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OCR for page 35
Contents
Preface
ix
Executive Summary
1
1 Introduction
15
Origins of the Study
16
Performance Partnership Grants
16
Other Influences
17
Charge to the Panel
18
Essential Definitions
19
Performance Measurement and Related Concepts
19
Categories of Performance Measures
20
Phase I: Focus on Selection of Performance Measures
22
Use of Measures of Process and Capacity as Well as Outcomes
22
Guidelines for Selecting Performance Measures
24
Limitations of a Program-Specific Approach to Performance Measurement
25
Need to Strengthen State and Local Capacity for Data Collection and Analysis
26
Inadvisability of Using Performance Measures Alone for Resource Allocation Purposes
26
Phase II: Data and Information System Development to Support Performance Measurement
27
A Vision for a National Health Information Network
27
Critical Issues
28
Structure of the Report
29
References
29
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2 Putting Performance Measurement in Context
30
Use of Performance Measurement in Accountability Systems
30
Performance-Based Accountability Systems
31
Operation of Performance-Based Systems
33
Applications of Performance Measurement
37
Examples of Performance Monitoring and Accountability Systems
40
Government Performance and Results Act
41
Use of Performance Measures in the Maternal and Child Health Services Block Grant Program
42
Reporting Requirements for the Temporary Assistance for Needy Families Program
44
State Developments in Performance-Based Budgeting
45
Health Care Performance Measurement in the Private Sector
48
Conclusions
52
References
55
3 Performance Measurement Considerations for Publicly funded Health Programs
59
Broad Array of Health-Related Services and Service Relationships
60
Measurement Considerations for Population-Based Health Services
61
Population Health Services
61
Monitoring Population Health Services
62
Monitoring the Infrastructure for Publicly Funded Health Programs
64
Some Performance Measurement Considerations Related to Program-Specific Matters
66
Environmental Health Programs
66
Mental Health Programs
68
Substance Abuse Programs
71
Process Guidelines as a Basis for Performance Measurement
74
Guidelines for Personal Health Services
75
Guidelines for Population-Based Health Services
76
Research Needs for Practice Guidelines and Performance Measurement
76
Conclusions
78
References
79
4 Data and Information Systems: Issues for Performance Measurement
83
Health Data Resources
84
Registries
85
Surveys
86
Patient Records and Related Clinical Encounter Data
87
Administrative Data
89
Claims Data
90
Linkage of Data Sets
91
Steps Toward Integration of Data Sets
93
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Assuring the Quality of Data and Data Analysis
95
Random Variation and Bias
96
Data Management
97
Challenges in Data Analysis
98
Developing and Implementing Standards for Data and Data Systems
103
Standardization Activities
103
Balancing Standardization and Change
108
Enhancing Performance Measurement through Advances in Information Technology
109
Data Collection and Transmission Technologies
109
Data Management and Analysis
110
Computer-Based Patient Records
111
The Internet and the World Wide Web
111
Limits of Technology
114
Privacy, Confidentiality, and Security of Health Data
114
Investing in Health Data and Data Systems
116
Data and Information Systems
117
Technology
119
Training and Technical Assistance
120
Taking a Collaborative Approach to the Development of Health Data and Information Systems
122
Meeting the Needs of Many Data Users
123
Collaboration in the Design and Implementation of Data Systems
125
Conclusions
126
References
127
5 Strategies for Supporting Performance Measurement through a National Information Network
132
Conclusions Regarding Performance Partnership Agreements
133
A National Information Network for Health-Related Data
134
Essential Features of a Health Information Network to Serve Different Levels of Decision Making
135
Major Policy Actions Needed
138
National Collaboration
138
Integration of Data Systems
143
Technology Policy
144
Operational Principles
145
Involve a Broad Range of Public Agencies
145
Build on Existing Information Systems
146
Implementation Standards
147
Required Investment for an Information Network
152
Data Systems
152
Training and Technical Assistance
154
A National Research Agenda
156
Final Observations
157
References
158
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Appendices
A Potential Health Outcome and Risk Status Measures
163
B Workshop Agenda
168
C Biographical Sketches
170
Representative terms from entire chapter:
health programs