1. Public Health Performance Standards District System Assessment www.cdc.gov/od/ocphp/nphpsp/ Karen O’Rourke, MPH Joan Orr, CHES 2009

2. Part 1: The National Performance Standards Program

3. 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

4. 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

5. State public health system Local public health system Local governance The Assessment Instruments

6. 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

7. 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

8. 1.Monitor health status 2.Diagnose and investigate health problems 3.Inform and educate 4.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

9. “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”

10. The Public Health System

11. 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

12. Standards should result in identification of areas for improvement Link results to an improvement process Key Concept 4: Quality Improvement

13. 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

14. Part 2: The National Public Health Performance Standards Local Assessment

15. 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

16. 10 Essential Services 30 Model Standards 325 Total Questions (109 questions, 216 sub-questions)

17. 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%)

18. Scoring Option Definitions ScoreDefinition NoNo activity. MinimalSome activity by an organization or organizations within a single service/geographic area. Not connected or minimally connected to others in or across the District. ModerateActivity 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. SignificantActivity 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. OptimalFully meets the model standard for the entire District.

19. The Data Quantitative Scores assigned based on responses Algorithm developed by CDC Qualitative Comments captured Themes developed

20. Reports Reports include: Overall Score for each Essential Service A summary score for each indicator A score for each component

21. Example ESPH #7: Link People to Needed Health Services Overall Score: 81.93 Indicator 3: Assuring Linkage of People to Personal Health Services Score 57.42 Assure the provision of needed personal health services33.33 Provide outreach and linkage services for the community39.17 Initiatives to enroll eligible beneficiaries in state Medicaid or medical assistance programs 100.00 Assure the coordinated delivery of personal health services47.92 Conducted an analysis of age-specific participation in preventive services 66.67

22. Example ESPH #1: Monitor Health Status Overall Score: 62.23 Indicator 2: Access to and Utilization of Current Technology Score 40.25 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

23. 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.

24. Activities & Timeline 2009 Maine Center for Public Health March -June Conduct 5 District Assessments Analyze Findings Conduct 3 District Assessments July -AugustSept. - Oct Fall Analyze Findings & Present Reports

25. 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.

26. 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

27. For More Information: www.cdc.gov/od/ocphp/nphpsp/ www.cdc.gov/od/ocphp/nphpsp/