Identifying pathways for improving performance: Results from the National Public Health Performance Standards Program

Introduction: This analysis explores how the performance of essential public health services varies across communities and identifies underlying domains of activity that may be driving variation in performance. Methods: This is a study of 452 local public health systems located within 30 states that completed the National Public Health Performance Standards Program Version 1 local public health system assessment instrument. The assessment instrument provides a summary measure of performance on the ten essential public health services and measures for 31 performance indicators, which represent major components, activities, or practice areas of the essential services. Following an analysis of the distribution of the essential services and performance indicators, a factor analysis of the 31 performance indicators was conducted to examine the underlying dimensions of performance that are reflected in these measures. Next, linear regression will be used to examine the relationship between a set of variables constructed from results of the factor analysis and the measures on the ten essential services. Results: The factor analysis revealed 4 domains or groupings of indicators that explain 54.7% of the variance in the 31 indicators. The domains could be generally categorized using the following descriptors: Domain 1—Core functions; Domain 2—Research and workforce assessment; Domain 3—Surveillance and emergency planning; and Domain 4—Workforce development and assuring service needs. Conclusions: The domains of performance identified in this study can aid public health administrators and planners in monitoring the performance of public health systems and can assist in identifying pathways for improving performance.