Summarizing Population Health: Directions for the Development and Application of Population Metrics (1998)

AGENDA

Plenary Session

2101 Constitution Avenue, N.W., Washington, D.C

Working Groups

2001 Wisconsin Avenue, N.W., Washington, D.C.

Sudhir Anand, M.D.

Acting Director, Harvard School of Public Health

Harvard Center for Population and Development Studies

Linda A. Bailey, J.D., M.H.S.

Senior Advisor for Health Policy

U.S. Department of Health and Human Services

Judith Bale, Ph.D.

Director, Board on International Health

Institute of Medicine

John Bartlett, M.D., M.P.H.

Atlanta, GA

Bobbie Berkowitz, Ph.D., R.N.

Deputy Director, Turning Point Program, School of Public Health and Community Medicine

University of Washington

Stanley Berman, Ph.D.

Economist, National Institutes of Health

Jo Ivey Boufford, M.D.

Dean, Robert F. Wagner Graduate School of Public Services

New York University

Peter Bouxsein, J.D.

Acting Director, Office of Clinical Standards and Quality

Health Care Financing Administration

A. David Brandling-Bennett, MD

Deputy Director, Pan American Health Organization

Dan W. Brock, Ph.D.

University Professor and Director, Center for Biomedical Ethics, Brown University

Claire V. Broome, MD

Deputy Director, Centers for Disease Control and Prevention

Ronald H. Carlson

Director, Office of Planning, Evaluation, and Legislation

Health Resources and Services Administration

Cheryl Austein Casnoff, M.P.H.

Director, Public Health Policy, Office of the Assistant Secretary for Planning and Evaluation

Nelba Chavez, M.D.

Administrator, Substance Abuse and Mental Health Services Administration

Carolyn Clancy, M.D.

Director, Center for Outcomes and Effectiveness Research

Agency for Health Care Policy and Research

Barbara A. DeBuono, M.D., M.P.H.

Commissioner of Health, State of New York

John Eisenberg, M.D.

Administrator, Agency for Health Care Policy and Research

U.S. Department of Health and Human Services

Pennifer Erickson, Ph.D.

Departments of Health and Human Development and Health Evaluation Sciences

Pennsylvania State University

Claude Earl Fox, M.D., M.P.H.

Acting Administrator, Health Resources and Services Administration

Spencer Foreman, M.D.

President, Motefiore Medical Center

New York City

Julio Frenk, M.D., M.P.H., Ph.D.

Executive Vice President, Mexican Health Foundation, MEXICO

Bruce M. Fried, Ph.D.

Director, Center for Health Plans and Providers

Health Care Financing Administration

Kristine Gebbie, R.N., Dr.P.H., F.A.A.N.

Associate Professor, Columbia University School of Nursing

Louise J. Gunning-Schepers, Ph.D.

Department of Social Medicine

Amsterdam Medical Center, THE NETHERLANDS

Jeffrey R. Harris, M.D., M.P.H.

Director, Division of Prevention Research and Analytic Methods

Centers for Disease Control and Prevention

Frances Kamm, Ph.D.

Department of Philosophy

New York University

Jeffrey Kang, M.D.

Chief Medical Officer, Center for Health Plans and Providers

Health Care Financing Administration

Robert Kaplan, Ph.D.

Department of Family and Preventive Medicine

University of California San Diego

Paul Kind

Senior Researcher, University of York

UNITED KINGDOM

David Kindig, M.D. Ph.D.

Professor of Preventive Medicine

Director, WI Network for Health Policy Research

University of Wisconsin-Madison

Richard J. Klein

Chief, Data Monitoring and Analysis Branch

Division of Health Promotion Statistics

National Center for Health Statistics

Jeffrey P. Koplan, M.D.

President, The Prudential Center for Healthcare Research

Samuel P. Korper, Ph.D., M.P.H.

Associate Director of National Intstitute on Aging/NIH

Sr. Advisor, Substance Abuse and Mental Health Services Administration

Donald P. Marazzo, M.D.

Pittsburgh, PA

James S. Marks, M.D., M.P.H.

Director, National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention

Kristine McCoy

Alexandria, VA

Michael McGinnis, M.D.

Scholar-in-Residence, Commission on Behavioral and Social Sciences and Education

National Research Council

Matthew McKenna, M.D., M.P.H.

National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention

Paul Menzel, Ph.D.

Provost, Pacific Lutheran University

David Moriarty

Centers for Disease Control and Prevention

Richard H. Morrow, M.D.

Director of Health Systems

Johns Hopkins University

Gregory Pappas, M.D., Ph.D.

Senior Public Health and Population Adviser

Office of International and Refugee Health

Jean-Pierre Poullier, Ph.D.

Office for Economic Co-operation and Development

Office of the Secretariat

FRANCE

Steven M. Safyer, M.D.

Vice President, Medical Affairs and Chief Medical Officer

Montefiore Medical Center

Howard Seymour, M.D.

Director, Health Care Development Unit

UNITED KINGDOM

Joanna Siegel, Sc.D.

Arlington Health Foundation

Clay Simpson, Ph.D.

Deputy Assistant Secretary for Minority Health

Office of Minority Health

Edward J. Sondik, Ph.D.

Director, National Center for Health Statistics

Dixie Snider, M.D., M.P.H.

Associate Director for Science

Centers for Disease Control and Prevention

Susanne A. Stoiber

Deputy Assistant Secretary for Program Systems

U.S. Department of Health and Human Services

Richard Surles, Ph.D.

President, Advanced Clinical Delivery

Merit Behavioral Care

Steven Teutsch, M.D.

Senior Research Scientist, Outcomes Research and Management

Merck and Co., Inc.

Joseph Thompson

National Committee for Quality Assurance

Martin Tobias, M.D.

Ministry of Health

NEW ZEALAND

Reed Tuckson, M.D.

Group Vice President for Professional Standards

American Medical Association

Peter Ubel, MD

Center for Bioethics

University of Pennsylvania

Diane K. Wagener, Ph.D.

Acting Director, Division of Health Promotion Statistics, Office of Analysis, Epidemiology and Health Promotion

National Center for Health Statistics

Daniel Wikler, Ph.D.

Professor, Medical School

University of Wisconsin

Alan Williams, Ph.D.

Professor of Economics

University of York, UNITED KINGDOM

Michael Wolfson, Ph.D.

Director, General Institutions and Social Statistics Branch

Statistics Canada, CANADA

1. Summary measures of population health status have been devised for various purposes. For the settings listed below, how useful would a summary measure be in providing information or insights not provided by other measures of health? What uses should have the highest priority in future efforts to develop and apply summary measures?

1. For public health surveillance/burden-of-disease monitoring at national/regional levels.

2. For comparing population health between/among countries/states/regions.

3. For resource allocation at national/regional levels.

4. For monitoring and comparing performance in managed care or similar settings.

5. For devising risk-adjusted capitation payments for use with managed care plans or other health care providers paid in whole or in part on a per-person basis.

6. For measuring health-related quality of life in clinical trials and contributing to cost-effectiveness analyses of alternative clinical interventions.

7. Other (discuss).

2. The practicality, credibility, and understandability of summary measures in different settings or for different constituencies is an important issue.

1. What problems of understanding or credibility do you see as deterrents to the use of summary measures in the settings of most concern to you?

2. Would these measures be comprehensible and credible to the constituencies that you serve or for whom you make decisions?

3. What efforts (e.g., education, survey of value systems, media coverage) would contribute to their comprehensibility or credibility?

3. Societal values (e.g., equity) may figure in decision making in different ways. For example, they may be among specific criteria used to evaluate measurement data and assess different options. Alternatively, value judgments can be incorporated in the construction of measures themselves (e.g., by assigning elements of a measure different weights).

1. To what extent would measures be more useful if they took explicit account of distributive/equity issues (e.g., related to disability or chronic disease burdens across different sociodemographic groups based on such variables as age, race, gender, or income)?

2. What social value or ethical issues should be emphasized in future efforts to develop and apply summary measures?

4. Certain summary measures incorporate information about preferences for living with different kinds of disabilities or illnesses.

1. For the uses listed in question 1, how relevant or central to credibility is the inclusion of such preferences into the measures themselves? Are there decision-making contexts where preferences are not necessary?

2. Where preferences are important to incorporate, whose preferences (e.g., patient, community) are most relevant in the different decision-making contexts?

3. What issues related to preferences should be priorities for attention in future work to develop and apply summary measures?

How important is it that a single summary measure be suited to a range of different uses?

1. What different goals or aspects of health might warrant different measures?

2. What are the trade-offs to consider in using single versus multiple measures?