Westin, A.F. Without such evidence or consensus in expert judgment, it is not reasonable to expect accountability for health improvement when, even under ideal circumstances, it may not be possible for the action taken to have the desired impact. Improving Health in the Community presents an attainable vision of a process that can achieve community-wide health benefits. These comparisons can be based on measurements over time within an individual community, comparisons with other communities or with state or national measurements, or comparisons with a benchmark or target value such as an objective from Healthy People 2000 (USDHHS, 1991). A variety of specialized compilations of data may provide additional reference points (e.g., Andrulis et al., 1995; Annie E. Casey Foundation, 1996; Wennberg, 1996). These reports are useful to support planning, identifying priorities or targeting resources, and for tracking progress towards broad community objectives. If local data remain unavailable or are not feasible to obtain, communities that are similar to the state as a whole may find some state-level data useful. Robustness and responsiveness to change in health system performance, particularly in targeted populations. In working from the broad perspective of the field model, critical "health" issues may also be found not only among conditions that create a substantial burden in terms of illness or costs of care but also in areas such as education and housing. 7 (October). As proposed by the committee, health is more than just the biological events occurring or not occurring in a person. The background information provided by a health profile can help a community interpret data on those issues. Vol. Communities may, through their health improvement activities, identify topics of local importance that should supplement the basic profile. 1991. Proportion of 2-year-old children who have received all age-appropriate vaccines, as recommended by the Advisory Committee on Immunization Practices. Draft for Comment. Regional Municipality of Hamilton-Wentworth. As noted. We provide a simple. MyNAP members SAVE 10% off online. Multisector collaborations that support shared ownership of all phases of community health improvement, including assessment, planning, investment, implementation, and evaluation. Learn about the quality of life of those 65+ where you live. Special Focus: Behavioral Risk Factor SurveillanceUnited States, 1991. TABLE 5-1 Proposed Indicators for a Community Health Profile, Distribution of the population by age and race/ethnicity, Number and proportion of persons in groups such as migrants, homeless, or the non-English speaking, for whom access to community services and resources may be a concern, Number and proportion of persons aged 25 and older with less than a high school education, Ratio of the number of students graduating from high school to the number of students who entered 9th grade three years previously, Proportion of children less than 15 years of age living in families at or below the poverty level, Number and proportion of single-parent families, Number and proportion of persons without health insurance, Numbers of deaths or age-adjusted death rates for motor vehicle crashes, work-related injuries, suicide, homicide, lung cancer, breast cancer, cardiovascular diseases, and all causes, by age, race, and gender as appropriate, Reported incidence of AIDS, measles, tuberculosis, and primary and secondary syphilis, by age, race, and gender as appropriate, Births to adolescents (ages 1017) as a proportion of total live births, Number and rate of confirmed abuse and neglect cases among children, Proportion of 2-year-old children who have received all age-appropriate vaccines, as recommended by the Advisory Committee on Immunization Practices, Proportion of adults aged 65 and older who have ever been immunized for pneumococcal pneumonia; proportion who have been immunized in the past 12 months for influenza, Proportion of the population who smoke, by age, race, and gender as appropriate, Proportion of the population aged 18 and older who are obese, Number and type of U.S. Environmental Protection Agency air quality standards not met, Proportion of assessed rivers, lakes, and estuaries that support beneficial uses (e.g., fishing and swimming approved), Per capita health care spending for Medicare beneficiaries (the Medicare adjusted average per capita cost [AAPCC]), Proportion of adults reporting that their general health is good to excellent, During the past 30 days, average number of days for which adults report that their physical or mental health was not good, Proportion of adults satisfied with the health care system in the community, Proportion of persons satisfied with the quality of life in the community. The New York State Community Health Indicator Reports (CHIRS) were developed in 2012, and are regularly updated to consolidate and provide information regarding health indicators in the County Health Assessment Indicators (CHAI) for all communities in New York. Adults receiving colorectal cancer screening based on the most recent guidelines (C-16) Caution may also be needed in using census data if there is reason to believe that a group may have been undercounted relative to others in the community. For the community health profile, proposed indicators were mapped to the domains of the field model (social and physical environment, genetic endowment, behavior, disease, health care, health and function, prosperity, and well-being) to identify potential gaps and to assess the distribution of indicators across domains. Field model domains: individual behavior, social environment, well-being, and prosperity. In 1996, MDPH implemented the Massachusetts Community Health Information ProfileMassCHIPan information service to provide dial-up access to community-level data for assessing community health needs, monitoring health status indicator, and evaluating programs. Determining whether an "intermediate" activity such as this will be monitored at the community level or by an individual stakeholder organization will depend on a community's approach to the health issue and the nature of the precondition to be achieved. National efforts such as those suggested for the development of community-level measures would also be useful for improving analytic techniques and developing resources for technical assistance. The pregnancy can have a negative impact on the health and well-being of the mother, father, grandparents, and child. The committee also sees a need for a variety of forms of technical assistance that can help communities understand how to use health profile indicators and obtain appropriate data. Donaldson and K.N. tion such as the Employee Retirement Income Security Act (ERISA) may take precedence without offering protection comparable to state laws (IOM, 1994). Selecting those that will be used is a critical stage in a CHIP. The committee's selections were also made to illustrate varying perspectives from which health issues might be viewed, including factors affecting population groups (infant and elder health); acute and chronic illness (breast and cervical cancer, depression); prevention and health promotion (tobacco and vaccine-preventable diseases); environmental and occupational health risk (lead exposure); operation of the health care system; and broad societal issues that have health implications (violence). for a state survey for the BRFSS) and school-based surveys (e.g., for the Youth Risk Behavior Surveillance System) for data on adolescents; maternal smoking status is recorded on birth certificates, but the quality of the data needs to be evaluated. The committee strongly supports more extensive use of such ''geocoding," particularly for data collected by states. Adding location identifiers (e.g., zip codes, census tracts) to survey and other types of data could improve their usefulness at the community level. Washington, D.C.: National Academy Press. All data elements are cross-linked to relevant Healthy People 2000 objectives. Amick, s. Levine, A.R. Smoking is the greatest risk factor associated with the leading causes of death. Inclusion in other indicator sets (monitoring sets). Data sources: community survey. The committee presents some examples that illustrate how communities might approach selecting such performance indicators. The data offer a comprehensive overview of demographics, health, and health behaviors among King County residents. For example, a community that has a significant percentage of young families may have a special interest in health issues related to children, pregnancy, teenagers, and injuries, whereas an older community may need to address health issues related to health care resources and utilization, and chronic disease associated with aging. Information provided by the performance indicators should guide subsequent steps: moving on to a new health issue, continuing or modifying the current effort, or perhaps returning to an earlier stage in the process to reassess the intervention strategy and the appropriate indicators to use. Cornell Law Review 80(3):451528. The guidance offered in this chapter and, by example, in the prototype indicator sets in Appendix A should help communities begin. Community-level data collection may also be possibleperhaps essentialfor obtaining some types of information. Process applies to activities that are being performed (e.g., numbers of pregnant women receiving smoking cessation counseling). It has been estimated that 14 percent of all deaths in the United States are related to diet and activity patterns (McGinnis and Foege, 1993). They contain over 50 measures of neighborhood health, emphasizing that our health starts where we live, work and play. In selecting indicators for the community profile, the committee frequently chose to suggest such potential sources of data rather than limit its list of indicators to only those for which community-level data are typically available now. Participation by a broad array of public and private stakeholders representing national, state, and local perspectives should be encouraged. Hennessy, C.H., Moriarty, D.G., Zack, M.M., Scherr, P.A., and Brackbill, R. 1994. Immunization ScheduleUnited States, JanuaryJune 1996. Field model domains: health and function and well-being. Proportion of adults reporting that their general health is good to excellent. It is widely used as an indicator of child health. 1992. For example, evidence of underimmunization among children or the elderly might encourage various sectors of the community to respond, through ''official" actions (e.g., more systematic provider assessments of patients' immunization status) and through community action (e.g., volunteer groups offering transportation to immunization clinics). This indicator is included in the consensus set recommended by CDC (1991) for use by all states and communities. 1. Federal legislation that would provide more comprehensive protection for health data has been proposed (e.g., U.S. Congress, 1995, 1996). Nevertheless, health plans, insurers, employers, and others in the private sector could contribute to community data resources, particularly for numerator data needed to calculate rates. The performance monitoring component of the CHIP outlined by the committee will require increased access to potentially sensitive data such as an individual's income level, employment status, medical diagnoses (e.g., HIV status, other sexually transmitted diseases, genetic conditions, mental illness), and lifestyle information (e.g., sexual practices, drug and alcohol use). Field model domains: individual behavior, genetics, social environment, health care, health and function, and well-being. 1996. A set of performance indicators is used to assess the multiple dimensions of a health issue and monitor the contributions of various accountable entities to the health improvement strategy. (PHS) 95-1260. For example, the categories of measures for the National Civic League's (1993) Healthy Community Indicators include health, family income, housing and homelessness, food assistance, child care, education, youth employment, transportation, public safety, and environmental issues. Structure applies to capacity to perform (e.g., whether smoking cessation counseling is available to pregnant women). Massachusetts Department of Public Health. Field model domains: individual behavior, social environment, prosperity, and health care. : U.S. Department of Health and Human Services. In other work, a small set of indicators was proposed for monitoring access to health care (IOM, 1993). Share a link to this book page on your preferred social network or via email. outreach services, and preventive services for the mother before and during pregnancy and for the child during the first year of life. All states have privacy protection laws regarding health data held by government agencies (e.g., communicable disease reports); the specific protections and penalties for violations vary from state to state (Gostin et al., 1996). Perrin, E.B. Even though indicators may be formulated with the intention of promoting actions that will have positive effects on community health, they must be based on an accurate understanding of their effect in the setting in which they will be applied. The committee's selection of indicators reflects consideration of several factors. For a community, an increase in the unemployment rate can increase demands on social services and might signal broader economic problems. The committee encourages the development of data for a variety of "community" units. Such assessments are valuable, but if resources are limited, comprehensive assessments should probably be prepared less frequently than updates to a health profile. Field model domains: disease, genetics, individual behavior, social environment, physical environment, health care, and prosperity. The second part of the chapter focuses on the development of indicator sets for performance monitoring, which are intended for use with health improvement strategies for specific health issues. Ready to take your reading offline? 5th ed. Discussed here are factors that should be considered in selecting sets of indicators for issue-specific performance monitoring. Costs of data generation may include designing data collection instruments, collecting or locating data, analyzing and summarizing the results, and reporting information to the community. Data sources: state or local child protection agency. Youth Risk Behavior SurveillanceUnited States, 1993. U.S. Preventive Services Task Force. Refer to the Data Profiles for the most frequently requested social, economic, housing, and demographic data by geography. Field model domains: social environment, health care, health and function, well-being, and prosperity. resources (e.g., funds, expertise, data systems) to producing CHIP data. Lohr, eds. Field model domains: health and function and well-being. For individuals, unemployment reduces household income, can limit access to health insurance, and can contribute to psychological stress. : U.S. Department of Health and Human Services. Walker, personal communication (1996). (See Appendix B for further discussion of methodological issues in selecting and using health profile and performance indicators. Most are associated with significant morbidity or health care costs. There is also evidence that children living with parents whose educational attainment is low have more health problems than other children, even after other socio-economic factors have been taken into account (Zill, 1996). U.S. Congress, Senate. The National Committee for Quality Assurance (NCQA, 1996) identified the following desired attributes of measures to be submitted for consideration for version 3.0 of the Health Plan Employer Data and Information Set (HEDIS): relevance (meaningful to users, health importance, financial importance, cost-effectiveness, strategically important, controllability, variance between plans, potential for improvement), scientific validity (reproducible, valid, accurate, risk adjustable, comparability of data sources), and feasibility (precisely specified, reasonable cost, confidential, logistically feasible). The committee proposes the following criteria for selecting indicators: Established validity and reliability. Individual communities will have to formulate performance indicators that are based on performance expectations for their particular accountable entities and that reflect specific needs and resources. Explorations in Quality Assessment and Monitoring . To. Adjustments will be needed to account for students who transfer to or from other schools. Rockville, Md. Obesity can be measured in terms of the body mass index, which can be constructed from weight and height data (kg/m2). Chicago: American Hospital Press. Washington, D.C.: Office of the Assistant Secretary for Health. The demographic composition of the population should be understood because significant disparities in health status between minority and nonminority populations may be due to factors including economic resources, health care access, discrimination, and genetic susceptibility to disease. Evidence-based link between performance and health improvement. In Society and Health. Lack of economic and social support can manifest in various diseases and health conditions. nity health assessment activities since 1991. Many potential performance indicators, generally "process" and "outcome" measures,1 will emerge in discussions about an issue, but some will be more appropriate than others. FAcct (Foundation for Accountability). It has been estimated that 19 percent of all deaths are related to smoking (McGinnis and Foege, 1993). 1994. The Community Health Profile (CHP) report uses publicly available, quantitative indicators to describe the overall health of the Nashville community. Morbidity and Mortality Weekly Report 44(SS-1). One source of interest has been health promotion and Healthy Cities/Healthy Communities activities by the World Health Organization (WHO, 1986) and others (e.g., Canadian Healthy Communities Project, 1988; National Civic League, 1993). SOURCE: Massachusetts Department of Public Health (1995); D.K. 1996. In making comparisons, however, communities must consider underlying factors that might contribute to observed differences. 1985. The school-based Youth Risk Behavior Surveillance System (YRBSS)a collaborative effort involving states, cities, and the CDC (1995)may lend itself to similar approaches to generating community data for adolescents. Availability of data in a timely manner at a reasonable cost. Annie E. Casey Foundation. Key indicators examined included socioeconomic characteristics, health status, health risk factors, and quality of life of state residents. Your patience is appreciated. a final product. The opportunity for such comparisons will be increased if there is widespread agreement across communities on a basic set of standard health profile indicators and their operational definitions. National Civic League. Some states, federal agencies, and private companies are already making data available through the Internet. Do you enjoy reading reports from the Academies online for free? tors, and health resource use, which are relevant to most communities. 1993. The Dartmouth Atlas of Health Care. Healthy People 2000: Activity Update. In Why Are Some People Healthy and Others Not? To interpret performance monitoring results, communities will have to take their specific circumstances into consideration. Atlanta, Ga.: U.S. Department of Health and Human Services. 2. Signposts on the Trail to Vision 2020: Hamilton-Wentworth Sustainable Indicators, 1996. The focus of this report is on developing the conceptual framework for a community health improvement process (CHIP) by which communities can use health profiles and performance measures to marshal the forces in their communities to improve the health of populations. The system is designed to be used by anyone with modem access, which could include local governments, health plans, individual health care providers, researchers, community agencies and organizations, and the general public. 1995. The list draws extensively from the "consensus set" of indicators for assessing community health status (CDC, 1991) that was developed in response to Healthy People 2000 Objective 22.1. Similarly, the committee selected health issues that present an opportunity for a variety of stakeholders to respond, including public health and other government agencies, health care providers, schools employers, community groups, and individuals. tor sets for several health issues: breast and cervical cancer, depression, elder health, environmental and occupational lead poisoning, health care resource allocation, infant health, tobacco and health, vaccine-preventable diseases, and violence. In some cases, however, opportunities may exist to develop sources of data for communities. Immunization rates, for example, are a. useful community health descriptor but could also be monitored as an outcome measure for targeted efforts to reduce the risk of vaccine-preventable disease. If you would like to request a copy of the 2023 TIP Report, please note we have decided to print the introduction section only this year, which excludes the country narratives. Minnesota Department of Human Services. The current series of immunizations recom-. Explorations in Quality Assessment and Monitoring . Donabedian, A. Care should also be taken that evidence of health problems not be used as a basis for negative labels for particular population groups or neighborhoods in a community. Estimates of the prevalence of smoking among adolescents (ages 1014 and 1519) might serve as a proxy for more direct measures of smoking initiation. CDC Studies Community Quality of Life. Comparisons over time within a community, among population groups within a community, or with other communities may be helpful in gauging the possible relationship between income and health status or other factors. For the community health improvement process, a performance indicator provides a concrete measure of a specific capacity, process, or outcome related to an accountable entity that is part of a defined health improvement strategy for a specific health issue. Do you want to take a quick tour of the OpenBook's features? Number and proportion of single-parent families. For some conditions, the numbers of cases may be too small to develop stable rates, but establishing the number of persons with the disease is important since nearly all cases are potentially prevent-. CDC. Healthy People 2000: National Health Promotion and Disease Prevention Objectives . Among the standard reports are sets of health status indicators for CHNAs. Guidelines for Clinical Practice: From Development to Use. Data sources: state employment security office. Under some circumstances, a stakeholder may have to assume responsibility for producing or assuring the existence of an enabling precondition for achieving health improvement, rather than assuming more direct responsibility for the health outcome itself. Washington, D.C.: Office of the Assistant Secretary for Health. Household income can affect a family's ability to obtain suitable housing, nutrition, or health insurance and may be related to behaviors that affect health. Baltimore: Annie E. Casey Foundation. obtain such data, modifications of those surveys or separate data collection methods will be needed. Filterable list of all indicator report titles grouped by program/owning organization. Click on a county to see its: Health Outcomes (morbidity and mortality); and Health Factors (health behaviors, clinical care, social and economic factors, and physical environment). 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