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.
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.
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
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.
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
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
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.
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
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.
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
National Academies: Committee on National Statistics NAP