Toward Quality Measures
for Population Health
and the Leading
Health Indicators

Committee on Quality Measures for the Healthy People Leading
Health Indicators

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu



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Committee on Quality Measures for the Healthy People Leading Health Indicators Board on Population Health and Public Health Practice

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Gov- erning Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This study was supported by Contract HHSP233201200032C between the Na- tional Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this pub- lication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-28557-5 International Standard Book Number-10: 0-309-28557-7 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among al- most all cultures and religions since the beginning of recorded history. The ser- pent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2012. Toward quality measures for population health and the leading health indicators. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal gov- ernment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of out- standing engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engi- neering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON QUALITY MEASURES FOR THE HEALTHY PEOPLE LEADING HEALTH INDICATORS STEVEN M. TEUTSCH (Chair), Chief Science Officer, Los Angeles County Department of Public Health, CA KEVIN GRUMBACH, Professor and Chair, University of California, San Francisco, Department of Family and Community Medicine ROMANA HASNAIN-WYNIA, Director, Addressing Disparities, Patient-Centered Outcomes Research Institute, Washington, DC JEWEL MULLEN, Commissioner of Health, Connecticut Department of Health, Hartford JOHN OSWALD, Adjunct Assistant Professor, School of Public Health, University of Minnesota, Minneapolis R. GIBSON PARRISH, Independent Consultant, Public Health Informatics Institute, Decatur, GA GREG RANDOLPH, Director, Center for Public Health Quality, and Professor of Pediatrics and Adjunct Professor of Public Health, University of North Carolina at Chapel Hill PATRICK REMINGTON, Professor and Associate Dean for Public Health, School of Medicine and Public Health, University of Wisconsin–Madison JANE E. SISK, Scholar in Residence, Institute of Medicine, Washington, DC PIERRE VIGILANCE, Associate Dean for Public Health Practice and Associate Professor of Global Health, School of Public Health and Health Services, George Washington University, Washington, DC IOM Staff ALINA BACIU, Study Director ANDRÉS GAVIRIA, Research Associate COLIN F. FINK, Senior Program Assistant DORIS ROMERO, Financial Officer HOPE HARE, Administrative Assistant ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its pub- lished report as sound as possible and to ensure that the report meets in- stitutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confi- dential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: BECHARA CHOUCAIR, Chicago Department of Health FERNANDO A. FERRER, University of Connecticut Health Center MARTHE R. GOLD, City University of New York Medical School KENNETH W. KIZER, Institute for Population Health Improvement MARY PITTMAN, Public Health Institute JOSHUA M. SHARFSTEIN, Maryland Department of Health and Mental Hygiene SHOSHANA SOFAER, Baruch College of the City University of New York JEANINE P. WIENER-KRONISH, Massachusetts General Hospital MICHAEL WOLFSON, University of Ottawa ALAN ZASLAVSKY, Harvard Medical School vii

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viii REVIEWERS Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the con- clusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by BOBBIE A. BERKOWITZ, Columbia University, and EDWARD B. PERRIN, University of Washington. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of the report was carried out in accord- ance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Contents SUMMARY 1 1 INTRODUCTION AND CONTEXT 9 Terminology and Definitions, 9 Context, 12 A Short History of Quality in Health Care and Public Health, 16 2 CRITERIA FOR SELECTING MEASURES 27 General Considerations for Selecting and Presenting Measures of Quality, 30 Criteria for Measure Selection, 32 Endorsing Quality Measures for the Field, 39 3 MEASURES OF QUALITY 45 Four Case Studies, 54 4 USING THE QUALITY MEASURES 77 Use by Governmental Public Health Agencies, 82 Use by Nonprofit Hospitals and Other Health Care Institutions, 84 Use in Expanding and Understanding the Three-Part Aim, 87 Key Requirements for Using Quality Measures for Improving Population Health, 89 Using Measures of Quality Beyond the Health Sector, 91 Concluding Observations, 93 ix

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x CONTENTS APPENDIXES A Glossary 95 B Sample Criteria Consulted 99 C Meeting Agenda 105 D Committee Biosketches 109 E References 117