National Academy of Medicine
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  • Vital Signs

    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.

    Successful implementation of the core measures will depend on their relevance, reliability, and utility to stakeholders. The NAM recently launched its Vital Signs initiative in an effort to further implement recommendations from the report. Over the next year, the NAM will convene multiple stakeholders at all levels in an effort to increase widespread adoption and application of a set of standardized measures. 

    Download the report | Report Highlights | Report Recommendations

     

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    Want to Learn More? 

    For more information, or to become involved in our Vital Signs initiative, please email Claire Wang at CWang@nas.edu.

     

  • Healthy People 

    Best current measure: Life expectancy at birth

    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

    Related Measures: Length of healthy life; quality-adjusted life years

    Best current measure: Self-reported health status

    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

    Related Measures: Multiple chronic conditions, depression

    Best current measure: BMI, a relative number derived from an individual’s weight and height.

    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

    Related measures: Activity patterns, healthy eating patterns

    Best current measure: Addiction death rate.

    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

    Related measures: Rates for tobacco use, drug illicit use and dependence, alcohol misuse and dependence

     

    Best current measure: Teen pregnancy rate

    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

    Related Measures: Contraceptive use, surveys of intention

    Best current measure: High school graduation rate

    Rationale: Health is a function of a wide range of community factors, from income and infrastructure, to education, housing, employment, and environment.

    Related Measures: Child poverty, childhood asthma, air quality.

     

     

    High-Quality Care 

    Best current measure: Childhood immunization

    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

    Related Measures: Colorectal cancer screening, breast cancer screening, tobacco use cessation

    Best current measure: Unmet care need

    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

    Related Measures: Usual source of care, delay of needed care

    Best current measure: Hospital acquired infection rate

    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

    Related Measures: Wrong site surgery, pressure ulcers, medication reconciliation

    Best current measure: Preventable hospitalization rate

    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

    Related Measures: Cardiovascular risk reduction, hypertension control, diabetes control composite, heart attack therapy protocol, stroke therapy protocol, unnecessary care composite

    Best current measure: Patient-clinician communications satisfaction

    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

    Related Measures: Patient experience, shared decision-making, advance care planning

     

     

     

     

    Affordable Care 

    Best current measure: Per capita expenditures on health care

    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

    Related Measures: Health care-related bankruptcies

    Best current measure: High spending relative to income

    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

    Related Measures: Total cost of care, health spending growth

     

     

     

    Engaged People 

    Best current measure: Health literacy rate

    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.=

    Related Measures: Involvement in health initiatives

    Best current measure: Social support

    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

    Related Measures: Availability of healthy food, walkability, community health benefit agendas

     

     

     

     

     

  • Building upon Vital Signs: Core Metrics for Health and Health Care Progress, the NAM is engaging a network of organizations to garner field leadership and partnerships for implementing the core metrics framework (proposed in the consensus study) as a driver for meaningful change. These organizations, who comprise the Vital Signs Partnership Network, share the inspirations put forward in the Vital Signs consensus study and are energized to share insights on the best path forward toward a comprehensive set of core measures, allowing our nation to achieve better care and healthier people at lower cost:

     

    To become a member of the Vital Signs Partnership Network, please contact Claire Wang at cwang@nas.edu.

  •  Vital Signs Core Metrics: Reducing Measurement Burden

    October 26, 2017 | Webinar

    This webinar is intended to describe the current state of play of health care quality metric reporting and the opportunities for sharpening focus through concerted efforts to measure what matters most. Key questions include: 

    • How are various measurement activities driving improvement and value in health care?
    • What is the current burden of quality metrics reporting among providers?
    • What are the ongoing initiatives and opportunities led by key stakeholders to sharpening focus towards core metrics? 

    Through insights obtained from quantitative and qualitative research, this webinar will identify opportunities for the National Academy of Medicine to facilitate stakeholder progress in the spread and scale of Core Metrics implementation.

    Visit the event page to access the full webinar recording. 

    Vital Signs Core Metrics: Learning from the California Demonstration Project

    June 16, 2017 | Webinar

    This webinar is intended to highlight the process and the results of the California Vital Signs Demonstration Project which implements Vital Signs at the community level and discuss challenges and opportunities. Key questions include:

    1. What are key drivers of feasibility and value of using Vital Signs at a community level?
    2. What are potential challenges of implementing Vital Signs?
    3. How can the Vital Signs framework support local and state-level population health goals? 
       

    Using lessons learned from the California Vital Signs demonstration, participants will identify opportunities and next steps to facilitate stakeholder progress in the spread and scale of Core Metrics implementation.

    Visit the event page to view the full webinar recording. 

  • Measuring Vital Signs: An IOM Report on Core Metrics for Health and Health Care Progress (2015)

    A JAMA Viewpoint written by David Blumenthal and Michael McGinnis, underscoring the call to action from the Vital Signs report in reducing measurement burden, in the contexts of the 2015 MACRA bill and other ongoing health policy reform efforts. Read the Viewpoint>>

     

    Observations from the Field: Reporting Quality Metrics in Health Care (2016)

    NAM Perspectives Discussion Paper

    NAM Perspectives discussion paper presenting perspectives and insights of several health care organization executives on the burden and benefit of quality metric reporting. Read the NAM Perspectives commentary>>

     

     

    Vital Directions for Health & Health Care (2017)

    NAM Special Publication

    An NAM Initiative guided by an 18-member steering committee, this initiative called on more than 150 leading researchers, scientists, and policy makers from across the United States to provide expert guidance on 19 priority issues for U.S. health policy. The resulting collection of discussion papers is organized around three overarching goals for the United States: better health and well-being, high-value health care, and strong science and technology. Read the special publication>>  

     

    Metrics That Matter for Population Health Action (2016)

    Workshop Summary 

    In times of rapid change and constrained resources, measures that are important, focused, and reliable are vital. However, there is an overabundance of measures available for evaluating various aspects of population health and previous efforts to simplify existing sets to meet the needs of all decision makers have been unsuccessful. The National Academies of Sciences, Engineering, and Medicine convened a workshop to explore the status and uses of measures and measurement in the work of improving population health. Participants explored existing and emerging population health metric sets and characteristics of metrics necessary for stakeholder action across multiple sectors. This report summarizes the presentations and discussions from the workshop. Read the workshop summary >>

     

    Toward Quality Measures for Population Health and the Leading Health Indicators (2013)

    Consensus Study

    The Institute of Medicine Committee on Quality Measures for the Healthy People Leading Health Indicators was charged by the Office of the Assistant Secretary for Health to identify measures of quality for the 12 Leading Health Indicator topics and 26 Leading Health Indicators in Healthy People 2020, the current version of the Department of Health and Human Services 10-year agenda for improving the nation’s health. Read the consensus study>>

     

    Best Care at Lower Cost (2012)

    Consensus Study

    America’s health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation’s economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at lower cost. Read the consensus study>>

     

    Communities in Action: Pathways to Health Equity (2017) 

    Consensus Study

    Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome. Read the consensus study>>

    See Appendix B – community-level indicators and interactive tools for health equity – which contains two important resources. Table B-1 contains publicly accessible indicators related to health equity, including measures of social determinants of health. Table B-2 describes interactive tools that communities can use to examine health equity indicators by geographic region as the foundation for community-based solutions and to monitor progress over time.

     

    Civic Engagement and Social Cohesion: Measuring Dimensions of Social Capital to Inform Policy (2014)

    Consensus Study

    Civic Engagement and Social Cohesion identifies measurement approaches that can lead to improved understanding of civic engagement, social cohesion, and social capital – and their potential role in explaining the functioning of society. With the needs of data users in mind, this report examines conceptual frameworks developed in the literature to determine promising measures and measurement methods for informing public policy discourse. Read the consensus study >>

     

    The Health Care Imperative: Lowering Costs and Improving Outcomes (2010)

    Workshop Series Summary

    The Health Care Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth, including scientific uncertainty, system fragmentation, lack of patient involvement, and underinvestment in population health. Experts discussed key levers for catalyzing a transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification, as well as quality and consistency in treatment. The workshop series summary is an excellent guide for policy makers at all levels of government, as well as for private sector healthcare workers. Read the workshop series summary>>

     

    Partner Resources:

  • The Nation

    Recommendation 1: The parsimonious set of measures identified by the committee should be widely adopted for assessing the state of America’s health and health care, and the nation’s progress toward the goal of better health at lower cost.

    All People—as Individuals, Family Members, Neighbors, Citizens, and Leaders

    Recommendation 2: All people should work to understand and use the core measure set to assist in taking an active role in shaping their own health prospects and those of their families, their communities, and the nation. The Federal Government

    Recommendation 3: With the engagement and involvement of the Executive Office of the President, the secretary of the U.S. Department of Health and Human Services (HHS) should use the core measure set to sharpen the focus and consistency and reduce the number and burden of measure reporting requirements in the programs administered throughout HHS, as well as throughout the nation. To this end, the secretary should incorporate the standardized core measure set into federally administered programs, concomitantly eliminating measures for which the basic practical issues are engaged by the core set:

    • HHS’s national agenda frameworks for health, including the National Quality Strategy and the National Prevention Agenda;
    • the Meaningful Use program, administered by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator (ONC), to ensure that the core measure set becomes a central element of every electronic health record;
    • CMS’s accountable care organization measurement and reporting requirements;
    • CMS’s strategies for promoting quality improvement and innovation in health care financing and delivery through the work of the Center for Medicare and Medicaid Innovation; • federal health care reporting requirements;
    • streamlined reporting requirements under state Medicaid waiver authority; and
    • categorical health grant program management. 

    Recommendation 4: With the engagement and involvement of the Executive Office of the President, the Secretary of HHS should develop and implement a strategy for working with other federal and state agencies and national organizations to facilitate the use and application of the core measure set. This strategy should encompass working with

    • the secretary of the Treasury on use of the core measure set by tax-exempt hospitals and health systems in demonstrating their community benefit contributions; • other Cabinet departments in administration of their health-related activities—for example, in social services, the environment, housing, education, transportation, nutrition, and parks and recreation;
    • state and local governments and voluntary organizations in adapting use of the core measures to their needs and circumstances; and
    • multiple stakeholders through the Center for Medicare and Medicaid Innovation in piloting implementation of the core measures through multilevel stakeholder initiatives. 

    Recommendation 5: The secretary of HHS should establish and implement a mechanism for involving multiple expert stakeholder organizations in efforts to develop as necessary, maintain, and improve each of the core measures and the core measure set as a whole over time. The secretary’s role should encompass stewardship of work on 

    • national standardization of the best current measures and related priority measures detailed in this report;
    • development of the longer-term measures necessary to improve the utility and generalizability of the core measures;
    • national standardization of reporting on health disparities for each of the core measures, including disparities based on race, ethnicity, gender, and socioeconomic status;
    • periodic review and revision of the individual measures in response to changing circumstances; and
    • periodic review and revision of the core measure set in response to changing circumstances.  

    Governors, Mayors, and Health Leaders

    Recommendation 6: Governors, mayors, and state and local health leaders should use the core measure set to develop tailored dashboards and drive a focus on outcomes in the programs administered in their jurisdictions, and should enlist leaders from other sectors in these efforts.

    Clinicians and Health Care Delivery Organizations

    Recommendation 7: Clinicians and the health care organizations in which they work should routinely assess their contributions to performance on the core measures and identify opportunities to work collaboratively with community and public health stakeholders to realize improvements in population health.

    Employers and Other Community Leaders

    Recommendation 8: Employers and other community leaders should use the core measures to shape, guide, and assess their incentive programs, their purchasing decisions, and their own health care interventions, including initiatives aimed at achieving transparency in health costs and outcomes and at fostering seamless interfaces between clinical care and supportive community resources.

    Payers and Purchasers

    Recommendation 9: Payers and purchasers of health care should use the core measures to capture data that can be used for accountability for results that matter most to personal and population health, refine the analytics involved, and make databases of the measures available for continuous improvement.

    Standards Organizations

    Recommendation 10: Measure developers, measure endorsers, and accreditors, such as the National Quality Forum (NQF), the National Committee for Quality Assurance (NCQA), and the Joint Commission, should consider how they can orient their work to reinforce the aims and purposes of the core measure set, and should work with the secretary of HHS in refining the expression and application of the core measure set nationally.

    Download the report in brief >>