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 usefulness in either gauging or guiding performance improvement in health and health care is seriously limited by their sheer number, as well as their lack of consistency, compatibility, reliability, focus, and organization. To achieve better health at lower cost, all stakeholders-including health professionals, payers, policy makers, and members of the public-must be alert to what matters most. What are the core measures that will yield the clearest understanding and focus on better health and well-being for Americans?

Vital Signs explores the most important issues-healthier people, better quality care, affordable care, and engaged individuals and communities-and specifies a streamlined set of 15 core measures. These measures, if standardized and applied at national, state, local, and institutional levels across the country, will transform the effectiveness, efficiency, and burden of health measurement and help accelerate focus and progress on our highest health priorities. Vital Signs also describes the leadership and activities necessary to refine, apply, maintain, and revise the measures over time, as well as how they can improve the focus and utility of measures outside the core set.

If health care is to become more effective and more efficient, sharper attention is required on the elements most important to health and health care. Vital Signs lays the groundwork for the adoption of core measures that, if systematically applied, will yield better health at a lower cost for all Americans.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON CORE METRICS FOR BETTER HEALTH AT LOWER COST
• Reviewers
• Preface
• Acknowledgments
• Abstract
• Summary
  • STUDY CHARGE
  • STUDY CONTEXT
  • APPROACH TO THE SELECTION OF CORE MEASURES
  • THE CORE MEASURE SET
  • IMPLEMENTATION: PUTTING THE CORE MEASURES TO USE
  • FRAMING PERSPECTIVES AND RECOMMENDATIONS
  • REFERENCES
• 1. Introduction and Overview
  • MEASUREMENT IN HEALTH AND HEALTH CARE
  • BETTER HEALTH AT LOWER COST: DOMAINS OF INFLUENCE
  • CHALLENGES TO MEANINGFUL MEASUREMENT
  • STUDY CHARGE AND APPROACH
  • RELATED WORK OF THE INSTITUTE OF MEDICINE
  • CORE MEASURES AND ISSUES: PREVIEW
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Health and Health Care Measurement in America
  • POLICY INITIATIVES PROMPTING ATTENTION TO MEASUREMENT
  • CURRENT MEASUREMENT PURPOSES AND ACTIVITIES
  • LIMITATIONS OF CURRENT MEASUREMENT ACTIVITIES
  • THE MEASUREMENT BURDEN
  • REFERENCES
• 3. Improving the Impact of Measurement
  • CHANGE AS A PRODUCT OF TARGETING THE CORE ISSUES
  • CRITERIA FOR A CORE MEASURE
  • CRITERIA FOR THE CORE SET
  • RELATED EXPERIENCE WITH SENTINEL MEASURES
  • Example Cases
  • REFERENCES
• 4. The Core Measure Set
  • APPROACH TO IDENTIFYING THE CORE MEASURE SET
  • THE CORE MEASURE SET
  • DEVELOPING, APPLYING, AND IMPROVING THE CORE MEASURES
  • REFERENCES
• 5. Implementation: Putting the Core Measures to Use
  • PRACTICAL APPLICATIONS
  • USE IN ASSISTING AND ASSESSING LARGE SOCIETIAL INITIATIVES
  • USE IN LEVERAGING EXISTING PROGRAMS AND REQUIREMENTS
  • IMPLEMENTATION CHALLENGES FOR STAKEHOLDERS AT MULTIPLE LEVELS
  • CONTINUOUS IMPROVEMENT
  • REFERENCES
• 6. Action Agenda
  • FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS
  • CRITICAL FACTORS FOR SUCCESS
• APPENDIXES
  • A Glossary
  • B Existing Reporting Requirements
  • C Existing Data Sources
  • D Existing Infrastructure
  • E Biosketches of Committee Members and Staff

This study was supported by Grant No. 7954757 between the National Academy of Sciences and the Blue Shield of California Foundation, Grant No. 10001457 between the National Academy of Sciences and the California HealthCare Foundation, and Grant No. 70991 between the National Academy of Sciences and the Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Suggested citation:

IOM (Institute of Medicine). 2015. Vital signs: Core metrics for health and health care progress. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.