NNPHI 2011

1. Performance Measurement in Public Health 1988 IOM report accelerated concerted efforts to enumerate public health services Invigorated efforts to measure performance of and impact of these services Led to the creation of the 10 Essential Public Health Services Also led to the creation of the National Public Health Performance Standards Program (NPHPSP) assessment instruments based on 10 EPHS Set standards for measurement of system performance Facilitate continuous quality improvement

2. NEPHPSP EPH professionals felt 10 EPHS and NPHPSP didn’t adequately measure range and impact of environmental services Didn’t capture broad scope of agencies providing environmental services Didn’t encompass broad range of specialized services provided Developed list of 10 essential environmental health services Developed measurement tool designed to measure system performance of 10 essential environmental health services Measures system not agency

3. 10 Essential Environmental Health Services Monitor environmental and health status to identify and solve community environmental health problems Diagnose and investigate environmental health problems and health hazards in the community Inform, educate, and empower people about environmental health issues Mobilize community partnerships to identify and solve environmental health problems Develop policies and plans that support individual and community environmental health efforts Enforce laws and regulations that protect health and ensure safety Link people to needed environmental health services and assure the provision of environmental health services when otherwise unavailable Assure a competent environmental health workforce Evaluate the effectiveness, accessibility, and quality of personal and population based environmental health services Research for new insights and innovative solutions to environmental health problems and issues

4. NEPHPSP Instrument Developed to measure performance of 10 Essential Environmental Health Services Part of curriculum of Environmental Public Health Leadership Institute 44 of 111 instruments available for analysis Includes local, state and private agencies Merged with 2008 NACCHO Profile and 2008 Community Health Status Indicators to investigate impact of capacity on performance and performance on health Use multiple data sets to examine greater scope of public health system inputs and outcomes

5. NACCHO 2008 Profile Information on LHD capacity variables Variables included: FTEs, number of EH specialists, food processing capacity (contract, state, local, NA), food safety education, epidemiological syndromic surveillance, epi environmental capacity

6. CHSI Contains county level data on health status demographic variables thought to influence health Variables included: E coli , Shigella, and Salmonella cases Reported-Expected cases/Total Population

7. NEPHPSP

8. Relationship between EH capacity and Performance

9. Preliminary Findings Number of contract FTEs negatively associated with performance EH budget positively associated with performance EH FTEs NA negatively associated with performance Employ EH specialist negatively associated with performance

10. Preliminary Findings Inspection of food processing at the local level significant at p=0.086 with Salmonella ratio Negative relationship between ES #10 and Salmonella ratio Positive relationship between ES#8 and Salmonella ratio

11. NEPHSP and Accreditation Accreditation is a data driven process Many PHAB standards and measures require data NEPHPSP instrument can help supply data Domain 9:QI Domain 10: Contributing to Evidence Base Other domains

12. Any Questions? Contact Robin Pendley: rppe222@uky.edu Cynthia Lamberth : cdlamb2@uky.edu Rick Ingram: rcingr2@uky.edu This research is supported by a visiting research program though the Centers for Disease Control (CDC) and Oak Ridge Institute for Science and Education (ORISE). This research has been approved by the University of Kentucky Institutional Review Board