Performance Management in Maternal and Child Health Stephen E. Saunders, M.D., M.P.H. Associate Director for Family Health Illinois Department of Human Services "Improving Health System Performance and Health Outcomes" Conference April 15, 2004
Federal / State Partnership Federal government selected 18 performance and 6 outcome measures States set targets, collect data and report annually States select at least 7 more performance measures
The State s Role Needs assessment, resource allocation and program management Use state and federal funds to address problems Work with local service providers Provide training and quality assurance
The Local Provider s Role Deliver services Collect and report data Their success is our success!
Implementation Select measures Set targets Data collection capacity Reporting mechanism Quality Assurance, Training & Technical Assistance Performance Contracting Support from local providers
Selecting Measures A limited number Broad agreement about importance Ability to collect, analyze and report data Reliable, valid method of measurement Started with, but not limited to, those set by federal government
For Example 1st trimester initiation of prenatal care Initiation of breastfeeding Fewer uninsured children Fully-immunized 2-year-olds Preventive health care for children
Setting Targets Relative vs. Absolute Targets Allowing for System Complexity
Relative vs. Absolute Targets Absolute Recognized Best Practice (HP 2010) States an ideal Relative Easy to do and understand Recognizes incremental improvement
HP2010 Goals 1st Trimester Prenatal Care: 90% Initiation of breast feeding: 75% Fully Immunized 2-year-olds: 90%
Relative vs. Absolute Standards: Immunizations Which Approach Should We Use?
Allowing for Complexity Urban vs. Rural Percent 100% 80% 60% 40% 20% 0% Urban Rural Insurance Immunization 1st Trim. MCH Performance Measure
Data Collection Capacity Vital Records Health Care Expenditures Service Delivery Ability to Link Records
Frequency Visual Impact Reporting Capacity Maps Ranking Reports Frequency Distributions Compare regions or providers
Maps September 2001 December 2003
Ranking Immunization Performance For June 2003 Downstate Ranking Report WIC Agency Immunizations For Children Born 7/1/00-7/1/02 (4-3-3-1) Large Agencies AGENCY PCT. RANK KANKAKEE CHD 90.8 1 TAZEWELL CHD 89.11 2 WINNEBAGO 88.66 3 MACON CHD 87.33 4 WILL CHD 86.55 5 DEKALB CHD 84.43 6 MCLEAN CHD 84.03 7 CHAMPAIGN-URBANA PHD 80.99 8 ROCK ISLAND CHD 79.22 9 VERMILION CHD 77.22 10 SPRINGFIELD CITY HD 69.96 11 MCHENRY CHD 68.18 12 LAKE CHD 66.93 13 COORDINATED YOUTH SERVICES 63.45 14 DUPAGE CHD 62.48 15 VISITING NURSE ASSOCIATION 60.87 16 LASALLE CHD 60.72 17 WELL CHILD CONFERENCE 60.25 18 PEORIA CITY/COUNTY HD 57.77 19 EAST SIDE HEALTH DISTRICT 52.73 20 ST CLAIR CHD 50 21 Large Agency Average % 72.46 First Standard Deviation: 13.19 Second Standard Deviation: 26.38 From Report HSPR1307 dated 7/16/03 (90% Required for a Rank of "1")
Ranking on Several Variables Rank service providers on several variables Sum or average ranks on each variable for composite ranking
Quality Assurance, Training and Staff Capacity Technical Assistance Performance Data and Record Reviews Regular meetings with providers to improve staff performance
Gaining and Maintaining Support Internal with program management and quality assurance staff External In the planning stages Regularly to identify and resolve problems
Results
45 Progress of Entry into MCH Services by the First Trimester of Pregnancy Source: CDC Pregnancy Nutrition Surveillance System, Illinois 40 35 30 Percent 25 20 15 10 5 0 1996 1997 1998 1999 2000 2001 2002 2003 Year
60 Progress of Illinois Breastfeeding Initiation Rates at Hospital Discharge Source: Cornerstone Summary Report, IDHS 55 50 45 Percent 40 35 30 25 20 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year
Insured Children in MCH Percent 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% Dec-00 Feb-01 Apr-01 Jun-01 Aug-01 Oct-01 Dec-01 Feb-02 Apr-02 Month and Year Jun-02 Aug-02 Oct-02 Dec-02
Illinois' MCH Immunization Campaign 90.0% 3:2:2 Series < Age 2 4:3:3:1 Series < Age 3 85.0% Percent Fully Immunized 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0% Sep-01 Dec-01 Mar-02 Jun-02 Sep-02 Dec-02 Mar-03 Jun-03 Sep-03 Dec-03 Month and Year
MCH Program Participants with At Least 3 Preventive Health Visits by Age 1 60.0 50.0 40.0 Percent 30.0 20.0 10.0 0.0 Sep-02 Dec-02 Mar-03 Jun-03 Sep-03 Dec-03 Month and Year Preventive Health Visits
Outcome Objectives Very Low Birth Weight Infant Mortality
All Births - Very Low Birth Weight 1997-2001 Percent of Live Births 2.0% 1.5% 1997 1998 1999 2000 2001 Year Total Medicaid Statewide
Infant Mortality Trend: Illinois 1991-2002 Source: Vital Records - Illinois Department of Public Health 11 Rate per 1,000 births 10.5 10 9.5 9 8.5 8 7.5 7 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Rate 10.7 10.1 9.6 9 9.3 8.4 8.2 8.2 8.3 8.3 7.5 7.2
Lessons Learned Measurement leads to improvement Competition is healthy Shifts focus to results & outcomes Shifts attention to data accuracy Requires a sophisticated MIS Supplement with QA activities Resistance can be overcome
Recommendations Set national vision and establish goals Keep it simple Translation to the community level is the key Give states flexibility Setting Targets Allocating Resources Invest in infrastructure Data Quality Assurance
Contact Information Stephen E. Saunders, M.D., M.P.H. Associate Director for Family Health Illinois Department of Human Services 535 West Jefferson Street Springfield, Illinois 62702-5058 voice 217/782-2736 email stephen.saunders@dhs.state.il.us