Performance Standards: Opportunities for Quality Improvement for Maternal and Child Health

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Performance Standards Opportunities for Quality
Improvementfor Maternal and Child Health

• Dennis Lenaway, PhD, MPH
• Centers for Disease Control and Prevention
• Public Health Program Practice Office

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1988 Institute of Medicine (IOM) Report

• Public health assuring conditions in which
  people can be healthy
• Identified three core functions
• Assessment
• Assurance
• Policy Development
• Focused attention on governmental public health

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Institute of Medicine Report

• The Future of the Publics Health (2002)
• Builds on the 1988 report but with a broader
  scope
• Recommendation 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

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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

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Vision Healthy People in Healthy Communities
Mission Promote Physical and Mental Health
and Prevent Disease, Injury, and Disability
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The Essential Public Health Services

• Monitor health status
• Diagnose and investigate health problems
• Inform and educate
• Mobilize communities to address health problems
• Develop policies and plans

• Enforce laws and regulations
• Link people to needed health services
• Assure a competent health services workforce
• Evaluate health services
• Conduct research for new innovations

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Infrastructure
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Building Public Health Infrastructure

• "...Its 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

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Infrastructure
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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.

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The Public Health System
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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

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Healthy People 2010

• Chapter 23 Public Health Infrastructure
• Some 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.

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MAPP

• Mobilizing for Action through Planning and
  Partnerships (MAPP)
• Developed by NACCHO and CDC
• Community strategic planning tool
• Web-based tool www.naccho.org

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The MAPP Model
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Coordination with MAPP

• Use of NPHPSP within MAPP ensures broad-based
  involvement
• MAPP provides the process for addressing
  strengths and weaknesses

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NPHPSP Vision and Goals

• To improve the quality of public health practice
  and performance of public health systems by
• Providing performance standards for public health
  systems and encouraging their widespread use
• Engaging and leveraging national, state, and
  local partnerships to build a stronger foundation
  for public health preparedness
• Promoting continuous quality improvement of
  public health systems and
• Strengthening the science base for public health
  practice improvement.

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Partners

• CDC Overall lead for coordination
• ASTHO State instrument
• NACCHO Local instrument and MAPP
• NALBOH Governance instrument
• APHA Marketing communications
• PHF- Research activities
• NNPHI Support through institutes

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The Assessment Instruments

• State public health system
• Local public health system
• Local governance
• International

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Instrument Format
Essential Service
Indicator
Model Standard
Measures
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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

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1. The Essential Services as a Framework

• Provides a foundation for any public health
  activity
• Describes public health at both the state and
  local levels
• Instruments include sections addressing each ES

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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.

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3. Optimal Level of Performance

• Each performance standard represents the gold
  standard
• Provide benchmarks to which state and local
  systems can strive to achieve
• Stimulate higher achievement

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4. Stimulate Quality Improvement

• Standards should result in identification of
  areas for improvement
• Link results to an improvement process
• NPHPSP Local Instrument - used within the MAPP
  planning process

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Four components of a performance management
system
Source Turning Point Performance Management
Collaborative, From Silos to Systems Performance
Management in Public Health (in press).
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Potential Uses of NPHPSP Data and Information

• Benchmarking
• Needs assessment
• Strategic planning
• Quality improvement
• Performance Management

• Community mobilization
• Alliance building
• Resource allocation
• Program evaluation
• Policy development
• Grant-writing
• Public accountability

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NPHPSP Moving Towards Quality Improvement

• Review scores and results
• Discuss comments and ideas made during the
  instrument completion process
• Identify priority areas to address
• Collectively develop strategies to address
  priorities
• Management of change

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Using the Results for Quality Improvement
Examples from the Field

• Mississippi
• Used the information to develop legislative
  language for a capital improvement bond
• Used data for BT grant proposal
• Used data for the Sunset Commission report
• Used data for a proposal addressing environmental
  health improvement

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Coordinated Statewide Process

• Use of multiple NPHPSP instruments in a
  coordinated approach
• Benefits
• Coordinated orientation, training, and technical
  assistance
• Aggregate reports of assessment results
• Coordinated quality improvement planning

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Statewide Activities
Currently using or planning for use statewide
Pilot / Field Test States
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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

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Quality Improvement and Science

• Provide information and consensus-based direction
  for quality improvement
• Develop practice data about performance and
  models of effective public health systems

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What gets MEASURED gets DONE !