Development of indicators for quality assurance in public health medicine.

OBJECTIVES--To develop structure, process, and outcome indicators within a quality rating index for audit of public health medicine. DESIGN--Development of an audit matrix and indicator of quality through a series of group discussions with public health physicians, from which self administered weighted questionnaires were constructed by a modified Delphi technique. SETTING--Five Scottish health boards. SUBJECTS--Public health physicians in the five health boards. MAIN MEASURES--Indicators of quality and a quality rating index for seven selected service categories for each of seven agreed roles of public health medicine: assessment of health and health care needs in information services, input into managerial decision making in health promotion, fostering multisectoral collaboration in environmental health services, health service research and evaluation for child services, lead responsibility for the development and/or running of screening services, and public health medicine training and staff development in communicable disease. RESULTS--Indicators in the form of questionnaires were developed for each topic. Three types of indicator emerged: "global," "restricted," and "specific." A quality rating index for each topic was developed on the basis of the questionnaire scores. Piloting of indicators showed that they are potentially generalisable; evaluation of the system is under way across all health boards in Scotland. CONCLUSION--Measurable indicators of quality for public health medicine can be developed.     

Ausgewählte Aspekte bei der mikrobiologischen Überwachung der Trinkwasserqualität

The new drinking water ordinance (TrinkwV 2001) entered into force in 2003. In this paper we report about experiences with monitoring microbiological quality of drinking water. Special problems, for instance requirements concerning the quality of raw water, new and "old" microbiological parameters, microbiological methods, assessment of parametric values, especially in the case of values higher than the imperative value, are also described. Possible developments in this field are discussed. The paper should support microbiological laboratories, public health officers and other public authorities in monitoring and assessment of drinking water quality.     

Why “What Data Are Necessary for This Project?” and Other Basic Questions are Important to Address in Public Health Informatics Practice and Research

Despite the likelihood of poor quality data flowing from clinical information systems to public health information systems, current policies and practices are pushing for the adoption and use of even greater numbers of electronic data feeds. However, using poor data can lead to poor decision-making outcomes in public health. Therefore public health informatics professionals need to assess, and periodically re-evaluate, the quality of electronic data and their sources. Unfortunately there is currently a paucity of tools and strategies in use across public health agencies. Our Center of Excellence in Public Health Informatics is working to develop and disseminate tools and strategies for supporting on-going assessment of data quality and solutions for overcoming data quality challenges. In this article, we outline the need for better data quality assessment and our approach to the development of new tools and strategies. In other words, public health informatics professionals need to ask questions about the electronic data received by public health agencies, and we hope to create tools and strategies to help informaticians ask questions that will lead to improved population health outcomes.     

四川地震重灾县基层公共卫生人员培训效果评估

目的:通过对"健康中国工程"四川地震重灾县基层公共卫生人员培训子项目进行系统性评估,探索同类培训的有效评价方法,保障并促进培训质量的提高。方法:问卷调查、实地座谈、深度访谈及典型调查等。结果:反应层次评估表明学员们对该期培训课程的总体满意率为93.67%,学习层次评估(闭卷考试)显示平均成绩与及格率都有较大幅度提高。行为与结果层次的评估表明,学员的业务素质与工作能力有明显提升,所在机构的公共卫生服务绩效提高。该培训子项目实现了预期目标。建议:今后同类培训应进一步改进完善,包括强化培训对象的针对性、根据各地实际需求设计培训时间与地点、丰富细化培训内容与方式等方面。     

基层卫生服务信息采集类APP的应用需求及发展对策研究

目的:了解四川省农村地区基层卫生机构的公共卫生服务工作现状和对卫生服务信息采集类APP的需求情况,同时了解"卫计E通"APP在试点区存在的挑战并提出建议。方法:定量调查和定性访谈相结合的方法,开展面上调查和试点区调查--两阶段现场调研。结果:我省农村地区基层卫生机构公共卫生服务工作负担大、人员匮乏、工作效率低、卫生服务数据质量差且未有效利用。此外,数据采集类APP在农村基层卫生机构的应用中,尚还面临着APP功能部分不合、推广培训模式欠佳、缺乏成本效果评估以及卫生信息系统未能互联互通等挑战。结论:应进一步联系基层实际,深入开展需求调研及可持续性系统评估,推行"服务性学习"辅助推广模式,同时取得政策支持实现信息的互联互通,有效提高农村地区基层卫生机构的卫生服务工作效率及质量。     

Adapting needs assessment methodologies to build integrated health pathways for people in the criminal justice system

Criminal justice health services should be underpinned with good public health evidence about the population's health needs. Health needs assessment methodologies can provide valuable intelligence for commissioners to evaluate the quality of services and innovate according to need. However, health needs assessment can be limited if it takes a conventional epidemiological approach, focussing on individuals' healthcare needs in criminal justice settings. Techniques used to measure health and social need could be more widely applied and appropriately employed in the planning of health and social care services, especially if the intention is to be effective in reducing social exclusion and tackling health inequalities. Assessment tools are available that capture individual, social and environmental risk factors and determinants predisposing people to health and criminogenic risks. Good evidence gathering can mean that public health practitioners not only improve health, reduce inequalities and tackle social exclusion, but contribute to reducing re-offending. This paper suggests a new approach to assessment that integrates the full range of assessment methodologies available to practitioners. An integrated approach may be the way to enhance and enrich the public health function in providing evidence to improve the quality of local public services.     

疾病预防控制机构突发公共卫生事件评估体系探讨

目前,突发公共卫生事件受到卫生行政部门的高度重视,疾病预防控制（简称疾控）机构作为突发公共卫生事件应急处置的主力军,其响应质量直接影响到突发公共卫生事件处置成功率,因此,建立疾控机构突发公共卫生事件应急响应评估体系有助于提高突发公共卫生事件的反应灵敏度,有利于今后有效、有序地开展突发公共卫生事件疫情处置。     

The Development of a Tool to Assess Quality of Cost Estimates

Objective: To develop and implement a quality assessment instrument to evaluate cost estimates in economic evaluation studies. Design and setting: The assessment instrument was devised through a consensus process. The instrument was developed in the process of estimating a national set of provincial standard costs for healthcare services in Canada. Participants: All healthcare providers for a variety of services including public health, inpatient acute care, ambulatory care, physicians, pharmaceuticals, blood and ambulance services, and workers’ lost productivity. Main outcome measures: An assessment form which evaluated estimates for the full cost of resources; the appropriate inclusion of resources and resource prices; the degree of detail in the unit of measurement; basis of evidence; and the sample of providers from which cost estimates were generated. Results: When applied to existing cost estimates, a wide variation in quality was observed between service categories and provinces. Inpatient hospital, physician services, and drugs had high quality estimates; public health, nursing home, and home care had lower quality estimates. Conclusions: This quality assessment instrument can be used to target deficiencies in cost estimates and to identify administrative units which are leaders in the field, and hence which can serve as role models for further development of these data.     

Disease Surveillance and Achieving Synergy In Public Health Quality Improvement

Objective

To examine disease surveillance in the context of a new national framework for public health quality and to solicit input from practitioners, researchers, and other stakeholders to identify potential metrics, pivotal research questions, and actions for achieving synergy between surveillance practice and public health quality.

Introduction

National efforts to improve quality in public health are closely tied to advancing capabilities in disease surveillance. Measures of public health quality provide data to demonstrate how public health programs, services, policies, and research achieve desired health outcomes and impact population health. They also reveal opportunities for innovations and improvements. Similar quality improvement efforts in the health care system are beginning to bear fruit. There has been a need, however, for a framework for assessing public health quality that provides a standard, yet is flexible and relevant to agencies at all levels.The U.S. Health and Human Services (HHS) Office of the Assistant Secretary for Health, working with stakeholders, recently developed and released a Consensus Statement on Quality in the Public Health System that introduces a novel evaluation framework. They identified nine aims that are fundamental to public health quality improvement efforts and six cross-cutting priority areas for improvement, including population health metrics and information technology; workforce development; and evidence-based practices (1).Applying the HHS framework to surveillance expands measures for surveillance quality beyond typical variables (e.g., data quality and analytic capabilities) to desired characteristics of a quality public health system. The question becomes: How can disease surveillance help public health services to be more population centered, equitable, proactive, health-promoting, risk-reducing, vigilant, transparent, effective, and efficient—the desired features of a quality public health system?Any agency with a public health mission, or even a partial public health mission (e.g., tax-exempt hospitals), can use these measures to develop strategies that improve both the quality of the surveillance enterprise and public health systems, overall. At this time, input from stakeholders is needed to identify valid and feasible ways to measure how surveillance systems and practices advance public health quality. What exists now and where are the gaps?

Methods

Improving public health by applying quality measures to disease surveillance will require innovation and collaboration among stakeholders. This roundtable will begin a community dialogue to spark this process. The first goal will be to achieve a common focus by defining the nine quality aims identified in the HHS Consensus Statement. Attendees will draw from their experience to discuss how surveillance practice advances the public health aims and improves public health. We will also identify key research questions needed to provide evidence to inform decision-making.

Results

The roundtable will discuss how the current state of surveillance practice addresses each of the aims described in the Consensus Statement to create a snapshot of how surveillance contributes to public health quality and begin to articulate practical measures for assessing quality improvements. Sample questions to catalyze discussion include:

• —How is surveillance used to identify and address health disparities and, thereby, make public health more equitable? What are the data sources? Are there targets? How can research and evaluation help to enhance this surveillance capability and direct action?
• —How do we identify and address factors that inhibit quality improvement in surveillance? What are the gaps in knowledge, skills, systems, and resources?
• —Where can standardization play a positive role in the evaluation of quality in public health surveillance?
• —How can we leverage resources by aligning national, state, and local goals? —What are the key research questions and the quality improvement projects that can be implemented using recognized models for improvement?
• —How can syndromic surveillance, specifically, advance the priority aims?

The roundtable will conclude with a list of next steps to develop metrics that resonate with the business practices of public health at all levels.     

Health technology assessment and public health: a commentary

This article reviews the developments in HTA in four countries, France, The Netherlands, Sweden, and United Kingdom, in relation to public health. It emphasizes that the majority of assessments made are concerned with individual clinical care rather than with the optimization of health. Possible reasons for the neglect of public health issues are that these are inherently more complex than the assessment of individual procedures or drugs. They are usually multisectoral, politically charged, and often considered mundane and "common sense" and, thus, not requiring evaluation (although when evaluations are done they are often counterintuitive). Unless more emphasis is given to the development and evaluation of public health measures, it is unlikely that there will be any major advances in health status. Possible areas for future assessment should include such issues as smoking, drug and other substance misuse, nutrition, and health inequalities. However, it is unlikely that these major areas of concern will be included in the future unless the methods of choice for priorities of development and assessment are changed to include measures that improve health status rather than only clinical services.     

Nonprofit Hospitals’ Approach to Community Health Needs Assessment

Objectives. We sought a better understanding of how nonprofit hospitals are fulfilling the community health needs assessment (CHNA) provision of the 2010 Patient Protection and Affordable Care Act to conduct CHNAs and develop CHNA and implementation strategies reports.Methods. Through an Internet search of an estimated 179 nonprofit hospitals in Texas conducted between December 1, 2013, and January 5, 2014, we identified and reviewed 95 CHNA and implementation strategies reports. We evaluated and scored reports with specific criteria. We analyzed hospital-related and other report characteristics to understand relationships with report quality.Results. There was wide-ranging diversity in CHNA approaches and report quality. Consultant-led CHNA processes and collaboration with local health departments were associated with higher-quality reports.Conclusions. At the time of this study, the Internal Revenue Service had not yet issued the final regulations for the CHNA requirement. This provides an opportunity to strengthen the CHNA guidance for the final regulations, clarify the purpose of the assessment and planning process and reports, and better align assessment and planning activities through a public health framework.The Patient Protection and Affordable Care Act of 2010 includes a provision requiring all nonprofit hospitals to conduct a community health needs assessment (CHNA) and develop an implementation strategies plan. Nonprofit hospitals must conduct a CHNA at least every 3 years and implement strategies to address identified priority needs.1 The Internal Revenue Service (IRS), the bureau responsible for the regulation and enforcement of Section 9007 of the Affordable Care Act, provides general guidelines to nonprofit hospitals regarding the CHNA requirement.1 Included in this requirement are identifying and prioritizing community health needs, inventorying resources, developing an implementation strategies report to address health needs, and involving stakeholders with public health knowledge and expertise and leaders, representatives, or members of medically underserved, low-income, and minority populations in the community.1Very little research has been conducted on nonprofit hospitals’ approach to the CHNA requirement, perhaps because of its relative newness. Using CHNA and implementation strategies reports developed by nonprofit hospitals in Texas, we evaluated and analyzed various CHNA methods, report components, and influential factors. In addition, we assessed CHNA and implementation strategies report quality by using a public health framework.     

Urban particulate air pollution: from epidemiology to health impact in public health

Major air pollution accidents which occurred in the 1950s led to public awareness of the health hazards involved. Since that period, levels of air pollution have decreased, but several studies conducted in North America and Europe indicate that particulate air pollution is linked to increased cardiorespiratory morbidity and mortality. Despite this evidence, several questions were raised concerning the interpretation of the results (threshold effect, harvesting effect and biological plausibility). The aim of this review is to present the link between epidemiological findings and their use in health impact assessment. We review the main causal criteria applied to epidemiology in light of scientific evidence currently available. Some causality criteria are more important than others, but they all support the causal nature of the relationship between air pollution and health, and thus justify the feasibility of health impact assessment calculations. Recent studies on relative risk assessment show that even if the risk linked to worsening air quality is low, public health consequences are high. Such information must be made accessible to policy makers and the population in general so that, together with the public health workers, they can all contribute to improving air quality and health in their communities.     

Integrating open-source technologies to build low-cost information systems for improved access to public health data

Effective public health practice relies on the availability of public health data sources and assessment tools to convey information to investigators, practitioners, policy makers, and the general public. Emerging communication technologies on the Internet can deliver all components of the "who, what, when, and where" quartet more quickly than ever with a potentially higher level of quality and assurance, using new analysis and visualization tools. Open-source software provides the opportunity to build low-cost information systems allowing health departments with modest resources access to modern data analysis and visualization tools. In this paper, we integrate open-source technologies and public health data to create a web information system which is accessible to a wide audience through the Internet. Our web application, "EpiVue," was tested using two public health datasets from the Washington State Cancer Registry and Washington State Center for Health Statistics. A third dataset shows the extensibility and scalability of EpiVue in displaying gender-based longevity statistics over a twenty-year interval for 3,143 United States counties. In addition to providing an integrated visualization framework, EpiVue's highly interactive web environment empowers users by allowing them to upload their own geospatial public health data in either comma-separated text files or MS Excel™ spreadsheet files and visualize the geospatial datasets with Google Maps™.     

The health of the health care industry: a report card from American consumers

This article reports on the public perceptions of the quality of health care services offered by three categories of provider professionals (physicians, dentists, and pharmacists) and three categories of hospitals (public, private, and those with religious affiliations). The authors examine quality along two dimensions: the quality of "cure" vs. the quality of "caring." Results show that, although the health care industry does a fairly decent job in delivering quality service, there is uneven performance across different providers. Data also show the quality of caring to be lagging the quality of cure; importantly, however, the former is more influential in earning patient loyalty. The role of the two types of quality in patient retention are presented, along with implications for health care industry managers.     

A prospective health impact assessment of the Merseyside Integrated Transport Strategy (MerITS)

BACKGROUND: Prospective health impact assessment is a new approach to predicting potential health impacts of policies, programmes or projects. It has been widely recognized that public policies have important impacts on health. In 1997, the Liverpool Public Health Observatory was commissioned to carry out a health impact assessment of the Merseyside Integrated Transport Strategy (MerITS). A secondary aim was to pilot a method for health impact assessment at the strategic level. METHODS: The methods used drew on previous health impact assessments of projects, on strategic environmental assessment, and on policy research. They included policy analysis, semi-structured interviews with key informants and literature searches. RESULTS: Four priority impact areas of MerITS were identified: establishing road hierarchies, economic viability, air quality, and public transport. Potential health impacts in each of these areas were estimated, and recommendations were made to minimize the effects of negative impacts and to enhance positive ones. CONCLUSION: This health impact assessment prospectively identified the key health impacts of a strategy on a defined population and made recommendations to maximize potential positive and minimize potential negative health impacts. The methods employed are generally applicable to prospective health impact assessments of public policies and strategies.     

某市社区卫生服务工作质量评估及改善建议

质量是社区卫生服务工作的生命。通过对湖南省某市社区卫生服务工作质量进行评估,发现城市社区卫生服务在加速发展的同时,存在机构设置规划不科学,经费拨付依据不充分,基本医疗服务不规范且费用偏高,基本药物制度试点效果不明显,部分机构服务质量低、态度差等问题。提出进一步完善社区卫生服务工作绩效考核指标和考核方法,实施公立医院“名医进社区”工程,全方位监管以有效规避社区卫生服务工作的道德风险,是提高社区卫生服务工作质量的必由之路。     

Indigenous Mortality (Revealed): The Invisible Illuminated

Inaccuracies in the identification of Indigenous status and the collection of and access to vital statistics data impede the strategic implementation of evidence-based public health initiatives to reduce avoidable deaths. The impact of colonization and subsequent government initiatives has been commonly observed among the Indigenous peoples of Australia, Canada, New Zealand, and the United States. The quality of Indigenous data that informs mortality statistics are similarly connected to these distal processes, which began with colonization. We discuss the methodological and technical challenges in measuring mortality for Indigenous populations within a historical and political context, and identify strategies for the accurate ascertainment and inclusion of Indigenous people in mortality statistics.An accurate picture of mortality informs a society as to its social progress, because mortality is a key indicator of effective public health policies and programs. Mortality data, particularly the causes of infant and childhood mortality, also reflect a broader set of social, economic, and political issues.1We address the key issues underpinning an accurate assessment of the excess burden of mortality carried by Indigenous populations, and cite the experiences of these populations in Australia, Canada, New Zealand, and the United States.2–7 We provide an overview of the gaps, challenges, and strategies to improve the accuracy of Indigenous mortality assessment within a historical context and suggest how these challenges may be addressed.Complete population ascertainment is essential to accurately define Indigenous life expectancy. Partial ascertainment of population groups results in erroneous information, most often because of the misclassification of Indigenous people as non-Indigenous. These effects are predominantly to the detriment of Indigenous popuations.2,8Five primary or core public health data sources are available—census, vital registration, surveillance, health care administrative or utilization data, and health survey data—and are affected by underlying challenges. In general, the challenge is about the correct, inclusive, and consistent identification of Indigenous people in all 5 sets. However, the accurate ascertainment of population births and deaths (vital statistics) is fundamental to the accurate assessment of the trends in mortality, which is the main focus of our article. Although core public health data demonstrate the changing health status of the population and enable the effects of health policies, services, and interventions to be monitored and evaluated, vital statistics data provide the numerator and denominator necessary to calculate mortality rates. Deficiencies and inaccuracies in vital statistics and other data collections impede the strategic implementation of evidence-based public health interventions aimed at preventing avoidable mortality (e.g., lack of vaccination data and avoidable accident and injury). Therefore, new strategies are required to improve data ascertainment, collection, and reporting within Indigenous populations, with more consideration given to ethical policy and methodological rigor.8–11     

Amtsärztliche Gutachten

The public health service is responsible for providing medical reports for the civil service. This is commonly carried out by public health departments. In recent decades, many decisions in public management and court orders have resulted in an increased need for reports and certificates from public health officers. The content of these reports is of great financial significance. To ensure the quality of these reports, various groups from the federal states have sought to introduce standards and quality assurance measures into the medical assessment process. However, because of their quantity and diversity, report enquiries use a large proportion of the resources available to the public health service. The extent to which these tasks need to be performed by the public health service and whether they can be outsourced has been examined in the past. Expert reports will continue to be a fundamental aspect of the public health service. As a result, possible methods for reducing expenditure are presented.     

Health needs assessment and needs-led health service change: a survey of projects involving public health doctors

OBJECTIVES: To describe the criteria that define an effective health needs assessment and to explore which factors are important for the delivery of effective health needs assessment in the English National Health Service (NHS). METHODS: A postal questionnaire to all public health doctors in an English health region to describe health needs assessment activity, including initiating factors, methods and outcomes. This was followed by semi-structured interviews with public health professionals and others involved in 10 purposively selected needs assessments. RESULTS: A response rate of 62% identified a total of 102 health needs assessments undertaken between 1993 and 1998. A number of themes emerged as being important in the impact of health needs assessments on policy and planning. These included careful design, methodological rigour, decisive leadership, good communication, involvement and ownership of the work from relevant stakeholders, support from senior decision-makers, appreciation of the political dynamics and engagement with local priorities, availability of resources and, finally, an element of chance. These themes can be categorised broadly into contextual factors and quality or robustness of the work. Our findings suggest that, although methodological and analytical quality are necessary characteristics of effective health needs assessment, they are not sufficient without a favourable political environment. CONCLUSION: There appear to be conditions under which needs assessment is more likely to be effective in terms of its influence on policy and planning. However, it is clear that needs assessment does not occupy a central position in health service decision-making, remaining vulnerable to a range of factors over which those responsible for its conduct have little or no control.