4
Core List of Candidate Leading Health Indicators

Prior to the third committee meeting, IOM staff and committee members developed 13 draft sets of potential leading health indicators; 3 of these were selected from the Leading Indicators for Healthy People 2010: A Report from the HHS Working Group on Sentinel Objectives (U.S. Department of Health and Human Services, 1997b) including the Health Status Model, Summary Measures/Leading Contributors Model, and Health Disparities Model. The remaining 10 draft sets were developed independently of each other by committee members and IOM staff and then circulated anonymously to the full committee membership. There were substantial differences between each of the 13 sample indicator sets with respect to number of indicators, conceptual framework, availability of existing data, and most important of all, actual content and wording of suggested measures for specific indicators. For example, the sets ranged from a dozen indicators to 125 indicators, with the majority somewhere between 15 and 30. Some conceptual frameworks focused solely on indicators of health outcomes, whereas others addressed only environmental and social determinants of health. Still others included measures to assess the well-being of individuals, while others focused on the community as the unit of analysis. Some indicator sets were organized by age categories, others relied on topics such as environmental health, access to care, preventable deaths, and preventive health behaviors to provide a structure for the selection of indicators and suggested measures for these indicators. Wherever possible, the language for the suggested measures was adapted from the full Healthy People 2010 model.

In an effort to compare the widely diverse sample sets of indicators, committee members were first asked to evaluate each draft set for congruence with the revised set of 14 criteria (Table 2-2) proposed and accepted by the committee. Tables displaying the congruence between criteria and six sample indicator sets are included in the report as Appendices A through F. Committee members were then asked to rank-order the top 5 sets of indicators according to their personal judgment. Review and analysis of these ratings were conducted at the third committee meeting (October 28–29, 1998). Results of these efforts indicated that there was still little consensus in both ratings of congruence with the criteria and the rank orderings.

The committee then collectively decided to identify the common themes between each of the 13 indicator sets and develop a core list of candidate indicators. These were organized by IOM staff into 5 general categories and 34 subcategories listed in Table 4-1.



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--> 4 Core List of Candidate Leading Health Indicators Prior to the third committee meeting, IOM staff and committee members developed 13 draft sets of potential leading health indicators; 3 of these were selected from the Leading Indicators for Healthy People 2010: A Report from the HHS Working Group on Sentinel Objectives (U.S. Department of Health and Human Services, 1997b) including the Health Status Model, Summary Measures/Leading Contributors Model, and Health Disparities Model. The remaining 10 draft sets were developed independently of each other by committee members and IOM staff and then circulated anonymously to the full committee membership. There were substantial differences between each of the 13 sample indicator sets with respect to number of indicators, conceptual framework, availability of existing data, and most important of all, actual content and wording of suggested measures for specific indicators. For example, the sets ranged from a dozen indicators to 125 indicators, with the majority somewhere between 15 and 30. Some conceptual frameworks focused solely on indicators of health outcomes, whereas others addressed only environmental and social determinants of health. Still others included measures to assess the well-being of individuals, while others focused on the community as the unit of analysis. Some indicator sets were organized by age categories, others relied on topics such as environmental health, access to care, preventable deaths, and preventive health behaviors to provide a structure for the selection of indicators and suggested measures for these indicators. Wherever possible, the language for the suggested measures was adapted from the full Healthy People 2010 model. In an effort to compare the widely diverse sample sets of indicators, committee members were first asked to evaluate each draft set for congruence with the revised set of 14 criteria (Table 2-2) proposed and accepted by the committee. Tables displaying the congruence between criteria and six sample indicator sets are included in the report as Appendices A through F. Committee members were then asked to rank-order the top 5 sets of indicators according to their personal judgment. Review and analysis of these ratings were conducted at the third committee meeting (October 28–29, 1998). Results of these efforts indicated that there was still little consensus in both ratings of congruence with the criteria and the rank orderings. The committee then collectively decided to identify the common themes between each of the 13 indicator sets and develop a core list of candidate indicators. These were organized by IOM staff into 5 general categories and 34 subcategories listed in Table 4-1.

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--> Table 4-1 Core list of Candidate Leading Health Indicators A. Health and Disease Outcomes   General physical well-being Infant mortality Death rates from preventable causes Disability-free survivorship Self-reported health status Sexually transmitted diseases HIV Cancer Low birth weight Cardiovascular disease (CVD) Asthma or Chronic obstructive pulmonary disease (COPD) Hip fractures or osteoporosis Injury Diabetes Disability days B. Preventive Health Behaviors   Unintended pregnancies Immunizations Tobacco use Physical activity Alcohol use Substance abuse Appropriate body weight Nutrition C. Mental Health   Psychological status D. Health System Access Physical accessibility Poverty Health literacy Education levels E. Ecological   Air quality Iatrogenesis Firearm death and injury rates Violence Homelessness Motor vehicle accident death and injury rates Committee members reviewed each of the indicators in the 13 draft indicator sets and voted to include or exclude each item on the master list. It was required that a majority of the committee (six members or more) vote in favor for each indicator for it to be included on the core list. The committee agreed that this master list of candidate indicators would guide the selection of sample

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--> leading health indicators and suggested measures for each of 6 proposed indicator sets described in Chapter 5. Each indicator has a high number of suggested measures which will be reduced significantly for the final recommended sets based on comment from the public and individual, organizations, and professionals involved in the delivery of public health care services.

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