CREATING AND VALIDATING PRACTICAL MEASURES FOR ASSESSING PUBLIC-HEALTH PRACTICES IN LOCAL-COMMUNITIES

Efforts to develop a surveillance system to measure local public healt h performance were initiated in 1991. The organizing framework for the proposed system consisted of three core functions formulated by the I nstitute of Medicine and linked with 10 practices previously defined. A surveillance protocol was developed using local public health jurisd ictions rather than specific agencies within the jurisdictions, as the units of study. Selection of 84 indicators was assisted by follow-up study of a group of departments analyzed in 1979 and by review of rece nt public health literature. Each of the 84 performance indicators was linked to one of the 10 practices. Responses to the survey were obtai ned from local health department directors, Results yielded scores for the surveyed jurisdiction with regard to adequacy of performance for each practice, the proportional contribution to performance by the loc al health department, and the identification of other providers contri buting to the coverage of each practice within the jurisdiction. A sho rtened version of the protocol (26 indicators) was tested in all local jurisdictions in six states and shown to correlate reliably with scor es obtained from the longer protocol for overall public health perform ance, as well as for performance of each of the three core functions a nd for some of the 10 practices. A subset of four indicators was shown to predict reliably the overall score. The findings support the propo sition that public health practice can be defined, measured, and monit ored and that current widely accepted definitions of core functions an d practices have utility. Measurement and surveillance tools for these functions and practices are available and tested.