Tracking 15 core measures, including evidence-based care and obesity, are crucial for assessing and monitoring the nation’s health, according to a new report from the Institute of Medicine (IOM). Progress in these vital signs—or core measures— should reduce the burden on clinicians of taking measurements, enhance transparency and comparability, and improve health outcomes nationwide.
While the nation’s healthcare costs and expenditures are the highest in the world, health outcomes and the quality of care are below average by many measures, study authors note. 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.
Although not intended to replace the full range of measures in use today, the set of 15 vital signs are expected to evolve over time, keeping pace with the needs and capabilities of the health system. They are:
- Life expectancy;
- Overweight and obesity;
- Addictive behavior;
- Unintended pregnancy;
- Healthy communities
- Preventive services;
- Access to care;
- Patient safety;
- Evidence-based care;
- Care that matches patient goals;
- Personal spending burden;
- Population spending burden;
- Individual engagement; and
- Community engagement.
Renewed attempts to align health measures in order to reduce redundancies and inefficiencies may now succeed because of significant changes in the measurement environment, most notably with growing data capture capabilities from widespread use of electronic health records (EHRs) and other digital tools, the committee said. The emerging health information technology (HIT) infrastructure could support a real-time measurement system for routine collection of information, and it provides an opportunity to measure what matters most, enabling goals to drive measures as a replacement for measures that drive goals.
The report calls for specific actions for different stakeholder groups to help ensure the adoption and implementation of the cores measures. In particular, the committee recommended that the secretary of the U.S. Department of Health and Human Services (HHS) should use the set of core measures to sharpen the focus and consistency and reduce the number and burden of measure reporting in HHS programs. In addition, 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.
Health measurements are requested and required by organizations for various purposes, but many of the individual measures in use today were developed without attention to the broader context. Measurements often overlap or are redundant and are implemented for a particular purpose and circumstance. For example, the Centers for Medicare and Medicaid Services’ (CMS) measure inventory catalogs nearly 1,700 measures, and the National Quality Forum’s measure database includes 630 measures. While several of these measures are of high quality and provide valid and useful information, most examine slight variations of the same target information and differ enough to prevent direct comparisons among the states, institutions, or individuals, the committee said. Moreover, measures focused only on limited component issues cannot reliably reflect the nation’s overall health system performance.
Source: National Academy of Sciences April 28, 2015
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