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1 Introduction and Context
Pages 9-26

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From page 9...
... . Quality in public health has been defined as "the degree to which policies, programs, services and research for the population increase desired health outcomes and conditions in which the population can be healthy" (Public Health Quality Forum, 2008)
From page 10...
... to "quality in the multisectoral health system." Although the committee recognized that the public health quality work in HHS's Office of the Assistant Secretary for Health (OASH) is grounded in the activities of public health practice, the scope of the Leading Health Indicators (LHIs)
From page 11...
... The Public Health Quality Forum defined the characteristics in the following way: 2 First meeting of the IOM Committee on Quality Measures for the Healthy People Leading Health Indicators, December 3, 2012, at the National Academy of Sciences Building, Washington, DC.
From page 12...
... Effective -- justifying investments by utilizing evidence, science, and best practices to achieve optimal results in areas of greatest need 9. Efficient -- understanding costs and benefits of public health in terventions and to facilitate the optimal utilization of resources to achieve desired outcomes In addition to being asked to identify measures of public health quality within the framework provided by the nine quality characteristics, the committee was asked to comment on the relationship with the six priority areas, also described as drivers, for improvement of quality in public health.
From page 13...
... .  Increased availability and use of health indicators, with key ex amples found in the decades-long national Healthy People effort, the state-oriented America's Health Rankings and the locally focused County Health Rankings (IOM, 2011a; Remington and Booske, 2011; United Health Foundation, 2012)
From page 14...
... Achieving the Healthy People objectives, and the overarching, aspirational goal of long, healthy lives for all people in the United States clearly requires collaboration with other sectors, within and outside government, and at all geographic levels. Although the nine quality characteristics refer primarily to the governmental public health agencies, it is well understood that public health action is not limited to government, therefore the committee considers the findings and recommendations in this report relevant to partners in health care delivery and in other sectors.
From page 15...
... Adults who meet current Federal physical activity guidelines for aerobic physical activity and muscle strengthening activity (PA-2.4)
From page 16...
... . On the public health side, the 1997 IOM report Improving Health in the Community: The Role for Performance Monitoring described the components of the community health improvement process, examined the role of performance monitoring in that process, and identified possible tools for communities wishing to develop performance measures.
From page 17...
... That is, measuring and improving quality does not apply only to the delivery of health care services, such as in eliminating overuse, underuse, and misuse of medical procedures. As described in Improving Health in the Community (IOM, 1997)
From page 18...
... . Building on the 1990 IOM definition, the PHQF defined quality in public health somewhat analogously as "the degree to which policies, programs, services, and research for the population increase desired health outcomes and conditions in which the population can be healthy" (Public Health Quality Forum, 2008)
From page 19...
... . A goal of the National Quality Strategy is to build consensus nationally on how to measure health care quality and align federal and state efforts "to reduce duplication and create efficiencies -- not just in measurement but in quality improvement efforts as well" (National Priorities Partnership, 2011, pp.
From page 20...
... The model is a simple illustration of the PHQF's definition of quality: "the degree to which policies, programs, services and research for the population increase desired health outcomes and conditions in which the population can be healthy." The model is obviously not intended to capture all the complete and complex pathways from inputs to outputs and outcomes that relate to health: it is intended instead to serve as a general guide for how to think about this complex area in the process of identifying measures of quality. The model, which resembles the logic model used by a previous IOM committee (see IOM, 2011a, 2012)
From page 21...
... Research is especially important because it serves as a foundation for policies, programs, and services, which in turn lead to healthy conditions and yield healthy outcomes. In practical terms, identifying measures of quality requires an evidence base that allows one to identify which interventions used to achieve a specific outcome are effective and to determine the extent to which they are effective (magnitude of effect)
From page 22...
... As a specific example, mammography screening programs, tobacco cessation services, and community education programs about healthy eating would go under Interventions, while mammography screening rates (women screened for breast cancer) , persons receiving tobacco cessation services, and the proportion of population informed about the value of healthy eating would be classified as Healthy Conditions.
From page 23...
... Although they are not explicitly reflected in the LHIs, the foundation health measures of Healthy People 2020 reside in four domains: 1. General health status (life expectancy, healthy life expectancy, years of potential life lost; physically and mentally unhealthy days; self-assessed health status; limitation of activity; chronic disease prevalence)
From page 24...
... . Healthy People 2020's overarching goals -- longer, healthier lives; health equity; health-promoting environments for all; and the promotion of healthy life, development, and behaviors across the lifespan -- acknowledge the importance of looking to population health outcomes to gauge the nation's progress in meeting health objectives (HHS, 2008; Koh, 2010)
From page 25...
... To help in achieving this recommendation, this report outlines selection criteria and provides sample metrics to support HHS and its partners in enhancing quality to ultimately improve population health. The intersection of quality improvement and the Healthy People 2020 effort in HHS, against the backdrop of health care reform and growing interest in population health concepts make this a time of great opportunity to create platforms on which public health and health care can begin to use same language, employ some of the same metrics, and work together to bring about the shared goal of long, healthy lives for all.


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