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Introduction and Framework (from Chapter 1)
Pages 5-10

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From page 5...
... The report does not attempt to review all of the program options and policies to be considered in structuring PPG agreements between DHHS and states: such issues as funding levels, matching requirements, holdharmless funding provisions, allocation of resources decisions, financial incentives, and the like are not covered. The panel's goal is to provide technically sound methods for assessing progress in meeting public health objectives and to provide states and others with practical and useful tools to advance their public health objectives.
From page 6...
... 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.
From page 7...
... 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.1 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. Outcomes are fundamental, and any process or capacity measure used to assess performance should be widely accepted as closely related to them.
From page 8...
... 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,
From page 9...
... 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.
From page 10...
... The panel recommends that DHHS and the states consider negotiating some items in their performance agreements that allow for longer term goals if relevant risk behaviors and process data can be used to measure progress toward the desired health outcomes. REFERENCES Institute of Medicine 1988 The Future of Public Health.

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