CDC Assessment Initiative, public health assessment, web-based data query systems (WDQS)



  1. Schumacher, Patricia MS, RD

Article Content

In July 2002, the Journal of Public Health Management and Practice published a focus issue featuring the work of six state health departments supported by the Centers for Disease Control and Prevention's (CDC) Assessment Initiative, a program aimed at strengthening systems and practices used to improve data accessibility and use in public health decision making. The Assessment Initiative, soon to be concluding its third 5-year funding cycle, is one example of a crosscutting CDC program that has evolved over time in response to the changing needs and directions of our nation's public health system. Its primary objective, however, has remained the same:


* to serve as a test-bed for the development of new methodologies, tools, and promising practices in public health assessment and


* to share the practical outcomes of this work within the broader public health community.1



This journal issue provides an opportunity to continue the Assessment Initiative's history of disseminating lessons learned, focusing on the use of interactive Web technology as a tool for making public health data accessible "on demand" to local health departments, community groups, policymakers, and others who play an integral role in public health assessment.


To better understand the context for this focus issue, it is helpful if readers first understand the Assessment Initiative's history, and the various forces that helped shape the program's evolution toward its current area of emphasis. The Assessment Initiative originated in the early 1990s as a result of two landmark efforts that greatly influenced the practice and priorities established by federal, state, and local government health agencies. The first of these was the Healthy People 2000 campaign, which established a common set of national goals for improving the health of the American people.2 The second was the 1988 Institute of Medicine report, The Future of Public Health, which described a fully developed assessment function as "an absolutely essential part of the ideal public health system," as well as a responsibility that governmental public health agencies "could not delegate."3(pp7,44) In response, the CDC established the Assessment Initiative as one means of assisting state and local health departments in assessing their progress toward meeting Healthy People 2000 objectives, and in using assessment information for developing policy and managing programs. During the initial 5-year funding cycle (1992-1996), eight state health departments were supported with funding or staff to assist in meeting those goals; lessons learned from the accomplishments of those states were shared in the literature.4,5


As the 1990s progressed, the nation's healthcare system witnessed the expansion of the managed care model in both the private and public sectors. Many states converted to a managed care system for delivery of Medicaid services, and managed care organizations (MCOs) became key players in what was previously considered a public health domain. Subsequently, MCOs were viewed as custodians of important administrative and claims data that, when merged with traditional public health data sets (birth, death, hospital discharge, etc), offered potential to provide a deeper understanding of health needs and concerns in states and communities. At the same time, public health had clearly entered the information age. This was evidenced by the emergence and growth of electronic systems to support the transmission and sharing of information among the different levels of government. For the first time, the need for ready exchange of data among public health agencies and other nontraditional partner organizations (MCOs, community groups, nonprofits, etc) was recognized as being critical to comprehensive health assessment. In response, the Assessment Initiative's second funding cycle (1997-2001) emphasized the formation of partnerships as a means of strengthening the process and outcomes associated with public health assessment. States were encouraged to use Assessment Initiative funding to evaluate the effectiveness of their existing data collection, analysis, and dissemination strategies, and to improve capacity to use and integrate health information systems to make data more readily available to communities and other partner groups.6 Again, major findings and accomplishments were shared in the literature.7-17


By the late 1990s, it was thought by some at the CDC that ongoing development of information systems, coupled with the movement of Web technology into the mainstream, was having an impact on public access to health data and statistics, but the extent of that impact was not known. Printed data reports and PDF files were becoming more costly to produce and were often outdated soon after their release. Concurrent with the Assessment Initiative, the CDC's Epidemiology Program Office embarked on a 3-year project (1999-2002) with ORC Macro, Inc, to gain a deeper understanding of the extent of states' use of the Internet to disseminate public health data for assessment. The project began in 1999 with an initial abstraction of the Web sites of all 50 states, plus three local jurisdictions, to examine the systems and approaches being used. One finding of particular interest was the identification of interactive data query capacity in 10 state health departments, allowing for user-customized queries of available data sets "on the fly."18 During the following 2 years, these 10 sites were explored in more detail with regard to their technical architecture and interface usability.19,20 It was learned that components of at least two of these "pioneer" systems had been exported to other states, and in most cases modified by the adopting organizations to better align with their distinct information technology requirements, user needs, and various other factors. In-depth interviews were conducted with state personnel to better understand the issues related to the successful development, adoption, and purchase of Web-based data query systems (WDQSs); usability testing was also conducted.21


As anticipated, the next few years saw a proliferation in the growth and development of WDQSs, along with an expansion and enhancement of system features and functionality. As a result of the CDC's work with ORC Macro, a Guide for Public Health Agencies Developing, Adopting, or Purchasing Interactive Web-based Data Dissemination Systems was developed and released.22 The Assessment Initiative's third funding cycle (2002-2006) was initiated, including a focus area to address the implementation of new, or enhancement of existing, systems for the dissemination of public health data; funded states were also directed to evaluate the impact of those systems on targeted users. Key contributions of seven states relative to this focus area are featured in this special issue, along with the commentary of selected subject matter experts and representatives from national public health data organizations and previous Assessment Initiative states active in the development or advancement of WDQS-related work.


Not surprisingly, a considerable amount of this publication's content is devoted to a discussion of current trends in WDQS features and functionality. Examples of standard and more advanced functionalities from several state and local health departments with well-established WDQSs are highlighted, emphasizing their relevance to other groups/organizations interested in developing or improving capacity to share data over the Internet. Contributions range from Grigg et al's account of the practical application of geographic information systems in Florida, and Braithwaite and Haggard's advances in user interface and data display capability in Utah; to Solet et al's description of new options for user-defined customization of demographic characteristics, geographic regions, and system outputs in Seattle-King County, Washington. Missouri's model for using community-defined strengths and challenges, in addition to comprehensive data, to prioritize local health needs is outlined by Simoes, Land, Metzger, and Mokdad; and Massachusetts' innovative integration of over 20 different data sets to generate more robust community health profiles is aptly depicted by Cohen, Franklin, and West.


The discussion of state-specific innovations is introduced by a provocative piece by Friedman and Parrish describing the range of functionalities and data sets in several of these established state WDQSs. Drawing from the recommendations of a recent consensus panel, functionalities are classified into three categories: basic, enhanced, or innovative. Through the information contained in this article, the tremendous growth in WDQS development over the past 5 years quickly becomes apparent, from only 10 states with WDQS capability in 1999-2000, to 26 states currently. It also points out that, although WDQSs developed by individual states/jurisdictions contain many similar functionalities and data sets, there are no commonly accepted guidelines or standards that might assist in promoting greater uniformity among the systems. Might the development of such standards decrease the investment of resources associated with each agency's "reinventing the wheel," and provide opportunities for greater collaboration among states and local jurisdictions in WDQS development and application? Is there a role for the federal government in promoting or coordinating the development of such standards? The closing commentary, Envisoning Futures for State WDQSs, also by Friedman, considers different possibilities for future actions and the potential outcomes associated with each. In addition, articles addressing organizational readiness and barriers associated with WDQS implementation (Love and Shah), differences in states' approaches to implementing WDQSs (Gjelsvik and Buechner), connections between public health assessment and WDQS utility (Irani et al), issues associated with the confidentiality and security of data (Rudolph, Shah, and Love), and use of logic modeling as a potential framework for evaluating WDQS impact (Haggard and Burnett) are insightful and worth reviewing.


Through its various activities, the CDC's Assessment Initiative has served as one focal point for the coordination and advancement of WDQS-related work, yet its range of influence has been limited, historically, by the size and scope of the program. The contributors to this focus issue fully recognize and appreciate the numerous other organizations, both domestically and abroad, that have made significant contributions to the body of knowledge impacting WDQS development and innovation. Through this publication, we hope to share practical information and insights that will be helpful for other public and private entities embarking on or hoping to strengthen their work in this area.




1. Sosin DM, Thacker SB. Tools for public health assessment in the twenty-first century. J Public Health Manag Pract. 2002;8(4): vi-vii. [Context Link]


2. US Department of Health and Human Services. Healthy People 2000 National Health Promotion and Disease Prevention Objectives. Washington, DC: US Dept of Health & Human Services, Public Health Service; 1991. DHHS publication number 91-50212. [Context Link]


3. Institute of Medicine. The Future of Public Health. Washington, DC: National Academy Press; 1988:7, 44. [Context Link]


4. Centers for Disease Control and Prevention, National Center for Health Statistics. The CDC Assessment Initiative: A Summary of State Activities. Hyattsville, Md: Centers for Disease Control & Prevention, National Center for Health Statistics; 1995. Statistics and Surveillance, number 7. [Context Link]


5. German RR, Janes R, Romaguera RA. Lessons learned from the first funding period of the CDC Assessment Initiative. J Public Health Manag Pract. 2001;7(5):50-57. [Context Link]


6. Dhara R. Advancing public health through the Assessment Initiative. J Public Health Manag Pract. 2002;8(4):1-8. [Context Link]


7. Land GH. Measuring 2010 national objectives and leading indicators at the state and local level. J Public Health Manag Pract. 2002;8(4):9-13. [Context Link]


8. Stafford-Alewine S, Land GH. The Missouri experience in providing tools and resources to promote community assessment. J Public Health Manag Pract. 2002;8(4):14-19. [Context Link]


9. Curtis DC. Evaluation of community health assessment in Kansas. J Public Health Manag Pract. 2002;8(4):20-25. [Context Link]


10. Hunt DC, Thomas-Yonke C. Use of a behavioral risk survey by employers to identify leading health problems among employees and their dependents. J Public Health Manag Pract. 2002;8(4):26-32. [Context Link]


11. Oswald JW, Collins NM. Recommendations for addressing quality and health assessment initiatives in Minnesota. J Public Health Manag Pract. 2002;8(4):33-37. [Context Link]


12. Gyllstrom ME, Jensen JL, Vaughan JN, Castellano SE, Oswald JW. Linking birth certificates with Medicaid data to enhance population health assessment: methodological issues addressed. J Public Health Manag Pract. 2002;8(4):38-44. [Context Link]


13. Byrne C, Crucetti JB, Medvesky MG, Miller MD, Pirani SJ, Irani PR. The process to develop a meaningful community health assessment in New York State. J Public Health Manag Pract. 2002;8(4):45-53. [Context Link]


14. Irani PR, Byrne C, Medvesky MG, Young CD, Waltz EC. Measuring the impact of a public health data training program. J Public Health Manag Pract. 2002;8(4):54-62. [Context Link]


15. Marshall LM, Howard RN, Sullivan A, Ngo DL, Woodward JA, Kohn MA. Public health surveillance approaches in Oregon's medicaid population. J Public Health Manag Pract. 2002;8(4):63-69. [Context Link]


16. Howard RN, Marshall LM, Mohr-Peterson J, Kohn MA. Tracking Oregon medicaid patients' enrollment and health utilization patterns. J Public Health Manag Pract. 2002;8(4):70-76. [Context Link]


17. Friedman DJ, Klein-Walker D, Coltin KL, Wood PA. Assessment partnerships between managed care and public health: the Massachusetts experience. J Public Health Manag Pract. 2002;8(4):77-84. [Context Link]


18. ORC Macro. Evaluation of State-based Integrated Health Information Systems: Summary of Abstractions. Submitted to Epidemiology Program Office, Centers for Disease Control and Prevention, Contract number 200-960598, Task order number23. Atlanta, Ga: ORC Macro; 2000. Available at: [Context Link]


19. ORC Macro. Evaluation of State-based Integrated Health Information Systems: Webmaster Interviews. Submitted to Epidemiology Program Office, Centers for Disease Control and Prevention, Contract number 200-960598, Task order number23. Atlanta, Ga: ORC Macro; 2001. Available at: http://sbh.orcmacro.\ [Context Link]


20. ORC Macro. Heuristic Evaluation of Query Interfaces for Analysis of Public Health Statistics. Submitted to Epidemiology Program Office, Centers for Disease Control and Prevention, Contract number 200-960598, Task order number 23. Atlanta, Ga: ORC Macro; 2001. Available at: [Context Link]


21. ORC Macro. Evaluation of State-based Integrated Health Information Systems: Technology Transference and System Analysis of Selected State-Based Queriable Dissemination Tools. Submitted to Epidemiology Program Office, Centers for Disease Control and Prevention, Contract number 200-960598, Task order number 23. Atlanta, Ga: ORC Macro; 2002. Available at: [Context Link]


22. ORC Macro. Web-based Systems for Dissemination of Health-related Data: A Guide for Public Health Agencies Developing, Adopting, or Purchasing Interactive Web-based Data Dissemination Systems. Submitted to Epidemiology Program Office, Centers for Disease Control and Prevention, Contract number 200-960598, Task order number 23. Atlanta, Ga: ORC Macro; 2002. Available at: [Context Link]