Performance measurement in public health: conceptual and methodological issues in building the science base.

The use of scientific methods for examining performance in the field of public health has lagged behind comparable efforts in medical practice. Accomplishments in other health care settings demonstrate that performance measurement systems can, if pursued rigorously and systematically, advance scientific knowledge and enhance the production of information to support improvements in public health practice. Numerous conceptual and methodological issues need to be addressed in order to use public health performance measurement processes for scientific inquiry. Nonetheless, the reward for careful analytic work in this area will be an expanding body of evidence to inform policy and administrative decision making in public health.