Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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B Methodological Issues in Developing Community Health Profiles and Performance Indicator Sets Michael A. Stoto
B Methodological Issues in Developing Community Health Profiles and Performance Indicator Sets Michael A. Stoto
Pages 360-373
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From page 360... ...
by which communities can use health profiles and performance measures to marshal the forces in their communities to improve the health of populations. Because of this focus, much of the committee's attention to the development of community health profiles and performance indicator sets has been focused on content issues.
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For example, Healthy People 2000 Objective 7.17 calls for local jurisdictions to have "coordinated, comprehensive violence prevention programs." Although a long list of attributes of coordinated and comprehensive programs is given in the text, no operational definition is provided by which to judge whether a particular jurisdiction's program is coordinated and comprehensive. It would be better to identify a small number of performance indicators connecting accountable entities to specific actions, as illustrated in the committee's prototype violence indicator set (Appendix A)
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The specific grouping of diagnostic codes used to define coronary heart disease is not, however, routinely available in vital statistics reports. In many communities, it might be more appropriate to measure progress in terms of readily available cardiovascular mortality rates, while bearing in mind that reduction beyond a certain point is unlikely.
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, whereas the second focuses on the individual. INTERPRETATION OF SURVEY DATA Population-based health interview surveys provide many of the health status measures that are used in Healthy People 2000 and are potentially available for performance measures.
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Consider, for example, Healthy People 2000 Objective 5.8: • Increase to at least 85 percent the proportion of people aged 10 through 18 who have discussed human sexuality, including values surrounding sexuality, with their parents and/or have received information through another parentally endorsed source, such as youth, school, or religious programs. Although survey data could provide information on aspects of this objective, specific questions would have to be designed to assess the proportion of adolescents that meet the specific criteria implied.
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have estimated the possible reduction in mortality rates that can be expected with the elimination of the most important risk factors for chronic disease. Mathematical models that relate health outcomes to specific interventions for many specific diseases and health behaviors can also be helpful in setting benchmarks.
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DATA FOR LOCAL AREAS If performance monitoring is to achieve its potential for community health improvement, communities of all sizes -- states, counties, municipalities, and other groups such as a company's employees and their families -- must adopt their own objectives and measure progress toward them. Counties, cities, and smaller communities, however, often find that local-level data are unavailable or of poorer quality than national data.
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The administrative data cited in the prototype indicator sets include records from managed care organizations and other health care delivery systems. Administrative records from a variety of public and private organizations (e.g., local welfare agencies and private employers)
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With regard to the first of these two objectives, one is likely to find that data on the percentage of health plan members who have had their cholesterol checked is available only from managed care organizations, and probably only from those with good cholesterol screening programs. Thus, the data likely would be biased upward.
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Communities differ in the age, race, and sex composition of their population, so communities with the same age-, race-, and sex-specific death rates will have different crude death rates, both overall and cause specific. In setting benchmarks for performance measures, communities should look at the national target set in Healthy People 2000 or some other source, as well as current rates of other communities.
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population as a standard, primarily because it would be consistent with the long-term practice of the National Center for Health Statistics and others in reporting mortality rates (Curtin, 1992)
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have found, however, that synthetic estimates did not agree with estimates obtained through a community health survey in the same small area. "Regression estimation" uses information from a sample of small areas with complete data on a continuous outcome variable -- the maternal mortality rate, for example -- and other generally available predictor variables to estimate a regression equation and then uses these results to calculate predicted values of the maternal mortality rate in other communities for which the predictor variables are available.
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1993. Bayesian Predictive Inference for Small Areas for Binary Variables in the National Health Interview Survey.
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1987. Forecasting Coronary Heart Disease Incidence, Mortality, and Cost: The Coronary Heart Disease Policy Model.
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