Reading the Institute of Medicine report “Vital Signs: Core Metrics for Health and Health Care Progress” gave me a sense of fresh hope. Anyone who has attended a hospital quality committee meeting recognizes that we are drowning in data. The term DRIP is often tossed around – ‘Data Rich, Information Poor’. It turns out that the IOM recently chartered a committee on core metrics for better health at lower cost, with Dr. David Blumenthal, the President of Commonwealth Fund, as its chair. This report was made by the committee in fall last year.
It turns out that the problem is even bigger than I thought, thanks to the enormous complexity of the U.S. health care system. Currently, the inventory of the Centers for Medicare and Medicaid Programs has 1,700 (yes, one thousand and seven hundred) measures in use. The National Quality Forum has a database with 630 measures endorsed by them. Similarly, the Healthcare Effectiveness Data and Information Set uses more than 80 measures and The Joint Commission uses more than 50 measures. For example, nationally, there are 113 measures for HIV and 68 measures for perinatal health. The committee noted that although many of the measures individually are of high quality and provide valid and useful information, the measurement system on the whole lacks focus, prevents meaningful accountability, and clarity on relationships between measures and outcomes that truly matter.
Dr. Blumenthal in the preface notes that the current measurement efforts are truly problematic. Health systems on average spend $3.5 to $12 million annually for data collection alone. We often fail to remember that measurement is a tool and not the goal. Measures are developed and established by too many experts and organizations with different goals and aspirations.
The report is an interesting read. The committee made important recommendations on core measures. The ultimate goal of the report is to enhance the efficiency and effectiveness of measurement of health and health care progress. The Committee identified a set of 15 core measures that together constitute the most vital signs for the nation’s health and health care: life expectancy, well-being, overweight and obesity, addictive behavior, unintended pregnancy, healthy communities, preventive services, care access, patient safety, evidence-based care, care match with patient goals, personal spending burden, population spending burden, individual engagement, and community engagement. In addition, they identified 39 related priority measures for each core measure.
The committee used the following criteria for each core measure individually: Importance for health, Strength of linkage to progress, Understandability of the measure, Technical integrity, Potential for broader system impact, and Utility at multiple levels. They also had criteria for the entire core measure set, and these criteria are Systemic reach, Outcomes-oriented, Person meaningful, Parsimonious, Representative, and Utility at multiple levels. To me, defining criteria for the entire set is new, fresh, and made a ton of sense.
The list of recommended measures is in the report. For example, in the domain ‘Care Quality’ -> Key element ‘Safe Care’ -> Core measure focus ‘Patient safety’, the committee’s recommendation for is to use the best currently available measure, ‘hospital-acquired infection (HAI) rate, with the current national performance at 1,700 HAIs per 100,000 hospital admissions. In the domain ‘Care Quality’ -> Key element ‘Appropriate treatment’ -> Core measure focus ‘Evidence-based care’, the committee’s recommendation for is to use the best currently available measure, ‘Preventable hospitalization rate, with the current national performance at 10,000 avoidable per 100,000 hospital admissions. In the core measure set with related priority measures, the core measure focus ‘Patient safety’ has Wrong-site surgery, Pressure ulcers, and Medication reconciliation. The core measure focus ‘Evidence-based care’ has Cardiovascular risk reduction, Hypertension control, Diabetes control composite, Heart attack therapy protocol, Stroke therapy protocol and Unnecessary care composite.
As the committee notes, leadership will be required at every level in order to reorganize the entire measurement process in the nation. To me personally, the report was music to my ears.
The full report is available at: http://www.nationalacademies.org/hmd/Reports/2015/Vital-Signs-Core-Metrics.aspx