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Suggested Citation:"Appendix A: Glossary." 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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A

Glossary

Clinical preventive services: Immunization, chemoprophylaxis, counseling, and screening with early intervention, provided to individuals to reduce their likelihood of disease, injury, or impairment, or to improve their overall health status and sense of well-being.*

Community: A group of people defined in many ways, such as by geography, culture, disease or condition, occupation, and workplace (IOM, 2012).

Community health programs: Actions sponsored by organizations, groups, or individuals within a community, to improve the status of the community and its most vulnerable citizens with respect to disease, injury, functional capacity, and sense of well-being.*

Continuous health care learning and improvement: The process of ongoing measurement and analysis to inform changes in the delivery of care. Continuous learning occurs both intra- and interinstitutionally and relies on the real-time capture and use of data on patient experience, outcomes, and process measures (IOM, 2012).

Core measures: A parsimonious set of measures that provide a quantitative indication of current status on the most important elements in a given field,

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* This glossary entry has changed or was added after the prepublication version of this report.

Suggested Citation:"Appendix A: Glossary." 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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and that can be used as a standardized and accurate tool for informing, comparing, focusing, monitoring, and reporting change.

Health system: See “Multisectoral health system.”

Learning health care system: A health care system in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices being seamlessly embedded in the care process, patients and families being active participants in all elements of care, and new knowledge being captured as an integral by-product of the care experience (Charter, IOM Roundtable on Value & Science-Driven Health Care).

Multisectoral health system: The array of sectors and entities that influence the health of the population through their activities, ideally in a coordinated manner, as a system, but in practice, operating through occasional and not always sustained collaboration. The system comprises public health agencies, health care delivery organizations, and parts of other sectors (e.g., businesses, schools) and the community (IOM, 2011). The report often shortens this term to “health system.”

Patient- and family-centered care: Patient and family-centered care is designed, with patient involvement, to ensure timely, convenient, well-coordinated engagement of a person’s health and health care needs, preferences, and values; it includes explicit and partnered determination of patient goals and care options; and it requires ongoing assessment of the care match with patient goals (IOM, 2015).*

Population health: The health of the public in a geopolitical location (IOM, 2013a).

Population health programs: Environmental, educational, organizational, social, or policy interventions that seek to advance the profile of a population group with respect to the level of disease, injury, functional capacity, and sense of well-being.*

Public health: Governmental action to advance health and safety through health promotion and health protection measures, through measures to ensure the quality and access of basic personal health services, and through enhanced understanding of factors shaping health status.*

Public health system: A complex network of individuals, organizations, and relevant critical infrastructures with the potential to act individually and

Suggested Citation:"Appendix A: Glossary." 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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together to create conditions of health. The system encompasses communities, health care delivery systems (e.g., home care, ambulatory care, private practices, hospitals, skilled nursing facilities), employers and businesses, the media, homeland security and public safety agencies, academia, and the governmental public health infrastructure (IOM, 2013b).

Safe care: Care that involves making evidence-based clinical decisions to optimize the health outcomes of individuals and minimize the potential for harm. Errors of both commission and omission should be avoided (IOM, 2004).

Value: Assessed using the following heuristic: Value = Outcomes/Cost (IOM, 2012).

REFERENCES

IOM (Institute of Medicine). 2004. Patient safety: Achieving a new standard for care. Washington, DC: The National Academies Press.

IOM. 2011. For the public’s health: The role of measurement in action and accountability. Washington, DC: The National Academies Press.

IOM. 2012. Best care at lower cost: The path to continuously learning health care in America. Washington, DC: The National Academies Press.

IOM. 2013a. Toward quality measures for population health and the leading health indicators. Washington, DC: The National Academies Press.

IOM. 2013b. Crisis standards of care: A toolkit for indicators and triggers. Washington, DC: The National Academies Press.

IOM. 2015. Transforming health care scheduling and access: Getting to now. Washington, DC: The National Academies Press.

Suggested Citation:"Appendix A: Glossary." 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 A: Glossary." 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 A: Glossary." 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 A: Glossary." 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 A: Glossary." 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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