performance standards: opportunities for quality improvement for maternal and child health dennis...
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Performance Standards: Opportunities for Quality
Improvementfor Maternal and Child Health
Dennis Lenaway, PhD, MPHCenters for Disease Control and Prevention
Public Health Program Practice Office
1988 Institute of Medicine (IOM) Report
Public health – “assuring conditions in which people can be healthy”Identified three core functions– Assessment– Assurance – Policy DevelopmentFocused attention on governmental public health
Institute of Medicine Report
The Future of the Public’s Health (2002)Builds on the 1988 report but with a broader scopeRecommendation #13 – “develop a research agenda … to build the
evidence base that will guide policy-making for public health practice.”
Other recommendations address specific aspects of public health practice and public health systems
Essential Public Health Services
Developed by the Core Public Health Functions Steering Committee (1994)– Included reps from national
organizations and federal agencies
– Charge: To provide a description and definition of public health
Vision:Healthy People in Healthy Communities
Mission:Promote Physical and Mental Health
andPrevent Disease, Injury, and Disability
The Essential Public Health Services
1. Monitor health status2. Diagnose and
investigate health problems
3. Inform and educate4. Mobilize communities
to address health problems
5. Develop policies and plans
6. Enforce laws and regulations
7. Link people to needed health services
8. Assure a competent health services workforce
9. Evaluate health services
10.Conduct research for new innovations
Infrastructure
Building Public Health Infrastructure
"...It’s vital that we take steps to address current inadequacies and ensure that our public health infrastructure is prepared to meet the challenges of any public health crisis.”
– Senator Bill Frist, MD, June 2000
Infrastructure
A Growing Focus on the Public Health System
More than just the public health agency“Public health system” – All public, private, and voluntary entities that
contribute to the delivery of public health services within a jurisdiction.
– A network of entities with differing roles, relationships, and interactions.
– All entities contribute to the health and well-being of the community.
The Public Health System
MCOs
Home Health
Parks
Economic Developmen
t
Mass Transit
Employers
Nursing Homes
Mental Health
Drug Treatment
Civic GroupsCHCs
Laboratory
Facilities
Hospitals
EMS Community Centers
Doctors
Health Department
Churches
Philanthropist
Elected Officials
Tribal Health
Schools
Police
Fire
Corrections
Environmental Health
NPHPSP Overview
Began in 1998 Partnership effort between CDC and six national public health organizations– APHA, ASTHO, NACCHO, NALBOH, PHF,
NNPHI– Numerous working groups
Extensive Field Testing – TX, FL, HI, MO, OH, MN, MS, NY, MA
National launch in June 2002
Healthy People 2010
Chapter 23 – Public Health InfrastructureSome examples:– #11 - “…meet performance standards for
essential services.”– #12 “…have a health improvement plan.”– #16 “…categorize expenditures by essential
services.”– #8 “…integrate competencies in essential
services into personnel systems.”
MAPP
Mobilizing for Action through Planning and Partnerships (MAPP)Developed by NACCHO and CDCCommunity strategic planning toolWeb-based tool – www.naccho.org
The MAPP Model
Coordination with MAPP
Use of NPHPSP within MAPP ensures broad-based involvement
MAPP provides the process for addressing strengths and weaknesses
NPHPSP Vision and Goals
To improve the quality of public health practice and performance of public health systems by:
1. Providing performance standards for public health systems and encouraging their widespread use;
2. Engaging and leveraging national, state, and local partnerships to build a stronger foundation for public health preparedness;
3. Promoting continuous quality improvement of public health systems; and
4. Strengthening the science base for public health practice improvement.
Partners
CDC – Overall lead for coordinationASTHO – State instrumentNACCHO – Local instrument and MAPPNALBOH – Governance instrumentAPHA –Marketing & communicationsPHF- Research activitiesNNPHI – Support through institutes
The Assessment Instruments
State public health systemLocal public health systemLocal governanceInternational
Indicator
ModelStandard
Measures
Essential Service
Instrument FormatInstrument Format
Four Concepts Applied in NPHPS
1. Based on the ten Essential Public Health Services
2. Focus on the overall public health system
3. Describe an optimal level of performance
4. Support a process of quality improvement
1. The Essential Services as a Framework
Provides a foundation for any public health activityDescribes public health at both the state and local levelsInstruments include sections addressing each ES
2. Focus on the “System”
More than just the public health agency“Public health system”– All public, private, and
voluntary entities that contribute to public health in a given area.
– A network of entities with differing roles, relationships, and interactions.
– All entities contribute to the health and well-being of the community.
3. Optimal Level of Performance
Each performance standard represents the “gold standard”Provide benchmarks to which state and local systems can strive to achieveStimulate higher achievement
4. Stimulate Quality Improvement
Standards should result in identification of areas for improvementLink results to an improvement processNPHPSP Local Instrument - used within the MAPP planning process
Four components of a performance management system
Source: Turning Point Performance Management Collaborative, From Silos to Systems: Performance Management in Public Health (in press).
Potential Uses of NPHPSP Data and Information
BenchmarkingNeeds assessmentStrategic planningQuality improvementPerformance Management
Community mobilizationAlliance buildingResource allocationProgram evaluationPolicy developmentGrant-writingPublic accountability
NPHPSP: Moving Towards Quality Improvement
Review scores and resultsDiscuss comments and ideas made during the instrument completion processIdentify priority areas to addressCollectively develop strategies to address prioritiesManagement of change
Using the Results for Quality Improvement:
Examples from the Field
Mississippi – Used the information to develop legislative language for a capital improvement bondUsed data for BT grant proposalUsed data for the Sunset Commission reportUsed data for a proposal addressing environmental health improvement
Coordinated Statewide Process
Use of multiple NPHPSP instruments in a coordinated approachBenefits:– Coordinated orientation, training,
and technical assistance– Aggregate reports of assessment
results– Coordinated quality improvement
planning
Statewide Activities
Pilot / Field Test States Currently using or planning for use statewide
NPHPSP in Practice
Ohio – establishing an accreditation process which
sets minimum agency standards for local health agencies and also requires all local areas to complete the NPHPSP Local Instrument.
New Jersey – by regulation, requires statewide use of local
and governance instruments.
Illinois – recently passed legislation with NPHPSP
Quality Improvement and Science
Provide information and consensus-based direction for quality improvementDevelop practice data about performance and models of effective public health systems
What gets
MEASUREDgets
DONE !
What gets
MEASUREDgets
DONE !