Summarizing Population Health

Directions for the Development and Application of Population Metrics

Committee on Summary Measures of Population Health

Marilyn J. Field and Marthe R. Gold , Editors

Division of Health Care Services


Washington, D.C.

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Summarizing Population Health Directions for the Development and Application of Population Metrics Committee on Summary Measures of Population Health Marilyn J. Field and Marthe R. Gold , Editors Division of Health Care Services INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1998

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NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing 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. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this project was provided by the U.S. Department of Health and Human Services (Contract Number 282-97-0019). The views presented are those of the Institute of Medicine committee and are not necessarily those of the funding organizations. International Standard Book Number: 0-309-06099-0 Additional copies of this report are available for sale from: National Academy Press 2101 Constitution Avenue, N.W. Box 285 Washington, DC 20055 Call 800-624-6242 (or 202-334-3313 in the Washington metropolitan area), or visit the NAP’s on-line bookstore at: For more information about the Institute of Medicine, visit the IOM’s home page at . Copyright 1998 by the National Academy of Sciences . All rights reserved. No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission from the publisher, except for the purpose of official use by the U.S. Government. Printed in the United States of America

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COMMITTEE ON SUMMARY MEASURES OF POPULATION HEALTH Harvey V. Fineberg, M.D., Ph.D.*(Chair), Provost, Harvard University Mohammed Akhter, M.D., Executive Director, American Public Health Association Norman Daniels, Ph.D., Professor of Philosophy, Tufts University Dennis Fryback, Ph.D., Professor of Preventive Medicine, University of Wisconsin, Madison Dean Jamison, Ph.D., Director, Center for Pacific Rim Studies, University of California Los Angeles Mary Mundinger, Dr.P.H., * Dean and Centennial Professor of Health Policy, Columbia University Paige R. Sipes-Metzler, D.P.A., Manager of Quality Management, Regence Blue Cross and Blue Shield Oregon Staff Marthe R. Gold, M.D., M.P.H., Project Consultant, Chair, Department of Community Health and Social Medicine, City University of New York Medical Center Marilyn J. Field, Ph.D., Study Director and Deputy Director, Health Care Services Dana Caines, Administrative Assistant (September December 1997) Cecilia Rossiter, Administrative Assistant (January March 1998) Kay Harris, Financial Associate    * Member, Institute of Medicine.

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Acknowledgments In developing this short report, the committee and staff particularly benefited from the experience and expertise of the presenters and other participants in the workshop the committee convened on December 12 and 13, 1997, in Washington, D.C. Appendix A lists the workshop participants, presenters, and agenda This report was subject to independent review by a group of outside experts chosen for their diverse perspectives and technical knowledge. The purpose of this review, which was conducted in accord with procedures established and overseen by the Report Review Committee of the National Research Council, was to assist the report authors and the IOM in producing a published report that met institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and the draft manuscript remain confidential to protect the integrity of the deliberative process. On behalf of the Institute of Medicine, the study committee wishes to think the following individuals for this participation in the review of this report: David Kindig, Ph.D., University of Wisconsin, Madison School of Medicine; John Ludden, M.D., Harvard Pilgrim Health Care; Donald Marazzo, Ph.D., University of Pittsburgh School of Public Health; Jean-Claude Poullier, Ph.D., Organization for Economic Cooperation and Development; Steven Teutsch, M.D., Merck and Company, Inc.; Hugh Tilson, M.D., Glaxo Wellcome Company; Alan Williams, Ph.D., University of York (United Kingdom); and Michael Wolfson, Ph.D., Statistics Canada. These reviewers provided many constructive comments and suggestions, but responsibility for the final content of this report rests solely with the Committee on Summary Measures of Population Health and the Institute of Medicine. Linda Bailey, J.D., the project officer for the study at the Department of Health and Human Services, helped in many ways with the study. The committee also benefited from discussions with a DHHS working group on measures of population health. Members included Yen-pin Chiang, Ph.D., Matthew McKenna, M.D., M.P.H.., Gregory Pappas, M.D., Ph.D., James Schuttinga, Ph.D., and Fred Seitz, Ph.D. Dr. Chiang organized a meeting on topics related to summary measures that made it possible for a number of additional experts to attend the Institute of Medicine (IOM) workshop. Earlier, DHHS, Jo Ivey Boufford, M.D., and Kristine McCoy helped establish directions for the project and, generally, made the study possible. At the IOM, Christopher Howson, Ph.D., spent many months negotiating the framework for the study. Claudia Carl, Mike Edington, and Evelyn Simeon assisted at various stages in the project.