A screening survey to assess local public health performance

Current studies are attempting to develop a national surveillance system to measure the extent that populations are served by local departments carrying out the core functions of public health. Early phases of the study featured observations on 14 health departments that have been subjects of a longitudinal study. These departments were surveyed using a protocol with 81 different indicators. The results permitted distinctions to be made among the departments on levels of performance according to core functions and their associated practices. To simplify the survey protocol so that it might be suitable for use with a large number of local public health jurisdictions, a subset of 26 indicators was selected from the previously developed protocol. Each indicator in the subset was linked with one of the three core functions of public health and with one of the associated practices. In an effort to display correlation between scores on the simplified survey and those in the full survey, scatter plots were prepared for overall scores and for those pertaining to each function and practice. Stepwise regressions were done to determine which queries or groups of queries were most predictive of variations in the screening responses. Four questions accounted for 96 percent of the variance in responses for overall performance. Results suggest that a three-tiered approach to the evaluation of local public health performance might be feasible. For the study departments, responses to four questions could be used to screen overall public health performance; responses to 26 questions could be used to yield information about performance of each of the three core public health functions; and responses to 84 questions could be used to yield more detailed information about performance for each of 10 public health practices. Experience with a larger set of departments might revise the number and nature of the screening queries.