摘要：A strategic opportunity exists to coordinate public health systems and services researchers’ efforts to develop local health department service delivery measures and the efforts of divisions within the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) to establish outcome indicators for public health practice in chronic disease. Several sets of outcome indicators developed by divisions within NCCDPHP and intended for use by state programs can be tailored to assess outcomes of interventions within smaller geographic areas or intervention settings. Coordination of measurement efforts could potentially allow information to flow from the local to the state to the federal level, enhancing program planning, accountability, and even subsequent funding for public health practice. In 2004, the current director of the Centers for Disease Control and Prevention (CDC) published a commentary sounding an alarm about the lack of activity in and measurement of chronic disease prevention and control in local public health practice. 1 Since then, several small studies have examined practice in local health departments (LHDs) for specific chronic diseases, such as diabetes control and obesity prevention. 2–4 Other large-scale studies have examined associations between aspects of practice such as health department spending and varying sets of outcome indicators for chronic disease practice. 5–7 More recently, investigators in public health systems and services research (PHSSR) have initiated the development of sets of comprehensive service delivery and activities measures in maternal and child health, infectious disease, and chronic disease for LHDs. 8,9 These activities have evolved within the context of several national efforts to develop and catalog community health indicators more generally, such as Healthy People 2020, Chronic Disease Indicators, County Health Rankings and Roadmaps, Community Health Status Indicators, and the Health Indicator Warehouse. 10–15 A strategic opportunity exists for closer coordination among researchers and practitioners conducting individual studies, as well as those developing sets of “dashboard” measures at the local level, and the efforts of divisions within the CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) to establish outcome indicators for public health practice in chronic disease. These indicators, although developed by divisions within CDC and intended for use by funded state programs, can be tailored to assess outcomes of interventions in smaller geographic areas (e.g., county) or intervention settings (e.g., health system or worksite). The Institute of Medicine has commented on the proliferation of indicator sets, which can “cause confusion, is inefficient, and impairs valid comparisons.” 16 (p55) For PHSSR researchers and practitioners developing service delivery and activities measures for LHDs, we provide an overview of the federal efforts in chronic disease indicator development, highlight methods used, and catalog relevant resources, some of which are only found in the fugitive literature. Alignment and coordination of activities to measure public health practice and outcomes could lead to the development of more standardized measurement, which in turn could allow information and data to flow from the local to the state to the federal level to enhance program planning, program impact, accountability, and even subsequent funding for chronic disease prevention and control. It may also allow for a common use of language that could facilitate greater collaboration and resource sharing during this era of resource constraints.
