Presentation on theme: "Measuring Performance of Public Health Systems"— Presentation transcript:
1 Measuring Performance of Public Health Systems Louis Rowitz, PhDDirectorMid-America Regional Public Health Leadership InstituteProfessor University of Illinois at ChicagoSchool of Public Health
2 Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System PerformancePUBLICHEALTHSYSTEMStructural CapacityInformation ResourcesOrganizational ResourcesPhysical ResourcesHuman ResourcesFiscal ResourcesMACROCONTEXTPHS Missionand PurposePhilosophyGoals“Core Functions”OutcomesEffectivenessEfficiencyEquityProcessesThe 10 EssentialPublic Health Services
3 Public Health Infrastructure Public Health ResponseBioterrorismEmerging InfectionsOther Public Hlth ProgramsSurveillanceLaboratoryPracticeEpidemicInvestigationsWorkforceInformationSystemsOrganizationalCapacityEssential Scientific CapabilitiesBasicInfrastructure
4 National Public Health Performance Standards Program: What It Is A partnership effort with national and state public health organizations to improve the public health delivery system through...The development of local and state based performance standards;The systematic collection and analysis of performance based data;A national leadership effort to improve system wide performance.
5 National Partners American Public Health Association Association of State and Territorial Health OfficialsNational Association of County and City Health OfficialsNational Association of Local Boards of HealthPublic Health Foundation
6 National Public Health Performance Standards Program Goals Improve QualityIncrease AccountabilityIncrease Science-Base for Public Health Practice
8 Structure of Assessment Tools Essential Public Health ServiceIndicatorModel Community StandardQuestions
9 Example From Local Tool Essential Service # 1: Monitor health status to identify community health problemsIndicator: Population-based Community Health ProfileModel Community Standard : The LPHS conducts regular community health assessments to monitor progress towards health related objectives. The information gathered from assessment activities are compiled into a community health profile….Etc.
10 Example From Local Tool (cont) 1.1.1 Has the LPHS conducted a community health assessment?If so:Is the community health assessment updated at regular intervals?Are data from the assessment compared to data from other representative areas or populations?Does the LPHS use data from community health assessments to monitor progress towards health-related objectives?
11 Structure of State and Local Tool 10 EPHS33 Indicators121 1st Tier Questions66 Likert ScaleState Tool10 EPHS50 Indicators200 1st Tier Questions100 Likert Scale
12 Focus of Field Testing Instrument Clarity Question Analysis Validity and Reliability of DataTime BurdenProcess of Implementation
14 Field Testing Assessment Tools National Public Health Performance Standards ProgramField Testing Assessment ToolsStateLocalGovernanceTexasNo61FloridaYes67Ohio11Missouri50Minnesota47Mississippi81Yes (state-level only)Hawaii8Other---Yes (7)
15 Scoring Three responses – Yes (1), Partial(.5), No(0) Indicators within each essential public health service are weighted equallyEssential public health services weighted equallyOverall score is percent of yes/partial responses
16 Percent Capacity of State Public Health Systems to Provide Essential Public Health Services State AState BState CMonitor Health Status467832Diagnose and Investigate9088Inform, Educate and Empower5136Mobilize Community Partnerships333522Develop Policies and Plans4564Enforce Laws and Regulations7241Link People to Needed Services68Assure Competent workforce342910Evaluate Effectiveness71Research655026State Average5340
17 Percent Capacity of Local Public Health Systems to Provide Essential Public Health Services State AState BState CMonitor Health Status423844Diagnose and Investigate618066Inform, Educate and Empower837565Mobilize Community Partnerships63Develop Policies and Plans504543Enforce Laws and Regulations686947Link People to Needed Services645458Assure Competent workforce4660Evaluate Effectiveness36Research5351State Average5952
19 Structure of Performance Measurement Tool and Relation to Validity Measures Are we measuring public health performance?Do these describe all public health activities involved in the EPHS?Essential Public Health ServicesHow well do these measure (or describe) what public health does?Indicator (s)Do these adequately measure performance in each EPHS?Model Standard(s)Are these the right indicators/ standards?Are these achievable?Specific Questions Measuring Attainment of Indicator/ StandardDo these contain key elements of good public health practice?
20 Individual Jurisdiction Analysis Overall average score (0 – 100%)Average score for each EPHS (0 – 100%)Score for each indicator (0 – 100%)Assessment of standardsFully metSubstantially metPartially metNot met
21 Potential Summary and Comparative Analyses Comparison of state scoresComparison of local jurisdiction with statesComparison with peer jurisdictionComparison of average local jurisdictions across statesComparison of average local jurisdiction across states by EPHSCorrelation of scores with morbidity/ mortality outcomes, socioeconomic and other variables
22 Timeline 1998 1999 2000 2001 February - Performance Measures Workgroup April- Texas pilotOctober/November - Florida, Missouri, and Ohio pilot2000July - OMB clearance for field testing local and governance toolJuly - Hawaii field testAugust - Performance Standards Scientific Consultation GroupAugust-October - Minnesota and Mississippi field test2001January/February - Final changes made to final draftMarch-August - OMB clearance for final draftFall - National implementation
23 ISSUES Performance Measurement vs Capacity Assessment Surveillance vs Quality ImprovementAccreditation of Local Public Health AgenciesModulesLinkage to CHSI Project (HRSA, PHF)Local Health Department Registry
24 Research Questions What “Performance” are we measuring? What factors determine a good performer?Do good performers have better community health outcomes?What are good measures to use in a surveillance system?
25 Accessing Web-based Survey Close instructions and Begin SurveySurvey Number 660; Password – Local5bUser ID PXS13; Password SCGHave fun!