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Vital Signs: Core Metrics for Health and Health Care Progress (2015)

Chapter: Appendix D: Existing Infrastructure

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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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D

Existing Infrastructure

This appendix includes the range of sentinel measurement initiatives that the Committee considered throughout its deliberations. A list of these measurement initiatives and a chart summarizing their common features are included here. A complete catalog of these measurement initiatives with additional detail is available online at http://www.nap.edu/catalog/19402.*

_______________

* This introductory text was added after the prepublication version of this report to reflect that part of the Appendix is now available only online.

Page 260 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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CONTENTS

Summary of Similarities and Differences Among Ongoing Core Metrics Projects

ASPE Health System Measurement Project

Blue Cross Blue Shield of Massachusetts: Alternative Quality Contract

Buying Value Coalition: Buying Value Ambulatory Core Set

Canadian Institute for Health Information: Canadian Health System Performance Measurement

CDC Surveys (e.g., NHANES, NHCS, NHIS, NVSS)

CMS: Health Homes Core Measures

CMS: Medicaid Adult Health Care Quality Core Set

CMS: Medicaid/CHIP Children’s Health Care Quality Measures (2013 Set)

CMS: Medicare Advantage Rating Measures

CMS: NQF Evolving Core Measure Set for Dual Eligible Beneficiaries

CMS: Shared Savings Program (ACOs)

The Commonwealth Fund: Why Not the Best?

Consumer Reports Health: Hospital Quality Measures

CQO Roundtable: Illustrative Set of Quality, Outcome, and Cost Measures

DOD: Military Health Service Strategic Imperatives Scorecard

HHS: Leading Health Indicators for Healthy People 2020

HHS: National Quality Strategy Measures

HRSA: Core Clinical Measures

IHA: P4P California Core Measure Set

IHI: Measures for Triple Aim Communities

Joint Commission: Accountability Measures

Joint Commission Example: Acute Myocardial Infarction Core Measure Set

Leapfrog: Hospital Safety Score Methodology

NCQA: HEDIS Measures (Health Plans, 2013)

ONC: Meaningful Use Clinical Quality Measures for Eligible Hospitals (2014)

ONC: Meaningful Use Clinical Quality Measures for Providers (2014)

Oregon Health Authority: Coordinated Care Organization Core Measures

Patient-Centered Medical Home Evaluators Collaborative

Premier: QUEST Measures

State of California: Let’s Get Healthy California

State of Massachusetts: Standard Quality Measure Set

State of Minnesota: Statewide Quality Reporting and Measurement System

Page 261 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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State of the USA Health Indicators

State of Vermont: ACO Core Measure Set

United Health Foundation: America’s Health Rankings

University of Wisconsin: County Health Rankings

Veterans Health Administration: ASPIRE Measure Set

World Health Organization Millennium Development Goal Scorecard

Page 262 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
Aim Safety Other measures of quality
Sponsoring organization or program Core metric initiative Population health Health care quality Cost Patient engagement Adverse events/errors Antibiotic prophylaxis HC-associated infection Medication review or reconciliation Access Preventive & screening services EHR use Care transitions/coordination Disparities/equity
ASPE Health System Monitoring Project X X X X X X X X X X X X
Blue Cross/ Blue Shield of Massachusetts Alternative Quality Contract X X X X X X X X
Buying Value Coalition (employers, purchasers), convened by NQF Buying Value Core Set X X X X X X
Canadian Institute for Health Information Canadian Health System Performance Measurement X X X X X X
CDC Health surveys (e.g., NHANES, NHCS, NHIS, Vital Statistics) X X X X X X X X X
CMS Medicare Advantage Ratings X X X X X X X
Page 263 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
Health outcomes and population health Patient centeredness Condition focus Cost and utilization
Sponsoring organization or program Core metric initiative Mortality (outcome or population) Health factors/risk/behaviors Current functioning/quality of life Patient experience/satisfaction Shared decision making Diabetes Cardiovascular conditions Respiratory conditions Cancer care Mental health Care utilization Resource use/health care expenditures Number of measures
ASPE Health System Monitoring Project X X X X X X X X 59
Blue Cross/ Blue Shield of Massachusetts Alternative Quality Contract X X X X X X X 80
Buying Value Coalition (employers, purchasers), convened by NQF Buying Value Core Set X X X X X X X X X 38
Canadian Institute for Health Information Canadian Health System Performance Measurement X X X X X 15
CDC Health surveys (e.g., NHANES, NHCS, NHIS, vital statistics) X X X X X X
CMS Medicare Advantage Ratings X X X X X X X 37
Page 264 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
Aim Safety Other measures of qulity
Sponsoring organization or program Core metric initiative Population health Health care quality Cost Patient engagement Adverse events/errors Antibiotic prophylaxis HC-associated infection Medication review or reconciliation Access Preventive & screening services EHR use Care transitions/coordination Disparities/equity
CMS Shared Savings Program (ACO) X X X X X X X X
CMS Center for Medicaid CMS Health Homes Core Measures X X X X
CMS Center for Medicaid Medicaid Adult Health Care Quality Measures X X X X X X
CMS Center for Medicaid Medicaid/ CHIP Pediatric Health Care Quality Measures X X X X X X X X
CMS/NQF Evolving Core Measure Set for Dual Eligible Beneficiaries X X X X X X
The Commonwealth Fund Why Not the Best? X X X X X
Consumer Reports Consumer Reports Health X X X X
Page 265 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
Health outcomes and population health Patient centeredness Condition focus Cost and utilization
Sponsoring organization or program Core metric initiative Mortality (outcome or population) Health factors/risk/behaviors Current functioning/quality of life Patient experience/satisfaction Shared decision making Diabetes Cardiovascular conditions Respiratory conditions Cancer care Mental health Care utilization Resource use/health care expenditures Number of measures
CMS Shared Savings Program (ACO) X X X X X X X X 33
CMS Center for Medicaid CMS Health Homes Core Measures X X X 8
CMS Center for Medicaid Medicaid Adult Health Care Quality Measures X X X X X X X X 26
CMS Center for Medicaid Medicaid/ CHIP Pediatric Health Care Quality Measures X X X X X X 26
CMS/NQF Evolving Core Measure Set for Dual Eligible Beneficiaries X X X X X X X 30
The Commonwealth Fund Why Not the Best? X X X X X 42
Consumer Reports Consumer Reports Health X X X X 17
Page 266 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
Aim Safety Other measures of quality
Sponsoring organization or program Core metric initiative Population health Health care quality Cost Patient engagement Adverse events/errors Antibiotic prophylaxis HC-associated infection Medication review or reconciliation Access Preventive & screening services EHR use Care transitions/coordination Disparities/equity
Department of Defense Military Health Services Strategic Imperatives Scorecard X X X X X X X X X X
Gretzky Coalition Gretzky Group X X X X X X
HHS Health People 2020 Project Leading Health Indicators for Healthy People X X X X
HHS in conjunction with the National Priorities Partnership National Quality Strategy X X X X X X X X
HRSA HRSA Core Clinical Measures X X X X X
IHA P4P California Core Measure Set X X X X X X
IHI Triple Aim Communities X X X X X X X
Page 267 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
  Health outcome and population health Patient centeredness Condition focus Cost and utilization
Sponsoring organization or program Core metric initiative Mortality (outcome or population) Health factors/risk/behaviors Current functioning/quality of life Patient experience/satisfaction Shared decision making Diabetes Cardiovascular conditions Respiratory conditions Cancer care Mental health Care utilization Resource use/health care expenditures Number of measures
Department of Defense Military Health Services Strategic Imperatives Scorecard X X X X X X X 26
Gretzky Coalition Gretzky Group X X X X X X X X X NA
HHS Health People 2020 Project Leading Health Indicators for Healthy People X X X X X X 26
HHS in conjunction with the National Priorities Partnership National Quality Strategy X X X X X X 14
HRSA HRSA Core Clinical Measures X X X 12
IHA P4P California Core Measure Set X X X X X X X 114
IHI Triple Aim Communities X X X X X X 9
Page 268 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×
Save
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
  Aim Safety Other measures of quality
Sponsoring organization or program Core metric initiative Population health Health care quality Cost Patient engagement Adverse events/errors Antibiotic prophylaxis HC-associated infection Medication review or reconciliation Access Preventive & screening services EHR use Care transitions/coordination Disparities/equity
Joint Commission Joint Commission Accountability Measures X X X X
Joint Commission Joint Commission Core Sets X X X X X
Leapfrog Leapfrog Safety Score Methodology X X X X X
Many organizations CQO Roundtable X X X X X X X X X X
NCQA HEDIS Measures X X X X X X
ONC Meaningful Use Clinical Quality Measures for Hospitals X X X X X
ONC Meaningful Use Clinical Quality Measures for Physicians X X X X
Page 269 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
  Health outcomes and population health Patient centeredness Condition focus Cost and utilization
Sponsoring organization or program Core metric initiative Mortality (outcome or population) Health factors/risk/behaviors Current functioning/quality of life Patient experience/satisfaction Shared decision making Diabetes Cardiovascular conditions Respiratory conditions Cancer care Mental health Care utilization Resource use/health care expenditures Number of measures
Joint Commission Joint Commission Accountability Measures X X X 43
Joint Commission Joint Commission Core Sets X X X X 11
Leapfrog Leapfrog Safety Score Methodology 26
Many organizations CQO Roundtable X X X X 13
NCQA HEDIS Measures X X X X X X X X X X X 79
ONC Meaningful Use Clinical Quality Measures for Hospitals X X 30
ONC Meaningful Use Clinical Quality Measures for Physicians X X X X X X 64
Page 270 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
Aim Safety Other measures of quality
Sponsoring organization or program Core metric initiative Population health Health care quality Cost Patient engagement Adverse events/errors Antibiotic prophylaxis HC-associated infection Medication review or reconciliation Access Preventive & screening services EHR use Care transitions/coordination Disparities/equity
Oregon Health Authority Coordinated Care Organization Core Measures X X X X X X X X
Patient-Centered Medical Home Evaluators Collaborative Patient-Centered Medical Home X X
Premier QUEST X X X X X X
State of California Let’s Get Healthy California X X X X X X
State of Massachusetts Statewide Quality Advisory Committee (SQAC) X X X X X X X X X
State of Minnesota Statewide Quality Reporting and Measurement System (SQRMS) X X X X X X X X X
Page 271 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
  Health outcomes and population health Patient centeredness Condition focus Cost and utilization
Sponsoring organization or program Core metric initiative Mortality (outcome or population) Health factors/risk/behaviors Current functioning/quality of life Patient experience/satisfaction Shared decision making Diabetes Cardiovascular conditions Respiratory conditions Cancer care Mental health Care utilization Resource use/health care expenditures Number of measures
Oregon Health Authority Coordinated Care Organization Core Measures X X X X X X X 50
Patient-Centered Medical Home Evaluators Collaborative Patient-Centered Medical Home X X X X X X 44
Premier QUEST X X X X 40
State of California Let’s Get Healthy California X X X X X X X X X 48
State of Massachusetts Statewide Quality Advisory Committee (SQAC) X X X X X X X X 113
State of Minnesota Statewide Quality Reporting and Measurement System (SQRMS) X X X X X X X X 25
Page 272 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×
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Summary of Similarities and Differences Among Ongoing Core Metrics Projects
Aim Safety Other measures of quality
Sponsoring organization or program Core metric initiative Population health Health care quality Cost Patient engagement Adverse events/errors Antibiotic prophylaxis HC-associated infection Medication review or reconciliation Access Preventive & screening services EHR use Care transitions/coordination Disparities/equity
State of the USA project State of the USA Health Indicators X X X X X X
State of Vermont Vermont ACO Core Measure Set X X X X X X
United Health Foundation America’s Health Rankings X X X X X
University of Wisconsin County Health Rankings X X X X
Veterans Health Administration Aspire Measures X X X X X X X X X
World Health Organization Millennium Development Goal Scorecard X X X X
Totals 25 37 19 21 7 12 9 13 29 32 11 25 8
Page 273 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Summary of Similarities and Differences Among O ngoing Core Metrics Projects
Health outcomes and population health Patient centeredness Condition focus Cost and utilization
Sponsoring organization or program Core metric initiative Mortality (outcome or population) Health factors/risk/behaviors Current functioning/quality of life Patient experience/satisfaction Shared decision making Diabetes Cardiovascular conditions Respiratory conditions Cancer care Mental health Care utilization Resource use/health care expenditures Number of measures
State of the USA project State of the USA Health Indicators X X X X X X X X X X 20
State of Vermont Vermont ACO Core Measure Set X X X X X X X 32
United Health Foundation America’s Health Rankings X X X X X X X X 48
University of Wisconsin County Health Rankings X X X X X X X 29
Veterans Health Administration Aspire Measures X X X X X X X X 68
World Health Organization Millennium Development Goal Scorecard X X 10
Totals 14 19 14 19 11 24 28 22 18 27 30 15 1,369
Page 274 Cite
Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix D: Existing Infrastructure." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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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.

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