Authors: Angela Jenkins, project manager and Marcia Hams, senior policy analyst
Back in January, we asked: “How do we get to better, smarter, healthier?”
One of the steps we identified was developing better people-centered health quality measures. These measures should:
(1) enable consumers to determine if they are getting real value for the money they (individuals or communities) put into health care
(2) be meaningful to and intelligible to patients
(3) focus less on the details of health care processes and more on outcomes that matter to patients.
The Institute of Medicine (IOM) recently released a report, Vital Signs: Core Metrics for Health and Health Care Progress, which has the potential to be a game changer in this effort.
Health system transformation and good measurement of health care quality go hand-in-hand. The IOM found that quality measurement is becoming as fragmented as the health care system itself with hospitals, health plans, states, and the federal government using thousands of measures.
For instance, there are at least 61 different measures currently used for smoking cessation alone. This creates a significant time burden on caregivers, confusion for patients, and uncertainty in demonstrating the effectiveness of health system transformation strategies in improving patient and community health.
The IOM report gives consumer health advocates a starting point for identifying measures that truly matter and that can lead to “better, smarter and healthier” — especially for populations that experience disproportionately poor health outcomes.
The consensus report discusses 15 standardized core measures, along with the best current measures that address each core area, related priority measures, and the value of each measure in understanding health disparities.
The report also finds that — in many cases — new, more comprehensive measures and data sources are needed. The core measure set covers four domains: healthy people, care quality, care cost and engaged people — the kind of broad framework we need to really understand the overall health of the individual patient, families, and communities.
“This is a thoughtful framework for measuring health,” said Stephen Martin, MD, a family physician on faculty at the University of Massachusetts, Boston University, and Harvard Medical School. “The report shifts away from process and surrogate measures — for instance, a target blood pressure or blood sugar number that may not improve health or even cause harm — to real indicators of reduced illness and improved health. The report also shows a wide gap, both in practice and in research, between current approaches and that those that IOM advocates.”
Of the 15 total, we believe the five measures summarized below are of particular interest to the health advocacy community:
Individual health is a function of a wide range of socioeconomic and community factors, and we know that the health of all individuals is closely tied to the health of the community in which they live. The report identified “high school graduation rate” as the best current measure, but proposed developing a composite measure that might include “education, air quality, walkability, socioeconomic status and access to healthy food.”
Many Americans are still uninsured, underinsured or live in areas with insufficient health care resources and staffing. The report identified “unmet care need” as the best current measure for care access and discussed alternative measures such as “usual source of care, delay in initiation of needed care, lack of health insurance, and underinsurance.”
Care Match with Patient Goals
This measure expresses the degree to which health care is patient-centered and patients’ values are considered as a factor in clinical decision making. The report identifies “patient-clinician communication” as the best current measure, which is currently used in CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys, and advocates for the construction of a more ideal measure that would address how the care process “effectively identifies patient and family goals, delivers the information necessary for decision making and works actively and successfully toward attaining those goals.”
The level of people’s engagement in their health and the health of others can have important implications for the quality of health and care at the individual, family and community levels. The report identifies “health literacy rate” as the best current measure, but calls for development of additional measures, such as “involvement in personal, family and community health; working actively to improve the health of oneself and others; and active involvement in promoting a health-oriented community culture.”
A health-oriented community culture is important to improving individual and community health and health care, and the IOM asserts that engaging key stakeholders through the places where people live, travel, work and relax is critical. The report identifies “social support” as the best current measure, which is well validated in the CDC’s Behavioral Risk Factor Surveillance System. The report calls for more research and development in this area, suggesting other potential measures, such as “the existence of community-wide agendas, the use of community benefit funds, and opportunity for public input.”
The IOM report makes a valuable contribution to the debate over health care quality measurement, refocusing the conversation on measurement that uses a people-centered approach. Community Catalyst is eager to contribute to that debate and will be helping consumer health advocates weigh in to ensure that these efforts continue to move in the right direction.