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Vital Signs: Core Metrics for Health and Health Care Progress (2015)

Chapter: Appendix B: Existing Reporting Requirements

« Previous: Appendix A: Glossary
Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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B

Existing Reporting Requirements

BIRTHS, DEATHS, AND REPORTING ON DISEASES OF CONCERN

In the United States, all vital events—such as births, deaths, and marriages—are recorded by local jurisdictions. These jurisdictions, including all 50 states, 5 territories, the District of Columbia, and New York City, vary in how they collect these data. Some have centralized vital records offices, while others have local registrars who manage the data. Jurisdictions also have local autonomy in the recording, processing, quality assurance, and analysis of the data. Although collected locally, the data are compiled nationally through a cooperative agreement with the National Center for Health Statistics in the Centers for Disease Control and Prevention (CDC). To ensure nationally uniform data, the agreement includes requirements for the data’s consistency, quality, and timeliness (NRC, 2009).

The value of these data is that they are not samples but represent almost all of the vital events that occur throughout the country. In fact, recent studies estimate that more than 99 percent of births and deaths are currently included (Guyer et al., 2000). From these data, the National Vital Statistics System can provide snapshots of the nation’s current status on a variety of dimensions, including (Guyer et al., 2000)

  • death rates and life expectancy,
  • leading causes of death,
  • maternal and infant mortality rates, and
  • population shifts.
Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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These data can be analyzed to search for trends, make comparisons across states and countries, and assess progress (Kochanek et al., 2012).

In a similar fashion, the process of reporting certain diseases centers on local initiative. Each state has laws requiring that providers of health care—laboratories, hospitals, individual clinicians—report incidences of particular diseases to their state or local health department. As with vital statistics, these data come from 57 jurisdictions, which vary as to the specific notifiable diseases that must be reported (CDC, 2012b). The completeness of reporting varies as well, although it appears to depend more on the particular disease than on geographic location (CDC, 2012b; Doyle et al., 2002). One challenge is that there often is little connection between the data stored in electronic health records and public health disease surveillance systems, except in a limited number of pilot initiatives (Klompas et al., 2012a,b).

National figures are calculated voluntarily by states, which share portions of their data with the National Notifiable Diseases Surveillance System, operated by the CDC in collaboration with the Council of State and Territorial Epidemiologists. For example, the list of nationally notifiable infectious diseases is developed through a collaborative process in which the Council of State and Territorial Epidemiologists, with input from the CDC, makes annual recommendations for additions to and deletions from the list. As shown in Box B-1, almost 70 diseases were listed for 2013, ranging from anthrax to cholera to HIV to yellow fever (CDC, 2013).

At the state and local levels, these data assist with conducting disease surveillance, controlling outbreaks, and managing and evaluating prevention activities. At the national level, these data can help with monitoring disease trends, managing and evaluating prevention activities and strategies, identifying high-risk populations or regions, and identifying and controlling potential outbreaks (CDC, 2012a,b).

PAYER-REQUIRED REPORTING OF THE DELIVERY AND PERFORMANCE OF MEDICAL CARE

The Centers for Medicare & Medicaid Services (CMS) uses measures for multiple purposes—ranging from performance-based payment to public reporting—for the Medicare and Medicaid programs and the Children’s Health Insurance Program (CHIP). As Table B-1 illustrates, several hundred measures are currently in use in each of the measure categories. Table B-2 shows the focus of these measures, which tend to capture care processes. However, a significant number of measures are now devoted to assessing health outcomes. The measures address primarily ambulatory, inpatient, and home care, although measures exist for many other care settings (see Table B-3). Finally, Table B-4 shows that reported measures address care

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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BOX B-1
National Notifiable Infectious Conditions (2013)

Anthrax

Arboviral diseases, neuroinvasive and nonneuroinvasive

Babesiosis

Botulism

Brucellosis

Chancroid

Chlamydia trachomatis infection

Cholera

Coccidioidomycosis

Cryptosporidiosis

Cyclosporiasis

Dengue virus infections

Diphtheria

Ehrlichiosis and anaplasmosis

Giardiasis

Gonorrhea

Haemophilus influenzae, invasive disease

Hansen’s disease

Hantavirus pulmonary syndrome

Hemolytic uremic syndrome, postdiarrheal

Hepatitis A, acute

Hepatitis B, acute

Hepatitis B, chronic

Hepatitis B, perinatal infection

Hepatitis C, acute

Hepatitis C, past or present

HIV infection (AIDS has been reclassified as HIV Stage III)

Influenza-associated pediatric mortality

Invasive pneumococcal disease

Legionellosis

Listeriosis

Lyme disease

Malaria

Measles

Meningococcal disease

Mumps

Novel influenza A virus infections

Pertussis

Plague

Poliomyelitis, paralytic

Poliovirus infection, nonparalytic

Psittacosis

Q fever

Rabies, animal

Rabies, human

Rubella

Rubella, congenital syndrome

Salmonellosis

Severe acute respiratory syndrome–associated coronavirus disease

Shiga toxin-producing Escherichia coli

Shigellosis

Smallpox

Spotted fever rickettsiosis

Streptococcal toxic-shock syndrome

Syphilis

Tetanus

Toxic shock syndrome (other than streptococcal)

Trichinellosis

Tuberculosis

Tularemia

Typhoid fever

Vancomycin-intermediate staphylococcus aureus and vancomycin-resistant staphylococcus aureus

Varicella

Varicella deaths

Vibriosis

Viral hemorrhagic fever

Yellow fever

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×

TABLE B-1 Uses for Measures Employed by the Centers for Medicare & Medicaid Services

Measure Use Number of Measures
Public reporting 283
Quality reporting 655
Pay for performance 286
Pay for reporting   84

NOTE: A measure may have multiple uses and may be represented in more than one category. As a result, sums of the table categories would be inaccurate.

SOURCE: U.S. Department of Health and Human Services Measure Inventory, 2013.

TABLE B-2 Focus of Measures Employed by the Centers for Medicare & Medicaid Services for Reporting Purposes

Measure Focus Number of Measures
Access   21
Efficiency   12
Outcome 222
Patient experience   41
Process 580
Structure   25
Other   12

SOURCE: U.S. Department of Health and Human Services Measure Inventory, 2013.

quality and outcomes for a diverse group of conditions and topics, with the category of cardiovascular and stroke receiving particular attention.

PROGRAMS OPERATED UNDER WAIVER AUTHORITY

In Medicaid and CHIP, new delivery system models and payment strategies can be tested using waivers, which give states the flexibility to tailor programs to their needs and priorities. Currently, there are almost 400 active waivers (CMS, 2013).

Four primary types of waivers exist (CMS, 2013):

  • research and demonstration waivers (section 1115),
  • managed care waivers (section 1915(b)),
Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×

TABLE B-3 Care Settings for Reported Measures Employed by the Centers for Medicare & Medicaid Services

Care Setting Number of Measures
Ambulatory surgery center     8
Ambulatory/office-based care 469
Dialysis facility   30
Home care 101
Hospice     2
Hospital inpatient 194
Hospital outpatient   28
Inpatient rehabilitation facility     2
Long-term care facility   39
Long-term care hospital     5
Managed care plan   33
Other     2

SOURCE: U.S. Department of Health and Human Services Measure Inventory, 2013.

TABLE B-4 Selected Topics or Conditions for Reported Measures Employed by the Centers for Medicare & Medicaid Services

Condition/Topic Number of Measures
Cancer   45
Cardiovascular and stroke 137
Central nervous system (dementia, Parkinson’s, epilepsy)   19
Chronic and elder care   57
Communicable diseases (immunizations, methicillin-resistant staphylococcus aureus [MRSA], influenza)   53
Dental     4
Diabetes   40
Mental health and substance abuse   59
Musculoskeletal (osteoarthritis, rheumatoid arthritis, back pain)   29
Patient experience   47
Patient safety   97
Respiratory conditions   34
Surgical procedures   54

SOURCE: U.S. Department of Health and Human Services Measure Inventory, 2013.

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×
  • home- and community-based services waivers (section 1915(c)), and
  • continuum of care to the elderly and people with disabilities waivers (concurrent section 1915(b) and section 1915(c)).

In general, the research and demonstration waivers can allow for more comprehensive programmatic flexibility (although some are written quite narrowly), while the managed care and home- and community-based services waivers focus on specific populations and services. States can use research and demonstration waivers for testing new approaches, including expansion of coverage to individuals not otherwise eligible for Medicaid or CHIP, provision of coverage for services not typically covered by the program, or the application of delivery system innovations to improve the quality and value of care (Alker and Artiga, 2012; Artiga, 2011).

A research and demonstration waiver is approved through negotiations between the state and the U.S. Department of Health and Human Services (HHS) agencies, sometimes with the involvement of the U.S. Office of Management and Budget (OMB) as well. Once a waiver has been approved, the state receives an award letter explaining which specific sections of the Social Security Act or other regulations are being waived and describing the terms and conditions of approval. One important metric is the cost of the program, as all approved projects must be budget neutral to the federal government over the course of the waiver. Because these types of waivers are intended for research purposes, the state is required to have an approved evaluation strategy in place (Alker and Artiga, 2012; Artiga, 2011). Generally, states have substantial flexibility in how they carry out their evaluation—including experimental and other quantitative and qualitative designs—with the constraints that the final evaluation design must be approved by CMS and published publicly.1

The Patient Protection and Affordable Care Act (ACA) augmented waiver authority by creating the CMS Innovation Center, which has the ability to test, evaluate, and expand care delivery and payment models in Medicare, Medicaid, and CHIP. If these models are found to be successful, the Secretary of HHS has the authority to scale them up nationally. Again, there is flexibility in what constitutes success, and the CMS actuary must verify that these models lead to spending reductions. In addition, another section of the ACA provides for State Innovation Waivers, which will allow states to test new models for their insurance exchanges; qualified health plans; and other benefit, cost sharing, and coverage provisions (Alker and Artiga, 2012; Artiga, 2011).

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1 42 CFR 431.424.

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×

Public and private payers have introduced multiple new payment models to move away from fee-for-service payment and align incentives toward high-quality, high-value care. These new payment models often require clinicians and hospitals to collect and report multiple measures on care processes and outcomes. In some cases, financial incentives are tied directly to performance on a given measure, while in others the measure is used to ensure that quality and outcomes remain consistent under the new payment method (Schneider et al., 2011). Table B-5 shows the multiple categories of payment models currently in use and for each model, the categories of measures employed (in dark gray), as well as the categories of measures discussed in program documentation (in light gray). Table B-6 illustrates the care settings assessed by different payment models, demonstrating that some models are focused exclusively on one care setting, such as inpatient care, while others consider outcomes from all settings.

REPORTING ON FEDERAL CATEGORICAL GRANT PROGRAMS

Federal grants to state and local governments are significant, accounting for more than $600 billion in fiscal year 2011, and the number of such grant programs has increased over the past three decades. The focus of these grant programs has shifted over time, with an increase in funding for Medicaid and other health programs and a decrease in funding for other activities. In recent reviews of federal grants, the U.S. Government Accountability Office (GAO) found a lack of appropriate performance measures and accurate data for agencies to use in assessing the performance of grant programs and ensuring that grant funds are being spent effectively (GAO, 2006, 2012). The specific measures and strategies used to assess performance and provide for accountability vary, with the details being determined by authorizing and appropriations legislation; the agency’s grant management, such as funding announcements and notification processes; and government-wide grant management legislation, regulations, and executive orders. Given the multiple types of federal grants—from categorical grants that focus on one activity to block grants that allow choice among a range of activities—some programs may want to provide for substantial flexibility in their assessment, while others may want to provide for greater accountability (GAO, 2006). Furthermore, agencies often are challenged by a lack of accurate and credible performance data, especially when those data are provided through third parties (GAO, 2012).

States have a long history of publicly reporting information on health care performance. One of the first state performance reports came from the New York State Department of Health, which in 1989 started publishing data on risk-adjusted mortality for cardiac bypass surgery (Chassin, 2002). The number of such programs has continued to grow, and at least half of

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×

TABLE B-5 Reporting Requirements for Different Payment Models by Measure Focus

Payment Reform Models
Measurement Domain Global Payment ACO Shared Saving Program Medical Home Bundled Payment Hospital-Physician Gain-sharing Payment for Coordination Hospital P4P Payment Adjustment for Readmissions Payment Adjustment for Hospital-Acquired Conditions Physician P4P Payment for Shared Decision Making
Outcome Mortality              
Health status Morbidity                
Functional status            
Health-related QoL          
Safety Outcomes                
Patient experience/satisfaction                
Other outcome                
Process Population health Preventive services              
Healthy behaviors            
Clinical care                
Care coordination                
Patient/family/caregiver engagement            
Safety practices            
Other process        
Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×
Cost/resource use Per capita
Episode
Service Imaging
Hospital LOS
Hospital readmits
ER/ED visits
Antibiotic prescribing
Other
Other cost/resource use
Structure HIT utilization
Management
Other structure
Access
Composite
Other measurement domain

NOTES: No shading: no measure statements, measures, or measure sets in program documentation.

Light shading: measure statements, but no measures or measure sets in program documentation.

Dark shading: specific measures or measure sets fit within this domain, or program documentation names a specific measurement algorithm.

ACO = accountable care organization; ER/ED = emergency room/emergency department; HIT = health information technology; LOS = length of

stay; P4P = pay for performance; QoL = quality of life.

SOURCE: Schneider et al., 2011.

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×

TABLE B-6 Reporting Requirements for Payment Models Organized by Their Care Setting

Payment Reform Models
Measurement Domain Global Payment ACO Shared Saving Program Medical Home Bundled Payment Hospital-Physician Gain-sharing Payment for Coordination Hospital P4P Payment Adjustment for Readmissions Payment Adjustment for Hospital-Acquired Conditions Physician P4P Payment for Shared Decision Making
Clinician office
Hospital/acute care facility Inpatient
Outpatient ER/ED
Surgery/ASC
Laboratory
Imaging
Clinic
Other outpatient
Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×
Post acute/ LTC Nursing home/SNF
Rehabilitation
Other post acute/LTC
Home health
Hospice
Dialysis facility
Ambulance
Other setting

NOTES: No shading: setting not mentioned in program documentation.

Light shading: setting mentioned in program documentation.

ACO = accountable care organization; ASC = ambulatory surgery center; ER/ED = emergency room/emergency department; HIT = health informa-

tion technology; LTC = long-term care; P4P = pay for performance; SNF = skilled nursing facility.

SOURCE: Schneider et al., 2011.

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×

the states now sponsor a public reporting program focused on care quality. These programs vary considerably as to whether they include information on care processes or health outcomes, whether they describe performance only for common diseases or for many diseases, and how their data are generated (Ross et al., 2010). In addition to public reporting, more than half of all states operate a hospital adverse event reporting system, which requires that the hospital report the incidence of specific types of patient harm. These systems vary significantly from state to state with respect to what types of adverse events must be reported (Levinson, 2008; Wright, 2012).

REPORTING TO REGULATORY AND CERTIFICATION BODIES

A variety of organizations are involved with accreditation of health care in the United States, including the Joint Commission and the National Committee for Quality Assurance (NCQA). The Joint Commission accredits approximately 20,000 health care organizations and programs, while NCQA accredits health plans and offers voluntary programs for new care delivery models (Berenson et al., 2013).

COMMON THEMES AMONG REQUIREMENTS

In a recent review of measures, RAND Corporation found that many organizations are using measures for multiple purposes, which implies that they are realizing the value of aligning measures across uses. RAND also found that measures are used most commonly for quality improvement and public reporting, while payment uses are almost half as common, and an even smaller number of measures are used for accreditation, certification, credentialing, and licensure. Process measures are the most commonly used type of measure, and claims and administrative data are the most common data sources used to calculate measures (Damberg et al., 2011).

This section describes characteristics of publicly reported measures based on data from the National Quality Measures Clearinghouse. This clearinghouse, a project of the Agency for Healthcare Research and Quality (AHRQ), contains more than 2,000 different quality measures that are in use or have recently been tested. An analysis of the subset of clearinghouse measures that are used for public reporting shows that most focus on the effectiveness of clinical prevention and treatment, with fewer being devoted to other National Quality Strategy aims (see Table B-7). Further, Table B-8 illustrates that publicly reported measures focus on ambulatory care, inpatient settings, and managed care plans, although they address many other elements of the health system as well.

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×

TABLE B-7 Number of Publicly Reported Measures by Aim of the National Quality Strategy

National Quality Strategy Aim Number of Publicly Reported Measures
Effective communication and care coordination   16
Health and well-being of communities 121
Making care safer   42
Making quality care more affordable     4
Person- and family-centered care   83
Prevention and treatment of leading causes of mortality 312

SOURCE: Analysis of National Quality Measures Clearinghouse data. Accessed May 31, 2013.

TABLE B-8 Number of Publicly Reported Measures by Setting or Organization Assessed

Element of the Health System Number of Publicly Reported Measures
Ambulatory/office-based care 159
Ancillary services   16
Assisted living facilities     0
Behavioral health care   10
Community health care   20
Emergency medical services   11
Emergency room     9
Home care   21
Hospices     9
Hospital inpatient   89
Hospital outpatient   14
Intensive care units     4
Managed care plans   88
Rehabilitation centers   11
Residential care facilities   12
Rural health care   10
Skilled nursing facilities   15
Substance use treatment programs/centers     1
Transition   16

SOURCE: Analysis of National Quality Measures Clearinghouse data. Accessed May 31, 2013.

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
×

REFERENCES

Alker, J., and S. Artiga. 2012. The new review and approval process rule for section 1115 Medicaid and CHIP demonstration waivers. Washington, DC: Kaiser Family Foundation.

Artiga, S. 2011. Five key questions and answers about section 1115 Medicaid demonstration waivers. Washington, DC: Kaiser Family Foundation.

Berenson, R. A., P. J. Pronovost, and H. M. Krumholz. 2013. Achieving the potential of health care performance measures. Washington, DC: Urban Institute.

CDC (Centers for Disease Control and Prevention). 2012a. National notifiable diseases surveillance system. http://www.cdc.gov/osels/phsipo/docs/pdf/factsheets/DNDHI_NNDSS_12_232372_L_remediated_10_26_2012.pdf (accessed June 5, 2013).

CDC. 2012b. Summary of notifiable diseases—United States, 2010. Morbidity and Mortality Weekly Report 59(53):1-111.

CDC. 2013. 2013 national notifiable infectious conditions. http://wwwn.cdc.gov/nndss/script/conditionlist.aspx?type=0&yr=2013 (accessed June 6, 2013).

Chassin, M. R. 2002. Achieving and sustaining improved quality: Lessons from New York state and cardiac surgery. Health Affairs (Millwood) 21(4):40-51.

CMS (Centers for Medicare & Medicaid Services). 2013. Waivers. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers.html (accessed June 7, 2013).

Damberg, C. L., M. E. Sorbero, S. L. Lovejoy, K. Lauderdale, S. Wertheimer, A. Smith, D. Waxman, and C. Schnyer. 2011. An evaluation of the use of performance measures in health care. Santa Monica, CA: RAND Corporation.

Doyle, T. J., M. K. Glynn, and S. L. Groseclose. 2002. Completeness of notifiable infectious disease reporting in the United States: An analytical literature review. American Journal of Epidemiology 155(9):866-874.

GAO (U.S. Government Accountability Office). 2006. Grants management: Enhancing accountability provisions could lead to better results. Washington, DC: GAO.

GAO. 2012. Grants to state and local governments: An overview of federal funding levels and selected challenges. Washington, DC: GAO.

Guyer, B., M. A. Freedman, D. M. Strobino, and E. J. Sondik. 2000. Annual summary of vital statistics: Trends in the health of Americans during the 20th century. Pediatrics 106(6):1307-1317.

Klompas, M., J. McVetta, R. Lazarus, E. Eggleston, G. Haney, B. A. Kruskal, W. K. Yih, P. Daly, P. Oppedisano, B. Beagan, M. Lee, C. Kirby, D. Heisey-Grove, A. DeMaria, Jr., and R. Platt. 2012a. Integrating clinical practice and public health surveillance using electronic medical record systems. American Journal of Public Health 102(Suppl. 3):S325-S332.

Klompas, M., J. McVetta, R. Lazarus, E. Eggleston, G. Haney, B. A. Kruskal, W. K. Yih, P. Daly, P. Oppedisano, B. Beagan, M. Lee, C. Kirby, D. Heisey-Grove, A. DeMaria, Jr., and R. Platt. 2012b. Integrating clinical practice and public health surveillance using electronic medical record systems. American Journal of Preventive Medicine 42(6, Suppl. 2):S154-S162.

Kochanek, K. D., S. E. Kirmeyer, J. A. Martin, D. M. Strobino, and B. Guyer. 2012. Annual summary of vital statistics: 2009. Pediatrics 129(2):338-348.

Levinson, D. R. 2008. Adverse events in hospitals: State reporting systems. Washington, DC: HHS, Office of Inspector General.

NRC (National Research Council). 2009. Vital statistics: Summary of a workshop. Washington, DC: The National Academies Press.

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Ross, J. S., S. Sheth, and H. M. Krumholz. 2010. State-sponsored public reporting of hospital quality: Results are hard to find and lack uniformity. Health Affairs (Millwood) 29(12):2317-2322.

Schneider, E. C., P. S. Hussey, and C. Schnyer. 2011. Payment reform: Analysis of models and performance measurement implications. Santa Monica, CA: RAND Corporation.

Wright, S. 2012. Few adverse events in hospitals were reported to state adverse event reporting systems. Washington, DC: HHS, Office of Inspector General.

Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Suggested Citation:"Appendix B: Existing Reporting Requirements." Institute of Medicine. 2015. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: The National Academies Press. doi: 10.17226/19402.
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Thousands of measures are in use today to assess health and health care in the United States. Although many of these measures provide useful information, their usefulness in either gauging or guiding performance improvement in health and health care is seriously limited by their sheer number, as well as their lack of consistency, compatibility, reliability, focus, and organization. To achieve better health at lower cost, all stakeholders - including health professionals, payers, policy makers, and members of the public - must be alert to what matters most. What are the core measures that will yield the clearest understanding and focus on better health and well-being for Americans?

Vital Signs explores the most important issues - healthier people, better quality care, affordable care, and engaged individuals and communities - and specifies a streamlined set of 15 core measures. These measures, if standardized and applied at national, state, local, and institutional levels across the country, will transform the effectiveness, efficiency, and burden of health measurement and help accelerate focus and progress on our highest health priorities. Vital Signs also describes the leadership and activities necessary to refine, apply, maintain, and revise the measures over time, as well as how they can improve the focus and utility of measures outside the core set.

If health care is to become more effective and more efficient, sharper attention is required on the elements most important to health and health care. Vital Signs lays the groundwork for the adoption of core measures that, if systematically applied, will yield better health at a lower cost for all Americans.

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