Characteristics of Community Report Cards -- United States, 1996

Efforts to improve community health require methods to compile local health data, establish local priorities, and monitor health-related activities. Community health report cards (i.e., health assessments or health profiles) are central to these efforts. In 1995, the UCLA Center for Healthier Children, Families, and Communities initiated a 3-year project to enhance community health improvement efforts through the design and use of effective community report cards. During the first year of the project, the project examined the construction and application of report cards. This report summarizes the results of the first year, which indicate great diversity in the targets, pro-cesses, and formats of community report cards.

A total of 250 public health officials, national and state public health organizations, public and private organizations with an interest in community health improvement, and others at the national, regional, and state levels were sent letters requesting that they identify persons responsible for developing community health report cards. A total of 115 communities that were developing or had completed report cards were identified. A self-administered questionnaire was mailed to contacts in each of the 115 communities asking about 1) the report card development process, including community participation; 2) report card design and content; and 3) links between the report card and community health-improvement activities. Respondents also were asked to provide a copy of their most recent community health report card.

Of the 115 communities, 85 had ever produced a report card; 65 (76%) returned a questionnaire and a copy of their report card. Most questionnaires were completed by the coordinator or director of the community report card project.

Report cards were received from 30 states; 11 were received from California and six each from Connecticut and Florida. Fourteen (22%) were compiled from state-level data, eight (12%) from multicounty-, 28 (43%) from county-, and 14 (22%) from city- or town-level data; one report card covered four zip code areas. Thirty-five (54%) of the reports included only health-related indicators; 15 (23%) included data about crime, transportation, education, and environment. Fifteen (23%) focused on a specific issue or population subgroup (e.g., children or adolescents) rather than on the total population.

Of the 65 respondents, 49 (75%) reported their programs had initiated development of report cards in 1992 or later; 51 (79%) were planning to produce another report card, and 36 (55%) planned to produce report cards at minimal intervals of 1-2 years. Twenty-seven (42%) reported using a pre-existing format (e.g., APEX, PATCH, or Model Communities 2000) to guide in development of report cards. Most (57%) developed report cards based on the experience of others; of these, 30% developed report cards based on the experience of other states, and 24% used programs within the same state. Barriers to producing report cards included difficulty collecting data at the local level (32%) and lack of data (29%).

Forty-one (63%) collected some data from local residents. Of those report cards using primary data, 49% used a research firm or outside consultant and 32% used the local health department to collect data. Trend data was used in 74% of reports. The data were compared with other benchmarks (i.e., state or national) in 89% of the reports.

Respondents identified three major report card uses: identifying areas of need (31%), formulating public policy (32%), and providing an up-to-date database (26%). Forty (62%) respondents reported that the community report card was part of a wider community health improvement effort, and an additional 20% said they were planning to link their report card to health-improvement activities. Of those report cards that were part of a wider community health effort, 28 (70%) used indicators linked to specific health-improvement activities. Report cards were disseminated through newspaper reports (42 {65%}), a mailing to community organizations (43 {66%}), and presentation of reports to local organizations (41 {63%}) and to local government (36 {55%}).

Reported by: JE Fielding, MD, N Halfon, MD, C Sutherland, PhD, Center for Healthier Children, Families, and Communities, University of California, Los Angeles. Div of Public Health Systems, Public Health Practice Program Office, CDC.

Editorial Note

Editorial Note: The findings in this report document the diversity in approaches to producing community report cards. Report cards have been produced at the national level to assess performance of discrete components of the health system (e.g., Health Plan and Employer Data and Information Set {HEDIS}). However, their primary objective is monitoring the health outcomes of patients and the specific performance of organizations (e.g., managed-care organizations) rather than assessing the health status of communities. This project, through comprehensive analysis of existing report cards and in-depth case studies in selected communities, will identify the most effective approaches for communities to design and use report cards and to improve community health processes, activities, and outcomes.

CDC assists communities and states in collecting and analyzing health relevant data, establishing priorities, and developing effective action plans. This project is establishing a baseline for developing and using these report cards at the local and state level. The preliminary findings suggest that some U.S. communities are using community report cards for developing public policy, establishing funding priorities, and developing programs with substantial community participation and support. During the second year of the project, eight report cards in communities with links to health-improvement activities and with broad community involvement will be analyzed to identify critical factors contributing to their effectiveness. During the third year, a technical-assistance manual will be produced to assist communities in designing report cards and in improving community health processes, activities, and outcomes.

Barriers for developing report cards include lack of data, constraints to obtaining reliable and valid local data, and the time required to develop report cards. User-friendly software and other design tools may assist communities in producing report cards in a timely manner using the best available data.

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