Key Performance Indicators (KPIs) for Core Public Health Services
Tobacco and Vaping Prevention and Cessation
Indiana witnessed an increase in youth e-cigarette use from 3.8% in 2012 to 19.8% in 2021 among high school students. Most e-cigarettes contain nicotine, which is highly addictive and can harm youth brain development. The first step in addressing tobacco and addictive nicotine prevention is building and maintaining a tobacco-free coalition that represents the whole community.
KPI: Number of counties that through a tobacco prevention and cessation coalition have a comprehensive program to address youth tobacco and addictive nicotine prevention
School Health Liaison
Over 1 million students attend K-12 schools in Indiana, and school health liaisons support schools across the state. Research shows that healthier students learn better and have greater academic success, leading to a lifetime of better health outcomes. Providing access to health services, such as vision, hearing and dental screenings, while limiting youth risk behaviors, supports community, physical, and intellectual development that can continue into adulthood.
KPI: Number of counties partnering with schools, based on community need, to implement wellness policies and comprehensive strategies to promote student health
Health-Related Areas during Emergencies/Disasters
Preparedness saves lives by enduring timely and effective response to public health emergencies such as natural disasters and disease outbreaks, reduces impact of these emergencies by providing essential services such as medical care, food/water, and shelter, fosters resilience among individuals and communities by enhancing their ability to recover, and protects national security.
KPI: Number of counties that have updated* public health emergency response plans. *”Updated” is defined as conducting research on latest national and state best practices, incorporation of lessons learned and areas of improvement from real world events and exercises, and inclusion of preparedness and response partners in content validation.
Chronic Disease Prevention
Indiana ranks 12th highest in the US for adult obesity, with 2/3 of adults being overweight or obese. In Indiana, 1/3 of children are overweight or obese. Obesity is a common risk factor for many chronic diseases, including heart disease, cancer, and diabetes. A key step in addressing chronic disease and obesity prevention is building and maintaining a healthy community coalition that represents the whole community.
KPI: Number of counties that through a healthy community coalition have a comprehensive, evidence-based program to address obesity and obesity-related disease prevention
Indiana has 240 food inspectors responsible for inspecting over 32,000 retail food establishments statewide. The risk-based food inspection method is a data-informed best practice for conducting timely routine inspections based on menu type, facility history and follow-up inspections for any complaints or issues.
KPI: Number of counties that have developed a timely and professional risk-based food inspection standard operation procedure
Lead Case Management and Risk Assessment
As of January 1, 2023, Indiana health care providers are required to offer blood lead testing to all children under age 2 years. Through August 31, 2023, there has been a 21% increase in unique children tested for elevated blood lead levels, with 10,588 more blood lead tests reported, compared to the same time period in 2022. Comparing January-August, 2022 and January-August 2023, there is a 393% increase in confirmed elevated blood lead levels.
There is no safe level of lead for children and the developmental and neurological damage caused by lead exposure during childhood will last a lifetime.
KPI: Number of counties with access to a trained or licensed case manager and risk assessor in the county and offering weekly lead testing at a location in the county
In 2023, 78% of all Indiana children had one measles-mumps-rubella (MMR) vaccine by age 35 months, compared to 89% in 2019. Community immunity against measles requires about 95% of a population to be vaccinated to prevent outbreaks. Providing accessible immunization services will help maintain robust immunization rates for disease prevention.
KPI: Number of counties that can vaccinate all individuals at time of service regardless of insurance status
KPI: Number of counties with extended vaccination hours beyond routine business hours to meet the needs of the community/jurisdiction through the LHD or community partners
Trauma and Injury Prevention
In Indiana, preventable injuries account for the leading cause of death in individuals aged 1-44 years (CDC WISQARS), notably poisonings and motor vehicle crashes. Identifying a leading cause of injury allows effective planning and prevention of those injuries and potential deaths.
KPI: Number of counties that identified a leading cause of injury and/or harm in their community and implemented a comprehensive, evidence-based program or activity for prevention
Access to and Linkage to Clinical Care
Some communities, such as those in rural areas, often face higher rates of chronic disease and limited access to health care. Access to public health services in all counties will enhance the health and well-being of all Hoosiers, reduce disease, and improve health outcomes.
KPI: Number of local health departments providing accessible, equitable clinical services, such as those related to communicable diseases, to meet the needs of the community
KPI: Number of local health departments engaging with the local and state health delivery system to address gaps and barriers to health services and connect the population to needed health and social services that support the whole person, including preventive and mental health services
Infectious Disease Prevention and Control
Infectious disease surveillance is essential to identify outbreaks and emerging infections, effectively and rapidly provide testing, treatment, and preventive measures, and monitor trends to inform prevention strategies. For example, nine out of ten individuals who are exposed to measles will become infected if they are not vaccinated. Prompt recognition of those exposed is essential so post-exposure vaccine can be given within 72 hours to prevent infection.
KPI: Number of counties that initiated a public health investigation within 24 hours for 95% of the immediately reportable conditions reported to them and within two business days for 85% of non-immediately reportable conditions reported to them
Tuberculosis (TB) Prevention and Case Management
An estimated 13 million people in the U.S. have latent tuberculosis infection (LTBI). Without treatment, one in 10 people living with LTBI will get sick with TB disease. Eliminating TB in the US requires expanding testing and treatment of LTBI. Testing for TB infection should be a routine and integral part of health care for patients with increased risk for TB. Each patient needs appropriate health care, treatment, and support services to reduce the spread of infection and development of drug resistance.
KPI: Number of counties with established partnerships for housing, food security, and interpretation services to assist in case management services for patients with TB and latent TB infection in their communities
In 2023, the Indiana General Assembly passed HEA 1457, which will allow a local health officer to issue a birth, death, or stillbirth certificate from the electronic registration system regardless of the location of the filing of the record. Planning is underway to implement this legislation statewide by Jan. 1, 2025. Natural disasters, such as floods and tornadoes, can damage or destroy vital records documents that Hoosiers need for identification. Adopting an emergency action plan in each county will ensure Vital Records services are available during a disaster.
KPI: Number of counties implementing birth certificates to all Hoosiers irrespective of their county of birth once the IDOH DRIVE system has appropriate functionality
KPI: Number of counties able to offer Vital Records services without disruption to business continuity during natural disasters/emergencies
Indiana ranks 36th nationally in child mortality: from 2018-2020, Indiana’s child mortality rate was 31.3 deaths per 100,000 children ages 1-19 years, compared to the national rate of 25.9 deaths. Understanding causes of child mortality helps drive education and action to prevent these deaths.
KPI: Number of counties that participate in local CFR, FIMR, and SOFR teams and provide birth certificates, stillbirth certificates, and death certificates to local fatality review teams
Indiana ranks 41st nationally in drug overdose deaths: in 2021, Indiana’s age-adjusted drug overdose rate was 43.0 per 100,000 people, compared to the national rate of 24.7 deaths. Indiana ranks 28th nationally in deaths due to suicide: in 2021, Indiana’s age-adjusted suicide rate was 16.4 deaths per 100,000 people, compared the national rate of 14.0 deaths. Understanding factors leading to overdoses and suicide helps drive education and action to prevent these deaths.
KPI: Number of counties that identified a leading cause of fatality in their community and implemented an evidence-based or promising prevention program or activity
Maternal and Child Health
Indiana ranks 41st in infant mortality, which is the death of an infant before the first birthday: in 2021, Indiana’s infant mortality rate was 6.7 deaths per 1,000 live births, compared to the national rate of 5.4 deaths. Understanding causes of infant mortality helps drive education and action to prevent these deaths.
KPI: Number of counties with documented processes to refer families to needed services including contraceptive care, WIC, home visiting, prenatal care, substance use disorder treatment, and insurance navigation
KPI: Number of counties at identified an opportunity to improve birth outcomes and implemented an evidence-based or promising program or activity to improve that birth outcome
Environmental Public Health
Health and safety hazards may exist within housing and outdoor environments resulting in infection or injury. Examples include faulty plumbing systems, rodent or insect infestations, improper ventilation, pool inspections, onsite sewage system permits and inspections, and poor sanitation.
KPI: Number of counties responding to all housing and nuisance complaints within a timeframe determined by urgency or risk
KPI: Number of counties with trained and licensed, if required, staff conducting required environmental inspections, such as onsite sewage, vector control, public and semi-public pools, and property-related complaints