Performance measurement in communities: Bringing health care and public health information systems together for population health improvement

In 1997 the Institute of Medicine released its report, Improving Health in the Community: A Role for Performance Monitoring. The report provided a conceptual framework for the community health improvement process and examples of indicators for a community health profile, and argued for the value of monitoring performance as a critical part of the improvement process. Since then many communities have developed health profiles to provide an overview of health status (e.g., mortality rates from various causes) and of the prevalence of important determinants of health (e.g., smoking rates and percent of the population with health insurance). Many communities have also adopted a set of indicators or measures to monitor their progress over time toward meeting specific health or health-care related goals. The recent emphasis on accreditation and accountability of local and state health systems is intended to provide communities with objective assurance that the performance of their health systems meets minimum standards.

In this session, members of the health care and public health communities will discuss the successes and failures of the past ten years of performance monitoring and what is needed over the next ten years to further facilitate their work. Dr. Elliott Fisher will discuss how data on the quality and outcomes of medical care currently available from the Dartmouth Atlas might be integrated in local level health profiles and performance assessment. Dr. Patrick Remington will describe how his work with local measures of health determinants and outcomes from the Wisconsin County Health Rankings has encouraged broader community engagement in the health improvement process. Following these presentations, Dr. Sharon McDonnell, Dr. James Marks, and Mr. Chris Queram will join the presenters in a panel discussion to explore approaches to support better community-based information.

Panelists will discuss the opportunities and challenges of integrating provider-based health care information systems with multiple population-based information systems, as well as strategies for the public health community to more effectively monitor and improve population health in collaboration with the medical care system. In addition, the discussion will address the value of having data from additional sources such as complete claims data for all payers and more comprehensive local data on health risks and determinants.

Finally, Dr. C.E. Koop will provide commentary on ways to engage more people, including clinicians, in public health.