Vital Signs Initiative
Reducing Burden, Sharpening Focus, Improving Performance
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 sheer number, as well as their lack of focus, consistency, and organization, limits their overall effectiveness in improving performance of the health system. What are the core measures that will yield the clearest understanding and focus on better health and well-being for Americans?
The 15 Core Metrics
In 2015, Vital Signs: Core Metrics for Health and Health Care Progress proposed a streamlined set of 15 standardized measures, with recommendations for their standardization and application at every level—national, state, local, and institutional. The study Committee concluded that this core set of measures—”vital signs” of the nation’s health—is instrumental for attainment of the nation’s full health potential, functional capacity, and sense of well-being.
Successful implementation of the core measures will depend on their relevance, reliability, and utility to stakeholders. The NAM recently launched its Vital Signs initiative in an effort to further implement recommendations from the report. Over the next year, the NAM will convene multiple stakeholders at all levels in an effort to increase widespread adoption and application of a set of standardized measures.
Goal I
Healthy People
Life Expectancy
Best current measure: Life expectancy at birth
Rationale: Healthier people tend to have longer life expectancy
Inclusive, high level indicator for health that encompasses deaths at all ages and from all causes—simple, reliable, accessible, and routinely utilized as a barometer for the overall health of a population
Related Measures: Length of healthy life; quality-adjusted life years
Wellbeing
Best current measure: Self-reported health status
Rationale: People’s perception of their own health is both an indication of well-being and often a predictor of utilization of, and satisfaction with, health care—it is a measure with the capacity to drive action
Related Measures: Multiple chronic conditions, depression
Overweight & Obesity
Best current measure: BMI, a relative number derived from an individual’s weight and height.
Rationale: More than two-thirds of Americans are overweight or obese, a fact that has causes and consequences that extend beyond the health system – including socioeconomic, cultural, political, and lifestyle factors
Related measures: Activity patterns, healthy eating patterns
Addictive Behavior
Best current measure: Addiction death rate.
Rationale: Addiction, including to nicotine, alcohol, and other drugs, is prevalent in the United States, representing a complex challenge for the health system, communities, and families. Substance abuse and addiction now cost the country more than $500 billion annually
Related measures: Rates for tobacco use, drug illicit use and dependence, alcohol misuse and dependence
Unintended Pregnancy
Best current measure: Teen pregnancy rate
Rationale: Unintended pregnancy, a significant challenge for both individual and community health, is a measure that represents a variety of social, behavioral, cultural, and health factors – particularly women’s knowledge about access to tools for family planning
Related Measures: Contraceptive use, surveys of intention
Healthy Communities
Best current measure: High school graduation rate
Rationale: Health is a function of a wide range of community factors, from income and infrastructure, to education, housing, employment, and environment.
Related Measures: Child poverty, childhood asthma, air quality.
Goal II
High-Quality Care
Preventive Services
Best current measure: Childhood immunization
Rationale: Preventive services (for example, screening for hearing loss or counseling for tobacco cessation) present a valuable opportunity for both improving health and reducing costs
Related Measures: Colorectal cancer screening, breast cancer screening, tobacco use cessation
Care Access
Best current measure: Unmet care need
Rationale: A person’s ability to access care when needed is a critical precondition for a high-quality health system. Factors that could hamper access to care include lack of health insurance, clinician shortages, lack of transportation, cultural and linguistic barriers, and physical limitations
Related Measures: Usual source of care, delay of needed care
Patient Safety
Best current measure: Hospital acquired infection rate
Rationale: Avoiding harm is a primary obligation of the health care system, yet one of every three hospitalized patients may be harmed during their stay, and one of five Medicare patients are rehospitalized within 30 days of admission
Related Measures: Wrong site surgery, pressure ulcers, medication reconciliation
Evidence-Based Care
Best current measure: Preventable hospitalization rate
Rationale: Ensuring that patients receive care supported by scientific evidence for appropriateness and effectiveness is a central challenge for the health care system. Currently, an estimated one-third of U.S. health care expenditures do not contribute to improving health. Aggregating carefully selected and standardized clinical measures can provide a reliable composite index of system performance
Related Measures: Cardiovascular risk reduction, hypertension control, diabetes control composite, heart attack therapy protocol, stroke therapy protocol, unnecessary care composite
Care Match with Patient Goals
Best current measure: Patient-clinician communications satisfaction
Rationale: Systematically assessing each patient’s individual goals and perspectives ensures that the health care system is focusing on the aspects of care that matter most to patients. The engagement process improves prospects for patient outcomes
Related Measures: Patient experience, shared decision-making, advance care planning
Goal III
Affordable Care
Population Spending Burden
Best current measure: Per capita expenditures on health care
Rationale: Care that is too expensive limits people’s access to care, delays the receipt of necessary care, and diverts resources from other needed goods and services
Related Measures: Health care-related bankruptcies
Individual Spending Burden
Best current measure: High spending relative to income
Rationale: Health care spending consumes a large portion of the U.S. gross domestic product, dwarfing the health care spending of other nations and constricting investment in other economic and social sectors. This burden can be measured at national, state, local, and institutional levels
Related Measures: Total cost of care, health spending growth
Goal IV
Engaged People
Individual Engagement
Best current measure: Health literacy rate
Rationale: Given the effects of personal choices on health and the potential for involvement to enhance outcomes, it is critical for individuals to be aware of their options and responsibilities in caring for their own health and that of their families and communities.=
Related Measures: Involvement in health initiatives
Community Engagement
Best current measure: Social support
Rationale: A health-oriented community culture is important to improving individual and community health and health care, and for example through public health, social services, addiction treatment programs, emergency medical facilities, and opportunities for social engagement
Related Measures: Availability of healthy food, walkability, community health benefit agendas
Our Partners
Vital Signs Partnership Network
Building upon Vital Signs: Core Metrics for Health and Health Care Progress, the NAM is engaging a network of organizations to garner field leadership and partnerships for implementing the core metrics framework (proposed in the consensus study) as a driver for meaningful change.
These organizations, who comprise the Vital Signs Partnership Network, share the inspirations put forward in the Vital Signs consensus study and are energized to share insights on the best path forward toward a comprehensive set of core measures, allowing our nation to achieve better care and healthier people at lower cost.
To become a member of the Vital Signs Partnership Network, please contact Claire Wang at [email protected].
Events
See the latest conferences, meetings, webinars, and other convenings.
Vital Signs Core Metrics: Reducing Measurement Burden (Webinar)
Vital Signs Core Metrics: Learning from the California Demonstration Project (Webinar)
