The Institute of Medicine (IOM) has published a report proposing 15 core metrics for health and health care improvement. Health measurements are requested or required by many organizations for many purposes, including efforts to track population, community, and individual health; assessments of health care quality and patient experience; transparency monitoring; public reporting and benchmarking; system or professional performance requirements; and funder reporting. Many of these measures are very similar, with only slight variations in terminology and methodology. However, their differences are often significant enough to prevent direct comparisons across states, institutions, and individuals.
In addition, many measures focus on narrow or technical aspects of health care processes, rather than on overall health system performance and health outcomes. According to the committee, the growing number of clinical measures, even those that provide valuable information, draws attention to narrow, specific elements and away from system capacity and effectiveness. The establishment of a core set of measures could improve efficiency and ensure a focus on the most important health outcomes.
The proposed fifteen metrics and priority measures are:
- Life expectancy (infant mortality, maternal mortality, violence and injury mortality)
- Well-being (multiple chronic conditions, depression)
- Overweight and obesity (activity levels, healthy eating patterns)
- Addictive behavior (tobacco use, drug dependence/illicit use, alcohol dependence/misuse)
- Unintended pregnancy (contraceptive use)
- Healthy communities (childhood poverty rate, childhood asthma, air quality index, drinking water quality index)
- Preventive services (influenza immunization, colorectal cancer screening, breast cancer screening)
- Care access (usual source of care, delay of needed care)
- Patient safety (wrong-site surgery, pressure ulcers, medication reconciliation)
- Evidence-based care (cardiovascular risk reduction, hypertension control, diabetes control composite, heart attack therapy protocol, stroke therapy protocol, unnecessary care composite)
- Care match 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)
- Individual engagement (involvement in health initiatives)
- Community engagement (availability of healthy food, walkability, community health benefit agenda)
The report was funded by the Blue Shield of California Foundation, California Healthcare Foundation, and Robert Wood Johnson Foundation.
The IOM also has published an interactive infographic of the 15 core metrics and priority measures.