Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health (1997) / Chapter Skim
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1: INTRODUCTION AND FRAMEWORK
1: INTRODUCTION AND FRAMEWORK
Pages 5-12
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From page 5... ...
, the panel is assessing the state of the art for performance measures for public health programs. The goal is to recommend a set of measures for use by local, state, and federal officials to assist in evaluating progress toward public health goals.
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As a result, some administrators of health programs at the federal, state, and local levels are concerned that the implementation process for the GPRA may become dominated by concerns of fiscal management unless good public health measures are available to evaluate program effectiveness. As articulated by DHHS, the PPG concept envisions that DHHS, in consultation with states, public health professionals, private organizations, public agencies, and citizens, will develop a broad menu of performance measures that can be used in one or more of the following ten areas: chronic diseases; sexually transmitted diseases (STDs)
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The panel's framework for assessing potential performance measures is simple: a public health program operating at the state level, with a certain size and structure (capacity) , uses the resources provided by a federal funding program (process)
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The ten specific areas that the panel was asked by DHHS to examine with regard to performance measures are a subset of the full range of public health concerns. Many critical responsibilities of state and local public health agencies, such as maternal and child health, injury prevention, and environmental health, are not covered in this report, but the guidelines for assessing performance measures presented here can be applied to these other areas.
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In some cases, actual health outcomes are impractical to measure as indicators of program performance because too much time is required between intervention and outcome or because many confounding factors affect the ultimate health outcome. In such cases, the panel recommends using an "intermediate" measure, risk status, for which there is general consensus that the result being measured is related to the health outcome.~ Meaningful analysis of performance requires determining whether desired health outcomes are achieved, whether specific agency commitments are carried out, and whether the agency has the capacity to conduct all the necessary processes.
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The panel notes, in fact, that DHHS supported a major study of public health infrastructure, which is expected to provide infrastructure capacity measures for use in the PPG process (Lewin-VHI, Inc., 1997~. ASSESSMENT GUIDELINES In considering how to assess the appropriateness of individual measures for tracking the performance of state public health agencies under the PPG process, the panel reviewed materials developed by DHHS, state partners, and other professional groups (see Annotated Bibliography)
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From page 11... ...
For example, a state's infant mortality rate is usually considered a valid measure in assessing the actual change in a state's rate of infant death from one period to another, but changes in that rate may not be a valid measure of the performance of an individual public health agency: the agency may have no control over many factors that can affect infant mortality, such as changing socioeconomic conditions or the demographic characteristics of the population. Performance measures must also be reliable: have a high likelihood of yielding the same results on repeated trials and, therefore, low levels of random error in measurement.
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From page 12... ...
Yet many important public health objectives, such as lowered incidence of cancer and HIV infection, cannot be achieved over this short time period. However, it would be unwise to divert resources from those objectives simply because demonstrable results cannot be expected in the 5-year period.
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