National Public Health Performance Standards Program Liza Corso Office of State, Tribal, Local, and Territorial Support Centers for Disease Control and Prevention Presentation to: Institute of Medicine, Committee on Public Health Strategies to Improve Health March 4, 2010
Program 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.
NPHPSP Assessment Instruments State public health system Local public health system Local public health governance Partners CDC APHA ASTHO NACCHO NALBOH NNPHI PHF
History of the NPHPSP vkey Dates Began in 1998 Version 1 instruments released in 2002 2002-2007 Version 1 instruments used in more than 30 states Development of Version 2 instruments 2005-2007 Release of Version 2 instruments Fall 2007 vcomprehensive Development of Instruments Practice-driven development by CDC and ASTHO, NACCHO and NALBOH Work Groups Significant subject matter expert input Field testing Validation studies
Four Concepts Applied in NPHPSP 1. 2. 3. 4. Based on the ten Essential Public Health Services Focus on the overall public health system Describe an optimal level of performance Support a process of quality improvement
1 The Essential Services as a Framework vdeveloped by the Core Public Health Functions Steering Committee (1994) Included reps from national organizations and federal agencies vdescribes public health at both the state and local levels vinstruments include sections addressing each Essential Service
The Essential Public Health Services 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
2 Focus on the System vmore than just the public health agency Community Health care delivery system v Public health system All public, private, and voluntary entities that contribute to the delivery of public health services within a jurisdiction. Governmental Public Health Infrastructure Assuring the Conditions for Population Health Academia The Media Employers and Business (IOM, 2003) (IOM, 2003)
Public Health System Public Health System EMS Schools Neighborhood Organizations Civic Groups Non-Profit Organizations Nursing Homes Community Centers Hospitals Doctors Drug Treatment Public Health Agency Laboratories Home Health Mental Health CHCs Law Faith Institutions Enforcement Tribal Health Fire Transit Employers Corrections Elected Officials
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
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 Act Plan Study Do
Sample NPHPSP Report How Did We Perform In The Ten Areas Of Essential Public Health Services (EPHS)? 100 90 88.2 Performance Score 80 70 60 50 40 30 20 78.5 54.1 48.3 49.3 74.3 72.5 44.6 21.3 15.5 10 0 1 2 3 4 5 6 7 8 9 10 Essential Public Health Service
NPHPSP Use in the Field Coordinated statewide approach Benefits in technical assistance and coordinated improvement planning Individual System / Board Use Common Catalysts for Use Statewide interest in improvement planning Interest in performance improvement Bioterrorism and emergency response planning Use within the MAPP process Interest in accountability
NPHPSP State Instrument Use (Thru December 2009, n = 27 states + DC) WA MT ND ME OR CA NV ID AZ UT WY CO NM SD NE KS OK MN IA MO AR WI IL MI IN KY TN OH NY PA WV VA NC SC VT NH MA RI CT NJ DE MD MS AL GA AK TX LA FL HI *Also includes sites using field test versions of the NPHPSP State Public Health System Performance Assessment.
NPHPSP Local Instrument Use (Thru December 2009) WA MT ND ME OR CA NV ID AZ UT WY CO NM SD NE KS OK MN IA MO AR WI IL MI IN KY TN OH NY PA WV VA NC SC VT NH MA RI CT NJ DE MD MS AL GA AK TX LA FL HI Significant Use (67% or greater) Moderate Use (33% - 66%) Limited Use (1% - 32%) *Also includes sites using field test versions of the NPHPSP Local Public Health System Performance Assessment.
NPHPSP Governance Instrument Use (Thru December 2009) WA MT ND ME OR CA NV ID AZ UT WY CO NM SD NE KS OK MN IA MO AR WI IL MI IN KY TN OH NY PA WV VA NC SC VT NH MA RI CT NJ DE MD MS AL GA AK TX LA FL Significant Use (67% or greater) HI Moderate Use (33% - 66%) Limited Use (1% - 32%) No Boards of Health *Also includes sites using field test versions of the NPHPSP Local Public Health Governance Performance Assessment.
NPHPSP Use in the Field (What the evaluation data* tell us) Reasons for Using NPHPSP State and Local Establish a baseline measure of performance Wanted a national developed & recognized assessment tool to help improve performance NPHPSP the best tool available for improving public health system effectiveness Was part of the MAPP process (local users only) *State evaluation data gathered through ASTHO survey 10/05-1/06 80% response rate (9 respondents reporting completion of State NPHPSP). Local evaluation data gathered through NACCHO survey to known NPHPSP and MAPP users in 01/06 05/06; 212 total respondents (149 respondents reporting completion of Local NPHPSP).
NPHPSP Outcomes Achieved ID strengths / weaknesses of PHS Awareness of interconnectedness of PH HD plan to make improvements Better understanding of health issues Stronger system collaboration Tangible commitments for improving PI processes that engage system partners Initiate a MAPP process 0 20 40 60 80 100 Percentage of respondents indicating achievement of these outcomes was partial/medium or high State Local
Impact of NPHPSP Use on the State / Local Public Health System Percentage of respondents indicating moderate to major effect 100 90 80 70 60 50 40 30 20 10 0 Leverage system staff for priorities Pool system resources More coordinated decisionmaking More grants where agency is partner State Local
State Example - New Hampshire NPHPSP State Performance Assessment October 2005, approx 150 system participants Public Health Improvement Action Plan 6 strategic priorities, led by diverse state partners Led to new funding, web-based data systems, and focusing ph initiatives on leading contributors to death, - tobacco, physical activity, nutrition and alcohol Sustainability through legislation Law enacted (June 2007) creating Statewide Council to manage public health improvement plan
NPHPSP and Community Health v NPHPSP Local Instrument used within MAPP to assess public health system capacity v Pairs with health status data, community input and forces of change v MAPP provides the process for planning, improvement and action Improvement Planning
NPHPSP Data Results Version 1 Users
Framework for Improving The Performance of Public Health Accreditation + PH System + Community Partners + Workforce Builds Operational Capacity (infrastructure) Impacts Every Community Program and Public Health Activity (Chronic Disease, Inf Disease, EH) Which leads to Better Health Outcomes Reduced Disparities Better Preparedness Investments here Pay big dividends here
Strategic Linkages v Policy support Healthy People 2010 Objective 23-11 and HP2020 Institute of Medicine reports State legislation that provide for or mention use of NPHPSP (e.g., IL, OH, NJ) v Accreditation NPHPSP as a complementary or preparatory tool Used as a source in creating PHAB standards v Community /State Health Improvement Planning Used within MAPP or MAPP-like processes Use both NPHPSP systems data and health status data
Strengthening the public health system Community Health care delivery system Governmental Public Health Infrastructure Assuring the Conditions for Population Health Employers and Business Academia The Media
and its core the governmental component Community Health care delivery system Governmental Public Health Infrastructure Assuring the Conditions for Population Health Employers and Business Academia The Media