Vital Signs Core Metrics for Health and Health Care Progress (2015) / Chapter Skim
Currently Skimming:
1 Introduction and Overview
1 Introduction and Overview
Pages 35-62
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From page 35... ...
Rather, thousands of different measures are used to assess intermediate aspects or qualities of the four key domains of influence on health and well-being that helped frame this study -- healthy people, care quality, care costs, and people's engagement in health and health care -- from emergency room wait times, to blood 35
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From page 36... ...
The implementation of core measures will depend on a culture of shared accountability for health. Responsibility for improving the nation's health outcomes must be assumed by all members of the multisectoral health system, defined broadly to include the full array of sectors and entities -- from clinicians and hospitals to schools and families -- that influence the health of the population through their activities (IOM, 2012b)
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From page 37... ...
Application of core measures across the health and health care stakeholder communities can offer important advantages to other measurement activities by fostering more standardization, providing reliable refer ence points in the analysis of other data, improving reliability of trials and regis tries, and building patient and public familiarity and confidence in measurement. Over time, with increasing experience on the capacity of core measures to trigger broader change, some of the measures can be retired.
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From page 38... ...
Americans' life expectancy and overall health tend to be poorer than in peer countries; the quality and safety of health care vary significantly across communities, regions, and states; health care is guided insufficiently by available evidence; and increases in health care costs generally have outpaced the nation's economy (IOM, 2012a; McGlynn et al., 2003; NRC and IOM, 2013; OECD, 2013)
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From page 39... ...
Similarly, significant opportunity costs are entailed in devoting resources to inefficient, redundant, or poorly specified measurement activities, which can displace other valuable opportunities to improve health and health care. The appendixes of this report provide widely ranging examples of measurement activities, reporting requirements, and data sources that support measurement of different aspects of the health system.
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From page 40... ...
This potential is shaped by the four key domains of influence noted above: healthy people, care quality, care costs, and people's engagement in health and health care.
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From page 41... ...
. While spending on health care is significantly higher in the United States than in other developed countries, the nation spends less, as a proportion of total spending, on public health and social programs that address those aspects of health outside of clinical care (Bradley et al., 2011)
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From page 42... ...
. Care Quality A major impetus for transforming the measurement enterprise is the uneven performance of the health system, which is characterized by islands of excellence existing alongside areas in need of improvement.
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From page 43... ...
. Care Costs The relative underperformance of the health system with respect to population health and health care quality has coincided with growth in health care costs that has vastly outpaced the rest of the economy, highlighting the lower levels of productivity being achieved by the health system (IOM, 2010, 2012a)
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From page 44... ...
Similarly important is that determinants of health be reflected in public agendas for health improvement, which demonstrate the extent of a community's commitment to addressing the population-wide factors in the community that shape people's health, health care, and health prospects. While the evidence base is still evolving in this domain as it is in the domains of healthy people, care quality, and care costs, an effective strategy for marshaling greater individual and public engagement in health and health care is needed.
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From page 45... ...
Moreover, the introduction of multiple new models for delivering, paying for, and organizing health care has coincided with new initiatives to improve personal and population health. Developments range from ACOs, insurance marketplaces, and value-based payment programs to regional and community health improvement collaboratives.
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From page 46... ...
Need for a Core Measure Set A set of core measures is needed to promote improved health and health care. As defined in Box 1-2, core measures, for present purposes, consist of a parsimonious set of measures that provide a quantitative indication of current status on the most important elements in a given field, and that can be used as a standardized and accurate tool for informing, comparing, focusing, monitoring, and reporting change.
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From page 47... ...
The existence of a parsimonious core measure set also can free institutions to direct additional measurement focus and resources to issues tailored to their particular circumstances. Relevance to Diverse Health Care Roles and Circumstances To serve their purpose of focusing attention on overriding health care and health goals, core measures must be broad-based and high-level; they cannot, by definition, capture the particular concerns and perspectives of each actor in the health system, regardless of the validity and compelling nature of those interests.
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From page 48... ...
In many cases, core measures may also need to be translated in ways that reveal their relevance and utility for actors at different levels of the health care system. For example, while the proportion of gross domestic product devoted to care provides a national view of health care spending, the concept of population spending burden is pertinent at the state, local, and institutional levels.
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From page 49... ...
The breadth of the Committee's charge reflected the extent of opportunities to achieve this goal. Study Approach The Committee convened to carry out this study comprised 21 individuals with a broad range of expertise, including health economics and policy, population health, health care delivery and safety net populations,
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From page 50... ...
The Committee's overarching approach to identifying core measures is illustrated in Figure 1-1. Its initial deliberations focused on clarifying the scope of the study and gathering input, while later meetings focused on synthesizing conclusions and formulating recommendations that would move measurement forward.
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From page 51... ...
These include activities stewarded through the HHS Secretary, the Secretary's Prevention Agenda and Healthy People Leading Health Indicators, the National Quality Strategy, the Joint Commission, the Institute for Healthcare Improvement, and the organizations mentioned above (CMS, CDC, AHRQ, NQF, and NCQA)
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From page 52... ...
The workshop discussions drew on existing measurement initiatives, identified the limitations of current measurement efforts, and began to identify a framework for core measures and the necessary infrastructure for implementation. The workshop summary, Core Measurement Needs for Better Care, Better Health, and Lower Costs: Measures That Matter, summarizes those discussions and served as a first step in the process of identifying a common core measure set suitable for assessing the health system (IOM, 2013a)
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From page 53... ...
The authoring Committee found that the nation did not have the necessary tools to assess and respond to these factors, and that the lack of such information limited the nation's ability to improve Americans' health. To address these challenges, the Committee recommends that HHS provide greater leadership, coordination, and guidance on population health information and statistics; that HHS lead the creation of a core measure set focused on priority health outcomes to improve alignment and enable comparisons among different communities, regions, and states; and that the nation adopt a single summary measure of population health that yields an overall picture of health and well-being at multiple levels.
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From page 54... ...
Presented in Table 1-1 is the analytic framework for the core measures. Because the scope of concepts, activities, and priorities is broad for each aspect of the four domains outlined above (healthy people, care quality, care costs, and people's engagement in health and health care)
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From page 55... ...
However, to accelerate the development and TABLE 1-1 Core Measure Framework Domain Key Element Core Measure Focus Healthy people Length of life Life expectancy Quality of life Well-being Healthy behaviors Overweight and obesity Addictive behavior Unintended pregnancy Healthy social circumstances Healthy communities Care quality Prevention Preventive services Access to care Care access Safe care Patient safety Appropriate treatment Evidence-based care Person-centered care Care match with patient goals Care cost Affordability Personal spending burden Sustainability Population spending burden Engaged people Individual engagement Individual engagement Community engagement Community engagement
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From page 56... ...
The Committee believes further that the core measure set recommended herein comprises the vital signs on the status and progress of the nation's health and health care, that a single measure can be chosen or developed for each of the core measure foci within each domain of influence, and that the development of a standardized measure is essential for each focus. The Committee also believes that, when applied, attention to these core measure foci will have the multiplier effect of improving performance broadly throughout the health and health care organizations engaged in their use.
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From page 57... ...
To begin to address this challenge, the Committee also identified 39 "related priority measures" for consideration, presented in Chapter 4. These measures, together with the core measures, give a more detailed view of the health system and are sufficiently granular and specific to be actionable by stakeholders as needed for their particular circumstances.
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From page 58... ...
A carefully designed effort under the stewardship of the HHS Secretary will be needed to focus the nation's attention in a manner that will accelerate progress across the board. Therefore, the Committee's recommendations place particular emphasis on the roles, responsibilities, and opportunities for implementation -- the critical features and actions necessary to achieve adoption and application of the core measures.
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From page 59... ...
This chapter serves essentially as a handbook for the core measures by providing details on each of the measures in turn, including the rationale for its selection, as well as the availability and quality of current data and measures and the path forward for improvement. Chapter 5 outlines issues and approaches with respect to implementing the measure set and ensuring that it is updated and improved over time.
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From page 60... ...
2009. State of the USA health indicators: Letter report.
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From page 61... ...
2013b. Toward quality measures for population health and the leading health indica tors.
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From page 62... ...
2008. Health indicators: A review of reports currently in use.
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