Transcript Assessment in Public Health: Thoughts, Ideas and Discussion

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Assessment in Public Health:
Thoughts, Ideas and Discussion
Dennis Lenaway, PhD, MPH
Director, Office of Standards and Emerging Issues in Practice
Office of Chief of Public Health Practice
Centers for Disease Control and Prevention
October 28, 2005
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Are We Ready for Challenges
of the 21st Century?
 Aging population
 Increasing diversity
 Escalating health costs
 Changes in access to health care
services
 Health disparities
 Global threats
 Terrorism
 Epidemic effects of chronic
diseases
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Why do Assessments?
Even if you’re on the
right track, you’ll get
run over if you just
stand still.
- Will Rogers
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3 Core Functions
(1988 IOM report)
• Assessment
• Policy Development
• Assurance
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10 Essential Public Health Services
• Monitor health status
• Diagnose and
investigate
• Inform, educate, and
empower
• Mobilize community
partnerships
• Develop policies and
plans
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• Enforce laws and
regulations
• Link people to needed
services / assure care
• Assure a competent
workforce
• Evaluate health
services
• Research
1. Monitor Health to Identify and Solve
Community Health Problems
• Accurate, periodic assessment of the
community’s health status.
• Surveillance Systems
• Utilization of methods and technology (e.g.,
GIS) to interpret and communicate data
• Population health registries
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2. Diagnose and Investigate Health Problems
and Hazards in the Community
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Timely identification of health threats (assessment?)
Case investigation protocols
Availability of diagnostic services
Guidelines for handling specimens
Response plans to address major health threats
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Without assessment and
planning, where do you end up?
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The BIG Picture
Assessment is part of a larger effort to
determine where we are, where we
want to go, and how we are going to
get there …and did we actually arrive?
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The Basics
Assess
Impact
Analysis
Action Plan
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Agency
Community
National
Accreditation
Preparedness
Credentialing
Program Impacts
NPHPS
MAPP
Preparedness
PACE-EH
LHA Profile
Futures Initiative
National Surveys
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National Public Health
Performance Standards
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Performance Standards
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.
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Four Concepts Applied in
National Performance Standards
1. Based on the 10 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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The Assessment
Instruments
• State public health system
• Local public health system
• Local governance
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Mobilizing Action
through Planning and
Partnership
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Mobilizing for Action
through
Planning and Partnerships (MAPP)
• Community strategic planning tool
• Developed by NACCHO and CDC
• Development began in 1996, released in
2001
• Web-based tool – www.naccho.org
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The MAPP Model
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Performance Improvement
• Performance improvement at all levels:
– Organization, System, and Statewide
• Collectively discuss scores and results
• Refer to comments and ideas
generated during the assessment
• Identify priority areas to address
• Collectively develop strategies to
address priorities
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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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CDC’s Futures Initiative
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CDC’s Futures Initiative
Input
ideas
implementation
Impact
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Outside-In Process
Partner Groups
Discussion and Organizations
Groups
Interviews
Our Customers,
the American
People
CDC’s
Stakeholders
CDC Futures
Initiative
Focus
Groups
E-mail
Feedback
HHS,
Policymakers,
Congress
Futures
Web site
CDC Staff
CENTERS FOR DISEASE CONTROL AND PREVENTION
Then
CDC WASHINGTON
OFFICE
OFFICE OF GLOBAL
HEALTH
OFFICE OF THE CHIEF
OPERATING OFFICER
OFFICE OF WOMEN’S
HEALTH
OFFICE OF
COMMUNICATION
OFFICE OF HEALTH AND
SAFETY
OFFICE OF THE
DIRECTOR
OFFICE OF EQUAL
EMPLOYMENT
OPPORTUNITY
OFFICE OF MINORITY
HEALTH
OFFICE OF EXECUTIVE
SECRETARIAT
OFFICE OF PROGRAM
PLANNING AND
EVALUATION
OFFICE OF GENOMICS
AND DISEASE
PREVENTION
OFFICE OF SCIENCE
POLICY AND
TECHNOLOGY TRANSFER
OFFICE OF CHIEF OF
STAFF
NATIONAL
CENTER ON
BIRTH
DEFECTS &
DEVELOPMENTAL
DISABILITIES
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NATIONAL
CENTER FOR
CHRONIC
DISEASE
PREVENTION
& HEALTH
PROMOTION
NATIONAL
CENTER FOR
ENVIRONMENTAL
HEALTH
NATIONAL
CENTER
FOR HEALTH
STATISTICS
NATIONAL
CENTER FOR
INFECTIOUS
DISEASES
NATIONAL
CENTER FOR
INJURY
PREVENTION
AND CONTROL
NATIONAL
CENTER FOR
HIV, STD, AND
TB PREVENTION
NATIONAL
INSTITUTE
FOR
OCCUPATIONAL
SAFETY
AND HEALTH
EPIDEMIOLOGY
PROGRAM
OFFICE
NATIONAL
IMMUNIZATION
PROGRAM
PUBLIC HEALTH
PRACTICE
PROGRAM
OFFICE
AGENCY FOR
TOXIC
SUBSTANCES
AND DISEASE
REGISTRY
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CDC Today
OFFICE OF THE
CHIEF OPERATING
OFFICER
CDC
WASHINGTON
OFFICE
OFFICE OF CHIEF
SCIENCE OFFICER
OFFICE OF CHIEF
OF PUBLIC HEALTH
PRACTICE
OFFICE OF
STRATEGY &
INNOVATION
OFFICE OF THE
DIRECTOR
OFFICE OF CHIEF
OF STAFF
OFFICE OF
ENTERPRISE
COMMUNICATION
OFFICE OF EQUAL
EMPLOYMENT
OPPORTUNITY
GLOBAL
HEALTH
TERRORISM
PREPAREDNESS
& EMERGENCY
RESPONSE
OFFICE OF WORKFORCE
& CAREER
DEVELOPMENT
ENVIRONMENTAL
HEALTH &
INJURY
PREVENTION
HEALTH
INFORMATION
& SERVICES
HEALTH
PROMOTION
INFECTIOUS
DISEASES
NCIPC
NCHS
NCHPDP
NCID
NCEH
NCHM
NCBDDD
NIP
NCPHI
NCHSTP
NIOSH
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GOALS MANAGEMENT
Assessment of Evidence
Input
Mission
Feasibility
Comparative Impact
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Goals
Health
Impact
Performance
Management
Evidence-based action plan
Accountability & responsibility
assignments
Resource allocation
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Strategic Imperatives
Health Impact
Customer-focus
Public Health Research
Leadership in the nation’s health
system
Increased focus on Global Health
Effectiveness and Accountability
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New Strategic Goals
Preparedness: All people in communities
will be protected from infectious,
environmental, and terrorist threats.
Health promotion and prevention of
disease, injury, and disability: All
people will achieve their optimal lifespan
with the best possible quality of health in
every stage of life.
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National Surveys
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Leading Causes of Mortality (2001)
Heart Disease
(700,142)*
Malignant Neoplasms
(553,768)
Cerebrovascular
(163,538)
Chronic Low Respiratory Disease
(123,013)
Unintentional Injuries
(101,537)
Diabetes Mellitus
(71,372)
Influenza @ Pnuemonia
(62,034)
Alzheimer's Disease
(53,852)
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5
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* (number of deaths)
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25
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Percentage of all deaths
Source: National Center for Health Statistics, National Vital Statistics Report 2003.
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Actual Causes of Death (2001)
Tobacco
(435,000)*
Poor diet/Lack of exercise
(400,000)
Alcohol
(85,000)
Infectious Agents
(75,000)
Pollutants/Toxins
(55,000)
Motor Vehicles Crashes
(43,000)
Firearms
* (number of deaths)
(29,000)
Sexual Behavior
(20,000)
Illicit Drug Use
(17,000)
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5
10
15
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Percentage of all deaths
Source: Mokdad AH, Marks JS, Stroup DF, and Gerberding JL. Actual Dauses
of death in the United States, 2000. (Submitted to JAMA)
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Agency Accreditation
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Accreditation of Public Health Agencies
Accreditation
Incentives for
Participation
State and Local
Agency Standards
Partnership Development
Other
Accreditation
Programs
State PH Accred.
Standards
Program
NPHPSP
Operational
Definition
of a LPHA
Growing
Interest
(IOM Recs., NACCHO Res.)
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Accreditation of Public Health Agencies
Principles
Voluntary
Peer- Controlled
Incentivized
Based on Foundations
Already Laid
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No matter how much
assessment and planning
there is, some things don’t
change….
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Subject: software for Husband 1.0
Dear Tech Support,
Last year I upgraded from Boyfriend 5.0 to Husband 1.0 and noticed a
distinct slow down in overall system performance particularly in the
flower and jewelry applications, which operated flawlessly under
Boyfriend 5.0.
In addition, Husband 1.0 uninstalled many other valuable programs,
such as Romance 9.5 and Personal Attention 6.5, and then installed
undesirable programs such as NFL 5.0, NBA 3.0. and Golf Clubs 4.1.
Conversation 8.0 no longer runs, and Housecleaning 2.6 simply
crashes the system.
I've tried running Nagging 5.3 to fix these problems, but to no avail.
What can I do?
Signed, Desperate
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Dear Desperate:
First keep in mind, Boyfriend 5.0 is an Entertainment Package, while
Husband 1.0 is an Operating System. Please enter the command:
http://www.ithoughtyoulovedme.html/ and try to download Tears 6.2
and don't forget to install the Guilt 3.0 update.
If that application works as designed, Husband 1.0 should then
automatically run the applications Jewelry 2.0 and flowers 3.0.
But remember, overuse of the above application can cause Husband 1.0
to default to Grumpy Silence 2.5, Happy Hour 7.0, or Beer 6.1. Beer
6.1 is a very bad program that will download the Snoring Loudly Beta.
Whatever you do, DO NOT install Mother-in-law 1.0 (it runs a virus in the
background, that will eventually seize control of all your system
resources).
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Also, do not attempt to reinstall the Boyfriend 5.0 program. These
are unsupported applications and will crash Husband 1.0.
In summary, Husband 1.0 is a great program, but it does have limited
memory and cannot learn new applications quickly.
You might consider buying additional software to improve memory and
performance. We recommend Hot Food 3.0 and Lingerie 7.7.
Good Luck,
Tech Support
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Achieving Health Impact
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Office of
Chief of Public Health Practice
WEBSITE:
www.cdc.gov/od/ocphp