Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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5 Measurement Tools for a Community Health Improvement Process
5 Measurement Tools for a Community Health Improvement Process
Pages 126-165
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From page 126... ...
ROLE FOR A COMMUNITY HEALTH PROFILE A community health profile is an integral component of the problem identification and prioritization cycle of the community health improvement process described in Chapter 4. The health profile is intended to be a set of indicators of basic demographic and socioeconomic characteristics, health status, health risk fac 126
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From page 127... ...
A community health profile is made up of indicators of sociodemo graphic characteristics, health status and quality of life, health risk factors, and health resources that are relevant for most communities; these indicators provide basic descriptive information that can in form priority setting and interpretation of data on specific health is sues. Health profile data can help motivate communities to address health issues.
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From page 128... ...
The committee emphasizes that communities should update their health profile data on a regular basis to maintain an accurate picture of community circumstances, including identifying positive or negative changes that might influence health improvement priorities. The health profile is not, however, intended to be a tool specifically to monitor changes in stakeholder performance or to establish responsibility and accountability for health outcomes.
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TABLE 5-1 Proposed Indicators for a Community Health Profile Sociodemographic Characteristics 1. Distribution of the population by age and race/ethnicity 2.
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Selection of Community Health Profile Indicators The committee's selection of indicators reflects consideration of several factors. Measures were sought that would be relevant across a broad range of communities.
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For the community health profile, proposed indicators were mapped to the domains of the field model (social and physical environment, genetic endowment, behavior, disease, health care, health and function, prosperity, and well-being) to identify potential gaps and to assess the distribution of indicators across domains.
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5. Household income Prosperity Census; intercensal estimates (behavior, social environment, physical environment, health care, health and function)
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agency; local air quality management agency 20. Water quality (for Physical environment State environmental quality recreational uses)
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NOTE: Secondary field model domains are listed in parentheses; some indicators could be addressed by questions developed for the state-based surveys of the Behavioral Risk Factor Surveillance System (CDC, 1993) , but special sampling methods would have to be adopted to obtain community-specific estimates.
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data system makes community-level health profile data available to the public as well as to the state's community health network areas (see Box 5-1 for additional information on MassCHIP)
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In 1996, MDPH implemented the Massachusetts Community Health Information Profile -- MassCHIP -- an in formation service to provide dial-up access to community-level data for assessing community health needs, monitoring health status indicators, and evaluating programs. In the initial phase, data on health status, health out come, program utilization, and sociodemographic characteristics are avail able from 18 separate data sets.
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These estimates are especially important if the population is changing rapidly in size or composition. Further Development of the Community Health Profile The community health profile proposed by the committee should be viewed as a starting point for further development, not
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, should also contribute to standardization of measures suitable for community health profiles. In addition, the work being done to develop indicators for state reporting for the proposed federal public health
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As presented here, the community health profile is based on a "community" defined by geographic or civic boundaries, frequently a county or city. This reflects the current form in which data are generally available and not a necessary or preferable basis on which to define a community.
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Once a health issue has been selected, a CHIP moves on to the analysis and implementation cycle, and a community's information needs expand from the descriptive measures in a community profile to the more "actionable" indicators that are crucial to performance monitoring and health improvement activities. As noted For the community health improvement process, a performance indi cator provides a concrete measure of a specific capacity, process, or outcome related to an accountable entity that is part of a defined health improvement strategy for a specific health issue.
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As a community moves on to the process of identifying potential performance indicators, it should specifically include consideration of (1) the domains of the field model that could be addressed by those indicators and (2)
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Therefore, health issues identified as community priorities and the performance indicators selected to assess progress should engage key stakeholders who must act or who can encourage action. The mix of stakeholders and their degree of involvement can be expected to vary depending on the health issue being addressed.
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Even though indicators may be formulated with the intention of promoting actions that will have positive effects on community health, they must be based on an accurate understanding of their effect in the setting in which they will be applied. For example, reducing the number of cigarette vending machines as a way to limit youth access to tobacco will not have the anticipated impact if teenagers buy most of their cigarettes in convenience stores.
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Another concern is how time factors are addressed in performance monitoring. Communities must approach performance monitoring with an understanding of when to expect measurable effects from health improvement.
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Performance indicators measure how well specific actions are being carried out by those who accept responsibility for them. There should be (under the best of circumstances)
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It should be possible to link performance indicators to specific community stakeholders who have accepted or been assigned responsibility for some aspect of health improvement. In some cases, a stakeholder may have responsibility for a defined portion of the total population (e.g., health plans and their enrolled members, schools and enrolled students)
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From page 147... ...
The resources available to a community, the mix of risk factors, and the interventions chosen will all influence the results achieved through a given health improvement strategy. Information provided by the performance indicators should guide subsequent steps: moving on to a new health issue, continuing or modifying the current effort, or perhaps returning to an earlier stage in the process to reassess the intervention strategy and the appropriate indicators to use.
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Comments are offered on likely sources of data and special considerations in using specific indicators. Table 5-3 shows the relationship to the field model domains of the indicators suggested for health improvement activities for vaccine-preventable diseases.
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. Various state provisions also protect privately held health data, but federal legisla
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150 TABLE 5-3 Field Model Mapping for Sample Indicator Set for Vaccine-Preventable Diseases Field Model Domain Construct Sample Indicators Data Sources Stakeholders Disease Eliminate vaccine Pneumonia and influenza Death certificates Health care providers preventable diseases death rates for persons Health care plans age 65 and older State health agencies Local health agencies Business, industry Community organizations Special health risk groups General public Individual Ensure that Medicare Percentage of Medicare Immunization Health care providers Response enrollees are immunized enrollees who received an registry or Health care plans appropriately influenza immunization medical charts State health agencies during the previous year; Local health agencies percentage who have ever Community organizations received a pneumococcal Special health risk groups pneumonia immunization General public Ensure that children are Immunization rate for children immunized appropriately at 24 months of age Social Ensure that populations Immunization rate at 24 Immunization Health care providers Environment with special health risks months of age for children registry or State health agencies are immunized currently enrolled in medical charts Local health agencies Medicaid Special health risk groups IMPROVING HEALTH IN THE COMMUNITY
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Reduce financial barriers Among children with Employers, insurance Health care plans to immunization commercial health licensing authority Local government insurance, percentage Business, industry with full coverage General public for immunization Provide leadership for Existence in the community Health care providers immunization efforts of an active childhood Health care plans MEASUREMENT TOOLS immunization coalition State health agencies Local health agencies Local government Business, industry Education agencies and institutions Community organizations Special health risk groups General public Health Care Ensure that the health Immunization rate for Immunization Health care providers care system is organized children at 24 months registry or Health care plans to provide high of age medical charts State health agencies immunization rates Local health agencies Business and industry Community organizations Special health risk groups General public Immunization rate at 24 Immunization Health care providers months of age for registry or Health care plans children currently medical charts Business and industry enrolled in managed General public care organizations 151 continued on next page
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TABLE 5-3 Continued 152 Field Model Domain Construct Sample Indicators Data Sources Stakeholders Health Care Existence in the Immunization Health care providers (continued) community of a registry, Health care plans computerized immuni- birth records State health agencies zation registry; if Local health agencies available, percentage General public of children in the community included Ensure that Medicare Percentage of Medicare enrollees are immunized enrollees who received an appropriately influenza immunization during the previous year; percentage who have ever received a pneumococcal pneumonia immunization NOTE: See Appendix A.8 for the full discussion of the prototype indicator set for vaccine-preventable diseases.
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Both the broad perspective of a community health profile and the narrower focus of issue-specific indicator sets are needed. To aid communities in assembling and using indicators and indicator sets, the committee has proposed specific indicators for a health profile and has illustrated how communities might develop indicator sets for specific health issues.
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1991. Consensus Set of Health Status Indicators for the General Assessment of Community Health Status -- United States.
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A Telephone Survey Methodology for Local Health Departments' Community Health Status and Risk Factor Assessments Relat ed to Healthy People 2000. DHHS/PHS/CDC Contract #200-94-7064.)
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APPENDIX 5A PROPOSED COMMUNITY HEALTH PROFILE INDICATORS 1. Distribution of the population by age and race or ethnicity.
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Field model domains: individual behavior, social environment, physical environment, prosperity, and well-being. Data sources: decennial census; intercensal data may be available from state or community data systems or estimates.
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Comparisons over time within a community, among population groups within a community, or with other communities may be helpful in gauging the possible relationship between income and health status or other factors. Field model domains: individual behavior, social environment, physical environment, prosperity, health care, and health and function.
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Single-parent families may experience many economic and social stresses that affect the health status of adults and children. Field model domains: individual behavior, social environment, physical environment, prosperity, health care, and well-being.
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At the community level, the number of deaths for any specific cause will be small, and data will need to be aggregated for multiple years to produce stable rates. Field model domains: disease, genetics, individual behavior, social environment, physical environment, health care, and prosperity.
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. Field model domains: disease, individual behavior, social environment, physical environment, health care, and well-being.
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Field model domains: disease, individual behavior, social environment, physical environment, prosperity, health care, and health and function. Data sources: community surveys (e.g., oversampling
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Field model domains: disease, individual behavior, social environment, physical environment, and well-being. Data sources: state environmental quality agency.
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Because data do not exist on the total health care costs for most communities, the per capita health care spending for Medicare beneficiaries serves as a proxy for the community's total health care costs. Field model domains: health care and prosperity.
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Field model domains: individual behavior, social environment, physical environment, prosperity, health care, health and function, and well-being. Data sources: community survey; questions related to quality of life have been developed for the BRFSS.
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