Public Health Performance Standards

District System Assessment

www.cdc.gov/od/ocphp/nphpsp/Karen O’Rourke, MPH

Joan Orr, CHES

2009

Part 1:The National Performance

Standards Program

To improve the quality of public health practice

and performance of public health systems by:

• Providing performance standards for public health systems;

• Promoting continuous quality improvement;• Engaging and leveraging partnerships;• Strengthening the science base for public

health practice improvement

Program Vision and Goals

• Began in 1998

• Partnership effort between CDC and five national public health organizations– APHA, ASTHO, NACCHO, NALBOH, NNPHI, PHF

• National launch in June 2002

• Tool revised in 2008

Background

HISTORICAL

BACKGROUND

• State public health system

• Local public health system

• Local governance

The Assessment Instruments

Four Key Concepts

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

• Provides a foundation for any public health activity

• Describes public health at both the state and local levels

• Instruments include sections addressing each essential service

Key Concept 1: The Essential 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

10 Essential PH Services

• “Public Health System”– A Network of…

• Public entities• Private entities• Voluntary entities

• All entities contribute to the health and well-being of the community

Key Concept 2: Focus on the “System”

The Public Health System

MCOs

Home Health

Parks

Economic Development

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

• Each performance standard represents the “gold standard”

• Provide benchmarks to which state and local systems can strive to achieve

• Stimulate higher achievement

Key Concept 3: Optimal Performance

• Standards should result in identification of areas for improvement

• Link results to an improvement process

Key Concept 4: Quality Improvement

• Improves organizational and community communication

• Provides a benchmark for public health practice improvements

• Brings partners to same table

• Promotes cohesion and collaboration

• Provides a systems view of public health• Provide a baseline for Maine’s emerging District

Public Health System

User Benefits

Part 2:The National Public Health

Performance StandardsLocal Assessment

The Tool

•Focus is on the District Public Health System

•10 Chapters• Based on essential services

•Each Essential Service• Indicators (components, activities)• Model standards (optimal performance)• Measures (questions)

Structure

Structure

•10 Essential Services

•30 Model Standards

•325 Total Questions (109 questions, 216 sub-questions)

Response Options

•Response Options• No activity•Minimal (>0 and 25% or less)•Moderate (>25% but no more than 50%)•Significant (>50% but no more than 75%)•Optimal (Greater than 75%)

Scoring Option Definitions

Score Definition

No No activity.

Minimal Some activity by an organization or organizations within a single service/geographic area. Not connected or minimally connected to others in or across the District.

Moderate Activity by one or more agency or organization that reaches across the District and is connected to other organizations in the District but limited in scope or frequency.

Significant Activity that covers the entire District [is dispersed both geographically and among programs] and is connected to multiple agencies/organizations within the District Public Health System.

Optimal Fully meets the model standard for the entire District.

The Data

Quantitative • Scores assigned based on responses• Algorithm developed by CDC

Qualitative• Comments captured• Themes developed

Reports

Reports include: • Overall Score for each Essential

Service• A summary score for each

indicator • A score for each component

ExampleESPH #7: Link People to Needed Health Services

Overall Score : 81.93

Indicator 3:

Assuring Linkage of People to Personal Health Services

Score57.42

Assure the provision of needed personal health services 33.33

Provide outreach and linkage services for the community 39.17

Initiatives to enroll eligible beneficiaries in state Medicaid or medical assistance programs

100.00

Assure the coordinated delivery of personal health services 47.92

Conducted an analysis of age-specific participation in preventive services

66.67

ExampleESPH #1: Monitor Health Status

Overall Score: 62.23

Indicator 2: Access to and Utilization of Current Technology

Score40.25

State-of-the-art technology to support databases? 62.50

Access to geo-coded health data? 0.00

Use geographic information systems (GIS)? 0.00

Use computer-generated graphics to identify trends and/or compare data?

100.00

Community Health Profile available in electronic version? 38.75

Recording Information

• While not an inventory of activities, we will record comments to identify themes and provide a context for the scores

• Specific programs, projects or organizations will generally not be included in the final report.

Activities & Timeline

2009

Maine Center for Public Health

March -June

Conduct5 District

Assessments

AnalyzeFindings

Conduct 3 District

Assessments

July -August Sept. - Oct Fall

Analyze Findings

&Present Reports

The Process

At each of the 3 meetings, we will:• Review the Essential Service Model Standard.• Discuss what each organization does with regard

to the model standard within the District.• Identify strengths, weaknesses, gaps and

recommendations for improvement or collaboration for the District.

• Facilitators will suggest a score upon completion of discussion. This will help ensure consistency across the 8 Districts.

Roles and Responsibilities

• Facilitators: – Guide participants through the process– Keep time– Allow everyone to speak– Suggest a score– Record results

• Participants– Participate fully in discussion from your organization’s

perspective – Keep comments brief (no more than 3 min)– Focus comments only on the indicator being discussed– Help identify strengths, weaknesses, gaps and

recommendations

For More Information:

www.cdc.gov/od/ocphp/nphpsp/