Using outcome measures in sub-national level performance management: When and under what circumstances?

Area of Science:

• Health Services Research
• Public Health Policy
• Health Management

Background:

• Growing interest in outcome-based measures for sub-national health system performance management.
• Application of population health indicators at sub-national levels is increasing, especially in high-income countries.

Purpose of the Study:

• To evaluate the use of population health outcome-based measures for sub-national health system performance management.
• To assess the technical validity and functional legitimacy of selected health indicators for decision-making.

Main Methods:

• Integrated empirical population-based data with health system expert perspectives.
• Evaluated amenable mortality and childhood ambulatory-sensitive hospitalization indicators.
• Assessed technical validity and stakeholder utility of performance information.

Main Results:

• Childhood ambulatory-sensitive hospitalization, an intermediate outcome, showed greater utility than amenable mortality, an end outcome, for identifying district-level performance variations.
• Performance information from childhood ambulatory-sensitive hospitalization is more suitable for improving decision-making.

Conclusions:

• Childhood ambulatory-sensitive hospitalization is a more appropriate and accepted measure for sub-national health system performance management.
• This indicator supports strategic decision-making and stakeholder engagement in health system improvement efforts.