Core Metrics for Health and Health Care Progress
Reducing Burden, Sharpening Focus, Improving Performance
Thousands of measures are in use today to assess health and health care in the United States. Although many of these measures provide useful information, their sheer number, as well as their lack of focus, consistency, and organization, limits their overall effectiveness in improving performance of the health system.What are the core measures that will yield the clearest understanding and focus on better health and well-being for Americans?
In 2015, Vital Signs: Core Metrics for Health and Health Care Progress proposed a streamlined set of 15 standardized measures, with recommendations for their standardization and application at every level—national, state, local, and institutional. The study Committee concluded that this core set of measures—”vital signs” of the nation’s health—is instrumental for attainment of the nation’s full health potential, functional capacity, and sense of well-being.
Why do we need a streamlined set of common measures?
- Definition: Length of life at various stages, birth to old age
- Rationale: Healthier people tend to have longer life expectancy
- Inclusive, high level indicator for health that encompasses deaths at all ages and from all causes—simple, reliable, accessible, and routinely utilized as a barometer for the overall health of a population
- Best current measure: Life expectancy at birth
- Related Measures: Length of healthy life; quality-adjusted life years
- Definition: One’s overall status with respect to disease, injury, functional capacity, and sense of well-being
- Rationale: People’s perception of their own health is both an indication of well-being and often a predictor of utilization of, and satisfaction with, health care—it is a measure with the capacity to drive action.
- Best current measure: Self-reported health status
- Related Measures: Multiple chronic conditions, depression
Overweight & Obesity
- Definition: Body Mass Index (BMI) of 25 or greater.
- Rationale: More than two-thirds of Americans are overweight or obese, a fact that has causes and consequences that extend beyond the health system – including socioeconomic, cultural, political, and lifestyle factors.
- Best current measure: BMI, a relative number derived from an individual’s weight and height.
- Related measures: Activity patterns, healthy eating patterns.
- Definition: Detrimentally pursuing reward and/or relief through tobacco, alcohol, or other drugs.
- Rationale: Addiction, including to nicotine, alcohol, and other drugs, is prevalent in the United States, representing a complex challenge for the health system, communities, and families. Substance abuse and addiction now cost the country more than $500 billion annually.
- Best current measure: Addiction death rate.
- Related measures: Rates for tobacco use, drug illicit use and dependence, alcohol misuse and dependence.
- Definition: Pregnancies that occur despite preferences to the contrary.
- Rationale: Unintended pregnancy, a significant challenge for both individual and community health, is a measure that represents a variety of social, behavioral, cultural, and health factors – particularly women’s knowledge about access to tools for family planning.
- Best current measure: Teen pregnancy rate.
- Related measures: Contraceptive use, surveys of intention.
- Definition: Community action and health status profile with respect to environmental, social, and cultural conditions and programs with substantial potential for health impact.
- Rationale: Health is a function of a wide range of community factors, from income and infrastructure, to education, housing, employment, and environment.
- Best current measure: High school graduation rate.
- Related measures: Child poverty, childhood asthma, air quality.
- Definition: Immunization, chemoprophylaxis, counseling, and screening to reduce the occurrence of disease, injury, or impairment.
- Rationale: Preventive services (for example, screening for hearing loss or counseling for tobacco cessation) present a valuable opportunity for both improving health and reducing costs.
- Best current measure: Childhood immunization rate.
- Related measures: Colorectal cancer screening, breast cancer screening, tobacco use cessation.
- Definition: Ease in obtaining needed care on a timely basis.
- Rationale: A person’s ability to access care when needed is a critical precondition for a high-quality health system. Factors that could hamper access to care include lack of health insurance, clinician shortages, lack of transportation, cultural and linguistic barriers, and physical limitations.
- Best current measure: Unmet care need.
- Related measures: Usual source of care, delay of needed care.
- Definition: Avoidance of harm related to health care.
- Rationale: Avoiding harm is a primary obligation of the health care system, yet one of every three hospitalized patients may be harmed during their stay, and one of five Medicare patients are rehospitalized within 30 days of admission.
- Best current measure: Hospital-acquired infection rate.
- Related measures: Wrong site surgery, pressure ulcers, medication reconciliation.
- Definition: Care delivered that is supported by evidence, and care supported by evidence that is delivered.
- Rationale: Ensuring that patients receive care supported by scientific evidence for appropriateness and effectiveness is a central challenge for the health care system. Currently, an estimated one-third of U.S. health care expenditures do not contribute to improving health. Aggregating carefully selected and standardized clinical measures can provide a reliable composite index of system performance.
- Best current measure: Preventable hospitalization rate.
- Related measures: Cardiovascular risk reduction, hypertension control, diabetes control composite, heart attack therapy protocol, stroke therapy protocol, unnecessary care composite.
Care Match with Patient Goals
- Definition: The extent to which care delivered aligns with explicitly ascertained patient and family goals and expectations.
- Rationale: Systematically assessing each patient’s individual goals and perspectives ensures that the health care system is focusing on the aspects of care that matter most to patients. The engagement process improves prospects for patient outcomes.
- Best current measure: Satisfaction with patient-clinician communication.
- Related measures: Patient experience, shared decision-making, advance care planning.
Personal Spending Burden
- Definition: Impact of health care costs on individuals and families.
- Rationale: Care that is too expensive limits people’s access to care, delays the receipt of necessary care, and diverts resources from other needed goods and services.
- Best current measure: Unreimbursed health spending relative to income.
- Related measures: Health care-related bankruptcies.
Population Spending Burden
- Definition: Impact on other sectors and overall economic productivity as a result of spending on health care.
- Rationale: Health care spending consumes a large portion of the U.S. gross domestic product, dwarfing the health care spending of other nations and constricting investment in other economic and social sectors. This burden can be measured at national, state, local, and institutional levels.
- Best current measure: The proportion of economic resources spent on health care.
- Related measures: Total cost of care, health spending growth.
- Definition: People’s levels of engagement in in their own health and health care, and that of others.
- Rationale: Given the effects of personal choices on health and the potential for involvement to enhance outcomes, it is critical for individuals to be aware of their options and responsibilities in caring for their own health and that of their families and communities.
- Best current measure: Health literacy rate.
- Related measures: Involvement in health initiatives.
- Definition: The extent to which communities devote resources, priorities, and initiatives to efforts to improve health and health care.
- Rationale: A health-oriented community culture is important to improving individual and community health and health care, and for example through public health, social services, addiction treatment programs, emergency medical facilities, and opportunities for social engagement.
- Best current measure: Social support.
- Related measures: Availability of healthy food, walkability, community health benefit agendas.
What can we achieve through the use of standardized measures?
The foundational motivation of this report, and of the health system at large, is improving the health of individuals, communities, and the nation.
While medical care is not the only or even the most important determinant of health status, individuals and families expect and deserve care that is based on the best evidence and matches with patient goals.
High out-of-pocket costs place financial pressure on individuals and families, often leading to care that is delayed or missed, as well as increasing debt burden.
People – patients, families, the public – play an increasingly direct role in health and health care, facilitated by changes in technology and access to information, technologies innovation, new models of care delivery, and better evidence on the link between patient engagement progress and the effectiveness of treatment.
- National Governors Association
- American Public Health Association
- American Board of Medical Specialties
- National Quality Forum
- National Association of County and City Health Officials
- Association of Schools and Programs of Public Health
For more information, or to become involved in the NAM’s Vital Signs initiative, please email Claire Wang at CWang@nas.edu.
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