Disease Surveillance and Achieving Synergy In Public Health Quality Improvement

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?