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Fifteen ‘Vital Signs’ to Improve Health Care

Institute of Medicine report finds industry swamped with redundant, contradictory measures

Thousands of measures are in use today to assess health and health care in the U.S., but their sheer number, as well as their lack of focus, consistency, and organization, limits their overall effectiveness in improving the performance of the health system, according to a new report from the Institute of Medicine (IOM).

With support from the Blue Shield of California Foundation, the California Healthcare Foundation, and the Robert Wood Johnson Foundation, the IOM convened a committee to identify core measures for health and health care. In its report, Vital Signs: Core Metrics for Health and Health Care Progress, the committee uses a four-domain framework — healthy people, care quality, lower cost, and engaged people — to propose a set of 15 standardized measures or “vital signs” to assess health progress and to improve system performance in high-priority areas.

While many of the measures currently in use provide valid and useful information, most of them overlap and are redundant, according to the IOM. For example, the Centers for Medicare & Medicaid Services’ measure inventory catalogs nearly 1,700 measures, and the National Quality Forum’s measure database includes 630 measures. All of these measures create their own set of problems.

A preliminary IOM survey found that hospitals and health systems required, on average, between 50 and 100 full-time employees and $3.5 to $12.0 million a year to conduct these measures, and slight variations in methodologies mean measurement reporting programs often lead to several reporting requirements for the same goal, according to the survey.

“U.S. health care costs and expenditures are the highest in the world, but health outcomes and the quality of care are below average by many measures,” David Blumenthal, president of the Commonwealth Fund and president of the committee that wrote the report, said in a statement. “If we want to know how effective and efficient our health expenditures are in order to improve health and lower costs, we need to measure the most crucial health outcomes to guide our choices and gauge impact. The proposed core set focuses on the most powerful measures that have the greatest potential to positively affect the health and well-being of Americans.”

The core measure set and related priority measures include:

  • Well-being (multiple chronic conditions, depression)
  • Life expectancy (infant mortality, maternal mortality, violence and injury mortality)
  • Addictive behavior (tobacco use, drug and alcohol dependency/misuse)
  • Unintended pregnancy (contraceptive use)
  • Overweight/obesity (activity levels, healthy eating patterns)
  • Preventive services (influenza immunization, colorectal cancer and breast cancer screening)
  • Community health (childhood poverty rate, childhood asthma, air quality index, drinking water index)
  • Patient safety (wrong-site surgery, pressure ulcers, medication reconciliation)
  • Care access (usual source of care, delay of needed care)
  • Individual engagement (involvement in health initiatives)
  • Community engagement (availability of healthy food, walkability, community health benefit agenda)
  • Evidence-based care (cardiovascular risk reduction, hypertension control, diabetes control composite, heart attack therapy protocol, stroke therapy protocol, unnecessary care composite)
  • Care alignment with patient goals (patient experience, shared decision-making, end-of-life, advanced care planning)
  • Personal spending burden (health care-related bankruptcies)
  • Population spending burden (total cost of care, health care spending growth)

In addition to providing these measures, the IOM’s report calls for providers and government agencies to help implement them. For example, it recommends that the Secretary of Health and Human Services (HHS) zero in on the most meaningful measures and reduce the burden of reporting in HHS programs, as well as develop a plan to collaborate with other federal and state agencies to apply the measures.

Sources: Vital Signs; April 2015; and FierceHealthcare; April 28, 2015.

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