Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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1 Introduction
1 Introduction
Pages 23-39
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Committee on Using Performance Monitoring to Improve Community Health outlines the elements of an ongoing and evolving health improvement process, discusses the role that performance monitoring can play, and offers tools to help communities develop and use performance indicators. In its proposals and recommendations, the committee is responding to the need it sees to introduce a conceptual framework for using performance monitoring concepts to improve community health as a whole -- as opposed to monitoring performance within specific community entities.
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A BROADER UNDERSTANDING OF HEALTH Contributing to the interest in health improvement and performance monitoring is a wider recognition that health embraces well-being as well as the absence of illness. For both individuals and populations, health depends not only on health care but also on other factors including individual behavior, genetic makeup, exposure to health threats, and social and economic conditions.
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Entities such as state health departments, federal agencies, managed care organizations, and national corporations have a broader scope than a single community but often have an important role at the local level. As communities respond to the multiple factors involved in various health issues, all parties will have to sort out their roles and responsibilities.
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These confounding influences must be taken into account in developing and implementing health improvement efforts based on accountable performance. GROWING INTEREST IN PERFORMANCE MONITORING Performance monitoring has gained increasing attention as a tool for managing processes and improving their outcomes.
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. HEDIS is a defined set of performance measures used by employers and managed care organizations to compare health plans on the basis of quality, access and patient satisfaction, delivery of preventive services, membership and utilization, financing, and descriptive management information.
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outlines 22 categories of measurable health objectives in health status, risk reduction, and services and protection, including both process and outcome measures. Many state and local health departments have adapted the national objectives to their own circumstances.
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. In general, however, health status assessments have provided baseline information about community health needs but have not explicitly addressed the performance of specific entities in the community, which raises different measurement and community action issues.
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The second cycle -- an analysis and implementation cycle -- is a series of processes to devise, implement, and evaluate the impact of health improvement strategies for priority health issues. More than one analysis and implementation cycle may be operating at the same time if a community is responding to multiple health issues.
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INTRODUCTION 31 Form Community Prepare and Analyze Health Coalition Community Health Profiles Problem Identification and Prioritization Cycle Identify Critical Health Issues Health Issue Health Issue Health Issue Analyze Health Issue Monitor Process Inventory Resources and Outcomes Analysis and Implementation Implement Cycle Develop Health Strategy Improvement Strategy Develop Identify Indicator Set Accountability FIGURE 1-1 The community health improvement process (CHIP)
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In the context of the committee's broad definition of health, appropriate indicators can be diverse. Selecting indicators requires careful consideration of how to gain insight into progress achieved in the health improvement process.
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Even when tools for health indicator development and implementation exist, communities may not have the necessary resources and circumstances for creating an operational health improvement process. As envisioned by the committee, a community-based performance monitoring program will require an enhanced information infrastructure that can support monitoring diverse phenomena in the many sectors that contribute to the health of populations, including clinical care, environmental services, individual and public education, community social services, and public policy that promotes behavioral change.
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The implications of the current social, scientific, and policy climate for community health improvement efforts and the further development of health-related performance monitoring are also a consideration. For example, some question whether meaningful responsibility and accountability for community health can be established across a range of largely autonomous entities, none of which controls all of the elements that may be critical to success (Nerenz, 1996)
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Practical matters of budget and timing will also influence the way in which communities choose health priorities and performance indicators. The committee presents specific recommendations intended to address essential elements of what needs to be done to support effective performance monitoring and its integration into a community health improvement process.
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• Trust and equity: By documenting actions and outcomes, performance monitoring can support increased public trust that "the system" is working. It can also, as part of a broader health improvement process, guide community actions toward minimizing major discrepancies in health status among subpopulations to promote greater equity in health throughout the community.
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Chapter 5 presents the committee's proposal for a community health profile and discusses issues in selecting performance indicators to be used in addressing specific health issues. Presented in Appendix A are prototype sets of issue-specific indicators developed by the committee to illustrate how communities might apply the concepts outlined in this report.
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1996. Community-wide Health Improvement: Les sons from the IHI-GOAL/QPC Learning Cooperative.
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1994. Analyzing Organizational Practices in Local Health Departments.
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