NOTE: AHA, American Hospital Association; AMA, American Medical Association; AOA, American Osteopathic Association; BRFSS, Behavioral Risk Factor Surveillance System; HEDIS, Health Plan Employer Data and Information Set.

^a Many of the measures in this indicator set are most easily interpreted by cross-sectional or longitudinal comparisons. Cross-sectional comparisons between one community and a similar benchmark community that appears to have equal resources (income) and outcomes (mortality), yet a lower-cost health system, represent one possibility. Longitudinal comparisons would allow individual communities to aim for improvement, regardless of their baseline rates on these numbers.

^b Evidence that advance directives are effective in themselves at reducing expenditures does not exist. They may, however, be a necessary precondition to other cost-saving interventions.

^c Surgical procedures prescribed by physicians in the absence of adequate provision of information to patients (potentially unwanted surgeries) include CABG, carotid endarterectomy, cholecystectomy, and back surgery. Small area analysis is only an indirect measure. Direct measure requires survey of information provision systems in a community.

^d Development of this measure will require (1) identifying agents for which substitution should be possible, (2) defining brand names that fall within that class, and (3) obtaining computerized pharmacy records for analysis.