METRICS THAT MATTER
for POPULATION
HEALTH ACTION
WORKSHOP SUMMARY
Joe Alper, Rapporteur
Roundtable on Population Health Improvement
Board on Population Health and Public Health Practice
Institute of Medicine
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS500 Fifth Street, NWWashington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and the Aetna Foundation (#10001504), The California Endowment (20112338), General Electric, HealthPartners, Kaiser East Bay Community Foundation (20131471), The Kresge Foundation (101288), Mayo Clinic, Missouri Foundation for Health (12-0879-SOF-12), National Association of City and County Health Officials, Nemours, New York State Health Foundation (12-01708), Novo Nordisk, ReThink Health, Robert Wood Johnson Foundation (70555), and Sanofi. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-39153-5
International Standard Book Number-10: 0-309-39153-9
Digital Object Identifier: 10.17226/21899
Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http/www.nap.edu.
Copyright 2016 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Metrics that matter for population health action: Workshop summary. Washington, DC: The National Academies Press. doi: 10.17226/21899.
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PLANNING COMMITTEE ON METRICS THAT MATTER FOR POPULATION HEALTH ACTION1
GEORGE ISHAM (Co-Chair), Senior Advisor, HealthPartners, and Senior Fellow, HealthPartners Institute for Education and Research
DAVID A. KINDIG (Co-Chair), Professor Emeritus and Emeritus Vice-Chancellor, University of Wisconsin School of Medicine and Public Health
RAJIV BHATIA, Executive Director, The Civic Engine
MARY LOU GOEKE, Executive Director, United Way of Santa Cruz County
MARTHE GOLD, Visiting Scholar, New York Academy of Medicine, and Emeritus Professor, Sophie Davis School of Biomedical Education, City College of New York
THOMAS LaVEIST, William C. and Nancy F. Richardson Professor in Health Policy and Director, Hopkins for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
SANNE MAGNAN, President and Chief Executive Officer, Institute for Clinical Systems Improvement
KATHERINE PAPA, Director of Public Health Initiatives, AcademyHealth
PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation
LILA J. FINNEY RUTTEN, Associate Scientific Director, Population Health Science Program, Department of Health Sciences Research, Mayo Clinic
__________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.
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ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1
GEORGE ISHAM (Co-Chair), Senior Advisor, HealthPartners, and Senior Fellow, HealthPartners Institute for Education and Research
DAVID A. KINDIG (Co-Chair), Professor Emeritus and Emeritus Vice-Chancellor, University of Wisconsin School of Medicine and Public Health
TERRY ALLAN, Health Commissioner, Cuyahoga County Board of Health
CATHERINE BAASE, Global Director of Health Services, The Dow Chemical Company
GILLIAN BARCLAY, former Vice President, Aetna Foundation
RAYMOND J. BAXTER, Senior Vice President, Community Benefit, Research and Health Policy, Kaiser Permanente, and President, Kaiser Permanente International
RAPHAEL BOSTIC, Judith and John Bedrosian Chair in Governance and Public Enterprise, Sol Price School of Public Policy, University of Southern California
DEBBIE I. CHANG, Vice President, Policy and Prevention, Nemours
CHARLES FAZIO, Medical Director, HealthPartners
GEORGE R. FLORES, Program Manager, The California Endowment
JACQUELINE MARTINEZ GARCEL, Vice-President, New York State Health Foundation
ALAN GILBERT, Director, Global Government and NGO Strategy, GE healthymagination
MARY LOU GOEKE, Executive Director, United Way of Santa Cruz County
MARTHE R. GOLD, Visiting Scholar, New York Academy of Medicine, and Emeritus Professor, Sophie Davis School of Biomedical Education, City College of New York
GARTH GRAHAM, President, Aetna Foundation
ROBERT HUGHES, President and Chief Executive Officer, Missouri Foundation for Health
ROBERT M. KAPLAN, Chief Science Officer, Agency for Healthcare Research and Quality
JAMES KNICKMAN, President and Chief Executive Officer, New York State Health Foundation
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.
PAULA LANTZ, Professor and Associate Dean for Research and Policy Engagement, Gerald R. Ford School of Public Policy, University of Michigan
MICHELLE LARKIN, Assistant Vice President, Health Group, Robert Wood Johnson Foundation
THOMAS A. LaVEIST, William C. and Nancy F. Richardson Professor in Health Policy and Director, Hopkins for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
JEFFREY LEVI, Executive Director, Trust for America’s Health
SARAH R. LINDE, Rear Admiral, U.S. Public Health Service, Chief Public Health Officer, Health Resources and Services Administration
SANNE MAGNAN, President and Chief Executive Officer, Institute for Clinical Systems Improvement
PHYLLIS D. MEADOWS, Associate Dean for Practice, Office of Public Health Practice, School of Public Health, University of Michigan, and Senior Fellow, Health Program, The Kresge Foundation
BOBBY MILSTEIN, Director, ReThink Health
JUDITH A. MONROE, Director, Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention
JOSÉ MONTERO, Vice President of Population Health and Health Systems Integration, Cheshire Medical Center/Dartmouth Hitchcock Keene
MARY PITTMAN, President and Chief Executive Officer, Public Health Institute
PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation
LILA J. FINNEY RUTTEN, Associate Scientific Director, Population Health Science Program, Department of Health Sciences Research, Mayo Clinic
BRIAN SAKURADA, Senior Director, Managed Markets and Integrated Health Systems
MARTÍN JOSE SEPÚLVEDA, Fellow and Vice President, Health Industries Research, IBM Corporation
ANDREW WEBBER, Chief Executive Officer, Maine Health Management Coalition
IOM Staff
ALINA BACIU, Study Director
COLIN FINK, Senior Program Assistant
AMY GELLER, Senior Program Officer
LYLA HERNANDEZ, Senior Program Officer
BETTINA RITTER, Research Assistant
DARLA THOMPSON, Associate Program Officer
ROSE MARIE MARTINEZ, Senior Board Director
Consultant
JOE ALPER, Rapporteur
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Reviewers
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
Sarah Burd-Sharps, Social Science Research Council
Dale Fleming, County of San Diego
Moira Inkelas, University of California, Los Angeles
Kristen Lewis, Social Science Research Council
Matt Stiefel, Kaiser Permanente
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Sue Curry, University of Iowa. She was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteur and the institution.
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Boxes, Figures, and Tables
BOXES
2-1 Highlights from Presentations on the Metrics Landscape
3-1 Highlights from Presentations on Local Use of Metrics
4-1 Highlights from Presentations on Measurement and Health Equity
4-2 National Health Interview Survey, 2005
5-1 Highlights from the World Café Session
FIGURES
2-1 Measurement of the total population and subpopulations
2-2 Framework for health and health care indicator development
2-3 County Health Rankings data mode
2-4 America’s Health Rankings framework
2-6 Logic model for developing quality measures for the Leading Health Indicators
2-8 Heat maps showing measures of public transit, recreation, and quality elementary education
2-9 Injury density per mile in San Francisco
2-10 Bay Area regional indicators for transportation planning
2-11 Regional indicators used to score a proposed transportation project
2-12 Cost–benefit analysis for transportation projects in the San Francisco Bay Area
3-1 The County Health Rankings and Roadmaps action model
3-2 Percentage of 11th grade students who reported feeling “very safe” or “safe” at school
3-3 Gang-related cases and number of gang-related cases by jurisdiction, January to June 2013
3-4 Elements of the population health continuum today
3-5 The desired population health continuum of the future
3-6 Dignity Health’s Community Need Index (CNI) online mapping tool
4-1 Impact of geography on life expectancy
4-4 All-cause mortality risk for men and women by years of education
4-5 Potential impact of education on mortality
4-6 Health outcomes in Kentucky, 2014
4-7 Age-adjusted mortality rates by race, ethnicity, and gender, 2009
4-8 Age and smoking prevalence by race and ethnicity among men
4-9 Age and smoking prevalence by race and ethnicity among women
4-10 Education and disparities in diabetes, age adjusted
4-11 Education and disparities in self-reported “fair” or “poor” health, age-adjusted
4-12 Income and self-rating of health: “very good” or “excellent” health
4-13 Income and hypertension diagnosis
4-14 African American/White Index of Dissimilarity 2000 and 2010
4-15 Hispanic/White Index of Dissimilarity 2000 and 2010
4-16 Excess deaths per 100,000 persons relative to Asian Americans, 2006
4-17 Percent of deaths that can be considered excess relative to Asian Americans, 2006
4-18 Projected demographic transformation of the United States, 1980-2050
4-19 Percent of people by color by county, 1980
4-20 Percent of people by color by county, projected, 2040
4-21 Projected population growth from 2010 to 2040 attributable to people of color
4-23 Regions included in the regional indicators database
4-24 A regional data profile from the National Equity Atlas
4-25 Indicators page of the National Equity Atlas
4-26 Indicators and milestones in Multnomah County’s Cradle-to-Career Effort
4-27 Cradle-to-Career indicators disaggregated by race
TABLES
3-1 Bending the Youth Violence Curve in Six Steps
4-1 Cross Tabulation of Race and Activities of Daily Living Within Income Groupings
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Acronyms and Abbreviations
| ADL |
activity of daily living |
| AHA | American Hospital Association |
| BRFSS |
Behavioral Risk Factor Surveillance Surveys |
| CDC |
Centers for Disease Control and Prevention |
| GDP |
Gross Domestic Product |
| GPI | Genuine Progress Indicator |
| HALE |
health-adjusted life expectancy |
| HIPAA | Health Insurance Portability and Accountability Act |
| HUD | U.S. Department of Housing and Urban Development |
| IOM | Institute of Medicine |
| IT | information technology |
| NCI |
National Cancer Institute |
| NIDA | National Institute on Drug Abuse |
| PERE |
Program for Environmental and Regional Equity at the University of South California |
| RBA | results-based accountability |
| RWJF | Robert Wood Johnson Foundation |
| SEER |
Surveillance, Epidemiology, and End Results |
| UCLA |
University of California, Los Angeles |
| WHO |
World Health Organization |
