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Suggested Citation: "Contents." National Research Council. 1999. Measuring Health Performance in the Public Sector: A Summary of Two Reports. Washington, DC: The National Academies Press. doi: 10.17226/9603.

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

Measuring Health Performance in the Public Sector: A Summary of Two Reports (1999)

Chapter: Contents

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Measuring Health Performance in the Public Sector: A Summary of Two Reports (1999)

Chapter: Contents