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3: POTENTIAL PPG MEASURES FOR 1997-2002
Pages 18-46

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From page 18...
... . Many of the performance measures discussed below can and should be used {As defined in this report, health outcome measures for performance partnership grants include health status, social functioning, and consumer satisfaction.
From page 19...
... First, data sets to generate comparable statelevel estimates exist for only a few health outcome measures; for the most part, data are not comparable across states. Second, as noted above, there are many reasonable process and capacity measures that states could adopt for PPG pur
From page 20...
... that are smoke free (or have limited smoking to separately ventilated areas) Proportion of elementary, junior high, and high schools with age-appropriate smoking prevention activities and comprehensive curricula Proportion of current tobacco smokers visiting a health care provider during the past 12 months who received advice to quit Proportion of managed care organizations (or schools or obstetric and gynecological service providers)
From page 21...
... CHRONIC DISEASES Prevention of chronic disease morbidity and mortality is the primary goal of many health programs, and the outcomes of these programs must be monitored. For the most part, however, chronic disease incidence and mortality data are not useful for PPG health outcome measures because the expected time period between most prevention activities and the effect of those activities on disease incidence or mortality greatly exceeds the 3-5 years of the performance grant concept.
From page 22...
... Screening for complications of diabetes was one exception: the panel included it because of the body of evidence showing the effectiveness of such screening, the existence of a large federal diabetes program, and the similarity in barriers and strategies for implementing these services and common general clinical preventive services. Potential Risk Status Measures Risk status measures represent intermediate health outcomes (see In.
From page 23...
... who do not engage in physical activity or exercise Screenings and Tests Hypertension Cholesterol Breast Cancer Colon Cancer Percentage of persons aged 18 and older who had their blood pressure checked within past 2 years5 Percentage of women aged 45 and older and men aged 35 and older who had their cholesterol checked within past 5 years6 Percentage of women aged 50 and older who received a mammogram within past 2 years7 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 years8 2The 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 3see In.
From page 24...
... 24 ASSESSMENT OF PERFORMANCE MEASURES IN PUBLIC HEALTH Cervical Cancer Diabetes HbAlC Foot exam Eye exam Percentage of women aged 18 and older who received a Pap smear within past 3 years9 Percentage of persons with diabetes who had HbAlC checked within past 12 monthsi° Percentage of persons with diabetes who had a health professional examine their feet at least once within past 12 monthsii Percentage of persons with diabetes who received a dilated eye exam within past 12 monthsi2 Examples of Process Measures Nutrition Program Strategy: Enable children to learn healthy dietary habits Process Measure: Percentage of schools with menus that meet dietary guidelines for fat content and five or more servings of fruits and vegetables dailyi3 Physical Activity Program Strategy: Increase opportunities for sedentary working adults to exercise Process Measure: Percentage of worksites with worksite wellness programs that include physical exercise Smoking Program Strategy: See Table 3-1 Screening Program Strategy: Educating patients regarding need for and appropriate timing of screening tests Process Measure: Percentage of persons with diabetes receiving diabetes health education 9see In.
From page 25...
... , hospital discharge data, Medicaid and Medicare encounter information and other relevant local data sets) that are established and maintained Percentage of local health departments receiving technical assistance and training Percentage of labs that meet quality standards Planning Percentage of population served by systematic community planning process, with leadership provided by the official health agency and participation of all relevant groups (e.g., consumers, providers, advocators)
From page 26...
... infections and tuberculosis, namely, the reduction of the suffering, complications, and loss of life that these infections cause. HIV infection, tuberculosis, and many of the STDs have a natural history that resembles noninfectious chronic diseases.
From page 27...
... Potential health outcome indicators include those that attempt to measure incidence or monitor prevalence in a defined population. Indicators that attempt to measure important risk factors closely linked to disease incidence or prevalence, such as sexual behaviors, drug and alcohol use, or behaviors related to seeking medical treatment, are candidates for related outcome indicators.
From page 28...
... Again, special surveys of client satisfaction will have to be conducted of these populations for states interested in using this outcome measure. Just as reduction in the prevalence of tobacco use is a valuable risk-related outcome indicator of prevention progress against lung cancer and heart disease, changes in sexual behavior, alcohol use, and condom use particularly among core transmitters provide potentially valuable risk-related outcome measures for STDs and HIV infection.
From page 29...
... In summary, there are three types of health outcome related measures available to states for performance agreements with DHHS in the areas of STDs, HIV infection, and tuberculosis: health status indicators (disease incidence and prevalence rates) , consumer satisfaction, and risk status indicators (including completion of treatment)
From page 30...
... 1~. 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 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 i7see In.
From page 31...
... . Currently, these groups are poorly defined, disaffiliated, and difficult to reach, but there is broad consensus on the desired primary health outcome measures for these diseases (i.e., reductions of the incidence rates)
From page 32...
... The development of process measures in the public mental health field has been hampered by a lack of consensus on practice standards; although some states and private providers have developed standards, there is little agreement on them. Furthermore, there are limited research findings that establish a connection between individual process activities and mental health outcomes.
From page 33...
... These measures are consistent with the values associated with recovery. Potential Health Status Outcome Measure Percentage of persons aged 18 and older receiving mental health services who experience reduced psychological distress Potential Social Functioning Outcome Measures 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)
From page 34...
... Nevertheless, the panel believes that these population-based mental health outcome measures when combined with related process and capacity measures that are under the direct control of these agencies can provide useful insights regarding state progress in meeting important mental health goals. Over the long run (5-10 years)
From page 35...
... Although vaccination rates are risk reduction measures, the validity of their relationship to target health status outcomes is direct, proven, and universally accepted as a valid and reliable intermediate outcome measure. Indeed, given the episodic and unpredictable nature of outbreaks of vaccine-preventable diseases, a strong argument can be made that vaccination rates are a better measure of program performance than are direct measures of disease incidence.
From page 36...
... . Age-appropriate vaccination rates for target age groups for each major vacc~ne group: children aged 2 years; children entering school at approximately 5 years of age mumps, measles, and rubella diphtheri a-tetanu s -pertu s si s polio hemophilus influenza B hepatitis B varicella adults aged 65 years and older diphtheria-tetanus hepatitis B influenza pneumococcal pneumonia Examples of Process Measures Program Strategy: improve access to immunization services Process Measure: Percentage of population who do not cite financial resources as a barrier to immunization Program Strategy: Increase parent education and awareness Process Measure: Percentage of parents with children under 18 who believe that the benefits of immunization outweigh the risks Process Measure: Percentage of parents with children under 18 who report receiving immunization reminders from their immunization providers For immunization, program capacity is, in effect, one of the core public health functions.
From page 37...
... conducted by the National Immunization Program Office in conjunction with the National Center for Health Statistics appears to meet many of the needs of the PPG program. Other potential sources of data include statewide registries, day care and Head Start programs, school reports, the Medicare statistical system, and for health maintenance organization's (HMOs)
From page 38...
... Given the lack of nationwide data for most of these measures, as well as the variability in how states use their federal substance abuse block grant funds, some flexibility in the final PPG measures negotiated with each state will be needed. As in the other areas discussed in this report, the panel expects that states will select from among the suggested measures listed below, to the extent that the measures can be supported by their data resources and reflect program priorities.
From page 39...
... Many of the health status and risk reduction measures listed below are not affected, in the short run, solely by the actions taken by a state agency for alcohol and drug abuse. Nevertheless, these substance abuse outcome and risk reduction measures when combined with related process and capacity measures that are under the direct control of the agencies can provide useful insights regarding progress in reducing problems caused by alcohol and drug abuse.
From page 40...
... ~ . Lea services Planning The presence or absence of statewide prevention and treatment needs assessment study completed within last 2 years Percentage of providers that use uniform criteria to assess and match clients to appropriate services There will need to be continued support for data definition and collection efforts at both the state and national level in order for states to report on the 22Although the estimated incidence rate would be a more appropriate measure of state agency performance, the most suitable data source for this measure is the YRBSS, which is a population survey and, therefore, only provides estimates of prevalence.
From page 41...
... It is important to include people at the state and local levels who are most knowledgeable about substance abuse in those decisions. SEXUAL ASSAULT, DISABILITIES, AND EMERGENCY MEDICAL SERVICES The panel was charged by DHHS to propose candidate performance measures in three specific areas of prevention: sexual assault, disabilities, and emergency medical services.
From page 42...
... Potential Health Status Outcome Measure Incidence rate of sexual assault reported by females This outcome measure is very unlikely to be affected solely by actions taken by the state health agency. Nevertheless, this measure when combined with related process and capacity measures that are under the direct control of state health agencies can provide useful insights regarding progress in reducing the incidence of this behavior.
From page 43...
... However, data systems to support these measures are not available in most states. Potential Health Status Outcome Measure Percentage of newborns with neural tube defects Potential Social Functioning Outcome Measure Percentage of persons aged 18-65 with disabilities who are in the workforce Potential Risk Status Measures Risk status measures represent intermediate health outcomes (see In.
From page 44...
... Process Measure: Percentage of high-risk women taking periconceptional folic acid supplementation Program Strategy: Reduce the incidence of elevated blood lead Process Measure: Number of counties with housing regulations designed to reduce lead hazards in low-income housing rentals Process Measure: Percentage of parents living in homes built before 1950 who can cite lead from paint as a potential health hazard to their children Examples of Capacity Measures Resources Percentage of disabled populationts) who have access to and receive special .
From page 45...
... Potential Health Status Outcome Measure Percentage of persons who suffer out-of-hospital cardiac arrest who survive Examples of Process Measures Process Measure: Percentage of trauma patients meeting state, or regional, triage guidelines that are transported to a trauma or burn center designated by the state or regional authority or meeting other nationally recognized criteria Process Measure: Average time from initial call to arrival of the patient at the destination hospital Process Measure: Percentage of emergency medical service systems with medical direction Process Measure: Percentage of inappropriate calls to 911 or the emergency medical services system Process Measure: Percentage of patients who receive appropriate early defibrillation Process Measure: Percentage of the population served by poison control centers 25Indicators related to prevention of injuries were also not included as part of the charge to the panel.
From page 46...
... 46 Examples of Capacity Measures Resources includes: ASSESSMENT OF PERFORMANCE MEASURES IN PUBLIC HEALTH Percentage of the state population with access to a trauma care system that legal authority to designate trauma centers authority to establish triage procedures that allow prehospital personnel to bypass nearer facilities trauma center identification and designation field categorization and triage protocols interhospital transfer agreements linkage to the rehabilitation system system evaluation activities Number of counties with 91 1 or enhanced 91 1 systems Number of counties with injury prevention programs Proficiencies Number of counties with 911 systems that have personnel who are able to communicate with users in their language and in a culturally competent way Planning Number of counties that maintain databases of prehospital care reports Number of counties that support a statewide trauma registry In the second phase of the panel's work, development of valid outcome measures for monitoring EMS system performance will be addressed. The panel recognizes that better systems of collecting prehospital care data with linkage to posthospital outcomes will be necessary.


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