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Vital Signs Core Metrics for Health and Health Care Progress


1. Life expectancy:  Life expectancy is a validated, readily available, and easily understandable measure for a critical health concept. Because life expectancy depends on a full range of individual and community

influences on health—from cancer to homicide—it represents an inclusive, high-level measure for health.


Infant mortality

Maternal mortality

Violence and injury mortality



2. Well-being: Well-being captures the subjective dimensions of health related to quality of life. Furthermore, levels of well-being often predict utilization of and satisfaction with health care. Self reported well-being is a reliable indicator


Multiple chronic conditions




3. Overweight and obesity: More than two-thirds of Americans are overweight or obese, a fact that has causes and consequences that extend beyond the health system—including socioeconomic, cultural, political, and lifestyle factors.


Activity levels

Healthy eating patterns



4. Addictive behavior: Addiction, including to nicotine, alcohol, and other drugs, is prevalent in the United States, representing a complex challenge for the health system, communities, and families. Every year, substance abuse and addiction cost the country more than $500 billion


Tobacco use

Drug dependence/illicit use

Alcohol dependence/ misuse



5. Unintended pregnancy: Unintended pregnancy, a signifi cant challenge for both individual and community health, is a measure that aggregates a variety of social, behavioral, cultural, and health factors— particularly women’s knowledge about and access to tools for family planning.


Contraceptive use


6. Healthy communities: Individual health is a function of a wide range of socioeconomic and community factors, from infrastructure to social connections. Community health includes critical elements of health that fall outside the care system, such as housing, employment, and environmental factors.


Childhood poverty rate

Childhood asthma

Air quality index

Drinking water quality index


7. Preventive services: Preventive services (for example, screening for hearing loss or counseling for tobacco cessation) present a valuable opportunity for both improving health and reducing costs


Influenza immunization

Colorectal cancer screening

Breast cancer screening



8. Care access: A person’s ability to access care when needed is a critical precondition for a high quality health system. Factors that could hamper access to care include lack of health insurance, clinician shortages, lack of transportation, cultural and linguistic barriers, and physical limitations.


Usual source of care

Delay of needed care


9. Patient safety: Avoiding harm is among the principal responsibilities of the health care system, yet adverse outcomes are common. Ensuring patient safety will require a culture that prioritizes and assesses safety through a reliable index of organizational results.


Wrong-site surgery

Pressure ulcers

Medication reconciliation



10. Evidence-based care: Ensuring that patients receive care supported by scientific evidence for appropriateness and effectiveness is a central challenge for the health care system. Currently, an estimated one-third of U.S. health care expenditures do not contribute to improving health. Aggregating carefully selected and standardized clinical measures can provide a reliable composite index of system performance


Cardiovascular risk reduction

Hypertension control

Diabetes control composite

Heart attack therapy protocol

Stroke therapy protocol

Unnecessary care composite


11. Care match with patient goals: Systematically assessing each patient’s individual goals and perspectives ensures that the health care system is focusing on the aspects of care that matter most to patients.


Patient experience

Shared decision making

End-of-life/advanced care planning


12. Personal spending burden: Care that is too expensive can limit access to care, lead people to avoid care, or prevent them from spending money in other areas of value to them—with far-reaching economic impacts.


Health care–related bankruptcies


13. Population spending burden: Health care spending consumes a large portion of the U.S. gross domestic product, dwarfing the health care spending of other nations. This burden can be measured at national, state, local, and institutional levels.


Total cost of care

Health care spending growth


14. Individual engagement: Given the effects of personal choices on health, as well as the increasing use of personal health devices, it is critical for individuals to be aware of their options and responsibilities in caring for their own health and that of their

families and communities.


Involvement in health initiatives


15. Community engagement: Across the United States, communities have and utilize different levels of resources to support efforts to maintain and improve individual and family health—for example, addiction treatment programs, emergency medical facilities, and opportunities for social engagement.


Availability of healthy food

Walkability Community health benefit agenda

Discussion of the IOM Core Measures Report 

The Story of the State of the USA

Key National Indicator System


Government Accounting Office  

GOA Report 2004

GOA Report to Congress 2011

The State of the USA. Inc

National Academies: Committee on National Statistics NAP 

The law to establish Commission on Key National Indicators

Report from IOM 


Vital Signs Core Metrics for Health and Health Care Progress

Institute of Medicine Core Metrics 

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