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Am J Prev Med. 2003 Nov;25(4):347-57.

Developing quality indicators for local health departments: experience in Los Angeles County.

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Department of Research and Evaluation, Southern California Kaiser Permanente, 393 E. Walnut Street #991, Pasadena, CA 91188, USA.



To develop public health quality indicators for local health department (LHD) use.


An indicator development team utilized public health quality measurement concepts, reviewed existing quality measurement-related initiatives, and conducted interviews with LHD staff in order to identify and develop quality indicators for the Los Angeles County Health Department.


Sixty-one recommended and 50 acceptable (i.e., scientifically sound but less useful) indicators were developed, with an emphasis on measuring process quality in services delivery. Pre-existing indicators from external sources, when available, were often not well suited to the Health Department's needs. The indicator development process clarified conceptual issues, highlighted strengths and limitations of potential indicators, and revealed implementation barriers.


A limited number of generally available, quantitative indicators of local public health quality exist. Indicators addressing the delivery of LHD services can be locally developed to fill an important gap in public health quality-improvement efforts. However, implementation of quality measurement is difficult due to limited evidence on public health practices, sparse data resources, unclear accountability, and inconsistent organizational motivation.

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