Health Performance Measurement in the Public Sector: Principles and Policies for Implementing an Information Network by National Research Council

Author:National Research Council
Language: eng
Format: epub
Tags: Health and Medicine : Policy, Reviews and Evaluations
Publisher: NATIONAL ACADEMY PRESS
Published: 1999-04-30T00:00:00+00:00

Health Data Resources

Diverse health-related data are required to monitor and better understand the health of the population, including the incidence and prevalence of disease, morbidity and mortality associated with acute and chronic illness, behavioral risk factors, disability, and the quality of life. Data are also needed to plan, implement, and evaluate health policies, programs, and services. The data to meet these needs are produced and used in both the public and private sectors and, increasingly, by public-private partnerships. The Performance Partnership Grants (PPG) proposal that was the impetus for the work of this panel focused attention specifically on data for performance measures to be used in the context of state reporting requirements for federal grants. The panel emphasizes, however, that if performance measurement activities are to succeed, they should fit into a broader agenda for collecting and using health data to protect the health of the public, as well as for guiding the development and implementation of health policies at the local, state, and federal levels.

Although the panel did not attempt to address measurement of the quality and performance of individual health care providers or health plans, it should be noted that these activities are generating similar concerns about such matters as the selection of suitable performance measures, the limitations of administrative data sets for assessing health outcomes, the need for greater standardization of measures and data and for methods to improve data quality, and broader use of new information technologies (see, e.g., Iezzoni, 1997a; National Committee for Quality Assurance, 1997; Palmer, 1997; Foundation for Accountability, 1998; and Joint Commission on Accreditation of Healthcare Organizations, 1998). Major changes in social welfare programs are also prompting a reexamination of the adequacy of data resources for monitoring those programs, especially at the state and local levels (e.g., Joint Center for Poverty Research, 1998; National Research Council, 1998).

Data for performance measurement can be drawn from a variety of sources, such as reports to disease surveillance or vital statistics systems, environmental monitoring systems, population surveys, and clinical or administrative records from service encounters. Considering only the program areas covered by the original PPG proposal, the panel identified 48 data systems that might provide data for performance measurement (National Research Council, 1997a). Most states and communities can be expected to have a similarly large number of systems from which to draw data for performance measurement.

Four basic types of data resources are available: (1) registries, often referred to as census data systems, that attempt to capture information about all events of interest on such matters as health status (e.g., births, deaths, cases of disease) or risk factors (e.g., immunizations, environmental contaminants); (2) surveys that obtain data through the systematic collection of information from a representative sample of a population of interest; (3) patient records that contain clinical information obtained in the course of providing health care; and (4) administrative data, such as billing records, that are collected as part of the operation of a program (although these records may include data on health status or clinical care, that is not their primary purpose).

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