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 |
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 |
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 |