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adequate for overall program assessment. In addition, it is important that performance measures be valid and reflect the quality and health impact of services. For example, it can be expected that reported STD rates will rise with expansion of screening efforts. Potential areas for which STD clinical practice performance measures should be developed include:
patient reports regarding care;
access, availability, and utilization of services;
cost and affordability of services;
time interval between seeking of care and examination, time interval between initial examination and treatment, and percentage of diagnosed persons treated;
incidence of reinfections or persistent infections; and
appropriateness of clinician diagnosis, treatment, and counseling; knowledge and compliance with treatment protocols; compliance with precautions and management of adverse reactions; and disease reporting.
The automated information systems of many managed care organizations and other health plans are a valuable source of data on patient encounters, disease diagnoses, and clinical outcomes. The Health Plan Employer Data Information Set (HEDIS), in particular, and other health services performance measures will be particularly valuable as new indicators related to preventive and public health services are developed and implemented. These data represent an excellent opportunity to conduct outcomes research and evaluate the effectiveness of interventions. Not all managed care organizations, however, are currently using such performance monitoring tools; STD-related data from other health plans will also need to be captured.
STD-related information systems should be developed and planned in the context of, and be consistent with, broader information system development initiatives to monitor a range of community health issues (IOM, 1997). Information systems should take into account evolving disease prevention management requirements and opportunities; promote and support cost containment and efficient resource allocation; optimally utilize current and evolving technology; and consider the analytic capacity necessary to maximize available information.
Therefore, the committee makes the following recommendations:
Federal, state, and local STD programs should encourage and provide technical assistance to employers and other purchasers of health care (including Medicaid programs), managed care organizations and other health plans, and other health care professionals to develop and utilize information systems that effectively integrate preventive services performance data with community health status indicators and STD program data. STD-related information systems should support assessment and evaluation of anticipated