Past Selection Criteria Described for the Leading Health Indicators and Other High-Level Indicator Sets
The National Academies of Sciences, Engineering, and Medicine committee reviewed several relevant sets of criteria developed by the Department of Health and Human Services and in previous National Academies reports that were intended to guide the selection of past Leading Health Indicators (LHIs) or other concise and high-level sets of national indicators. The following sections describe the committee’s thinking regarding these sets of criteria.
In the Healthy People 2010 initiative, the LHIs were defined as
a subset of the Healthy People 2010 objectives that reflect the major public health concerns in the United States … chosen on the basis of their ability to motivate action, the availability of data to measure their progress, and their relevance as broad public health issues. These indicators reflect individual behaviors, physical and social environmental factors, and important health system issues that greatly affect the health of individuals and communities. (NCHS, 2010, LHI-3)
Although the National Academies committee could not locate a list of criteria for Healthy People 2020 LHI selection, it noted the following about LHIs for Healthy People 2020:
[The LHIs were] selected and organized using a Health Determinants and Health Outcomes by Life Stages conceptual framework. This approach is intended to draw attention to both individual and societal determinants that affect the public’s health and contribute to health disparities from
infancy through old age, thereby highlighting strategic opportunities to promote health and improve quality of life for all Americans.
Determinants of Health and Health Disparities. Biological, social, economic, and environmental factors—and their interrelationships—influence the ability of individuals and communities to make progress on these indicators. Addressing these determinants is key to improving population health, eliminating health disparities, and meeting the overarching goals of Healthy People 2020.
Health Across Life Stages. LHIs are being examined using a life stages perspective. This approach recognizes that specific risk factors and determinants of health vary across the life span. Health and disease result from the accumulation (over time) of the effects of risk factors and determinants. Intervening at specific points in the life course can help reduce risk factors and promote health. The life-stages perspective addresses one of the four overarching goals of Healthy People 2020: “Promote quality life, healthy development, and health behaviors across all life stages” (HHS, 2019b).
The Institute of Medicine (IOM) 1999 report Leading Health Indicators for Healthy People 2010 recommended six criteria for LHIs:
- worth measuring;
- can be measured for diverse populations;
- understood by people who need to act;
- information will galvanize action;
- actions that can lead to improvement are known and feasible; and
- measurement over time will reflect results of action (IOM, 1999).
The 2011 IOM report Leading Health Indicators for Healthy People 2020 added three criteria to the 1999 list: (1) the objective is well defined; (2) data for the objective are available for various geographic levels (local, national) and population subgroups (e.g., race/ethnic, socioeconomic status, rural/urban); and (3) changes in societal domains other than health (e.g., socioeconomic or environmental conditions or public policies) can have a detectable effect on the objective (IOM, 2011).
The 2015 IOM report Vital Signs: Core Metrics for Health and Health Care Progress outlined criteria for a small set of national measures. The criteria for selecting individual core measures were “importance for health, strength of linkage to progress, understandability of the measure, technical integrity, potential for broader system impact, and utility at multiple levels.” Criteria for the set were “systemic reach, outcomes-oriented, person meaningful, parsimonious, representative, [and] utility at multiple levels” (IOM, 2015, p. 14).
The 2013 IOM report Toward Quality Measures for Population Health and the Leading Health Indicators stated that criteria for conditions or outcomes to be measured should be “reflective of a high preventable burden and actionable at the appropriate level for intervention.” The report gave the following criteria for measures under consideration:
- Timely—data collection frequency and timeliness of availability;
- Usable for assessing various populations (zip code, different levels of government, etc.);
- Understandable (includes face validity, transparency);
- Methodologically rigorous (having suitable methodological and quantitative characteristics, such as sensitivity, specificity, reliability, validity, and consistency over time, and being managed by an established, regularly updated process); and
- Accepted and harmonized (e.g., endorsed by the National Quality Forum or used by America’s Health Rankings or County Health Rankings) (IOM, 2013).
The 2010 IOM report For the Public’s Health: The Role of Measurement in Action and Accountability put forward the following criteria:
- Face validity (meaningfulness, relevance, and understandability),
- Feasibility (availability or collectability of data),
- Methodologic soundness (validity and reliability), and
- Fairness (to the stakeholders whose performance they will evaluate).
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