate the actual number of emergency room encounters due to alcohol or other drugs.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

Drug Abuse Warning Network; state emergency room data; hospital discharge data; Medicaid hospital and claims data.

Limitations of Data:

DAWN data are only available for selected hospitals within a state; therefore, statewide estimates will not be available from this source. A further complication may occur as managed care and medical facility consolidation progress, if the base of reporting systems of emergency room facilities deteriorates. Such erosion of the reporting base would cast doubt on the validity and reliability of performance demonstrated, even for a substate area, through the use of DAWN data or through Medicaid hospitalization data.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse social functioning

Measure:

Prevalence rate of substance abuse clients who report experiencing diminished severity of problems after completing treatment as measured by the Addiction Severity Index (ASI) or a similar measure.

Numerator:

Number of clients with reduced severity scores on given dimension.

Denominator:

Number of clients followed up after treatment.

Rationale for Measure:

Changes in the areas measured by the ASI (medical problems; employment or financial problems; alcohol and drug use; illegal activity; family or social problems; and psychological problems) are key indicators of treatment effectiveness.

Limitations of Measure:

Many personal and socioeconomic factors can influence alcohol and drug use that are difficult for a state agency to measure in the short term.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

Treatment Episode Data Set (if discharge and follow-up added); state client data systems (e.g., California Alcohol and Drug Data System, Iowa Substance Abuse Reporting System and Minnesota Treatment Accountability Program).

Limitations of Data:

Not all states collect ASI data because of cost considerations. Not all clients can be located for follow-up; follow-up periods may vary in different states; some states collect data on all clients, not just those paid for with block grant funds, making cross state comparisons misleading.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse social functioning

Measure:

Ration of substance abuse clients involved with the criminal justice system before and after completing treatment.

Numerator:

Percentage of clients with arrests or convictions after completing treatment.

Denominator:

Percentage of clients with arrests or convictions before treatment.

Rationale for Measure:

Reduced crime (and the cost associated with it) is a key indicator of treatment effectiveness, especially for other drug users.

Limitations of Measure:

Criminal behavior can be affected by many factors that are not under the direct control of the state substance abuse agency, which typically does not have responsibility for delivering or administering services to jail or prison populations.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Uniform Crime Reporting; state client data systems (e.g., Colorado Drug/Alcohol Coordinated Data Systems).

Limitations of Data:

Not all clients can be located at follow-up; difficult to combine data from separate systems due to data privacy and other technical issues. State surveys may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; nonresponse error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse risk status

Measure:

Prevalence rate of adolescents aged 14–17 engaged in heavy drinking* or other drug use.

Numerator:

Number of adolescents who report heavy drinking* or using other drugs.

Denominator:

Number of adolescents.

Rationale for Measure:

Heavy drinking and other drug use can lead to severe consequences, such as driving accidents, sexual and other abuse, violence, and death. (This measure corresponds to Healthy People 2000 Objectives 4.6 and 4.7.)

Limitations of Measure:

Many personal and socioeconomic factors can influence heavy drinking and drug use that are difficult for a state agency to influence in the short term. In addition, a school-based measure misses dropouts, who may be at increased risk for substance abuse.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

Youth Risk Behavior Surveillance System (YRBSS); state high school surveys.

Limitations of Data:

The methodology used to collect YRBSS data may vary significantly across states, making interstate comparisons with these data alone problematic. It should also be noted that the YRBSS is currently conducted in fewer than half of all states and often does not involve a representative sampling of schools in a given state.

* The most common definition of heavy drinking across states is five or more drinks on one occasion. If a state has defined heavy drinking to be other than five or more drinks, it could propose to use its definition in a performance agreement with the DHHS. Ultimately, it would be desirable for all states to use a common definition.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse risk status

Measure:

Prevalence rate of persons aged 18 and older engaged in heavy drinking* or other drug use.

Numerator:

Number of people aged 18 and older engaged in frequent heavy drinking* or other drug use.

Denominator:

Number of people aged 18 and older.

Rationale for Measure:

High-risk alcohol and other drug use can lead to severe consequences, such as death or permanent disability (traumatic brain injury).

Limitations of Measure:

Many personal and socioeconomic factors can influence alcohol and drug use that are difficult for a state agency to measure in the short term.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

Behavioral Risk Factor Surveillance System (BRFSS); state needs assessment surveys

Limitations of Data:

The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons with these data alone problematic. BRFSS may also underestimate use because of respondents' reluctance to report use to an interviewer over the telephone or because of missing populations without phones (e.g., the homeless and those living in institutions).

* The most common definition of heavy drinking across states is five or more drinks on one occasion. If a state has defined heavy drinking to be other than five or more drinks, it could propose to use its definition in a performance agreement with the DHHS. Ultimately, it would be desirable for all states to use a common definition.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse risk status

Measure:

Percentage of women who gave birth in the past year and reported using alcohol or other drugs during pregnancy.

Numerator:

Number of pregnant women who gave birth in the past year and reported using alcohol or other drugs.

Denominator:

All women giving birth in the state.

Rationale for Measure:

The use of these substances during pregnancy can lead to adverse birth outcomes (e.g., fetal alcohol syndrome). (This measure corresponds to Healthy People 2000 Objective 14.10.)

Limitations of Measure:

Alcohol and drug use by a state's pregnant female population can be affected by many factors, including exposure to advertising, that may not be under the direct control of state agencies.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

Birth records; Behavioral Risk Factor Surveillance System (BRFSS); adverse pregnancy outcome registry; maternal and child health case management records

Limitations of Data:

The methodology used to collect BRFSS may vary significantly across states, making interstate comparisons problematic, unless supported by other data sources, such as state screening and reporting systems or medical information systems. Sample sizes may not be sufficiently large to accurately identify rates of substance abuse among the subpopulation of pregnant women.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse risk status

Measure:

Mean age at first use of ''gateway" drugs (tobacco, marijuana, alcohol)

Numerator:

Mean age of children and adolescents reporting first use of tobacco, marijuana or alcohol.

Denominator:

Number of children and adolescents.

Rationale for Measure:

Early use of these substances may be a precursor of more serious drug use or abuse.

Limitations of Measure:

Measure does not distinguish between those who use gateway drugs and subsequently go on to further use and those whose first use does not lead to any subsequent behavior.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

Youth Risk Behavior Surveillance System (YRBSS); state student surveys

Limitations of Data:

The methodology used to collect YRBSS data may vary significantly across states, making interstate comparisons with these data alone problematic. It should also be noted that the YRBSS is currently conducted in fewer than half of all states and often does not involve a representative sampling of schools in a given state.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse risk status

Measure:

Percentage of adolescents aged 14–17 stating disapproval of marijuana use.

Numerator:

Number of adolescents indicating disapproval of marijuana use.

Denominator:

Number of adolescents.

Rationale for Measure:

Peer disapproval of marijuana use is a strong protective factor; when the percentage of youth with this attitude is high, marijuana rates tend to be low. (This measure corresponds to Healthy People 2000 Objective 4.9)

Limitations of Measure:

Indirect measures may understate actual use, as high-risk populations (dropouts, incarcerated adolescents) are often not included in surveys.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

State surveys.

Limitations of Data:

Surveys are not available in many states, and where available may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; nonresponse error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse risk status

Measure:

Percentage of adolescents aged 14–17 who report parents or guardians who communicate non-use expectations.

Numerator:

Number of adolescents who report that parents or guardians clearly communicate the expectations of non-use.

Denominator:

Number of adolescents.

Rationale for Measure:

Parental expectation for non-use by their children is a significant protective factor. When the percentage of parents or guardians who clearly communicate a non-use message is high, use rates tend to be low.

Limitations of Measure:

Indirect measures may understate actual use, as high-risk populations (dropouts, incarcerated adolescents) are often not included in surveys.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

State surveys.

Limitations of Data:

Surveys are not available in many states, and where available may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; nonresponse error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Substance abuse risk status

Measure:

Percentage of drug abuse clients who engage in risk behaviors related to HIV/AIDS after completing treatment plan.

Numerator:

Number of clients engaging in needle sharing and unprotected sex after completing treatment plan.

Denominator:

Number of clients followed up after completing treatment plan.

Rationale for Measure:

Drug and alcohol abusers are at high risk for HIV/AIDS due to needle sharing and unprotected sex.

Limitations of Measure:

Many personal and socioeconomic factors can influence alcohol and drug use that are difficult for a state agency to measure in the short term.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state agencies are having the desired impact.

Data Resources:

State client data systems (e.g., Minnesota Drug and Alcohol Abuse Normative Evaluation System).

Limitations of Data:

Most states do not collect these data; collecting data on sexual behaviors can be controversial. State surveys may be limited by numerous sources of error: e.g., coverage error, which is the result of neglecting to measure all parts of the population; nonresponse error, which is caused by individuals who refuse the survey or cannot be located; and sampling error, which reflects the difference between the general population and the specific sample chosen for the survey.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Sexual assault health status outcome

Measure:

Incidence rate of sexual assault reported by females.

Numerator:

Total number of sexual assaults reported by females.

Denominator:

State female population.

Rationale for Measure:

This is the key sexual assault indicator currently available. (This measure corresponds to Healthy People 2000 Objective 7.12.)

Limitations of Measure:

Sexual assault experienced by a state's female population can be affected by many factors, including state law enforcement, availability of special educational programs for young adolescents, availability of counseling services for offenders, and other factors that may not be under the direct control of the state's health agency. The rate of sexual assaults of males, particularly those in prison, is omitted by this measure.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agency are having the desired impact.

Data Resources:

 

Numerator:

Sexual assault victims service providers; FBI; state police; criminal justice data systems.

Denominator:

Official state population estimate.

Limitations of Data:

The reported rate of sexual assault is widely regarded as understating the actual incidence of sexual assault; however, this may not be a problem if the ratio of reported to unreported assault remains relatively stable.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Disability health status outcome

Measure:

Percentage of newborns with neural tube defects.

Numerator:

Infants birth with neural tube defects.

Denominator:

Total births.

Rationale for Measure:

Neural tube defects are dramatically reduced by appropriate folic acid intake prior to conception. (This measure corresponds to Healthy People 2000 Objective 14.17.)

Limitations of Measure:

Neural tube defects may be affected by other factors that are not under the direct control of the state health agencies.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

 

Numerator:

Birth records or adverse pregnancy outcome registries.

Denominator:

Birth records.

Limitations of Data:

Neural tube defects may not always be recorded by medical or hospital staff.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Disability social functioning

Measure:

Percentage of persons aged 18–65 with disabilities who are in the workforce.

Numerator:

Number of people aged 18–65 with disabilities who are in the workforce.

Denominator:

Number of people aged 18–65 with disabilities.

Rationale for Measure:

One measurement of functionality for an individual with a disability is employment.

Limitations of Measure:

There may be individuals with certain disabilities for whom working is not possible.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Current Population Survey (CPS); National Health Interview Survey (NHIS).

Limitations of Data:

The CPS only provides state-level estimates for approximately ten states.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Disability risk status

Measure:

Percentage of children aged 6 or younger with blood lead greater than 10 micrograms per deciliter.*

Numerator:

Number of children less than 6 years of age with blood lead levels greater than 10 micrograms per deciliter.

Denominator:

Number of children less than six years of age in state.

Rationale for Measure:

Lead intoxication has been demonstrated to result in decreased intelligence and social functionality. (This measure corresponds to Healthy People 2000 Objective 11.4.)

Limitations of Measure:

Lead intoxication in young children living in a state can be affected by many factors, such as the average age of the housing stock, that may not be under the direct control of the health agencies.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

 

Numerator:

Reports of children with lead greater than 10 micrograms per deciliter to state health agencies. (In most states physicians and clinical labs are required to report these results.)

Denominator:

Official state population estimate.

Limitations of Data:

Physicians and clinical labs may not always report each incident of high blood lead levels; not all at-risk children may be tested.

* The numerical value in this measure is the level that is generally regarded as appropriate by the medical community; it does not represent a level that has been independently determined or endorsed by the panel.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Disability risk status

Measure:

Percentage of women who gave birth during the past year and reported using alcohol, tobacco, or other drugs during pregnancy.

Numerator:

Number of women who gave birth during the past year and reported using alcohol, tobacco, or other drugs during pregnancy.

Denominator:

All women giving birth in the state.

Rationale for Measure:

Alcohol, tobacco, and other drug use during pregnancy is a leading cause of birth defects that can result in disability of newborns and in later stages of life. (This measure corresponds to Healthy People 2000 Objective 14.10.)

Limitations of Measure:

Alcohol, tobacco, and other drug use by a state's pregnant female population can be affected by many factors, including exposure to advertising, availability of vending machines, and other factors that may not be under the direct control of the health agencies.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by the state health agencies are having the desired impact.

Data Resources:

Birth records; Behavioral Risk Factor Surveillance System (BRFSS); adverse pregnancy outcome registry; maternal and child health case management records.

Limitations of Data:

It is widely understood that birth record data may understate the actual use of alcohol, tobacco, and other drugs by pregnant women. Nevertheless, this should not be a problem in examining trends over time or making intrastate comparisons if the reporting bias is consistent from one time period to another across jurisdictions. The methodology used to collect BRFSS data may vary significantly across states, making interstate comparisons problematic. Sample sizes may not be sufficiently large to accurately identify rates of substance abuse among the subpopulation of pregnant women.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×

Measure Type:

Emergency medical services health status outcome

Measure:

Percentage of persons who suffer out-of-hospital cardiac arrest who survive.

Numerator:

Number of people discharged from hospitals following out-of-hospital cardiac arrest.

Denominator:

All cases of out-of-hospital cardiac arrest.

Rationale for Measures:

Cardiac arrests are a leading cause of death. Promptly provided emergency medical services can increase the likelihood of survival.

Limitations of Measure:

The rate of cardiac arrest survival of a state's population can be affected by many factors, including the average age of its population, the percentage of its elderly population living in rural areas, and the quality of care provided by its hospitals' emergency medical rooms. None of these factors is within the control of a local or regional emergency medical services system.

Use of Measure:

This outcome measure should be used in conjunction with relevant process and capacity measures in order to gain a sense of whether the actions taken by EMS providers are having the desired impact.

Data Resources:

State EMS data systems.

Limitations of Data:

EMS data systems may vary significantly across states, making interstate comparisons problematic.

Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
×
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×
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Suggested Citation:"APPENDIX C: POTENTIAL HEALTH OUTCOME AND RISK STATUS MEASURES." National Research Council. 1997. Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health. Washington, DC: The National Academies Press. doi: 10.17226/5806.
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Next: APPENDIX D: ANALYSIS OF COMMENTS ON DRAFT REPORT »
Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health Get This Book
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The U.S. Department of Health and Human Services is carrying out an ambitious new program to assure that funds for public health programs are spent as effectively as possible. Under the new program, every state will develop a set of performance objectives to measure its progress in terms of outcomes, processes, and capacity. In the first phase of the program, states are to propose such measures to be achieved over three to five years.

This book examines the technical issues involved in the development of performance measures in 10 areas: mental health, substance abuse, HIV infection, sexually transmitted diseases, tuberculosis, immunization, chronic diseases, disability, rape, and emergency medical services. From more than 3,200 candidate measures proposed by researchers, policymakers, and public health professionals, the panel proposes more than 50 potential outcome measures. The book details the advantages and limitations of potential measures as well as the data sources that can support them. This volume will be an invaluable resource to everyone involved in public health.

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