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Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

Index

A

Academic health centers, 384

Access to health care

barriers, 43, 61, 331

community health profile indicators, 159, 161-162

interventions to improve, 430, 434

performance indicators, 362

uninsured persons, 159

Accountability

accreditation and, 81

approaches to, 5, 10, 64-66, 75, 99-100

community role, 64-66

concerns about, 62-64

establishing, 10, 65-66, 99-100, 437

market forces and, 99, 437

performance monitoring and, 5, 10, 29, 30, 86, 100, 146, 185-186, 378

private-sector role, 64-65, 83, 379

public-sector requirements, 64, 99-100, 397

reporting requirements, 64

social change and, 439-442

stakeholder, 3, 25, 42, 146, 437-438

state role, 64, 81

written agreements, 437

Accreditation, 81, 89, 109, 397

Accountable entities. See Stakeholders

Adolescents

births to, 161

interventions for, 54, 425-426, 433

smoking/tobacco use, 53, 141, 143, 300-307, 309

violence, 345-350, 353, 377

Advisory Committee on Immunization Practices, 279, 294, 437

Agency for Health Care Policy and Research, 394

Aid to Families with Dependent Children, 285, 292

AIDS, 160-161

Air quality, 138, 163

Alberta, Canada, 440-442

Alcohol and drug control programs, 46, 47, 431-432

Ambulatory care sensitive conditions, 266, 271, 362

American Academy of Family Physicians, 246

American Academy of Pediatrics, 246, 289

American Association of Retired Persons, 237

American Cancer Society, 196

American Hospital Association, 71-72, 269, 271

American Managed Behavioral Healthcare Association, 27, 86

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

American Medical Association, 246, 269, 271

American Osteopathic Association, 269

American Public Health Association, 406

Analysis and implementation cycle. See Community health improvement process

Area Agency on Aging, 231, 235, 237

Arizona Partnership for Infant immunization (TAPII), 433-434, 435, 437

Assessment

of community health improvement process, 17-18, 105-106, 175-176

of community health needs, 4, 28, 84-85, 89-93, 389-392, 428-430, 443-444;

see also Community health profile

definition, 109, 418 n.3

function of public health departments, 28, 44, 89, 91, 108-109, 173 , 379-380

of interventions, 103-106;

see also Performance monitoring

public health practice, 4, 28, 379-382

quality of care, 82

Assessment Initiative, 135

Assessment Protocol for Excellence in Public Health (APEXPH)

analysis of health issues and resources, 95-97

approach, 84

capacity assessment, 113

environmental health addendum, 387

performance monitoring applications, 28, 142, 380, 381, 387, 406-407, 437

priority-setting with, 93

users, 85, 98, 381, 396, 428-429

workbook, 396-397, 406-407

Assurance

definition, 109, 418 n.3

function of public health departments, 44, 89, 99-100, 109

B

Behavior

adherence to treatment, 52

genetic influence, 52, 423

health status and, 8, 52, 56, 420, 423

individual, 158-163, 165, 264-265, 274

Behavior, as field model domain

breast and cervical cancer, 194-195, 203

community health profile indicators, 156-163, 165

depression, 212-214

infant health, 280-283

prototype performance indicators, 150, 194-195, 265-266, 274, 280-283, 303-304, 321, 327-330, 342, 348-350, 358

tobacco and health, 303-304

vaccine-preventable diseases, 327-330, 342

violence, 348-350, 358

Behavioral change

individual, 47

triggers for, 440

Behavioral Risk Factor Surveillance System (BRFSS), 131, 135-137, 139, 159, 162-165, 197, 198, 208, 209, 213, 216, 220, 235, 267, 270 , 293, 366

Births, to adolescents, 161

Block grants, reporting requirements, 29, 81, 86, 101, 138, 147, 175, 375, 393

Blueprint for a Healthy Community, 108, 111, 397

Breast and cervical cancer, prototype performance indicators

behavior, 194-195, 203

community health profile indicators, 160

data sources, 202-204

disease, 191-193, 202-203

genetic endowment, 194-195, 203

health care and, 191-193, 202-203

overview, 189-191

sample indicator set, 196-200, 202-204

social environment, 195-196, 204

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

C

Calhoun County Health Improvement Program, 434-435

California, 46, 85, 176, 431-432

California Wellness Foundation Health Improvement Initiative, 378

Canada, 49, 138, 144 n.2, 440-442

Canadian Task Force on the Periodic Health Examination, 246

Cancer, 51, 97, 144, 160, 423;

see also Breast and cervical cancer

Cardiovascular diseases

mortality, 160

risk reduction, 52, 104-105, 107, 430, 442

Catholic Health Association, 72, 83

Center for Public Health Practice, 384

Center for Substance Abuse Prevention, 71

Center for the Advancement of Health, 378, 379

Centers for Disease Control and Prevention (CDC), 97, 105, 131, 158 , 159, 161, 176, 246, 247, 366, 380, 394, 407, 433

Cervical cancer. See Breast and cervical cancer

Change. See Social change

Children's health.

See also Infant health

abuse and neglect, 161, 283, 349-351

community health profile indicators, 158, 159-160, 161-162

data sources on, 136-137

family structure and, 50, 421

immunization, 80, 95, 96, 97, 116, 161-162, 324-325, 385, 425, 430 , 433-434, 437

lead poisoning, 242-244

monitoring, 85

socioeconomic status and, 158, 425

Civic Index, 96-97

Civic infrastructure, 109, 113

Clinic Assessment Software Application (CASA), 433

Clinical performance measures, 101 n.2, 375, 394

Clinical practice guidelines, 82, 145

Coalitions and coalition building

data collection and analysis, 91, 92-93

definition of, 70-71, 87

formation of, 87-89, 442

incentives to participate, 89, 391-392

inclusiveness, 14, 88, 171

leadership, 87-88

meetings, 94

organizational structure, 88

participants, 88-89;

see also Stakeholders

research on, 71-72

resource consumption by, 443-444

roles, 14-15, 75, 87-88, 91, 93, 110, 172, 445

Columbia Presbyterian Medical Center, 377

Columbia University, 377

Communicable diseases, 160, 430

Community

capacities, 34, 108-109

definition, 24-25, 59-60, 139

empowerment, 111

health centers, 44

outside influences on, 25-26

Community benefit, 83, 86, 89, 175, 385

Community Care Network, 71-72, 105

Community health improvement process (CHIP).

See also Community health profile;

Interventions to improve health;

Performance monitoring

accountability approaches, 5, 10, 99-100

administrative skills and resources, 112

analysis and implementation cycle, 5-11, 30-31, 32, 78-79, 95-103, 140-141, 167-168, 183

analysis of health issues, 8, 95-96

assessment of, 5, 17-18, 103-106, 117-118, 175-176

authority to act, 111

capacity building for, 106, 108-117

coalition building, 87-89

community empowerment, 111

components, 78-80

consumer role, 88

data collection and analysis, 30, 80-81, 89, 91-93, 102-103, 135-140, 153, 173-174

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

evolutionary nature of, 5, 30, 80-81

expertise and skills, 96, 111-112, 153

federal role, 18-19, 81-82, 115, 139, 172-173, 174, 176-177

field model and, 11-12, 78, 86-87, 96, 116-117, 141-142, 166-167, 169

funding, 81, 85, 96-97, 102, 112

implementation resources, 90, 112

information systems, 112

leadership, 80, 87-89, 110-111

learning from, 103-106

motivation for participation, 36, 62, 83, 128, 385

operationalizing, 167-172

origins, 81-86

performance indicator development, 100-101, 169-170

performance monitoring, 102-104, 167

priority-setting, 93-95, 102, 111, 391

private-sector role, 83, 87, 89, 103, 173-174, 379, 384-386

problem identification and prioritization cycle, 5-7, 30-31, 78-79, 87-95, 126, 140, 167-168, 183

professional training, 116-117, 177-178

public health sector roles, 80, 84-85, 89, 91, 108-109, 173-174

resources for, 9, 35-36, 96-97

selecting indicators;

see Community health profile indicators;

Performance indicators

state role, 15-17, 18-19, 80, 81, 91-92, 173-175, 176-177

tools, 114-116, 176-177, 375

Community health profile

comparisons based on, 128

definition, 127

further development of, 137-140

privacy and confidentiality issues, 128

proposed indicators, 129-130, 156-165

role for, 7, 32, 91, 126-129, 140

size of community and, 139-140

updating, 128-129, 139

Community health profile indicators

access to health care, 127, 157, 161-162

and CDC consensus indicators, 130-131, 137, 138, 158, 159-161, 221

for children, 158-159, 161-162

communicable diseases, 160-161, 162

data sources, 127, 131-137

death rates, by leading causes, 160

demographic composition of population, 156-157

economic prosperity, 158-159

education, 157, 158

environmental quality, 163

family structure, 159

field model domains, 131-134, 138, 156-165

functional status, 9, 130, 134, 164

health resource use, 9, 127, 130, 134, 164

health risk factors, 9, 126-127, 130, 133, 161-163

health status, 8, 73, 85, 126, 127, 129, 133, 159-161, 164

immunization, 127, 161-162

infant mortality, 159-160

obesity, 163

as performance indicators, 128-129, 221

quality of life, 9, 127, 130, 131, 134, 135, 165

rate calculations, 137

selection of, 130-135, 138

smoking, 162-163

sociodemographic characteristics, 8, 126, 127, 129, 132, 156-159

standard measures, development of, 18-19, 27, 128, 176-177

unemployment rate, 159

uninsured persons, 159

uses, 7, 91, 93, 127-128, 139

Community Intervention Trial for Smoking Cessation, 85, 176

Community Mental Health Services Block Grant program, 81

Community-oriented primary care, 83

Community-wide Health Improvement Learning Collaborative, 106, 107

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

Competition, and performance monitoring, 437, 443

Comprehensive health planning, 82

Confidentiality. See Privacy and confidentiality issues

Conflict theory, 439

Consumer Assessment of Health Plans Study, 394

Consumer satisfaction, 115

Continuous quality improvement. See Quality improvement

Core functions. See Public health agencies/system; specific functions

Coronary heart disease, 52, 85, 104-105, 176, 362, 424

Critical periods in human development, 50, 53, 54, 95, 144, 171, 421-422, 425

D

Data.

See also Behavioral Risk Factor Surveillance System;

Information systems;

Methodological issues;

Youth Risk Behavior Surveillance System

from administrative records, 367-368

availability of and access to, 135-137, 138, 146

breast and cervical cancer, 202-203

collection and analysis, 15-16, 33, 89, 91-93, 103, 116, 135-137, 143-144, 376, 389-390, 395, 397, 400

community health assessment, 377, 389-390

community health improvement process, 80-81, 89, 91-93, 103

for community health profile indicators, 131-137

comparative data/benchmark, 73, 93, 128, 138-139, 265, 268

costs of collection, 143-144, 395

environmental health, 386-387, 390

epidemiological, 93, 436, 443-444

geocoding, 15, 137, 174

immunization, 150-152

performance monitoring, 55, 74, 102-106, 146, 374, 376, 388, 445-446

privacy and confidentiality, 92, 111, 128, 149, 153, 174

private sector, 15-16, 92, 103, 174-175, 397

for prototype performance indicators, 202-204, 227-228, 240-241, 259-261, 274-275, 298-299, 321-323, 342-344, 358-359

and qualitative information, 11, 74, 94, 102-103, 390, 436

sharing, 15-16, 174-175

Demographic composition of population, 156-157

Depression, prototype performance indicators

behavior, 212-214

data sources, 227-228

disease, 207-209, 212, 227

genetic endowment and, 212

health and function, 209-211, 227

health care, 217-219, 228

overview, 205-207

physical environment, 212, 216-217

risk factors, 212

sample indicator set, 220-224, 227-228

social environment and, 212, 214-216, 227-228

stakeholders, 227-228

well-being, 209-211, 227

Determinants of health.

See also Field model of health determinants

biomedical construct, 43, 48, 55-56

conceptual model, 36, 47-48, 82

community-level, 53, 55, 62

critical periods in human development, 50, 53, 54, 95, 144, 421-422, 425

nature of, 42-43

research needs, 56

targeting interventions to, 53-54

Disease, as field model domain

breast and cervical cancer, 187, 191-193, 202-203

community health profile indicators, 158-163

depression, 207-209, 227

elderly people, 230-231, 240

infant health, 278-280, 298

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

lead poisoning, 245-251, 259

prototype performance indicators, 150, 187, 191-193, 202-203, 230-231, 240, 245-251, 259, 278-280, 298, 302-303, 321, 326-327, 342, 347-348, 358

tobacco and, 302-303, 321

vaccine-preventable diseases, 326-327, 342

violence and, 347-348, 358

Disease, individual experience of, 40

Drugs. See Alcohol and drug control programs

Duke Endowment, 71

E

Economic analysis, 93, 97-98

Economic prosperity, as field model domain, 51, 54, 56, 157-165, 187, 231, 234, 241, 288-289, 308-309, 353, 422

Education.

See also Professional training

and health status, 50, 157, 421-422

indicators, 157, 158

maternal, 50, 157, 422

preschool, 50, 421-422

provider, 427, 433-434

Elder health, prototype performance indicators

data sources, 240-241

disease, 230-231, 240

economic prosperity, 231, 234, 241

health care, 230-231, 240

Kaiser Permanente Northern California Region performance measurement

areas, 231, 232-233

overview, 229-230

physical environment, 235, 241

sample indicator set, 235-241

social environment, 231, 234, 241, 424

stakeholders, 240-241

Employee Retirement Income Security Act, 153

End-stage renal disease, 362

England, 50, 421

Environmental health.

See also Lead poisoning;

Physical environment

air quality, 163

community health status indicators, 163

community-level focus, 53

data collection and analysis, 386-387, 390

interventions, 430

measures for, 93, 387, 397

model, 387

performance standards, 387

risk monitoring, 137

toxic substances, 51, 423

water quality, 163

Escondido Health Care and Community Services Project, 46, 47, 431-432, 437

Epidemiological data, use of, 93, 436, 443-444

F

Family structure and resources, 50, 96, 159, 277-278, 377, 421

Federal role, 16, 18-19, 81, 113, 115-116, 172-173, 174, 176-177

Field model of health determinants

and community health improvement process, 78, 82, 86-87, 96, 116-117, 141-142, 169

and community health profile indicators, 131-134, 138, 156-165

community-level factors, 53, 62

domains of model, 3, 24, 47-48, 49-52, 420-424;

see also specific domains (behavior, disease, economic prosperity, genetic endowment, health and function, health care, physical environment, social environment, well-being)

framework, 3, 47-53, 141, 166, 420-421, 425

importance of, 36, 42

interrelatedness of domains, 2-3, 24, 25, 48, 52-53, 56, 59, 420, 423, 424

and performance indicator selection, 100-101, 140, 141-142, 150-152, 183, 184, 187, 191-196, 202-204, 207-219, 227-228, 230-235, 240-241, 244-255, 259-261, 265-269,

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

274-275, 278-291, 298-299, 302-311, 321-323, 326-334, 358-359, 347 -353, 358-359;

see also specific prototype performance indicators (breast and cervical cancer, depression, elder health, health care resource allocation, infant health, lead poisoning, tobacco and health, vaccine-preventable diseases, violence)

Florida, 91

Foundation for Accountability, 27, 65, 86, 147

Functional status

community health profile indicators, 9, 130, 134

Future of Public Health, The, 15-16, 28, 80, 113, 173, 379, 407

G

Genetic endowment, as field model domain, 51-52, 56, 131, 156-157, 160-161, 163, 184, 187, 194-195, 203, 283-284, 305, 327, 359, 423, 424

Genetic influences

on behavior, 52, 423

on health, 51-52, 423, 424

GOAL/QPC, 107

Government Performance and Results Act, 86

Great Britain

Whitehall study of civil servants, 50, 422

Group Health Cooperative of Puget Sound, 83, 89, 375, 384-386

H

Health. See also Determinants of health

as biomedical construct, 41, 43, 48

defining, 2, 24, 40, 41-47, 55-56

multidimensional nature, 42-43, 48-49, 53

Health and function, as field model domain

community health profile indicators, 158, 159, 160-165

depression, 209-211, 227

prototype performance indicators, 209-211, 227, 291, 311, 334, 347 -348, 358

tobacco and health, 311

vaccine-preventable diseases, 334

violence, 347-348, 358

Health Belief Model, 440

Health care

benchmarks, 265, 268-269

biomedical model of health and, 43

competing interests, 61-62

expenditures, 29, 60-61, 164, 262-264

inefficiencies, 262-263

legislation, 61

and life expectancy, 43, 52, 424

lost opportunities, 263

reform, 4, 60-62, 382-383, 388

satisfaction with, 164

Health care, as field model domain

breast and cervical cancer, 191-193, 202-203

community health profile indicators, 158, 159, 160-165

depression, 217-219, 228

elder health, 230-231, 240

infant health, 289-291, 299

lead poisoning, 245-251

prototype performance indicators, 151-152, 187, 191-193, 202-203, 228, 230-231, 240, 245-251, 259, 309-311, 323, 327-330, 332-334, 343-344, 350-351, 359

tobacco and health and, 309-311, 323

vaccine-preventable diseases, 327-330, 332-334, 343-344

violence and, 350-351, 359

Health Care Financing Administration, 164

Health care resource allocation, prototype performance monitors

benchmarked rates, 268-269

data sources, 274-275

individual behavior and, 265-266, 274

overview, 262-264

physical environment and, 266, 274

provision and utilization of services, 267-269, 274-275

public health capacity, 267-268

sample indicator set, 269-271, 274-275

social environment and, 266

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

Health care sector, community health improvement initiatives, 81-83

Health care system

accountability in, 62-63

changing nature, 43-44, 440-442

Health data organizations, 153

Health improvement.

See also Community health improvement process

ecologic/systems theory approach, 47

social and political contexts for, 60-62

Health Insurance Portability and Accountability Act of 1996, 61

Health maintenance organizations. See Managed care organizations

Health Plan Employer Data and Information Set (HEDIS), 27, 33, 86, 101 n.2, 144, 147, 185, 186, 198, 217-218, 222, 264, 266, 290, 294 , 301, 310, 329, 335, 336, 338, 379, 388, 397-398, 406, 433, 437, 442

Health plans

capacity needs of, 108

coverage, 61

performance indicators, 27, 378-379

reporting, 375

Health promotion, 41, 45, 84, 440

Health Resources and Services Administration, 384

Health status

community health profile indicators, 8, 73, 85, 126, 127, 129, 133

self-reported, 164

Healthy Cities/Healthy Communities, 28, 84, 85, 105, 127, 425

Healthy Communities Handbook, 84

Healthy Communities 2000: Model Standards, 28-29, 84, 85, 101 n.2, 147, 185, 380, 396, 406, 407, 437

Healthy People 2000

for comparative data/benchmarks, 73, 93, 128

and indicator development, 85, 101 n.2, 127, 130-131, 138, 147, 185 , 221, 395

methodological and statistical issues, 360-371

objectives, 28-29, 147, 212-213, 243, 244, 251, 267, 276-277, 301, 310, 335, 337, 338, 360-371, 375, 380, 395, 396, 407

objectives, as performance measures, 185, 280, 368, 380, 381, 406, 407, 437

Performance Partnership Grants and, 393

and reporting requirements for block grants, 138

Hill-Burton program, 43

Homeless people, health care for, 157, 385

Homicide, 160, 345-347

Housing conditions, 51, 423

Hungary, 50, 421

I

Illinois

capacity assessment, 114

data systems and sources, 91, 135, 136

health improvement leadership, 80

McHenry County Project for Local Assessment of Need, 97, 98, 428-430

performance monitoring of local health departments, 81, 381-382

Project Health, 64

Immunization.

See also Vaccine-preventable diseases

analysis of issue, 96, 324-325

coalitions, 339

coverage, 80, 324-325

elderly people, 162

health profile indicators, 127, 161-162

interventions, 97, 385, 425, 430, 433-434

measurement issues, 328

performance indicators, 144, 150-152, 279, 437

recommended doses, 161-162, 290, 324

registries, 116, 137, 149, 162, 334, 339

Income

community health profile indicators, 158

and mortality rates, 51, 422

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

Indicators. See Community health profile indicators; Measures; Performance indicator sets; Performance indicators

Infant health, prototype performance indicators

data sources, 298-299

disease, 278-280, 298

economic prosperity and, 288-289

genetic endowment, 283-284

health and function, 291

health care and, 289-291, 299

individual response, 280-283

overview, 276-278

physical environment and, 287-288, 299

sample indicator set, 291-295, 298-299

social environment and, 287-287, 298-299

stakeholders, 298-299

well-being and, 291

Information Network for Public Health Officials, 116

Information systems. See also Data

capacity, 33, 112, 135

clinical performance measures database, 101 n.2, 394

development of, 80, 115-116

and health profile indicators, 135-137, 139-140

infrastructure, 33

Internet, 91-92, 135

location identifiers, 137, 174

limitations, 33, 419

Medicaid/Medicare databases, 103 n.3

National Information Infrastructure project, 116, 392-393

private sector, 92, 103

public-private partnerships, 388

technical expertise, 112, 153

Injury, 238, 277, 287-288, 423, 430;

see also Violence

Input measures, definition, 426 n.6

Institute for Health Improvement, 107

Interventions to improve health.

See also Community health improvement process;

performance monitoring;

specific programs

barriers to success, 98-99

business role, 427-428

community-level, 53, 425, 434-435

cost-effectiveness, 93, 106

development, 9-10, 97, 99

evidence base for, 32, 78, 80, 97, 104-105, 145, 176, 186, 389, 399 , 425, 442, 443

funding, 430, 431-432, 434, 442

implementation, 10, 101-102

multidisciplinary approach, 2, 24, 42-43, 48, 54-55, 56, 72, 420, 425-426

needs assessment, 428-430

organization/institution role, 72-73, 426-427

performance-monitoring considerations, 144, 426-427

population effects, 4, 54, 425

staffing and resource utilization, 430

studies of, 93-94, 104-105, 176, 425

targets for, 53-54, 80, 85, 420, 425-426

''theory of change" in, 99

time frames, 13-14, 54, 171, 424-425

Iowa, 91

J

Joint Commission on Accreditation of Healthcare Organizations, 27, 101 n.2, 398-399, 406

Joint Council of Governmental Public Health Agencies, 397

K

Kaiser Family Foundation Community Health Promotion Grant Program, 85, 105, 176, 442

L

Lalonde Report, 47

Lead poisoning, prototype performance indicators

adults, 244

children, 242-244

data sources, 259-261

disease and, 245-251, 259

economic prosperity and, 424

health care and, 245-251, 259

physical environment and, 251-254, 259-261

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

sample indicator set, 255-257, 259-261

social environment and, 254-255, 424

stakeholders, 259-261

Life expectancy, 43, 52, 424

M

Managed care organizations.

CDC activities with, 394-395

community health promotion activities, 55, 83, 431-432

"community" served by, 55, 427

growth, 44, 83

information tools, 427

Medicaid beneficiaries, 27, 81, 83, 333

performance monitoring, 26-28, 44, 147

provider education, 427, 433-434

Massachusetts

capacity assessment, 114

Community Health Network Areas, 71, 74, 80, 81, 94, 432-433

MassCHIP data system, 91, 135, 136, 139-140

North Shore Community Health Network Area, 432-433

McHenry County Project for Local Assessment of Need, 97, 98, 428-430

Measures.

See also Community health profile indicators;

Input measures;

Outcome measures;

Performance indicators;

Process measures

clinical performance, 101 n.2, 375, 394

of community health, 93, 130, 138-139

community-level, 139

development of, 65, 115, 380-381

diet and exercise, 139

environmental health, 387, 397

public health practice, 380-381

quality of life, 165

of satisfaction, 164, 165

of smoking initiation, 162

updating, 91, 138-139

Medicaid, 27, 43, 83, 89, 158, 175, 246, 294

Medical Outcomes Study, 209

Medical Outcomes Trust, 145 n.2

Medical practice patterns, 82

Medicare, 27, 43, 83, 89, 103 n. 3, 164, 264, 329, 331

Methodological issues

administrative records as data sources, 367-368

assessment of health improvement activities, 106

benchmarks, 93-94, 268, 364-366, 369

comparisons, 128

immunization rates, 328

interpretation of survey data, 363-364

local-level data, 366-367

small-area estimation, 370-371

specification of performance indicators, 101, 170-171, 361-362

standardization of rates, 369-370

units of analysis, 362-363

Michigan, 434-435

Migrants, 157

Minnesota, 85, 113, 135, 176

Missouri Community Health Assessment and Resource Team, 89, 90, 91

Models.

See also Field model of health determinants

biomedical, 43, 48

community development model of change, 440

environmental health factors, 387

Health Belief, 440

of health improvement, 444

PRECEDE-PROCEED, 440

of social change, 68-70, 439-440, 446

stages of change, 440

statistical, for small-area estimation, 370-371

Model Standards, 437;

see also Healthy Communities 2000: Model Standards

Monitoring. See Performance monitoring

Mortality

education and, 421

income and, 51, 422

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

infant, 159-160, 385;

see also Infant health

social class and, 50, 422

N

National Association of County and City Health Officials, 396-397, 406

National Breast and Cervical Cancer Early Detection Program, 197

National Cancer Institute, 85, 176, 365

National Center for Health Statistics, 135, 137, 370, 395

National Civic League, 109, 111, 113, 138

National Committee for Quality Assurance (NCQA), 27, 64-65, 109, 144 n.2, 186, 263-264, 379, 397-398, 406

National Health and Nutrition Examination Survey, 368

National Health Interview Survey, 363-364, 395

National Heart, Lung, and Blood Institute, 85, 104-105, 176, 442

National Immunization Survey, 433

National Information Infrastructure project, 116, 392-393

National Institutes of Health, 43

New York City Washington Heights/Inwood neighborhood, 96, 375, 377

New York State, 91

Non-English-speaking populations, 157

North Shore Community Health Network Area, 432-433

Norway, 50, 421

O

Obesity, 163

Occupational Safety and Health Administration, 244, 246-247

Ontario, Canada, 138, 144 n.2

Organization for Economic Cooperation and Development, 51, 422

Organizations and institutions

expectations of, 55, 427

identification of stakeholders among, 427

internal monitoring, 427

model of social change, 440

Outcome measures

assessment instruments, 145 n.2

clinical, 388

definition, 142 n.1, 426 n.6

environmental health, 387

functional capacity and well-being, 48

intermediate, 426 n.6

Outcomes research, 82, 97-98, 425

P

Pacific Business Group on Health, 44, 45

Patient navigator program, 196

Performance indicator sets

breast and cervical cancer, 148, 196-200, 202-204

catalogs of, 101 n.2

data sources, 150-152, 202-204, 227-228, 240-241, 259-261

definition, 140

depression, 141, 148, 220-224, 227-228

development of, 10, 101, 183, 187, 374-375, 407

elder health, 142, 148, 235-241

field model domains of, 148, 150-152, 183, 184, 191-196, 202-204, 207-219, 227-228, 235-241, 244-255, 259-261, 264-269, 274-275, 278 -291, 298-299, 334-339, 342-344, 354-359

health care resource allocation, 148, 269-271, 274-275

health plan assessment, 27, 378-379

health status, 28-29, 85, 395, 432-433, 437, 443

Indicator Measurement System, 398-399

infant health, 148, 291-295

lead poisoning, 148, 257-261

mental health and chemical dependency services, 27

prototypes, 147-148, 150-152, 183-187

selecting, 141

stakeholder roles, 150-152, 183, 187

tobacco and health, 141, 148, 312-318, 408-409

uses, 81, 143, 147, 378, 406, 407, 443

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

vaccine-preventable diseases, 13, 148, 150-152, 184, 334-339, 342-344

violence, 148, 354-359

Performance indicators

assessment of, 101

characteristics, 100, 419, 443

community health profile indicators as, 128-129

community responses to, 438

of cooperation among organizations, 100

criteria for selection, 13-14, 144-147, 184-185, 170-171

data availability, 146, 185

data collection and analysis costs, 143-144

definition, 140

development tools, 115, 177, 419

environmental health, 387

gaps in, 142, 379

health improvement links, 145, 184

health plan, 27, 378-379

health status indicators and, 73, 85, 432-433, 437, 443

immunization, 437

inclusion in other indicator sets, 146-147, 185

normative element, 378

operational issues, 143, 378

overall program evaluation distinguished from, 437

privacy and confidentiality issues, 149, 153

public health practice, 380-381

robustness and responsiveness to change, 146, 184-185

selection of, 12-13, 32, 42-43, 49, 99, 100-101, 142-147, 148, 170 -171, 184-186, 390-391, 408, 419, 420, 436-437, 445

sources, 100-101, 185

specification of, 361-362

stakeholders linked to, 12, 32, 146, 185, 170-171

standard measures, development of, 18-19, 27, 176-177, 186, 397, 436-437

strategic concerns, 171, 378

technical aspects, 177, 378

uses, 32, 430

validity and reliability, 145, 184, 362

Performance monitoring

and accountability, 5, 10, 29, 30, 86, 100, 145, 186, 378

barriers to, 34-35, 62

benchmarks, 93-94, 265, 268, 364-366

best practices, 96, 427

cultural competence, 72

data collection and analysis, 11, 72, 102-103, 376, 388, 426

definition, 4, 26, 418

federal role, 56, 64, 392-395

goals, 62, 397, 399, 418-419

identification of stakeholders, 142, 427, 432

implementation, 72-73, 409-410, 438

importance, 26-29, 63, 166-167, 416

leadership, 72, 438

measures, 55, 142, 186;

see also Input measures;

Outcome measures;

Performance indicator sets;

Performance indicators;

Process measures

participants, 56, 59, 72, 376, 435-436, 445;

see also Stakeholders

population-based perspective, 26, 105, 377, 419

priority setting, 72, 148

by private sector, 26-28, 55, 81, 86, 385, 386, 396-399, 443

by public sector, 28-29, 379-382

and qualitative information, 11, 27-28, 55, 74, 94, 102-103

"reinventing government," 26, 86

report cards, 27, 86, 397-398, 427

resource management, 36-37, 72

selection of health issues, 141-142, 436, 438

systems, 28-29, 68, 399-401, 419

time factors, 144

use of data from, 14-15, 27, 103-106, 374, 445-446

Performance Partnership Grants, 29, 81, 139, 175, 186, 393

Perry Preschool Study, 50, 421-422

Personal Responsibility and Work Opportunity Reconciliation Act, 285 n.1

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

Pew Health Professions Commission, 109

Physical environment, as field model domain

community health profile indicators, 8, 157, 158, 159, 160, 162-163, 165

depression, 216-217

elder health, 235, 241

and health, 51, 52, 423

health care resource allocation, 266, 274

and infant health, 287-288, 299

lead poisoning, 251-254, 259-261

performance indicators, 216-217, 235, 241, 251-254, 259-261, 266, 274, 287-288, 299. 307-308, 322, 332, 353, 359

tobacco and health, 307-308, 322

vaccine-preventable diseases and, 332, 359

violence and, 353, 359

Plan-Do-Check-Act cycle, 82

Planned Approach to Community Health (PATCH), 28, 84, 96

Poverty. See Economic prosperity

PRECEDE-PROCEED model, 440

Privacy and confidentiality issues, 92, 111, 128, 149, 153, 174

Private sector.

See also Managed care organizations;

Organizations

and institutions

community health activities, 384-386

data for health assessments, 92, 103, 173-175

health assessment guide, 85

health care costs, 60

incentives for participation, 89

performance monitoring, 26-28, 55, 81, 86, 385, 386, 396-399, 443

public-sector partnerships with, 114

standardization of data, 16-17, 174

Problem identification and prioritization cycle. See Community health improvement process

Process measures

definition, 142 n.1, 426 n.6

environmental health, 387

public health practice, 380

Professional

competencies, 109

training, 19, 116-117, 177-178, 384

Project Health, 64

Prostate Patient Outcome Research Team, 262-263

Public health agencies/system

assessment of performance of, 379-382

capacity, 108-109, 113

core functions, 28, 44, 89, 91, 108-109, 113, 379-380, 404, 407, 418 n.3

essential services, 108, 267-268

health planning activities, 84-85

infrastructure database, 393

private-sector partnerships with, 113, 388

roles and responsibilities in community health improvement process , 15-16, 80, 88, 89-90, 93, 95-96, 99-100, 103, 112, 113, 172-175, 176-177, 375-376

Public Health Foundation, 366

Public Health sector, health improvement activities, 84-85

Public Health Service, 18-19, 176-177

Public hospitals, 44

Q

Quality assurance

definition, 418 n.3

private-sector systems, 44

public-sector role, 44, 82-83, 397

Quality improvement

and accreditation standards, 109

continuous (CQI), 4, 82, 102, 106, 107, 113, 332

definition, 418 n.3

indicator sets, 27-28, 101 n.2

internal, by health care organizations, 86

Quality of care, 27, 164

Quality of life, 18-19, 84, 115, 131, 135, 164, 165

R

Recommendations

assessment of community health improvement process (CHIP), 17-18, 175-176

coalitions, 14-15, 171-172

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

community health profiles, 173-174, 176-177

data collection and analysis, 16-17, 173-174

defining health, 11-12, 169

development of CHIP, 17-19, 175-178

development of measurement tools, 18-19, 176-177

enabling policy and resources, 15-17, 172-175

implementation of CHIP, 17-18, 175

operationalizing CHIP concept, 11-15, 167-172

performance indicators, 12-14, 18-19, 169-170, 177

professional education, 19, 177-178

public health agency roles, 15-16, 172-173

stakeholder accountability, 11-12, 169-170, 175

timing of goals, 14, 171

Regional Municipality of Hamilton-Wentworth, Canada, 138, 144 n.2

Research

on coalition building, 71-72

on community health interventions, 105

on determinants of health, 56

on health outcomes, 82, 97-98, 425

on measurement techniques, 115

Rhode Island, 85, 176

Robert Wood Johnson Foundation, 46, 71, 375, 417

S

Satisfaction

with health care system, 18-19, 164, 264

with quality of life, 165

Seattle-King County, Washington, 73, 92-93, 375, 387, 389-392

Senior citizens. See Elder health

Sexually transmitted diseases, 143, 433

Single-parent families, 50, 159, 421

Smoking.

See also Tobacco and health

adolescents, 53

community health profile indicators, 162-163

genetic influences on, 52, 423

interventions, 53, 85, 425, 432-433

and lung cancer, 144

maternal, 96

measures of initiation, 162, 361-362

stages of change model, 440

workplace policies, 53

Social change

and accountability, 439-442

agents, 67

authoritarian model of, 68-69

community coalition building and, 70-72, 75

in health care, 440-442

individual level, 440

managing, 66-72

models of, 75, 439-440, 446

organizational level, 440

process of, 68-70

readiness for, 400-401

reallocation of resources, 68

resistance to, 67-68

stakeholder involvement, 3, 67-68

strategies and tactics, 70

willing compliance model of, 68, 69-70

Social class, and health, 50-51, 54, 422

Social environment, as field model domain

behavior and, 52, 423

breast and cervical cancer, 195-196, 204

community health profile indicators, 156-165

community-level focus, 53

depression, 214-216, 227-228

elder health, 231, 234, 241

epidemiology applied to, 436

and health, 8, 49-51, 52, 56, 421-422, 423

health care resource allocation, 266

infant health, 284-287, 298-299

lead poisoning, 254-255

prototype performance indicators, 150-151, 195-196, 204, 214-216, 227-228, 284-287, 298-299, 305-307, 321-322, 327-332, 342, 351-353, 359

tobacco and health and, 305-307, 321-322

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

vaccine-preventable diseases and, 327-332, 342

violence and, 351-353, 359

Social networks, 50, 422

Social systems, health and, 45, 47

Socioeconomic status

and children's health, 424

Stages-of-change model, 440

Stakeholders.

See also Coalitions and coalition building

accountability, 3, 25, 32, 56, 59, 437-438

accountable entities, 12, 32, 56, 63-64, 66, 80, 88, 147, 169

collaboration/coordination among, 3, 36, 59, 74-75, 87-89, 433

definition of, 25, 63-64

depression, 227-228

development of performance indicators, 142, 183-184, 437

diversity of, 2, 25, 36, 56, 61-62, 187

elder health, 240-241

identification of, 75, 142, 427, 432, 433, 435-436, 445

infant health, 298-299

involvement in change process, 67-68

lead poisoning, 259-261

roles and responsibilities, 2-3, 25, 59, 65-66

tobacco and health, 321-323

vaccine-preventable diseases, 150-152, 342-344

Standards for Pediatric Immunization Practices, 332

State role.

See also individual states

in accountability, 64, 397

in community health improvement process, 15-17, 18-19, 80, 81, 91-92, 173-175, 176-177

in quality assurance, 397

Structural functionalism, 439

Substance Abuse Monitoring system, 135

Suicide, 160, 205, 209, 211, 348-349

Surgeon General's Workshop on Violence and Health, 347

Sustainable Development Indicators, 138, 144 n.2

Symbolic interactionism, 439

Syphilis, 160-161

T

Task Force on Community Preventive Services, 18, 97, 105, 176

Temporary Assistance to Needy Families, 285 n.1

Tobacco and health, prototype performance indicators

data sources, 321-323

disease, 302-303, 321

economic prosperity and, 308-309

genetic endowment, 305

health and function, 311

health care, 309-311, 323

individual response, 303-304, 321

overview, 300-302

physical environment and, 307-308, 322

sample indicator set, 312-318, 321-323

social environment and, 305-307, 321-322

stakeholders, 321-323

well-being and, 311

Tuberculosis, 160-161

U

U.S. Census Bureau, 366

U.S. Department of Health and Human Services, 29, 186, 375, 392-393, 417

U.S. Environmental Protection Agency, 163, 243, 249

U.S. Preventive Services Task Force, 97, 145, 246, 395

Unemployment, 51, 159, 422

Uninsured persons, 159

United States

social-class effects, 50-51, 422

University of

Florida, 380

Illinois at Chicago, 380, 381

Kansas, 105

North Carolina, 380

Washington School of Public Health, 375, 384

V

Vaccine-preventable diseases, prototype performance indicators

data sources, 150-152, 342-344

disease domain, 150, 326-327, 342

genetic endowment and, 327

health and function, 334

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
×

health care and, 151-152, 327-330, 332-334, 343-344

individual behavior and, 150, 327-330, 342

physical environment and, 332, 359

sample indicator set, 13, 150-152, 334-339, 342-344

social environment and, 150-151, 327-332, 342

stakeholders, 150-152, 342-344

Violence, prototype performance indicators

data sources, 358-359

disease and, 347-348, 358

economic prosperity and, 353

genetic endowment and, 359

health and function, 347-348, 358

health care and, 350-351, 359

individual response, 348-350, 358

overview, 345-347

physical environment and, 353, 359

sample indicator set, 354-359

social environment and, 351-353, 359

well-being and, 346, 358

Voluntary Hospitals of America (VHA), 72, 83

W

W.K. Kellogg Foundation, 72, 434

Wales, 50, 421

Washington State, 73, 80, 92-93, 382-392

Washington State Public Health Improvement Plan, 114, 375, 382-383

Water quality, 163, 430

Well-being, as field model domain, 157, 159, 160-161, 163, 164, 165 , 166, 209-211, 227, 291, 311, 346, 358

Western Consortium for Public Health, 379

Whitehall study of British civil servants, 50, 422

WIC, 158, 285, 292, 331

Work-related factors, 51, 160, 422

World Health Organization

definition of health, 40

Health for All by the Year 2000 program, 84

and Healthy Cities/Healthy Communities, 84, 127

Y

Youth Risk Behavior Surveillance System (YRBSS), 136-137, 163, 208 , 209, 221

Suggested Citation:"Index." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.
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Improving Health in the Community: A Role for Performance Monitoring Get This Book
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How do communities protect and improve the health of their populations? Health care is part of the answer but so are environmental protections, social and educational services, adequate nutrition, and a host of other activities.

With concern over funding constraints, making sure such activities are efficient and effective is becoming a high priority.

Improving Health in the Community explains how population-based performance monitoring programs can help communities point their efforts in the right direction.

Within a broad definition of community health, the committee addresses factors surrounding the implementation of performance monitoring and explores the "why" and "how to" of establishing mechanisms to monitor the performance of those who can influence community health. The book offers a policy framework, applies a multidimensional model of the determinants of health, and provides sets of prototype performance indicators for specific health issues.

Improving Health in the Community presents an attainable vision of a process that can achieve community-wide health benefits.

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