committee should recommend a minimum of two candidate indicator sets that would (1) elicit interest and awareness among the general population, (2) motivate diverse population groups to engage in activities that will exert a positive impact on specific indicators and in turn, improve the overall health of the nation, and (3) provide ongoing feedback concerning progress toward improving the status of specific indicators. In subsequent meetings between committee members and staff from the U.S. Department of Health and Human Services, this charge was reviewed and clarification sought where necessary. Specifically, the committee was informed that the charge also included the development of potential dissemination strategies to promote the leading health indicators to the lay public and traditional public and private health care communities. It was also established that clear linkages should be demonstrated between the proposed indicators and the existing full draft of Healthy People 2010, including the two overarching goals, four enabling goals and 26 focus areas. Finally, the committee received additional direction that the candidate indicator sets should contain no more than 10 indicators and that any proposed indicator set should be supported by a conceptual framework around which the specific indicators could be organized.

Overview of Indicator Set Development

This report provides a detailed discussion of the committee's efforts to develop leading health indicator sets that could focus on health and social issues as well as evoke response and action from the general public and the traditional audiences for Healthy People. Briefly, three sets of leading health indicators were developed through the standard Institute of Medicine committee process. The committee followed an iterative approach to guide selection of conceptual frameworks and specific indicators for potential indicator sets. These efforts resulted in consideration of 13 conceptual frameworks and more than 50 categories of indicators. The committee then followed a consensus-based approach to facilitate selection of conceptual frameworks and specific indicators. This resulted in three unique conceptual frameworks and 19 indicators unique to the three proposed sets.

The diverse expertise and experience of the committee members strongly influenced the process of selection of the conceptual frameworks and indicators. However, the appointed committee is confident about the strengths of the three conceptual frameworks underlying each of the proposed sets and similarly, the ability of specific indicators within each set to meet the final set of six essential criteria. The committee is also confident that the three proposed indicator sets are responsive to every aspect of the committee's charge.

The committee also focused on identification of a set of essential criteria to guide the selection of suitable indicators for each of the candidate indicator sets. Initially, the committee accepted the nine criteria that had been recommended by the Working Group on Sentinel Indicators for Healthy People 2010. The committee then decided to expand this initial set of nine to include five additional criteria. As the committee progressed in its efforts to select appropriate indicators, they shared a growing awareness of the need to select criteria that would be understandable to the lay public and traditional public and private health care professionals as well as feasible to implement. Ultimately the committee decided that 14 criteria were too numerous and therefore, not feasible to apply in the selection of specific indicators. Following an interactive process that also reflected the committee's best judgments and their consideration of relevant literature and public comment resulted in a smaller set of six essential criteria that were worded in the simplest and most understandable terms. These criteria then became the essential conditions used by the committee to guide selection of the final indicators in each of the three proposed sets. The final set of six criteria are presented in the following Table E.1.

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