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2 Criteria for Selecting Measures
Pages 27-44

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From page 27...
... In this chapter, the committee offers guidance for selecting measures to assess and improve quality in the multisectoral health system, and especially among health care and public health participants. To make progress toward long, healthy lives for all, pertinent stakeholders need to create healthy communities and address the underlying factors that influence health outcomes and disparities in those outcomes among different subgroups.
From page 28...
... and processes (e.g., policies, programs, and services) are succeeding in moving health improvement efforts toward the desired health outcomes and greater equity.
From page 29...
... and 12 LHIs could be classified as measures of the effectiveness of an intervention. When the LHIs are organized according to the logic model above, most measures fit in the categories of Healthy Conditions and Health Outcomes.
From page 30...
... For example, the update of childhood vaccines is an intermediate outcome, whose ultimate outcomes are the rates of morbidity and mortality from certain infectious diseases. GENERAL CONSIDERATIONS FOR SELECTING AND PRESENTING MEASURES OF QUALITY The committee provides some preliminary considerations for selecting measures of quality related to the LHIs and for population health more broadly.
From page 31...
... Other pertinent measurement activities include the CDC Community Health Status Indicators, which provides a portfolio of 200 measures, with a set for each of the 3,141 U.S. counties, and allows comparisons between peer counties to inform quality improvement efforts and the sharing of best practices.
From page 32...
... the measure has been developed, adopted, adapted, or endorsed by an appropriate organization.4 With the exception of the criteria for selecting LHIs, the sets of criteria listed were developed for measures largely pertinent to health care delivery, and the committee did not feel that any existing set of measures was sufficiently specific for selecting measures of quality for the multisectoral health system. Because none of the sets of criteria listed is primarily oriented toward population health, they miss some of the nuances that are important in population health interventions.
From page 33...
... Published Criteria Category of HHS SAC, Criteria NQF, 2012b 2011 IOM, 2010 IOM, 2003b Impact (importance) X X X X Improvability X unclear X X Scientifically sound measure X n/a X n/a Geographic, temporal, and population coverage n/a X X unclear Data availability X n/a X n/a NOTES: X indicates that the published criteria included one or more items in the category listed in the first column; n/a = not applicable.
From page 34...
... RECOMMENDATION 2-1: The committee recommends that the Department of Health and Human Services and its partners in population health improvement (e.g., public health agencies, health care organizations, and communi ties) adopt a portfolio of measures of the quality of the multisectoral health system.
From page 35...
... Measures are also necessary to inform quality improvement and to demonstrate accountability for population health improvement. Measures of quality will inform clinicians and health care organizations, public health agencies, and others in their community health improvement process work at the state and local levels.
From page 36...
... Assessing the evidence of effectiveness may be done by reviewing published findings of the Guide to Community Preventive Services, the Cochrane Collaboration, and similar entities. The following characteristics of interventions are important to consider: the feasibility of implementing the intervention (particularly the feasibility in different settings)
From page 37...
... . Finding an effective programs may be done both by referring to systematic reviews, such as those provided by the Guide to Community Preventive Services and the Cochrane Collaboration, or by looking to other rigorous efforts to identify best practices, such as the work of the Public Health Law Research program in establishing the Law Atlas, which could in the future help identify associations between changes in policy and health outcomes.6 The criterion "timely" refers both to data for a measure (1)
From page 38...
... National data include those collected in such systems as the BRFSS, vital rec ords, the American Community Survey, and the Small Area Health Insurance Estimates, while state and local data include those used in the Community Health Status Indicators, drawn from electronic health records, and from other sources used by America's Health Rankings and the County Health Rankings.
From page 39...
... contains a table that details priorities, goals, and sample measures organized according to the HHS Three-Part Aim. The section of the table with the heading Population Health is subdivided into three columns: clinical preventive services, healthy lifestyle behaviors, and community health index.
From page 40...
... . The AHRQ Prevention Quality Indicators is a set of individual and composite measures derived from entirely clinical data and designed to assess the effectiveness of a local community's ambulatory health care delivery system.7 This situation concerning population-based measures suggests that key national efforts to describe health priorities and measures have been predominantly clinical in orientation, as has much of the national effort on quality and prevention, and more attention is warranted for measures related to population-based preventive interventions.
From page 41...
... ; and  Include expert panel membership and staff support to identify and assess measures of quality for the multisectoral health sys tem, with consideration of data sources, methodology, and other issues that span sectors and disciplines. Measuring the quality of population-based nonclinical interventions, such as policies, presents more challenges than measuring the quality of individual-based clinical interventions.
From page 42...
... . The Measurement Policy Council, which was established in 2012 as a subgroup of the HHS National Quality Strategy effort, is focused on policies for measure development, implementation, and alignment across HHS.
From page 43...
... The former called for strengthening the population health information infrastructure, and for integrating, aligning, and standardizing health data and health outcome measurement at all geographic levels.8 The latter called for a research infrastructure to establish the value of public health and prevention strategies, mechanisms for their effective implementation, health and economic outcomes derived, and the comparative effectiveness and impact of those strategies.9 8 Recommendation 1: The committee recommends that: (1) The Secretary of Health and Human Services transform the mission of the National Center for Health Statistics to provide leadership to a renewed population health information system through enhanced coordination, new capacities, and better integration of the determinants of health.
From page 44...
... The ability to develop good quality measures requires ensuring that timely data are available at national, state and, in particular, local levels, and that these data can be stratified for vulnerable subpopulations to assess changes in health disparities during improvement efforts.  Development of data systems and measures to capture research-quality infor mation on key elements of public health delivery, including program imple mentation costs.


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