Post on 06-Apr-2018
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 1/114
Health Indicators A Review o Reports
Currently in Use
Conducted or Te State o the USABy
Cheryl Wold, MPH
Wold and Associates
July 2008
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 2/114
Acknowledgements: Te author would like to thank Nicole Lurie, MD, MSPH, or her guidance with this project. Additional
thanks go to Charlotte Kahn (Te Boston Foundation); Neal Halon, MD, MPH (UCLA); Marilyn Metzler, RN (U.S.
Centers or Disease Control and Prevention); Alonzo Plough, PhD, MPH (Te Caliornia Endowment), Paul Simon, MD,
MPH (Los Angeles County Public Health); Sandra Ciske, MN (Seattle/King County Health Department); Larry Cohen,
PhD (Te Prevention Institute); and John E. Wennberg, MD, MPH (Dartmouth Medical School) or their advice. Tanks also
to David Moriarty (U.S. Centers or Disease Control and Prevention) or resources on composite measures o health, and to
Mercedes Perez, MPH, and Roberto San Luis or their assistance with the preparation o this report.
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 3/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 1
Contents
1.0 Background ............................................................................................................................................................ 4
2.0 Methods ................................................................................................................................................................. 5
3.0 Overview o Reports .............................................................................................................................................. 8
3.1 Approaches ................................................................................................................................................. 8
able 1: Reports Included in Review: Focus and Key Features ............................................................... 13
3.2 Health Indicators and Data Sources ......................................................................................................... 22
able 2: Selected Indicators Common to General Health Sets ............................................................... 25
able 3: Selected Indicators Common to General Health Sets ............................................................... 26
able 4: National Data Sources ................................................................................................................ 27
able 5: Selected Indicators or Health System Perormance: Access to Care ........................................ 32
able 6: Selected Indicators or Health System Perormance: Cost/Eciency o Care .......................... 33
able 7: Selected Indicators or Health System Perormance: Quality—Eective Care, Patient Saety . 34
able 8: Health System Perormance Data Sources ................................................................................ 35
3.3 Presentating and Framing o Health Indicators ....................................................................................... 37
3.4 Gaps in Indicators .................................................................................................................................... 41
able 9: Example Indicator Set—Merging Lie Course and Determinants Approaches ........................ 42
4.0 Summary o Each Indicator Report
4.1 General Health—National Reports ......................................................................................................... 43
4.1.1 America’s Health Rankings: A Call to Action or People and their Communities(United Health Foundation, American Public Health Association,Partnership or Prevention) ........................................................................................................ 43
4.1.2 Community Health Status Indicators—CHSI(U.S. Centers or Disease Control and Prevention)..................................................................... 45
4.1.3 Healthy People 2010—Leading Health Indicators (National Center or Health Statistics) ..... 474.1.4 Robert Wood Johnson Foundation—Commission to Build a Healthier America .................... 48
4.1.5 America’s Children (Interagency Forum and Child and Family Statistics) ............................... 50
4.1.6 Kids Count (Annie E. Casey Foundation) ................................................................................. 52
4.1.7 Older Americans 2008: Key Indicators o Well-Being(Interagency Forum on Aging-Related Statistics) ..................................................................... 54
(Contents continued on page 2)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 4/1142 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.2 General Health—State and Local Health Reports .................................................................................. 56
4.2.1 Communities Count—Seattle/King County, Washington(Public Health—Seattle and King County) ............................................................................... 56
4.2.2 Georgia Health Disparities Report (State o Georgia Public Health) ....................................... 58
4.2.3 Key Health Indicators (Los Angeles County Public Health) .................................................... 60
4.2.4 New York City Community Health Proles(New York City Department o Health and Mental Hygiene) .................................................. 62
4.2.5 New York City Health Disparities Report(New York City Department o Health and Mental Hygiene) .................................................. 64
4.2.6 Health o Wisconsin Report Card 2007(University o Wisconsin Population Health Institute) ............................................................. 65
4.2.7 Te Boston Paradox: Lots o Health Care; Not Enough Health.Indicators o Health, Health Care and Competitiveness in Greater Boston
(New England Healthcare Institute or Te Boston Foundation) ............................................. 66
4.3 Quality o Lie—Comprehensive Indicator Systems ............................................................................... 68
4.3.1 Quality o Lie Factbook 2008(Te Organization or Economic Cooperation and Development) ........................................... 68
4.3.2 Boston Indicators Project (Te Boston Foundation) .................................................................. 68
4.3.3 Jacksonville Quality o Lie Report ( Jacksonville County Community Indicators) ................... 70
4.3.4 Australia’s Measures o Progress (Australian Bureau o Statistics) ............................................. 71
4.3.5 Canadian Index o Well-Being (Atkinson Foundation) ............................................................. 71
4.4 Health System Perormance .................................................................................................................... 72
4.4.1 State Scorecard on Health System Perormance (Te Commonwealth Fund) .......................... 72
4.4.2 Dartmouth Atlas o Health Care (Dartmouth Institute or Health Policy and Clinical Practice, Dartmouth Medical School) .................................................................... 74
4.4.3 National Healthcare Quality Report (Te Agency or Healthcare Quality and Research) ......... 76
4.4.4 National Healthcare Disparities Report (Te Agency or Healthcare Quality and Research).....77
4.4.5 Organization or Economic Cooperation and Development—Health Care Quality Index ...... 78
4.4.6 Five Million Lives (Te Institute or Healthcare Improvement) ............................................... 80
4.4.7 Patient Saety in American Hospitals Study (HealthGrades) .................................................... 81
4.4.8 Hospital Compare (Centers or Medicare and Medicaid Services) ........................................... 824.4.9 rends and Indicators in a Changing Health Care Marketplace Chartbook
(Kaiser Family Foundation) ....................................................................................................... 84
4.4.10 World Health Organization’s World Health Statistics (WHO Inormation Systems) ............. 85
4.4.11 Health Care Costs 101 (Caliornia Healthcare Foundation) ..................................................... 86
Contents
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 5/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 3
4.5 Other—Framing Approaches/Gaps/Frameworks ....................................................................................87
4.5.1 op 10 Priorities or Prevention (rust or America’s Health) .................................................. 87
4.5.2 Good Health Counts: A 21st Century Approach to Health and Community in Caliornia—Prototype Indicator Set (Te Prevention Institute) .................................................................... 90
4.5.3 Environmental Public Health Indicators (U.S. Centers or Disease Controland Prevention, National Center or Environmental Health, Environmental Hazardsand Health Eects Program) ..................................................................................................... 91
4.5.4 Early Childhood Indicators—Project Trive Prototype(National Center or Childhood Poverty) .................................................................................. 89
4.5.5 Big Cities Health Inventory—Te Health o Urban USA(National Association o City and County Health Ocers) ..................................................... 93
5.0 Figures ...................................................................................................................................................................94
Figure 1: Determinants o Health ..................................................................................................................... 94Figure 2: Social Determinants—Community Guide .........................................................................................94
Figure 3: Lie Course Health Development (IOM) ......................................................................................... 95
Figure 4: Early Experiences and Health (RWJ) ................................................................................................ 95
Figure 5: Six Key Dimensions o Health Care (IOM Committee on the Quality o Health Care) ................. 96
Figure 6: Health System Perormance—Health Care Quality Index (OECD) ................................................ 97
Figure 7: OECD Factbook: Quality o Lie ...................................................................................................... 98
Figure 8: Measures o Australia’s Progress ......................................................................................................... 99
Figure 9: Canadian Index o Well-Being .......................................................................................................... 99
Figure 10: Hospital Care Intensity Index (Te Dartmouth Atlas) .................................................................... 100Figure 11: Example o Standard Selection Criteria ........................................................................................... 101
Figure 12: Framing Example: rust or America’s Health ................................................................................ 101
Figure 13: Framing Example: Prevention Institute Prototype ...........................................................................101
Figure 14: Ranking Example: Big Cities Inventory .......................................................................................... 103
Figure 15: Grades Example: Wisconsin ............................................................................................................ 104
Figure 16: Grades Example: Georgia ................................................................................................................ 105
Figure 17: Use o GIS and Maps: U.S. Lie Expectancy by County ................................................................. 106
Figure 18: Health rajectories ........................................................................................................................... 106
6.0 Reerences .......................................................................................................................................................... 107
Appendix A: Links to echnical Data About Data Sources ....................................................................................... 109
Appendix B: Selected Indicators and Data Sources .................................................................................................... 110
Contents
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 6/1144 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
1.0 Background
he State o the USA (SUSA) is a comprehensive key indicator system planned or launch early in 2009. It will
eature indicators rom all sectors o American lie, and provide a rich inormation environment that seeks to be
the “rst and nal word or inormation on progress.” Several o SUSA’s stated aims have implications or the selection
o indicators. SUSA requires indicators that are relevant, and those that resonate with users in order to build their
brand and interest. Te site must eature indicators that are supported by the highest quality data sources and statistics
to support SUSA’s aim to be the rst place many Americans go to both rame and answer serious questions.
A review o health indicator reports was prepared or SUSA to support the process o indicator selection, specically,
to provide background inormation to a committee o the Institute o Medicine charged with the task o selecting 20
health indicators or the launch o the SUSA web site. Although challenging, this committee’s work will benet rom
decades o collective experience in the development and use o health indicators in the U.S. and abroad. Indicators
are powerul tools or monitoring and communicating critical inormation about health. Tey have been used in thehealth arena in varied ways, in support o planning, community engagement, and health policy development. Tey have
been used successully to promote accountability among governmental and nongovernmental agencies and to engage
partners in civic eorts. Tis review will provide a broad range o working examples o such indicators as obtained rom
reports and systems primarily in the U.S. and also internationally.
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 7/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 5
2.0 Methods
Sample Selection
R eports at the national level, compiled by ederal agencies and private oundations, were supplemented with state,
local, and international reports in order to analyze and present a variety o examples o health indicator content,
topics, and conceptual and communication approaches. Reports were selected or review on the basis o the ollowing
eatures: Tey had to be created rom high-quality and currently available data, relevant to important health problems,
and created through the use o participatory processes and involving reputable individuals and organizations. An eort
was made in the selection process to represent dierent geographic regions and to avoid redundancy in approach
or content. All reports in the sample were designed or broad dissemination. A small group o project advisors—
individuals knowledgeable about health indicators and reports, data sources, and the use o health indicators—provided
input to address potential gaps in the report selection (see Acknowledgements).
Te review drew upon conceptual models in widespread use to allow the broadest sample o indicators to be captured
in a practical manner. Conceptual models o health are based upon the weight o peer-reviewed science about the major
contributing actors to health. Tose reerenced in this review were developed and/or promulgated in conjunction with
the Institute o Medicine, Healthy People and the Federal Interagency Forum, and other reputable processes. Te
primary models o interest to the review included the broad determinants o health (Section 5.0, Figure 1), those with
a special ocus on social determinants (Figure 2), lie course (Figure 3, Figure 4), and key dimensions o the health care
system (Figure 5 and Figure 6). Tese conceptual approaches were supplemented with other approaches, including
those used to monitor health equity, quality o lie (comprehensive key indicator systems) and aspects o health system
perormance to more ully represent the landscape o health indicator sets.
Many health indicator sets are developed using a broad health determinants approach, shown in Figure 1 (Evans and
Stoddart, 1990). Tis approach is based upon the understanding that patterns o health and disease are infuenced by
conditions in the social and physical environment as well as by personal behaviors, biology, and availability and use
o medical care. Tis model is also consistent with changing denitions o health over the past hal century, which
have shited toward concepts o well-being, quality o lie, and ability to unction ully and to adapt to changing
circumstances. Broad health determinants have been used to inorm public health interventions to improve individual
and population health (IOM, 2007). Te social determinants o health approach is related, and ocused on those
societal conditions (institutions, surroundings, and social relationships) that aect health, as shown conceptually in
Figure 2 (Anderson, et al, 2003).
Te Lie Course conceptual model emphasizes health optimization throughout the lie course, and is primarily ocused
on health and development early in lie. During the prenatal period through age ve, biology, social relationships and
environments interact “continuously and dynamically” to infuence health and well-being (Shonko 2000). Prenatal and
early lie exposures to toxins, economic and social stress, and interactions with one’s environment prooundly infuence
health during childhood. A large body o research has shown that brain, cognitive, and behavioral health during early
childhood are strongly linked to an array o important health outcomes later in lie, including many chronic diseases,
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 8/1146 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
obesity, smoking, drug use, and depression—conditions that account or a major portion o preventable morbidity and
premature mortality in the United States (Braveman, 2008).
Te conceptual model or Lie Course Health Development (IOM, 2004a) eatures indicators related to amily,
institutional, and community social environments, characteristics o the care systems with which children and amilies
interact, as well as physical environmental exposures. Te time periods o exposure to these risk and protective actors
are considered critical in this approach, as there are specic biologic and developmental stages where interactions with
these actors have greater or lesser impact (Halon 2002). Lie course and social determinants indicators are oten
merged, because o the magnied infuence o these social actors on health development early in lie (Section 5.0,
Figure 4).
Te Committee on the Quality o Health Care in America (IOM, 2001) proposed six aims or a 21st century health care system that orm the conceptual approach or indicators related to health system perormance. Tese six
dimensions state that health care should be sae, eective, patient-centered, timely, ecient, and equitable (Section
5.0, Figure 5). Te conceptual model developed by the Health Care Quality Indicators Project o the Organization or
Economic Cooperation and Development (OECD) is consistent with these aims, however provides a more complete
conceptual model (Arah, 2006) or health that includes non-medical health determinants, access, cost, and equity
(Section 5.0, Figure 6).
Tese conceptual approaches were supplemented with three types o indicator sets to address gaps or enable a
broader sample. First were indicators that track health care costs and spending, a critical component o health system
perormance. Growth health care costs and spending (due to infation, intensity o resource use, public entitlements)has resulted in health care spending that will consume an estimated 20% o the entire U.S. GDP by 2015. Te U.S.
Comptroller has called or several dramatic measures to reign in costs and spending, not the least o which includes
calls or key national indicators to better track and monitor spending and perormance in the health sector (Walker,
2008).
Te other indicator sets included were those ocused on health equity, a conceptual lens that is applied to both medical
and non-medical determinants o health to examine disparities in these determinants and outcomes. Last, quality
o lie, is a general approach used requently by comprehensive indicator systems to provide a complete picture o
lie in communities and nations, including health. Such systems have played a role in the conceptual and practical
development o Te State o the USA (GAO 2003 and 2004).
2.0 Methods
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 9/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 7
Analysis and Organization o Findings
he sample o reports was reviewed or content (indicators, measures, and ocus areas) and context (conceptual
approaches, rameworks, and purposes o the indicators) with key themes rom this analysis summarized in
Section 3.1.
Next, an analysis at the individual indicator level examined the characteristics o the indicators based on representative
sets o health indicators rom sub-samples o the reports. Selected data sources and measures were also examined to
aid in the committee’s consideration o the analytical capabilities o the measures (e.g., ability to be disaggregated by
geography, race-ethnicity, age, income, or other characteristics), availability o data, strengths and limitations o selected
data sources, and ability to make international comparisons (see Section 3.2).
Communication aspects o health indicators were examined based on the reports and other inormative sources.
Presentation and raming approaches, measures used to translate complex statistics into meaningul inormation or
broad audiences, graphical and other eatures were examined, and are described in Section 3.3. Observed gaps in
indicators or data, and possible indicators to ll those gaps are presented in Section 3.4.
Te next section o the report (4.0) is a summary o each report in the sample, including the indicator sets and ocus
areas, and other observations. Figures, reerences and technical data are provided in Sections 5.0 and 6.0, and in the
Appendices.
2.0 Methods
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 10/1148 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
3.1 Approaches
he sample, based on dierent conceptual approaches, resulted in a comprehensive set o associated indicators.
able 1 summarizes each indicator report including its compiling organization, ocus areas, and key eatures. able
1 is organized into our groups o reports.
National General Health Reports
he rst group includes general population health indicator reports produced at a national level. Tese include
Community Health Status Indicators (produced by the U.S. Centers or Disease Control and Prevention and
reviewed in its current drat orm), America’s Health Rankings (produced by United Health Foundation, AmericanPublic Health Association and the Partnership or Prevention), Healthy People 2010 Leading Indicators (produced by
the National Academy in conjunction with the U.S. Department o Health and Human Services), and the Commission
on a Healthier America (report titled What Drives Health? ), a joint public and private eort (sponsored by the Robert
Wood Johnson Foundation).
Although the ocus varies somewhat, these our reports eature indicators consistent with a broad health determinants
approach. Te Community Health Status Indicators include the most comprehensive set o health indicators, and has
been designed to provide data or local areas (counties) throughout the U.S. Tese reports share similar emphases on
major health outcomes infuenced by the major health determinants. Indicators include those or behaviors, such as
smoking, physical activity, and alcohol and drug abuse, chronic health conditions, such as obesity and diabetes, injuries,and other outcomes such as mortality, health related quality o lie, and health unction. All with one exception include
access to health care and appropriate use o clinically eective services, such as cancer screening, prenatal care. Te
degree that social determinants are emphasized in the health indicator reports varies. Te Robert Wood Johnson
Foundation’s Commission or a Healthier America has compiled a set o 13 indicators based upon 6 social actors and
three key health conditions (early childhood, obesity, and diabetes) impacted by these social actors, which include, or
example, income/poverty and educational attainment. In addition, indicators related physical environmental health
determinants are limited (examples o such indicators are provided later in this report). Specic indicators are shown in
detail in Section 3.2.
Te next three reports in this group ocus on the general well-being o specic population groups, namely children
and amilies and older Americans. America’s Childrenand Older Americans are both produced by Federal Interagency
Forums—one on Child and Family Statistics and the other on Aging-Related Statistics. Kid’s Count (produced by the
Annie E. Casey Foundation) ocuses on the well-being o children and youth.
3.0 Overview o Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 11/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 9
Te child health indicators primarily refect a combination o broad determinants and lie course approaches. For
children, measures o health and development are intertwined with saety, economic security, social and emotional
well-being, and educational and developmental opportunities—all actors that optimize healthy development as well as
infuence short- and long-term health outcomes.
Te Older Americans report constructs a “broad picture o well-being” in the later lie stages—those starting at age 65
years and beyond. Indicators o health are refective o a wider dimension o health outcomes, as compared to general
health reports, refective o the health experience o older persons, including the maniestations o normal aging as well
as reduced health due to chronic conditions, physical and psychological impairments, and increased need or health
care and supportive services. Health problems, ability to unction independently, sensory impairments, and use o
prescription medication and equipment, out-o-pocket medical costs, long term care, and health literacy, are examples.
State and Local Health Reports
General health reports rom state and local health departments complement the rst group o national reports with
other approaches. Seattle-King County’s Communities Count and Los Angeles County’s Key Health Indicators
each provide examples o the use o social indicators in health reports. Specically, Seattle tracks societal resources or
health (e.g., living wage, aordable housing and homelessness, social cohesion), and both include health indicators
o amily and community environments during in early childhood (e.g., child care needs and experience, parenting
practices). Both o these indicator sets benet rom local surveys or their breadth.
Reports rom the State o Georgia and New York City provide examples o indicators ocused on health inequities or
disparities. Variations in health determinants and health outcomes by income or geographic jurisdiction (i.e., counties,
neighborhoods), and race or ethnic background are shown. Te Health o Wisconsin grades health and disparities using
ew indicators per age group. Te report is organized by lie stage and uses grades to communicate how the state is
doing as compared to selected states and among its own demographic sub-groups.
A local health report, Te Boston Paradox: Lots o health care; not enough health, provides some contextual data that is
unique to local health reports, and describes the health care economy and the juxtaposition o quality o lie and better
and more equitably distributed health, relative to costs and spending on health care.
3.1 Approaches
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 12/11410 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Quality o Lie—Comprehensive Indicator Systems
Several examples o comprehensive indicator systems, rom around the world and within the U.S. are based upon
a quality o lie approach. Tese were important to include as they directly relate to the evolution o the State o
the USA model, which was inormed by many comprehensive indictor systems that were the subject o a national
indicators orum (GAO 2004). Health is usually one o a dozen or so components o overall societal well-being. For
example, the Organization or Economic Cooperation and Development in its Factbook: 2008 Economic, Environmental
and Social Statistics includes eleven categories (as shown in Section 5.0, Figure 7). Health is included under “Quality
o Lie” and includes just three indicators: lie expectancy, inant mortality, and obesity. Another system, Measures o
Australia’s Progress (MAP), outlines several dimensions o progress that are ramed or “individuals” (includes health,
education and training, work), “the economy and economic resources”, “the environment”, and “living together” (see
Section 5.0, Figure 8). Te MAP areas are similar to OECD’s cross-cutting categories (economic, environmental,social). In the Australian example, the indicator or health is lie expectancy. Te Canadian Index o Well-being is
currently developing a similar comprehensive indicator system or the nation which includes eight categories (shown in
Section 5.0, Figure 9), although constructs o each are not available.
Te comprehensive systems vary greatly, but are generally used to promote civic engagement and problem solving on
the part o communities, and responsiveness and accountability on the part o agencies and public leaders. Similar
to the national indicator systems, health is one among several components contributing to the overall quality o lie
in these regions. Several o these systems were the subject o a orum and subsequent GAO review (GAO 2003;
GAO 2004) and contributed to the evolution o the State o the USA. Examples o such systems include the Boston
Indicators Project and the Jacksonville County Community Indicators.
Health System Perormance Reports
his next section o reports includes indicators or the ollowing broad dimensions o health system perormance:
access, cost o health care, and quality.
Tere are two transitional points worth noting here. First, is that access to health care is both a eature o general health
reports as well as a key dimension o health system perormance. Nearly all o the general health reports include
indicators regarding health insurance coverage, and several include measures o related to having a usual source o care
or “medical home”. Many include indicators related to barriers to getting needed care (e.g., cost o care or other barriers
such as waiting times). However, they rarely include measures related to scal and economic, structural, quality, and
saety aspects o the health care system.
3.1 Approaches
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 13/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 11
Te State Scorecard on Health System Perormance produced by Te Commonwealth Fund uses indicators that are similar
to those just described, and also creates a bridge between general health and health system perormance reports. Tis
report is ocused on equity in access, quality, avoidable use o hospitals and costs o care, and mortality amenable to
health care.
Another report plays a bridging role. Te Older Americans, although included above with general health reports,
links to the health system perormance indicator reports or at least two reasons. Te rst is because the majority
o those receiving health care services in the U.S. are older adults, and the majority o health care use by individuals
occurs during the last two years o lie. Tis report diverges rom some o the standard health reports used in general
to include indicators o long term care, sensory impairments, depressive symptoms, out-o-pocket health care
expenditures, veterans’ health care, personal assistance and equipment, and need or/use o residential services.
Indicator sets that track costs and opportunities to reduce health care spending include those rom the Kaiser Family
Foundation (KKF), Te Dartmouth Atlas o Health Care , the Organization or Economic Cooperation and
Development’s (OECD) Health Care Quality Indicators, and Health Care Costs 101 rom the Caliornia HealthCare
Foundation. Tese reports provide examples o indicators that quantiy key measures and variations in health care
expenditures, costs, intensity o health care resource use, and identiy where spending could easibly be reduced and
greater eciencies realized. Te most recent release o Te Dartmouth Atlas o Health Care is ocused on the treatment o
chronic conditions in the last two years o lie, and includes indicators that refect the intensity o health care resources
use and explore unwarranted variations and costs between hospitals and types o services.
It is also important to consider indicators o cost rom the perspective o consumers and businesses, as refective o public concern. For example, among KFF’s many indicators are those that speak to the increasing burden o health care
costs on individuals and amilies due to increasing out-o-pocket costs, rising insurance premiums—also a burden or
employers—and avoidance o needed care by millions due to cost, and among those without health care coverage.
Te last broad dimension or indicators o health system perormance is quality. One o the most extensive bodies
o indicators work regarding health system quality comes rom the Agency or Healthcare Research and Quality
(AHRQ). wo reports produced by AHRQ are the National Healthcare Quality Report and the National Healthcare
Disparities Report . ogether, these reports provide one o the most comprehensive set o health systems measures related
to quality. Both ollow the six conceptual areas outlined by the IOM (Figure 4; IOM, 2001), although also acknowledge
that indicators are not uniormly available or all o these dimensions. Te rst o these reports provides a set o 41 core
measures o health care quality: use and delivery o eective care (screening, treatment, disease management), timely
care, and patient centeredness. Te National Healthcare Disparities Report adds indicators o access because disparities
in quality are driven, in part, by dierential access by race/ethnicity and income. Te OECD also developed indicators
based upon extensive review by participating countries or the purpose o acilitating international comparisons in
health care quality. While ewer in number, these indicators are similar to AHRQ’s.
3.1 Approaches
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 14/11412 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Te Dartmouth Atlas uses domestic comparisons and benchmarking to show unwarranted variations—variation in
clinical practice or spending that cannot be explained on the basis o illness, strong scientic evidence, or well-inormed
patient preerences—in spending and resource use. Tese variations contribute to poorer outcomes and quality (e.g., use
o clinically eective care, patient experience) as well as ineciency in health care.
Te Institute or Healthcare Improvement (IHI), also a private sector leader in health care quality, is monitoring eorts
to improve patient saety and reduce incidents o harm, in the context o its quality work. Te “Five Million Lives”
Campaign is a comprehensive health system reorm initiative with goals to involve over 4,000 hospitals and prevent ve
million people rom incidents o medical harm. Indicators are aligned with those rom all o the major national health
care improvement initiatives (see Exhibit 4.4.6; Five Million Campaign, 2007). Another example o a patient saety
indicator set is provided by HealthGrades, which has produced a report card based on a composite index using the
Agency or Healthcare Research and Quality’s Patient Saety Indicators (PSIs). Individual hospitals are ranked along with state on measures o patient saety.
Indicators addressing health system quality in terms o patient-centered care rom the patient’s perspective are
included in consumer-oriented sites such as Hospital Compare and Nursing Home compare, compiled by the Centers
or Medicare and Medicaid Services. Many o these same indicators are drawn rom surveys, such as the Consumer
Assessments o Healthcare Providers and Systems (CAHPS), which also used by the Agency or Healthcare Research
and Quality (AHRQ) in quality monitoring eorts.
3.1 Approaches
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 15/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 13
Table 1: RepoRTs included in Review: Focus and Key FeaTuRes
Name
OF RePORT
COmPiliNg
ORgaNiZaTiON
FOCus
(NumBeR OF iNDiCaTORs)
KeY
FeaTuRes
3. Hthy
Pop 2010
ldn (x.
t)
NCHs wth
dr, prvt
prtnr.
Ovr oc o objctv to
ncr th qty o nd
onvty, nd rdc hth
dprt.
ldn ndctor corrpondn
to 26 objctv + cro cttn
objctv.
• Objectives for health
provnt n th u.s. (ovr
400).
• Well regarded and broadly used.
• Developed using consensus.
• Indicators are suggested
r nd r not wy
trckd nory.
2. Conty
Hth stt
indctor (drt
or)
CDC, NCHs, nd
othr pbc
prtnr.
sry r o hth,
nton dn c o dth,
r o brth nd dth,
rtv hth portnc,
vnrb popton,
nvronnt hth,
prvntb ncto d,
prvntv rvc ,
cc to cr, rk ctor or
prtr dth
(~ 60 ndctor nd ~200
r)
• Indicators for 3,140 U.S.
cont.
• Comparative data (peer
cont, Hthy Pop 2010)
• Interpretive tools to facilitate
brod (.., rnkn or
rtv hth portnc)
nd downodb p nd
brochr.
1. arc’
Hth Rnkn
untd Hth
Fondton,
arcn
Pbc Hth
aocton, nd
th Prtnrhp
or Prvnton
Dtrnnt o hth nd
otco: pron bhvor,
conty nvronnt, pbc
hth nd hth poc, nd
cnc cr.
(20 ndctor)
• Collaborative private effort –
pportd by pronnt hth
ornzton.
• State rankings and state data.
• Statistical and contextual data
o hh-qty (.., vdtd
throh pr rvw.)
GeneRal HealTH RepoRTs—naTional
4. Coon
to Bd
Hthr
arc—
What Drives
Hth?
Robert Wood
Johnon
Fondton
Foc on ht oc ctor:
ry xprnc, dcton,
nco, work, hon,
conty, rc nd thncty,
nd th conoy. Thr hth
condton: obty, chronc
d, nd ry chdhood.
• Emphasizes underlying causes of
poor hth nd dprt.
• Emphasizes social factors and
conty nvronnt.
3.1 Approaches
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 16/11414 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Name
OF RePORT
COmPiliNg
ORgaNiZaTiON
FOCus
(NumBeR OF iNDiCaTORs)
KeY
FeaTuRes
5. arc’
Chdrn
intrncy
For on Chd
nd Fy
stttc (ovr
40 dr
dprtnt,
nc nd
ofc).
svn cton tht covr y
nd oc nvronnt (8),
conoc crctnc (3), hth
cr (4), phyc nvronnt nd
ty (7), bhvor (5), dcton
(6), nd hth (6).
• Collaborative federal effort –
brod ncy pport.
• Broad approach – health and
w bn o chdrn nd yoth
n u.s.
• Identies data gaps
6. Kd Cont ann e. Cy
Fondton
Foc: Condton o brth
throh yon dthood. Brod
dtrnnt.
• Data center that links with state
nd conty-bd dt, whr
vb.
• User-friendly query system.
7. Odr
arcn 2008:
Ky indctor
of Well-Being
intrncy
For on
an-Rtd
stttc
Fv oc r (38 ndctor
tot) ncdn popton (6),
conoc (7), hth tt (7),
hth rk nd bhvor (8),
hth cr (10).
Th rport o contn two
ddton oc r on trcy
nd hth trcy, nd dntf
dt p.
GeneRal HealTH—naTional wiTH Focus on speciFic aGe GRoups (cHildRen and eldeRs)
8. Cont
Cont (stt
Kn Conty,
Washington)
stt/Kn
Conty Pbc
Hth wth
pbc nd
prvt prtnr
a t o 38 oc, hth,
nvronnt nd rt ndctor:
Basic Needs and Social Well-being
(7), Potv Dvopnt throh
l st (8), sty nd Hth
(19), Conty strnth (4),
Ntr nd Bt envronnt (5),
nd art nd Ctr (4).
• Indicators are framed by “valued
condton” xprd by
conty rdnt throh
prodc rvy.
• Breadth of social and health
dtrnnt.
• Linked to community process/
cvc nd.
GeneRal HealTH—local and sTaTe
9. gorHth
Dprt
Rport
stt ogor Pbc
Hth
soc nd conoc w-bn;Hth tt (d, prtr
dth); Qty nd cc to cr;
Hth proon workorc.
• County proles with grades (andcrtr) nd rnkn/copron
to othr cont n th tt.
Table 1: RepoRTs included in Review: Focus and Key FeaTuRes (t)
3.1 Approaches
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 17/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 15
11. Nw York
Cty Conty
Hth Prof
NYC
Dprtnt
o Hth nd
mnt Hyn
Coprhnv hth rport
crd or Nw York’ 42
nhborhood. On n h
qck p nd tttc or 42
boroh on tn ndctor.
• Indicators supported by large
oc rvy.
• On-line query system.
• Related static reports.
• Interesting organization of large
amount (Ten “Take Care New York
go”)
10. lo an
Conty
Ky Hth
indctor
lo an
Conty Pbc
Hth
Brod dtrnnt o hth:
oc nd nvronnt
dtrnnt, bhvor, hth
tt nd otco.
• Rich local data on social and
nvronnt dtrnnt
pcy rtd to ry
chdhood, chronc d
prvnton.
• Indicators supported by large
oc rvy.
• Static report and limited on-line
qry yt.
GeneRal HealTH—local and sTaTe (t)
12. Nw York
Cty
Hth
DprtRport
NYC
Dprtnt
o Hth nd
mnt Hyn
Hth dprt bd on oc
nqt. Ftr ropd
nhborhood copron o
hth otco (.., prtrortty, orbdty).
• Poor/afuent neighborhood
copron.
• Geographic, racial/ethnic
(ncdn o rntrop), ndr dprt
13.Hth o
Wisconsin
Rport Crd
2007
unvrty
of Wisconsin
Popton
Hth inttt
Foc ortty nd hth-
rtd qty o n drnt
t: innt (<1 yr);
chdrn nd yon dt (
1-24 yr); workn d dt
(25-64 yr); nd, odr dt
( 65 +).
• Grades are assigned for each
rop by ndr, dcton
ttnnt, typ o conty, nd
rc/thncty, nd or dprt.
• Clear criteria for grading.
14. Th Boton
Prdox: lot o
hthcr; not
noh hth
Nw ennd
Rrch
inttt
Foc on brod hth
dtrnnt
• Includes indicators related to
th hth cr conoy nd
nvtnt n pbc hth nd
rrch.
Name
OF RePORT
COmPiliNg
ORgaNiZaTiON
FOCus
(NumBeR OF iNDiCaTORs)
KeY
FeaTuRes
Table 1: RepoRTs included in Review: Focus and Key FeaTuRes (t)
3.1 Approaches
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 18/11416 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
QualiTy oF liFe (compReHensive indicaToR sysTems)
Name
OF RePORT
COmPiliNg
ORgaNiZaTiON
FOCus
(NumBeR OF iNDiCaTORs)
KeY
FeaTuRes
16. Boton
indctor
Projct
Th Boton
Fondton;
Th JohnLaWare
ldrhp
For; Th
Cty o Boton;
Boton
Rdvopnt
athorty;
mtropotn
ar Pnnn
Conc
Qty o (10 ctor): cvc
vtty, ctr nd th rt,
th conoy, dcton, thnvronnt, hth, hon,
pbc ty, tchnooy, nd
trnportton.
Hth rwork: ndctor
ornzd rond ht
o (20 ndctor r, nd
pproxty 40 ndvd
r).
• Comprehensive indicator system.
• Public-private effort that
pport cvc nd.• Data paired with information
bot poc nd othr
ovrnnt nd prvt
nttv.
15. OeCD
Fctbook 2008:
econoc,
envronnt
nd soc
stttc
Ornzton
or econoc
Cooprton
nd
Dvopnt
Qty o rwork ncd
hth, r, octy, trnport.
• Indicators suitable for
ntrnton copron on
23 contr crrnty.
17. Jckonv
indctor or
Pror—JCCi
2007 Qty o
l Rport
Jckonv
Conty
Conty
indctor
Qty o , pror (9 r):
dcton, conoy, ntr
nvronnt, oc nvronnt,
rt nd ctr, hth,
ovrnnt, trnportton, nd
pbc ty. (100+ ndctor)
• Well regarded comprehensive
oc ndctor rport.
• Broad participation (i.e.,
bn, conty br,
non-proft nd ovrnnt
nc).
• Community perceptions survey.
Table 1: RepoRTs included in Review: Focus and Key FeaTuRes (t)
3.1 Approaches
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 19/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 17
QualiTy oF liFe (compReHensive indicaToR sysTems) (t)
HealTH sysTem peRFoRmance
Name
OF RePORT
COmPiliNg
ORgaNiZaTiON
FOCus
(NumBeR OF iNDiCaTORs)
KeY
FeaTuRes
18. atr’
mr o
Pror
atr
Br o
stttc
Frwork: ndvd, conoy
nd conoc rorc, th
nvronnt, nd vn tothr.
“Headline” dimensions of
pror: Hth, dcton,
trnn, nton nco,
conoc hrdhp, nton
wth, hon, prodctvty,
th ntr ndcp, th r
nd tophr, ocn nd
tr, y, conty, nd
oc cohon, cr, docrcy,
ovrnnc nd ctznhp.
sppntry dnon:ctr nd r,
copttvn nd opnn,
ination, communication, and
trnport.
19. Cndn
Index of Well-
bn
(Prototyp)
atknon
Fondton
(brod
cobortv
ort)
Foc r: hthy popton,
conty vtty, t ,
dctd popc, coyt
hth, rt nd ctr, cvc
nnt, vn tndrd.
• National comprehensive
ndctor yt wth pr to
susa.
• Composite index will be created
ro oc r.
20. Coon-
wth
Fnd stt
scorcrd on
Hth syt
Prornc
Prvt
rrchr
Coond
by Coon-
wth Fnd n
coborton
wth Co-
on or
Hth syt
Prornciprovnt.
Foc r (nbr o
ndctor): cc (4), qty
(14), potnty vodb
o hopt nd cot o cr (9),
qty, hthy v (5)
• Improvement and equity focus.
• Several measures comparable to
dvopd contr (.., OeCD)
Table 1: RepoRTs included in Review: Focus and Key FeaTuRes (t)
3.1 Approaches
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 20/11418 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Name
OF RePORT
COmPiliNg
ORgaNiZaTiON
FOCus
(NumBeR OF iNDiCaTORs)
KeY
FeaTuRes
21. Drtoth
at o Hth
Cr
Drtoth
inttt or
Hth Pocy
nd Cnc
Prctc,
Drtoth
mdc schoo
Foc: mdcr pndn,
rorc octon nd ,
nd ptnt otco t tt,
ron nd hopt v.
• Interactive data tools providing
coprhnv tttc on hth
yt prornc.
• Comparative statistics and
bnchrk by hopt, hopt
rrr r, conty, tt, nd
nton.
• Emphasis on Medicare
bnfcr wth ro chronc
n nd ptnt wth vr
chronc n n thr t two
yr o .
22. Nton
Hthcr
Qty Rport
ancy or
Hthcr
Qty nd
Rrch
wth th u.s.
Dprtnt
o Hth nd
Hn srvc
(HHs)
Foc ctvn, ptnt
ty, tn, ptnt-
cntrdn, nd fcncy o
hth cr rvc.
Dnon o fcncy
xpord n th 2007 rport.
• Uses highest quality data
vb, whch not yt
nory vb cro
dnon or rvc ctor.
• 42 core measures
• Effectiveness of prevention,
dno, trtnt,
nnt or nn cnc
condton/cr ttn.• State snapshots (online)
copr qty trnd or
ctd copot r.
23. Nton
Hthcr
Dprt
Rport
ancy or
Hthcr
Qty nd
Rrch
( bov)
Foc dprt n
ctvn, ptnt ty,
tn, nd ptnt-
cntrdn o hth cr
rvc.
• Disparities by race/ethnicity,
oco-conoc tt, nd
wthn/btwn othr prorty
popton.
• 42 measures of quality and 8
r o cc
24. OeCD
Hth Cr
Qty indx
Ornzton
or econoc
Cooprton
nd
Dvopnt +
Hth cr qty provnt
(13 r).
• Indicators suitable for
ntrnton copron.
• Health care system performance
r—coprb tttc
on cnc qty o cr nd
otco or 23 contr.
3.1 Approaches
Table 1: RepoRTs included in Review: Focus and Key FeaTuRes (t)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 21/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 19
27. Hopt
Copr
Cntr or
mdcr
nd mdcd
srvc
Foc n or r: proc o
cr, otco o cr, ptnt
xprnc wth cr, nd
mdcr pynt nd vo.
Copron to vr o u.s.
hopt nd hopt n tt or
ron.
26. Ptnt
sty narc
Hopt stdy
Hthgrd Ptnt sty Rport crd or
u.s. hopt bd pon aHRQthodooy (16 ptnt ty
ndctor).
• Composite safety score and
rnkn o tt.• Analysis of best performing
hopt/yt.
• Trends in medical error and costs.
25. Fv mon
lv
inttt or
HthCr
iprovnt
12 ntrvnton n 4,000 u.s.
hopt to rdc ncdnt o
ptnt hr by 5 on ovr
two yr prod.
• Large private campaign to
trnor hth cr yt.
• Possible indicators cut across to
dcrb prtcpton (dopton
o cton by hopt) nd
nbr o ncdnt o hr
prvntd.
HealTH sysTem peRFoRmance (t)
Name
OF RePORT
COmPiliNg
ORgaNiZaTiON
FOCus
(NumBeR OF iNDiCaTORs)
KeY
FeaTuRes
28. Trnd nd
indctor n
th ChnnHth Cr
mrktpc
Chrtbook
Kr Fy
Fondton
Foc on trnd n hth cr
pndn nd cot, ncdn
prcrpton dr, hthnrnc nront, hth
nrnc pr, hth
nrnc bnft, trctr o
th hth cr rktpc,
hth pn nd provdr
rtonhp, nd pcton
o hth rkt, nd trnd or
conr nd th ty nt.
• Approximately 80 indicators.
• Describes increasing costs
nd dprt n on thnnrd nd by pyr typ.
• On-line chart book; regularly
pdtd.
29. World
Hth
Ornzton
World Health
Ornzton
inortonsyt
Foc o Tn stttc Hhht:
Rk Fctor, Nton Hth
accont, Hth syt
Foc o rport: hth tt
(ortty, orbdty), hth
rvc covr, rk ctor,
hth yt, nqt
n hth, dorphc nd
ococonoc tttc.
• Comparative statistics for 193
contr.
• “Ten statistical highlights”
3.1 Approaches
Table 1: RepoRTs included in Review: Focus and Key FeaTuRes (t)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 22/11420 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
oTHeR—FRaminG appRoacHes and Gaps
Name
OF RePORT
COmPiliNg
ORgaNiZaTiON
FOCus
(NumBeR OF iNDiCaTORs)
KeY
FeaTuRes
30. Hth Cr
Cot 101
Corn
HthCr
Fondton
Trnd n hth cr pndn
(dor ont, rowth,
pndn ctor nd pynt
orc, drvr o ) n th u.s.
(ctd dt or Corn).
ur-rndy nphot o hth
cr pndn.
31. Trt or
arc’
Hth:Top 10 prort
or prvnton
(Frwork
xp)
Trt or
arc’
Health – Acoton
o 130+
ornzton.
Tn prort: Prootn d
prvnton; cobtn th
obty pdc; prvntntobcco nd xpor;
prvntn nd contron
ncto d; prprn or
potnt hth rnc nd
botrror ttck; rconzn
th rtonhp btwn
hth nd u.s. conoc
copttvn; rdn
th nton’ ood ppy;
pnnn or chnn hth
cr nd o nor; provn
th hth o ow-nco nd
norty cont; rdcnnvronnt thrt; p
cro-cttn rcondton or
hodn ovrnnt ccontb
or protctn th hth o
arcn.
• Ten components of an
ctv nton prvnton
trty provd rwork orcondrton.
32. Prvnton
inttt—good
Hth Cont
(Prototyp)
Th Prvnton
inttt
(Coond
nd pbhd
by thCorn
endownt)
Frwork: envronnt (oc
nd phyc) tht proot hth
nd prvnt hth prob.
• Potential use for addressing
p n ndctor or hthy
conty condton--phyc
nd oc nvronnt tht
optz hth.
3.1 Approaches
Table 1: RepoRTs included in Review: Focus and Key FeaTuRes (t)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 23/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 21
oTHeR—FRaminG appRoacHes and Gaps (t)
Name
OF RePORT
COmPiliNg
ORgaNiZaTiON
FOCus
(NumBeR OF iNDiCaTORs)
KeY
FeaTuRes
35. BCt Hth
invntory
Ntonaocton o
Cty nd Conty
Hth Ofc
Foc o r: trnd nd ctyrnkn n hth otco by
ndr, rc/thncty.
• 54 largest cities in the U.S.• Health outcomes and status
(ortty, brth dt, nd
rportb d).
• City socio-demographic data.
34. ery
Chdhood
indctor—
Projct Thrv
(Prototyp)
Nton
Cntr on
Chdhood
Povrty
Foc o r: ovrrchn
otco, popton-bd
rk, hth nd dc ho,
pc nd, oc-oton
dvopnt nd nt hth,
ry cr nd dcton, y
pport nd prntn.
• Comparisons of data available in
jor nton ndctor t.
• Potential use for addressing
p n ndctor or ry
chdhood —oc dtrnnt
nd pocy/yt ntrvnton.
• Uses results-based accountability
pproch.
33.Environ–
nt
Pbc Hth
indctor
Projct
u.s. Cntr or
D Contro
nd Prvnton,
Nton
Cntr or
envronnt
Hth,
envronnt
Hzrd nd
Hth ect
Pror
Phyc nvronnt
dtrnnt o hth.
• Topics: Based upon Healthy
Pop 2010 nd pthwy or
orc, nt, nd vnt.
• Type of indicators (hazard,
xpor, hth ct, nd
ntrvnton)
• Tiers of indicators (core,
opton, nd dvopnt).
• Potential use for addressing
p n phyc nvronnt
dtrnnt.
3.1 Approaches
Table 1: RepoRTs included in Review: Focus and Key FeaTuRes (t)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 24/11422 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
3.2 Health Indicators and Data Sources
his section describes indicators rom selected reports, and highlights key data sources or those indicators. ables
2 and 3 compare indicators rom a sample o national general health indicator reports, and able 4 shows several
data sources used to create those indicators. ables 5, 6 and 7 compare indicators o health system perormance (access,
cost, and quality, respectively) and able 8 is the companion data source summary. Tis summary is illustrative, and
points out some general similarities and dierences among the various indicators as well as some o the data source
capabilities. Indicators rom each o the individual reports are provided in Section 4.1–4.5 o this report. echnical
inormation rom a sample o reports is provided in Appendix B.
General Health Indicators and Data Sources
able 2 shows the areas o greatest similarity between the indicators used in general health indicator reports. Most
use comparable measures related to birth and death. Indicators or lie expectancy, premature mortality (measured
in Years o Potential Lie Lost or YPLLs), and health early in lie (low birth weight, or adequacy o prenatal care, social
characteristics o the amily or mother such as age o educational attainment) are very robust, and are available rom
the National Vital Statistics System. Tese data benet rom completeness o reporting and support demographic sub-
group and small geographic level analysis (e.g., to the county level).
Another commonly-used type o indicator measures health-related quality o lie. Sel-assessments o overall health
status by individuals or their proxies (e.g., health-related quality o lie assessed using a measure o poor health days orsel-rated health status) are very reliable measures and have an extensive literature about their useulness in capturing
morbidity, early mortality, and use o health care services. Composite measures that capture multiple dimensions o
health, such as healthy lie expectancy, quality-adjusted lie years, and disability-adjusted lie years, are used in studies
but less oten in indicator reports at the present time. (See Agwunobi, 2006, and reerences provided in Appendix A.)
ypical indicators or health risks/behaviors include obesity, smoking, physical inactivity, and alcohol and drug abuse,
lack o insurance coverage.
Social indicators and risks that are standard to most (i not all) reports include educational attainment or completion o
high school, crime, violence, and poverty as important determinants o health. All reports include indicators or race/
ethnicity or emphasize disparities, although how this is presented varies depending on the ocus o the report.
able 3 illustrates how indicators used in various reports diverge in emphasis. For example, CHSI emphasizes
outcomes—specic health conditions and disease, including health risks and protective actors. Tese indicators largely
mirror the availability o national data at local (county) levels or health. Other reports, such as the Robert Wood
Johnson Foundation report, emphasize social indicators, a number o which are available to support state and county-
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 25/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 23
level analyses. Indicator reports that are ocused on child and amily well-being also emphasize social indicators and a
range o experiences and exposures to children (e.g., parental educational attainment).
Examples o data sources or Social and Environmental Determinants are shown in able 4. Tere are several high
quality data sources that provide data or social, economic, educational and social indicators (e.g., household income,
educational attainment, household and amily size and composition, languages spoken, including English prociency,
and employment) rom Census products. For example, in addition to the decennial Census, the American Community
Survey now provides annual estimates or populations o 65,000 or greater. Estimates or smaller areas or sub-groups
within regions may be obtained by combining years. Te survey was designed to provide annual data to local areas and
replaces the “long orm” that was ormerly conducted every ten years. Design and sampling eatures, or example, a 15%
sample o the U.S. households and very high response rates, make this a very robust data source.
Another Census product, the Current Population Survey, also provides high-quality annual household data but reliable
disaggregation is limited to the state level (and selected large sub-state areas). Te CPS is an important source o data
regarding children’s health insurance coverage, income, and ood security.
Examples o data sources or Health Outcomes are also shown in able 4. Data or birth and death are available in any
jurisdiction in the U.S. rom the Vital Statistics Reporting System. Te data are considered to be high-quality and
accompanying demographic data support sub-group analysis.
Data sources or health outcomes throughout the lie course (health behaviors, risks, status) are primarily rom surveys
and disease reporting systems, which vary in analytical potential. While all are respected data sources at the nationallevel, each will have limitations or producing local estimates or conducting geographical and/or sub-group analyses.
For example, the Behavioral Risk Factor Survey System (BRFSS; sample size approximately 350,000) is comprehensive
and representative, and is able to support state and large MMSA analyses. Reliable estimates at the county level depend
on population size, sample (denominator) and prevalence estimate (numerator). o illustrate this point, estimates o the
number o counties reportable rom aggregation o BRFSS surveys were tabulated or the CHSI project (available in
methods documents or this source). Te number o reportable U.S. counties ranges rom 2,719 counties or diabetes, as
compared to 687 counties or Pneumonia vaccine or persons ages 65 years and older. (See Community Health Status
Indicators). National Health Interview Survey (NHIS) produces excellent national-level data. Its sampling rame is
also used by other studies, such as the Medical Care Expenditure Panel’s Household component. It also provides child-
related health data through its substantial sample o children.
Several issues apply to the quality and representativeness o dierent surveys, which are beyond the scope o this review.
Tere are many helpul resources or assessing the strengths and limitations o dierent survey methods and quality
o data. For example, Fahimi, et al (2008) compares estimates rom the BRFSS, NHIS and NHANES in light o
declining telephone survey response rates. Additional reerences or reviewing data sources are provided in Appendix A
or the committee’s reerence and consideration, depending on the indicators selected.
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 26/11424 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Tere are many instances where an indicator may be considered important, but not be able to produce reliable state
or local estimates. For example, i the committee selects childhood overweight as an indicator, it will be currently be
limited to sel-reported data (by a parent/legal guardian) rom the National Survey o Children’s Health (NSCH) or
National Health Interview Survey (NHIS). Height/weight measures, provide more accurate data, but are available
only rom the National Health and Nutrition Examination Survey (NHANES), which pairs interview data with
clinical exams. While a valid national sample, NHANES is limited to national estimates (although state estimates can
be obtained by combining multiple years). Te problem o indicators or childhood overweight may improve as other
data sources become available, however. For example, the use o school-based testing has become a valuable source o
surveillance or child overweight, and is becoming more common. In Caliornia, or example, height/weight measures
or 5th, 7th, and 9th grade students who attend public schools are available rom the Caliornia Department o
Education as part o its tness testing program (Simon and Lee 2005).
A dierent but related issue is in the many possible cases where multiple data sources are available or the similar
indicators. Such a case would be with health insurance coverage, which is most oten obtained rom the Current
Population Survey, the National Health Interview Survey, and the Medical Expenditures Panel Survey. However, in all
these examples, health insurance coverage is asked and can be quantied in multiple ways, with dierent implications
or the indicator. For example, asking whether anyone in the household was without health insurance at some point
during the past year will yield a higher proportion than asking whether the respondent is currently (or recently)
uninsured. While the ormer may quantiy the extent o the problem more ully, the latter may provide more accurate
point-in-time estimates. (See Understanding Estimates o Uninsured.) Appendix A includes a table with examples o
health insurance indicators and data sources.
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 27/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 25
C H s i
a H R
H P 2 0 1 0 ( l d )
R W J
a r c ’ C h d r n
O d r a r
c n
T a b l e 2 : s e l e c T e d
i n d i c a T o R s c o m m o n T o
G e n e R a l H e a l T H s e T s
l x p c t n c y
m o r t t y b y g
i n n t o r t t y
l d n g c
o d t h n d
p r v n t b d t h
( n j r y , v o n c ) .
m r o B r t h
( B r t h t o
w o n < 1 8
y r , n r r d
w o n , o w / v r y
o w b r t h w g h t
n d p r t r
b r t h ) .
R k c t o r
( o k n g ,
d r n k n g , p h y c
n c t v t y , r t n d
v g t b t n g ) .
H t h c r
( h t h n r n c ,
p r v n t v r v c
— c n c r
c r n n g ,
n z t o n ) .
H R Q l ( p o o r h t h
d y , - r t d
h t h t t ) .
N o H s d p o ,
r c n t d r g .
R c / t h n c t y
P r t r d t h
( Y P l l )
i n n t o r t t y
B n g d r n k n g ,
o b t y ,
o k n g
l c k o h t h
n r n c ,
n z t o n
P o o r p h y c /
n t h t h
d y
H s g r d t o n ,
v o n t c r ,
c h d r n n p o v r t y
R c / t h n c t y
P r v n t b
d t h ( c o d
b p c f d
w t h Y P l l o
r
j o r c
o
p r t r d t h )
l o w b r t h w
g h t
s b t n c
b ,
p h y c c t v t y ,
w g h t , t o b
c c o
.
H t h c r
c c ,
H t h n r n c ,
i n z t o n
V o n c ,
p o v r t y
D p r t
l x p c t n c y
i n n t o r t t y ,
o w b r t h w g h t
P h y c n c t v t y ,
o k n g
s - r p o r t d
h t h t t ,
c t v t y t t o n
R c / t h n c t y
P r v n t b
d t h ( n j r y ,
v o n c )
m o r t t y ( n n t ,
c h d r n , y o t h )
o w b r t h w g h t ,
d o c n t b r t h
s o k n g , c o h o
, c t d r g
i n z t o n ,
h t h n r n c
P o v r t y
R c / t h n c t y
l x p c t
n c y ,
o r t t y
s o k n g , p h y c
c t v t y , o b
t y
V c c n t o n
s - r t d h
t h
t t
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 28/11426 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
C H s i
a H R
H P 2 0 1 0 ( l d )
R W J
a r c ’ C h d r n
O d r a r
c n
T a b l e 3 : s e l e c T e d
i n d i c a T o R s c o m m o n T o
G e n e R a l H e a l T H s e T s
m j o r c h r o n c
c o n d t o n
( o b t y , d b t ,
h y p r t n o n )
s v r w o r k
d b t y
m j o r d p r o n
P h y c n / h t h
c r p r o v d r
p p y
D n t t p p y
T o x c c h c / r
q t y t n d r d
u n p o y d
n d v d .
C H D n d c n c r
d t h
O c c p t o n
t t
P r v n t b
h o p t z t o n
a d q c y o
p r n t c r
P r c p t p b c
h t h p n d n g
P r v n t b
d t h ( c o d
b p c f d
w t h Y P l l o
r
j o r c
o
p r t r d t h )
D b t y
H y p r t n o
n
c r n n g ,
d b t c y
x ,
c n c r c r
n n g /
d t c t o n
O r h t h .
P h y c
n v r o n n
t
C o g n t v
d v o p n t
a d t c h r o n c
c o n d t o n
( o b t y , d b t ,
C H D )
a c t v t y t t o n
d t o c h r o n c
c o n d t o n
u o r c o
c r
s o c c t o r ,
h o n g ,
c o n t y , w o r k ,
t h c o n o y ,
n c o
H t h c r
x p n d t r
( O e C D c o n t r )
P r v n t b l d t h
( n j u r y , v o l n c )
a t h m
e m o t o n l /
b h v o r l
d f c u l t
C h l d m l t r t m n t
F m l y n d o c l :
P r n t d u c t o n l
t t n m n t , l n -
g u g p o k n t
h o m , d f c u l t y
p k n g e n g l h ,
c h l d l v n g r r n g -
m n t .
e d u c t o n : F m l y
r d n g t o y o u n g
c h l d r n , m t h n d
r d n g c h v -
m n t , H s c d m c
c o u n l n g , y o u t h
n o t n c h o o l o r
w o r k n g , c o l l g
n r o l l m n t )
e c o n o m c c r c u m -
t n c : s t b l p r -
n t m p l o y m n t ,
o o d n c u r t y n d
d t q u l t y - H l t h y
e t n g i n d x ( H e i ) .
P h y s i c a l E n v i r o n –
m n t n d s t y :
D r n k n g w t r
q u l t y , h o u n g
p r o b l m , y o u t h
v c t m o r o u
c r m .
C h l d n d
d o l c n t n j u r y
C h r o n c h
t h
c o n d t o n
s n o r y
p r n t
,
o r h t h ,
d p r v
y p t o ,
F n c t o n
t t o n
D t q t y
— H e i
u o h t h c r
r v c ,
o g r
p h y ,
p r c r p t o n
d r g
H t h c r
x p n d t r ,
s o r c o
p y n t o
r
h t h c r
r v c .
C o t o c r
( o t o p o c k t
x p n d t r ) ,
v t r n ’ h
t h
c r , n r n
g
h o c r
l t r c y , h t h
t r c y
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 29/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 27
Table 4: naTional daTa souRces
Toxc Rinvntory, ePa
NHaNes
ar Qtysyt, ePa
Toxc chc r ntonvronnt
indoor r qty
Otdoor r qty (potntconcntrton, tot pnddprtct)
X
X
X
X
X
some
some
( bow)
Dt coctd by tt ndron r qty ontornnc
arcn Honsrvy
Hon X X lr tro r
Ntonant oedctonProrus Dpt. o edcton
edcton chvnt(.., th, rdn, cncprofcncy)
X X lr rbn dtrct
CrrntPopton srvyus Cn Br
Chdrn’ hth nrnccovr, nco, ood crty,poynt, bor orcchrctrtc
X X approxt p 60,000hohod (ro yr 2001orwrd); tt-bd pdn
arcnContysrvyus Cn Br
Popton nd dorphcchrctrtc (.., ,x, rc/thncty, nco,povrty, chdrn vnn povrty, dcton
ttnnt, hohod z ndcopoton)
X X X X aCs p provd nntt to popton o65,000 or rtr
NaTiONalDaTa sOuRCes
eXamPles OFiNDiCaTORs/measuRes
geOgRaPHiCDRILL DOWN
aPPROXimaTe samPle siZe;geOgRaPHiC aND suB-gROuPaNalYses; OTHeR CaPaBiliTies
i NT ’ l
NaT i ON
s T aT e
C O uNT Y
s ert Hth dtrt
ph ert
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 30/11428 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Nton Vtstttc syt—mortty ndmtp C oDth FNCHs
C-pcfc ortty,Prtr ortty (.., YPll),l xpctncy
X X X X Dt or ot jrdcton.art r nddn c nryvb or b-rop nynd n yr rportn.
Nton Vtstttc syt—Brth F ndlnkd Brth-Dth FNCHs
Brth (nnt ortty, ow brthwht, dqcy o prntcr, dcton ttnnt oprnt)
X X X X Dt or ot jrdcton. lowprvnc vnt td orb-rop ny nd nyr rportn
NaTiONalDaTa sOuRCes
eXamPles OFiNDiCaTORs/measuRes
geOgRaPHiCDRILL DOWN
aPPROXimaTe samPle siZe;geOgRaPHiC aND suB-gROuPaNalYses; OTHeR CaPaBiliTies
i NT ’ l
NaT i ON
s T aT e
C
O uNT Y
Hth ot: brth dth
Hth ot: Hth stt, Rk, bhr
montorn thFtr
Dr, coho, crtt ,tttd, nd prcptonon yoth (n 8th, 10th, nd12th rd)
X approxty 48,500 tdntn 410 choo wr rvyd n2006
DsrvncsytCDC
incto d (HiV/ aiDs, TB, Hptt, sxyTrnttd D)
some X X X a jrdcton; vrbcoptn o rportn ontrnton copron
Bhvor RkFctor srvy
syt (BRFss)CDC
Hth-rtd qty o (poor hth dy, tc.), hth
condton (th, dbt),obty/ovrwht, orcondd hth crrvc, hth bhvor (..,okn, phyc ctvty), ndcc to cr
X X some Vrb by popton znd prvnc tt* (
not); ann p zpprox. 350,000. Ovrpvb. 170 tropotn ndcropotn tttc r(mmsa)
Table 4: naTional daTa souRces (t)
3.2 Health Indicators and Data Sources
*Hhy vrb dpndn on popton z, p (dnontor) nd prvnc tt (nrtor). ett o th nbr
o cont rportb ro rton o BRFss rvy wr tbtd or th CHsi projct. For xp, th nbr o rportb
cont rnd ro 2719 cont or dbt to 687 cont or Pnon vccn or pron 65 yr nd odr.
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 31/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 29
NaTiONalDaTa sOuRCes
eXamPles OFiNDiCaTORs/measuRes
geOgRaPHiCDRILL DOWN
aPPROXimaTe samPle siZe;geOgRaPHiC aND suB-gROuPaNalYses; OTHeR CaPaBiliTies
i NT ’ l
NaT i ON
s T aT e
C
O uNT Y
Hth ot: Hth stt, Rk, bhr (t)
Yoth RkBhvor srvyCDC
Ovrwht, phyc ctvty,dt, choo ood nvronnt.
X some Dt or ctd r (..,prvnc o ovrwht or29 tt nd 14 r trodtrct)
Nton
inztonsrvyNCHs, CDC, NiP
inzton drn chdhood
or vccn-prvntb d
X X sp z pproxty
27,000 chdrn 19-35onth. Dt vb by ttnd pprox. 30 rbn r bypovrty, rc/thncty.
Nton srvyo Chdrn’Hth (NsCH)(anyzd by CaHmi)
NCHs
Hth nd ncton tt(oton, bhvor, hth,dvopnt prob onchdrn; chdhood ovrwht,th); ery chdhood(prntn prctc), ddchdhood nd docnc(p, xrc, rdn,oc/oton dfct,
choo nnt); Fynctonn (y ctvt,tr); Prnt hth,Nhborhood condton.
X X HRsa ron.Rbty o ndn?
Nton Hthnd Ntrtonexntonsrvy (NHaNes)
CDC nd NHCs
Chronc d (ncdnndnod condton) ndcondton, obty, rchotro, bood prr,phyc ftn, dt ndntrton, okn, xpor totobcco ok, nztontt, nt hth, orhth
X Ntony rprnttvp; ann contnopn (ro 1999 orwrd).approx. p z 9,000-10,000 or 2003-04. Ovrpo o b-rop; tdrc/thnc b-rop ny.
Nton Hthintrvw srvyCDC
in, njr, ctvtytton, hth nrnccovr, o hth rvc,hth condton, okn,coho , vccnton, cncrcrnn, nd othr nrhth topc
X adt nd chd dt; Rcntrvy hv ovrpd Bcknd Hpnc pron. Dtddorphc dt nbb-rop ny. spz (coptd ntrvw) pproxty 35,000hohod contnn bot
87,500 pron. No rbtt-v tt.
3.2 Health Indicators and Data Sources
Table 4: naTional daTa souRces (t)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 32/11430 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Indicators and Data Sources or Health System Perormance
able 5, able 6, and able 7 provide examples o indicators o health system perormance, organized by access,
cost, and quality.
Indicators o access to health care primarily relate to insurance coverage, usual (or regular) source o care, diculties/
delays in the receipt o needed care due to cost, physician supply, and physician/dental visits (able 5). Reports ocused
on disparities diverge slightly, with Georgia emphasizing provider supply and diversity, linguistic isolation, and the
availability o ederally qualied health centers. Kaiser Family Foundation also provides measures related to the health
care saety net. Te National Healthcare Disparities Report, unlike its companion report also rom AHRQ, includes
indicators o access to health care as a contributor to poor quality.
able 6 shows examples o indicators related to health care costs and eciency. Health care costs are measured in several
reports using comparable measures or the nation as a whole and or governmental spending (e.g., per capita health
care spending, annual growth in spending, percentage o GDP, spending by category, etc.); several o these measures
are comparable to those in OECD countries, and are appropriate or international comparisons. In addition to national
spending, costs are measured rom other perspectives such as employer costs (e.g., insurance premiums) and costs to
consumers (out-o-pocket spending on prescription medication, co-payments) in both the Kaiser and the Caliornia
HealthCare Foundation reports.
Another category related to cost is unnecessary spending and avoidable care. Indicators like avoidable hospitalizations
(e.g., ambulatory care sensitive conditions, readmission rates) are shown in the State Scorecard as well as AHRQ reports. Tese measures are oten linked to poor access to outpatient care or variation in hospital capacity. Other
indicators measure variations in expenditures (use and cost o health care) among Medicare recipients during the
last two years o lie relative to national or regional benchmarks, as shown in the Dartmouth Atlas. Tese indicators
represent huge costs in terms o Medicare reimbursements. Te Atlas uses several measures to identiy patterns o care
that, i changed, would generate savings and improve quality and the receipt o eective care.
Eciency measures are important, but not widely available. However, two reports use composite indexes to quantiy
relative eciencies o hospitals. Te rst, published by the Dartmouth Atlas’s is the “hospital care intensity index” or
HCI (Section 5.0, Figure 10). Te HCI index can be generated to show or compare any hospital reerral region, county,
or state using an interactive eature on the web site or other query tools. Te second is AHRQ’s “relative index o
hospital cost eciency”, which is considered developmental at this point.
able 7 shows indicators related to quality, including the use o clinically eective care, patient saety, receipt o timely
and patient-centered care, and patient perspectives on experience with receipt o health care services. One o the main
sources o quality indicators is the National Healthcare Quality Report rom AHRQ, the result o a broad consensus
and technical process involving agencies throughout HHS. Te majority o measures are or use o eective care in
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 33/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 31
the detection, treatment, and management o chronic conditions as well as acute health events. Fewer measures are
available or receipt o timely and patient-centered care.
In terms o patient saety, indicators rom HealthGrades employ patient saety indicators (PSIs) developed by the
AHRQ in a composite measure that can be used to compare perormance in dierent hospitals and states, as done
in their report card. Te PSI’s, however, may represent a limited spectrum o patient saety indicators. By contrast,
IHI’s Five Million Lives campaign sets a broader quality ramework or improvements in patient saety, and may oer
indicators to monitor the impact o the system improvements that result in decreased incidents o medical error and
patient harm. (See Five Million Lives, 2007).
Examples o data sources or Health System Perormance indicators are shown in able 8. Many data sources come rom
individual reports rom hospitals and providers, or example, hospital discharge and billing data, and represent datathat are voluntarily reported as well as mandated. In some cases, the data are designed or other purposes and may
be incomplete (e.g., data on medical error and patient saety as derived rom discharge codes) but still represent the
most valid data available. Indicator reports that provide summary measures o U.S. health care costs are based on data
rom several sources, including the Centers or Medicare and Medicaid Services (CMS) Oce o the Actuary, which
publishes data on total national health expenditures.
While the ocus o this review is largely on available data collected at a national level and disaggregated to state and
local level, many indicators worthy o consideration may be limited in their ability to be disaggregated geographically
or by population groups (age, racial/ethnic groupings). Te review attempts to be suciently broad as to be useul or
inorming uture data development or collection eorts.
In addition, local jurisdictions oten analyze state and local inormation or their indicator eorts, and many
such examples are noted in the individual report summaries. Such sources include local surveys or assessments,
administrative data rom state or local service systems, or geographic level data about community conditions. While
this review is limited to national data sources that can be disaggregated to local levels, it is acknowledged that part o
the challenge to the committee and to SUSA will be sorting out what state/local data may be standardized enough to
roll up (or scale) to the national level.
Selection criteria
Last, selection criteria are related to all aspects o indicator reports. Selection criteria are critical or evaluating
whether the indicators themselves represent a vital health issue, and multiple dimensions o an important
health problem. Selection criteria are relevant to the data sources and ability to measure the condition o importance,
and whether the data can be analyzed in a way as to be meaningul (e.g., geographic, racial/ethnic, or other sub-
groups). And selection criteria apply to communication and whether people intrinsically understand the indicator as
communicated. An example o standard selection criteria or health indicators is provided in Section 5.0, Figure 11.
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 34/11432 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Table 5: selecTed indicaToRs FoR HealTH sysTem peRFoRmance: access To caRe
Trnd nd indctorn Chnn Hth
Cr mrktpc
Chrtbook (Kr Fy
Fondton)
Nton HthcrDprt Rport
(aHRQ)
stt scorcrdon Hth syt
Prornc (Th
Coonwth Fnd)
gor HthDprt Rport
Trnd n hth
nrnc nront
Trnd n hth
nrnc pr
Trnd n hth
nrnc bnft
Trnd n th trctr
o th hth cr
rktpc
Trnd n hth pn nd
provdr rtonhp
ipcton o hth
rkt trnd or
conr
Pop ndr 65 wth
hth nrnc
Pop nnrd yr
Pop who hv
pcfc orc o
onon cr
Pop who hv
prry cr provdr
Pop who xprnc
dfct or dy n
obtnn hth cr or
do not rcv ndd
cr
Pop who xprnc
dfct or dy
n obtnn hth
cr d to fnnc or
nrnc ron
Dnt vt n pt yr
Potnty vodb
hopt don
mnt hth nd
coho/dr trtnt
nd conn
adt ndr 65
nrd
Chdrn nrd
adt vt to doctor n
pt two yr
adt wthot t
whn thy ndd to
doctor bt cod not
bc o cot
acc to provdr—
Fdr Hth
Proon short
ar or prry cr,
nt hth nd
dnt hth
Hth proon
dvrty (phycn)
Hth nrnc
covr
Pron vn n
ntcy otd
hohod
Hth cr vb
or nnrd pop
(prry cr ty nt)
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 35/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 33
Table 6: selecTed indicaToRs FoR HealTH sysTem peRFoRmance:
cosT and eFFiciency oF caRe
Ornzton
or econoc
Cooprton nd
Dvopnt
Hth Cr Cot
101
(Corn
HthCr
Fondton
Drtoth at
(Drtoth
inttt or Hth
Pocy nd Cnc
Rrch)
stt scorcrd
on Hth syt
Prornc (Th
Coonwth
Fnd)
Nton
Hthcr Qty
Rport (aHRQ)
Hth crxpndtr:
Tot xpndtron hth, % gDPTot xpndtron hth, Prcpt us dor
Pbc xpndtron hth, % totxpndtr onhth
Phrctcxpndtr, % otot xpndtr
on hth
Hth crrorc:Prctcnphycn, nr:dnty pr 1,000popton
mdc rdt,nrn rdt:dnty pr1,000 prctcnphycn/nr.
act cr bd,dnty pr 1,000popton.
mRi nt pron poptonCT scnnr pron popton
Tot Hth crpndn
Hth cr hr o gDP
Pr cptpndn
growth npndn (totnd pr cpt)
Contrbtor topndnPynt orc
spndnctorgrowth npndn byjor pndnctor
ann ot-o-pockt pndnpr cpt
mdcr pndnon ptnt wth
chronc n nth t 2 yr o:
Copotr ontnty ohthcrrorc nt 2 yr o (HCi) rtv tobnchrk.
- Tot pndn
- Rorc nptpr 1,000 ptnt- Cr intnty- Trn cr- Copron tobnchrk
Rbrntpr dcdnt;hopt dy prdcdnt; ndrbrntpr dy; doront nd rto
o pndn tobnchrk.
avodb
Hoptzton
(abtoryCr sntv
Condton -
aCsC):
adon or
pdtrc th
athtc wth n
rncy roo
or rnt cr vt
mdcr hopt
dt or aCsC’
mdcr
30-dy hopt
rdon rt
Nrn Ho
rdnt wth
hopt don
or rdon
wthn 90 dy.
Tot n
pr pr
nrod poyt prvt ctor
tbhnt.
Tot mdcr
(a&B)
rbrnt pr
poy.
Cot o potnty
vodb hopt
don
Rtv ndx
o hopt cot
fcncy
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 36/11434 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Table 7: selecTed indicaToRs FoR HealTH sysTem peRFoRmance:
QualiTy—eFFecTive caRe, paTienT saFeTy
Hth Cr QtyRport (aHRQ)
Hth Cr Qtyindx (OeCD)
Ptnt sty:Hthgrd
Fv mon lvCpn—intrvnton
Brt Cncr: erycrnn nd trtnt,ortty
Dbt: mnnt odbt nd nd-trn d
Hrt D: Connon rk ctor, trtnto ami nd ct hrtr, dth pr 1,000
hopt don wthami.
HiV/aiDs: prvnton onw c.
mtrnty cr: Typrnt cr (n frttrtr), innt brthwht
Chd hth: rcpt ovccnton by 35 onth,trtnt o trontr-t, rcpt o prvntvhth cr, dnt vt.
mnt Hth ndsbtnc ab: trt-nt or dpron, b-tnc b.
Rprtory d:Pnon inztonnd trtnt, nnc-ry ntbotc (orcod).
ath nntTbrco trtnt
Nrn Ho, Ho
Hth nd Hopc Cr:Hr drn ty n nr-n ct, otco oho hth cr.
Tn: gttn p-pontnt or cr.
Ptnt Cntrdn:Ptnt xprnc o cr.
Cncr:Brt cncr rvvmorphy crnnCrvc cncr rvvCrvc cncr crnnCoorct cncr rvv
act myocrdinrcton (ami) 30-dyortty rt
strok 30-dy c ttyrtsokn rt
Vccn prvntb d-:Covr or bc vc-cnton
ath ortty rtInuenza vaccination fordt ovr 65
Waiting time for femurrctr rry
Copot cor bdpon 16 Ptnt styindctor ro aHRQ:proporton o hh/owprorn hopt;
Dth d tomd rror
Nbr o tt dopt-n NQF’ ptnt tydn.
Conr QtyindctorCms/CaHPs/HoptCopr
Copot qty cor( mdcr/mdcdnro)
Ptnt rtn o xpr-nc drn t hoptty.
Dpoy rpd rpont to ptnt t rko crdc or rprtoryrrt.
Dvr rb, vdnc-bd cr or ct yo-crd nrcton
Prvnt dvr drvnt throh dr rc-oncton (rb doc-
ntton o chn ndr ordr)
Prvnt cntr n nc-ton
Prvnt rc t nc-ton
Prvnt vnttor-oc-td pnon
Prvnt prr cr
Rdc thcn-rtnt stphyococc
r
(mRsa) ncton
Prvnt hr ro hh-rt dcton
Rdc rc copc-ton
Dvr rb, vdnc-bd cr or contvhrt r.
gt bord on bord.
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 37/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 35
Table 8: HealTH sysTem peRFoRmance daTa souRces
mdcr C—Cms enront, , cot, pynt,dtd rvc, dno,
procdr, cc to nd
qty o cr. Dt vb
or ot provdr nd typ
o hth cr rvc (..,
hopt, otptnt, nrn
ho, ho hth cr,
hopc).
CostQua
lity
X X X Dt or nro. Conty,cty, hopt nd hopt
rrr r v Drtoth
at.**
Hthcr Cot
nd utzton
Projct
(HCuP)
Pbc/Prvt
Hopt dchr dt ncd
dno nd procdr,
dchr tt, ptnt
dorphc, nd chr
or ptnt, rrd o
pyr (.., pron covrd
by mdcr, mdcd, prvt
nrnc, nd th nnrd)
X X Th norton trntd
nto nor ort to
ctt both ttt nd
nton-stt copron nd
ny. so (~20) tt o
contrbt rncy roo
don dt nd btory
rry dt, nd pdtrc
nptnt dt.
Hth Cr
Qty indctor
(HCQi)
OeCD
mr o ctvn,
ty, nd ptnt cntrdn
X stb or ntrnton
copron wth 23 OeCD
contr
Hthcr
ectvn Dt
nd inorton
st (HeDis)
NCQa
mr o o ctv
cr, cc to cr, ptnt
tcton n otptnt cr
ttn
X X other ud by Hth pn tht
r ccrdtd or crtfd
(rqrd or pn tht ccpt
mdcd nd mdcr). Dt
covr prtcptn hth cr
yt ony. Rport crd on
ndvd pn.
Conr
ant o
Hth Provdr
nd syt
(CaHPs)
aHRQ
Ptnt xprnc wh n th
hopt or n btory cr
ttn
X X spport tndrdzd rvy
o conr nd ptnt
xprnc wth hth cr.
avb on Hopt Copr
(Cms)
DaTa sOuRCe
eXamPles OFiNDiCaTORs/measuRes
geOgRaPHiCDRILL DOWN
NOTes
i NT ’ l
NaT i ON
s T aT e
C O uNT Y
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 38/11436 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Nton Hopt
Dchr srvy
HCuP
Prvntb hoptzton
(.., arc’ Hth
Rnkn), ldn c
o hopt don ( ..,
gor Hth Dprt).
Ptnt sty indctor
X X X By hopt. Rportd by
hopt to tt ovrht
nc. stt dt coctd
v HCuP ( dr-tt-
prvt prtnrhp tht
prodc ny dtb
rtd to hopt cr).
mdc
expndtr Pn
srvy (mePs)
aHRQ
Hth cr , xpndtr,
orc o pynt, nrnc
covr, nd qty o cr
X Hohod, dc provdr,
nd nrnc coponnt.
13–15,000 families annually.
DaTa sOuRCe
eXamPles OFiNDiCaTORs/measuRes
geOgRaPHiCDRILL DOWN
NOTes
i NT ’ l
NaT i ON
s T aT e
C
O uNT Y
** Not whr condry ny w crtc to ndctor dvopnt
3.2 Health Indicators and Data Sources
Table 8: HealTH sysTem peRFoRmance daTa souRces (t)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 39/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 37
3.3 Communication—Presenting and Framing o Health Indicators
he central purpose o all o the indicator reports is to improve health through a variety o mechanisms—more
inormed citizens and decision makers, better planning and priority setting, better unctioning systems, and
targeted investments, or example. However, the indicators reviewed have varied abilities to communicate with broad
proessional, much less public, audiences.
A critical concern or the committee charged with selecting the indicators or the State o the USA is how the
indicators will be communicated based on what the American public wants and needs to know. Te choices as to how
the indicators are ramed and communicated will certainly need to be based upon pressing concerns in order to engage
inquiry on the part o site visitors. How these concerns are dened is the subject o other work, however, at least three
contextual considerations emerge rom the landscape o health indicator reports reviewed:
• First, is that the current rate of spending on health is not sustainable. Furthermore, Americans and public ocials at
all levels o government are extremely concerned about rising health care costs and the impact on budgets as well as
access.
• Second, is that our level of health, quality of life, and performance of our health system are not consistent with our
level o spending. Nor is health always equitably distributed, especially among all racial/ethnic and income groups.
Many opportunities or prevention, and increasing the health return on investment exist.
• Tird, the evidence that social factors such as poverty, poor educational attainment, and degraded community
environments contribute to poor health is increasingly acknowledged in health indicator reports. Tese actors also
contribute to many other problems in our society, including crime and violence.
Some o the more engaging examples use goals or desired results to rame and select the indicators, and this can be
accomplished in a variety o ways. Seattle-King County in Community Counts, used responses to a biennial public
survey to rame “valued conditions” or their community, which then rame the indicators. Valued conditions as stated
by the community dier rom traditional conceptual rameworks, and include statements such as “People create a
balanced daily liestyle with adequate time or interaction with amilies, riends, or leisure activities, and or volunteer
activities in the community”. Another is that businesses and corporations are “amily and community riendly…” and
“quality daycare is available or all who need it”. As such, these valued conditions orm a compelling basis not only or
indicators but or a collective agenda to address them.
Valued conditions share many similarities with Results-based Accountability (RBA; Friedman 2005), or example,
where groups agree upon a set o goals. RBA provides a structure and denition or goals (e.g., conditions or status
we want or our children, communities, etc.), indicators (e.g., how these conditions will be measured), and strategies
(approaches based on evidence) and links these with perormance measurement and budgeting measures (e.g.,
governmental or private perormance and investments). Many local indicators eorts are summarized by Friedman,
in addition to providing guidance as to various raming approaches. Project Trive, a national eort to improve and
3.3 Communication—Presenting and Framing o Health Indicators
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 40/11438 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
standardize indicators tracked by state early childhood programs, exemplies the RBA approach. Friedman oers
guidelines or assessing the qualities o indicators. In addition to “data power” and “proxy power,” “communication
power” assesses whether you could stand in ront o a crowd in the town square and make a statement about your
indicator that will be readily understood by all. New York City’s “ake Care New York” community health proles
speak directly to lay persons in their indicator raming approach (see Exhibit 4.2.4).
Indicators can also be ramed and linked with civic agendas, as is shown in the comprehensive indicator systems at
the local level such as Te Boston Indicators Project as well as the Jacksonville County Community Indicators Project.
Whereas citizen’s interest eed into what is measured, what is measured eeds back to the community to join together
to promote responses or interventions. For example, in Jacksonville, local meetings about what is and should be done
in response to crime is a process organized in response to indicators o increased crime and community perceptions o
being unsae.
Te rust or America’s Health has developed “op en Priorities or Prevention” (shown in Section 5.0, Figure 12).
Tese priorities share similarities with the approaches described above in that they set goals as well as attach themselves
to uture directions and actions. Te Prevention Institute has developed a prototype set o indicators or primary
prevention ramed around social indicators—equity o opportunity, people, place, and health system actors (Section
5.0, Figure 13). Sample indicators to accompany this ramework are shown in Section 4.0, Exhibit 4.5.2.
Rankings/Grades
Several reports employ rankings by state, city, or county (e.g. America’s Health Rankings, Kids Count, Big Cities
Health Inventory). Kids Count employs two sets o rankings or states, one or “Right Start” which is based upon 10
indicators related to birth outcomes, and another or Kids Count based upon 10 indicators related to children and youth.
Big Cities Health Inventory includes rankings or the 54 largest cities in the U.S. An example o an eective graphic or
a comparative ranking is shown in Section 5.0, Figure 14, which shows the percentage dierence between lung cancer
mortality rate and the Healthy People 2010 goal or each city. Tese can be useul as summary indicators or several
individual indicators when comparing states or local areas.
Te Health o Wisconsinreport is broken down into our lie stages: Inants (<1 year); children and young adults (ages
1–24 years); working aged adults (25–64 years); and, older adults (age 65 +). Within these categories, overall grades are
assigned or health and disparity. Grades are also assigned or gender, educational attainment, type o county, and racial/
ethnic categories (Section 5.0, Figure 15).
A more in-depth use o rankings is shown in the State o Georgia Health Disparities report which uses grades to rate
each o the state’s counties on indicators o health disparities, and uses comparative rankings with other counties in
Georgia (Section 5.0, Figure 16).
3.3 Communication—Presenting and Framing o Health Indicators
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 41/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 39
Use o the Index
he index is a useul means o communicating complex concepts in a single measure. Some indexes are useul
or acilitating comparisons. An example o this kind o index that was mentioned earlier is in the Dartmouth
Atlas, called the Health Care Intensity (HCI). Te HCI provides one measure o the level o health care resources
used during the last 2 years o lie, and provides a basis upon which to make comparisons by type o service, hospital,
geographic area or other categories o health care. It is useul or benchmarking because at varies greatly across dierent
health care systems and locations, and a high HCI is associated with both excessive costs and poor outcomes (clinical
and patient experience) (personal communication with John Wennberg). Another index is the composite measure
o incidents o medical error used in HealthGrades report on patient saety. It allows the 16 patient saety indicators
developed by AHRQ to be easily tracked over time and compared among dierent regions and hospital systems.
Recently, the Gallup-Healthways Index o Well-being made news with its “index o health and happiness” constructed
rom the results o daily surveys o 1,000 Americans (Index o Well-Being, 2008). It observed that while 49% o the
U.S adult population is happy and healthy, 47% are “struggling” and 4% are “suering”. Te ongoing survey that inorms
this index is being conducted all over the world with the hope o making regular international comparisons. Te Child
Well-being Index (Foundation or Child Development, 2007) is another eort to measure relative child well-being,
while keeping cohort eects constant, and to acilitate national comparisons. On the one hand, while indexes are
simple and proound (i.e., worries about money, ood, jobs, poor health lead to suering), they can over simpliy. Good
indexes can also obscure important patterns o health and poor health obtained by capturing variation, and can also be
insensitive to changes over time, depending on how they are constructed (i.e., quality and sensitivity o the variables
that are included in them). Furthermore, it is at times dicult to attach meaning to a number—what does a child well-being result o “5” really mean?
3.3 Communication—Presenting and Framing o Health Indicators
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 42/11440 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Use o Maps and Geographic Inormation Systems
he availability o GIS has allowed or reliable health indicators, such as premature mortality and lie expectancy,
to be analyzed by geographic and demographic actors. GIS methods provide powerul tools or analyzing trends
and disparities in county-level lie expectancy (Ezzati, 2008) as well as relative gains and losses in health (mortality) by
social actors such as income, a variable that is not available rom Vital Records (Krieger, 2008). Such methods are not
only important or research but provide examples about how to communicate complex patterns and trends in health
in a manner that can be easily understood. Highlights rom both studies were summarized in the New York imes, as
shown in Section 5.0, Figure 17.
Several reports including Community Health Status Indicators, and New York City’s Community Health Proles, and
Te Dartmouth Atlas provide examples o the use o maps. Te Dartmouth Atlas is perhaps the most prominent amongeorts to show variation in measures o health services use and outcomes by geographical areas—jurisdictional, hospital
service, or other boundaries. Community Health Status Indicators will also employ small area analysis at the county level,
and will include peer county comparisons and maps on approximately 200 indicators. New York City Community
Health Proles show statistics and thematic maps based upon 10 health indicators or New York’s 42 community areas.
Several reports serve as examples o presentation approaches that aid in the dissemination and communication o
indicators. For example, RWJ’s “What drives health” eatures charts that can be downloaded as PDFs or Powerpoint
slides. CHSI compiles county and comparative statistics into a user-riendly brochure that can be used to duplicate or
meetings or or groups without access to the Internet.
Indicators directed to Consumers
E xamples o health system perormance indicators designed or use by consumers include the Hospital Compare
and Nursing Home Compare sets (CMS). Te ederal HEDIS health plan report cards also provide data or the
consumers, and, although it is not included in this review, may be a possible indicator source or quality.
3.3 Communication—Presenting and Framing o Health Indicators
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 43/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 41
3.4 Gaps in Indicators
In spite o the importance o health and health data, many gaps in our national statistical system exist (NCVHS
2002). For example, while a large body o evidence has accumulated about the importance o conditions and
experiences early in lie, robust data sources on early childhood health and social and community environments are
not well developed. Te National Survey o Early Childhood health is an important eort to ll these gaps but has
not received steady nancial support. Te National Center on Childhood Poverty’s Project Trive (Exhibit 4.5.4) is in
its early stages and is attempting to ll the gap o indicators at the state (and national) level related to early childhood
based upon potential early childhood indicators rom major national and state sources. For youth, the YRBS provides
very ew state and local estimates.
Consistent with the growing interest in early childhood indicators (RWJ, 2008; IOM, 2003) are Lie Courseindicators, which would refect optimized health over the entire lie course. A modest set o lie course can be ound
in the Healthy People 2010 leading indicators (Chrvala and Bulger [eds.], 1999). Social indicators to monitor “school
readiness,” ocused on health and developmental optimization were used in Los Angeles County (Wold and Nicholas,
2007). And yet, practical examples o indicator reports organized by lie course are not readily ound. able 9 shows
a hypothetical example o indicators organized by lie course. Tese indicators are ocused on protective actors (e.g.,
sae, nurturing and positive social environments in amilies and in communities) and risks (maternal depression, amily
violence, social isolation) that are important determinants or child health and relate to improving health trajectories
over time, well into adulthood, as depicted in Section 5.0, Figure 18 (Halon, 2005).
Physical environmental conditions are also important determinants o health, although somewhat limited tomonitored exposures and illness (e.g., lead poisoning) as well as drinking water and air quality—important, but small
slivers o environmental health interactions. Environmental public health indicators rom the National Center or
Environmental Health are provided in a ramework that is organized along a continuum o such interactions, including
indicators related to hazards, exposures, health eects, and interventions related to the physical environment. Disaster
preparedness planning may also be generating some important indicators related to human interactions with the
natural physical environment (see Exhibit 4.5.3).
Another notable gap is related to older people and indicators o long term care needs, availability o services, and
quality o services. Nursing Home Compare (CMS) is one attempt to provide such data, but represents a airly narrow
slice o the long term care universe. Te need or indicators or health in aging is emphasized by projections that the
number o people over 65 will more than double over orty years—rom approximately 34 million in the year 2000 to
80 million by 2040.
3.4 Gaps in Indicators
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 44/11442 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Table 9: example indicaToR seT—
meRGinG liFe couRse and deTeRminanTs appRoacHes
F ct ct:
Povrty
inco
Vonc
stb epoynt
edcton
Hon—xpor to toxn, crowdn
Food crty
Rc/thncty—dprt n opportnt nd bovndctor
Prnt dcton ttnnt t brth nd ry nchdhood
Prnt thn 18 yr
Prntn prctc
Prnt dpron or oton/bhvor prob
itrt th hth r t (r
thrght):adqt prnt cr
inzton
Rcpt o w-chd cr, dvopnt pport,
Rcpt o prvntv rvc
mnnt o chronc condton
avodb hoptzton
itrt th thr t—r thrght (h r, t, j
jt, h r t):
Pr-choo ttndnc
low/Hh prorn choo
Hh choo copton
Co ttndnc
Prptrtor/vct o cr
Chd trtntPrnt or y br n crn jtc yt
Hth Trjtr ot:
sokn
acoho/Dr b
Phyc ctvty
Dt nd ntrton
actvty tton
Poor hth dy
Obty
ath
injr
incto D
Chronc Hth Condton
Prtr Dth
l xpctncy
3.2 Health Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 45/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 43
4.1 General Health—National Reports
4.1.1 ameRica’s HealTH RanKinGs:
a call To acTion FoR people and THeiR communiTies
c : ut Hth Ft, ar p Hth at, th
prtrh r prt
Last published: 2007
http://www.unitedhealthoundation.org/media2007/shrmediakit/ahr2007.pd
ctt: Stated purpose: Te ultimate purpose o America’s Health Rankings is to stimulate action by individuals,
communities, public health proessionals, health industry employees and public administration and health ocials to improve the health o the population o the United States.
Framework: Determinants o health and health outcomes. Focus is on our areas “that we can aect” combined with
outcomes related to those our determinants, which are stated as ollows:
1. Personal behaviors…everyday decisions we make that aect our personal health. It includes habits and practices we develop as
individuals and amilies that have an eect on our personal health and on our utilization o health resources.
2. Community environment refects the reality that the daily conditions in which we live our lives have a great eect on
achieving optimal individual health.
3. Public and health policies are indicative o the availability o resources and the extent o reach o public and health programsinto the general population.
4. Clinical care refects the quality, appropriateness and cost o the care we receive at doctors’ oces, clinics and hospitals.
ctt:
Number o indicators: 20
Number o measures: 20
Indicator selection criteria: Indicators represent a broad range o issues that aect a population’s health; individual
components need to use common health measurement criteria; data had to be available on a state level; and data had to
be current and updated periodically. Te selection o indicators and measures used a reputable process and individuals.
For example, there was a rigorous review by a scientic advisory committee.
4.0 Summary o Health Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 46/11444 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Primary measures:
All states are ranked on measures – comparisons among states and statistics within each state.
rend analysis provides historical context and perspective on selected indicators.
Disparities by race/ethnicity in premature death (YPLL) shown.
ct: Report includes commentaries rom Te Commonwealth Fund (State Health System Perormance),
the Caliornia Medical Association Foundation (Addressing Health Disparities by Engaging Ethnic Physicians); Te
National Alliance or Hispanic Health (A Call to Action or Healthier Communities); and the National Business
Group on Health (Te Nation’s Quality o Lie and Standard o Living are at Serious Risk: We Must Act Now).
pr bhr
sokn
Bn drnkn
Obty
Hh choo rdton
ct ert
Vont cr
Occpton tt
incto d
Chdrn n povrty
p Hth p
lck o hth nrnc
Pbc hth pndn (pr cpt)
inzton covr
c cr
adqcy o prnt cr
Prry cr phycn
Prvntb hoptzton
ot
Poor nt hth dy
Poor phyc hth dy
innt ortty
Crdovcr dth
Cncr dth
Prtr dth
at:
any o hth dprt by ctd ndctor.
exHibiT 4.1.1: ameRica’s HealTH RanKinGs—HealTH indicaToR seT
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 47/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 45
4.1.2 communiTy HealTH sTaTus indicaToRs—cHsi (dRaFT FoRm)
c : u.s. ctr r d ctr prt
Link to test site: http://chsi.primescapesolutions.net/HomePage.aspx
ctt: Tis system was initially developed in 2000. It is scheduled or launch in July 2008, now unded by a
new partnership that includes the Centers or Disease Control and Prevention (including NCHS and ASDR),
the National Institutes o Health/National Library o Medicine, the Health Resources Services Administration, the
Public Health Foundation, the Association o State and erritorial Health Ocials (ASHO), National Association
o County and City Health Ocials (NACCHO), National Association o Local Boards o Health (NALBOH), and
Johns Hopkins University School o Public Health.
Te report uses a determinants o health ramework and has the stated purpose o making “health data available to
local areas throughout the U.S.”
Stated goal o Community Health Status Indicators (CHSI) is to provide an overview o key health indicators or local
communities and to encourage dialogue about actions that can be taken to improve a community’s health. Te CHSI report was
designed not only or public health proessionals but also or members o the community who are interested in the health o their
community.
ctt:
Focus areas: Summary Measures o Health, National Leading Causes o Death, Measures o Birth and Death; RelativeHealth Importance; Vulnerable Populations; Environmental Health; Preventable inectious disease; Preventive Services
Use; Access to Care; and, Risk Factors or Premature Death.
Number o indicators: 60+
Number o measures: 200+
Primary measures: Each CHSI report includes comparisons o a given county to peer counties, U.S. rates, and Healthy
People 2010 targets. Te re-launch o CHSI includes 3,141 county health status proles representing each county in
the United States excluding territories. CHSI will include updated data, mapping capabilities o health indicators, and
a website where the public can access and download the data and inormation.
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 48/11446 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
ct: Te CHSI report is accompanied by a companion document entitled Data Sources, Denitions, and
Notes. Tis document gives detailed descriptions on data estimations, denitions, caveats, methodology, and sources .
In addition to the web pages, community proles can be displayed on maps or downloaded in a brochure ormat. Te
CHSI mapping capability allows users to visually compare similar counties (termed peer counties) as well as adjacent
counties with their county. Te downloaded CHSI report allows broad dissemination o inormation to audiences that
may not have access to the internet.
sr mr Hthl expctncy
a C mortty
s-rtd Hth stt
unhthy Dy
nt lg c
dth
ct prg/
brth
Brth dct
injr
Hocd
Cncr
scd
Hrt D
HiV/aiDs
mr brth dth
low brth wht
Vry ow brth wht
Prtr brth
Brth to won ndr 18
Brth to won ovr 40
Brth to nrrd won
No cr n frt trtr
Rt Hth irt(Coprtv tttc;
copron to pr cont)
vr pt
No Hs dpo
unpoyd ndvd
svr work dbty
mjor dpron
Rcnt dr
ert Hth
incto D
Toxc Chc
ar qty tndrd
prt t
aiDs
Tbrco
Haemophilus inuenzae B
Hptt a
Hptt B
m
Prt
Connt Rb syndro
syph
prt sr u
Prvntv srvc u—chdrn
(d, nz, dnt cr n/)
Prvntv rvc —dt
Pp
mor
sodocopy
Pnon vccn
F vccn
a t cr
unnrd ndvd
mdcr bnfcr
mdcd bnfcr
Prry cr phycn
Dntt
Conty hth cntr
Hth proon hort r
Rk Ftr r
prtr dth
No xrc
Fw rt/vtb
Obty
Hh bood prr
sokr
Dbt
exHibiT 4.1.2: communiTy HealTH sTaTus indicaToRs
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 49/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 47
4.1.3 HealTHy people 2010—leadinG HealTH indicaToRs
c th nt ctr r Hth stttPartners: Federal agencies (13), Healthy People Consortium (over 400 organizations, local health departments, etc.),and MOU partners.
ctt: Maximum set o leading indicators combines determinants, prevention, and lie course sets: Each indicator
exists as an objective in one or more o the 28 HP2010 ocus areas. Te three proposed indicator sets ocus on some o
the most signicant determinants o health disparities as well as the six priority areas o the President’s Initiative on
Race, and the U.S. Department o Health and Human Services’ initiative, Eliminating Racial and Ethnic Disparities in
Heath.
Goal: Healthy People 2010 has our enabling goals (Promote Healthy Behaviors, Promote Healthy Communities,Prevent and Reduce Diseases and Disorders, Improve Systems or Personal and Public Health) and one cross-cutting
goal (Reduce health disparities).
Approach: Te process o selecting the Leading Health Indicators mirrored the collaborative and extensive eorts undertaken
to develop Healthy People 2010. Te process was led by an interagency work group within the U.S. Department o Health and
Human Services. Individuals and organizations provided comments at national and regional meetings or via mail and the
Internet. A report by the Institute o Medicine, National Academy o Sciences, provided several scientic models on which to
support a set o indicators. Focus groups were used to ensure that the indicators are meaningul and motivating to the public.
ctt:
Leading indicators: 20Objectives: 28
Measures: Approximately 430
ct: Healthy People 2010 provides a broad ramework or more detailed measures. Te process o dening
health indicators or HP2020 is currently underway.
Povrty
Tobcco
Dbty
Phyc ctvty
Prvntb dth
Hth cr cc
Cncr crnn nd dtcton
Phyc nvronnt
Hs rdton
Weight
Hth inrnc
sbtnc ab
Contv dvopnt
Vonc
low brth wht
Chdhood nzton
Hyprtnon crnn
Dbtc y x
exHibiT 4.1.3: HealTHy people 2010 leadinG indicaToRs—
HealTH indicaToR seT (maximum seT)
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 50/11448 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.1.4 RobeRT wood JoHnson FoundaTion—
commission To build a HealTHieR ameRica
itle: What drives health?
http://www.commissiononhealth.org/WhatDrivesHealth.aspx
ctt: Te stated purpose o the Robert Wood Johnson Foundation Commission to Build a Healthier America:
A national, independent, non-partisan group o leaders that will raise visibility o the many actors that infuence health,
examine innovative interventions that are making a real dierence at the local level and in the private sector, and identiy
specic, easible steps to improve Americans’ health. America’s public debate on “health” has mostly centered on access to and
aordability o care, even though a large body o evidence tells us that, in most cases, whether or not a person gets sick has little
to do with seeing a doctor. Tis Commission will ocus on those actors beyond medical care that have an enormous infuence on
health and will ask what we can do about it.
ctt: Charts and slides showing relationship between social actors—including income level, educational
attainment, and race/ethnicity. Focus is on three health conditions (or risks): early lie experience, adult chronic disease,
and obesity. OECD country comparisons in inant mortality rankings (1980 and 2002) and health care expenditures vs.
lie expectancy are provided.
Number o indicators: 13 (shown in approx. 30 charts on web site)
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 51/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 49
s Ftr
inco
Work
Hon
Conty
Rc nd thncty
Th econoy
K Hth ct
innt nd Chd HthObty
adt Chronc D
itr
% dr povrty v (4 ctor)
chd povrty (OeCD contr)
dcton ttnnt ( nd prnt)
xpctncy
nnt ortty
-rportd hth tt (dt nd chdrn)
ctvty tton (HRQl)
ctvty tton d to chronc condton
hth cr xpndtr (OeCD cont)prvnc o dbt
prvnc o chd
phyc nctvty
okn
exHibiT 4.1.4: commission on a HealTHieR u.s.
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 52/11450 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.1.5 ameRica’s cHildRen
c : itrg Fr ch F sttt (over 40 ederal departments,
agencies and oces).
Link to 2007 report: http://www.childstats.gov/americaschildren/
ctt: Stated Purpose and rationale: “America’s Children: Key National Indicators o Well-Being, 2007 is a
compendium o indicators—drawn rom the most reliable ocial statistics—illustrative o both the promises and the diculties
conronting our Nation’s young people. Te report presents 38 key indicators on important aspects o children’s lives. Tese
indicators are easily understood by broad audiences, objectively based on substantial research, balanced so that no single area o
children’s lives dominates the report, measured regularly so that they can be updated to show trends over time, and representative
o large segments o the population rather than one particular group.”
As stated, America’s Children draws upon several conceptual rameworks to characterize the well-being o a child and
infuence the likelihood that a child will grow to be a well-educated, economically secure, productive, and healthy adult.
Criteria or indicator selection stated that indicators should be:
• easily understood by broad audiences;
• objectively based on substantial research connecting them to child well being, and easily estimated based upon
reliable data;
• balanced so that no single area of children’s lives dominates the report; measured regularly; and,
• representative of large segments of the population.
ctt: Focus areas (number o indicators): Seven sections that cover amily and social environment (8), economic
circumstances (3), health care (4), physical environment and saety (7), behavior (5), education (6), and health (6).
otal number o indicators: 39
Number o measures: Approximately 65
Overall geographic level: nation with some breakdowns by race/ethnicity and income (% o Federal Poverty Level).
Uses standard categories or race and ethnicity and includes category or two or more races as reported in the Census.
ct: Identies critical data gaps or indicators needed and challenges the agencies involved to “do better”
at providing the data. Tis process has been ongoing with several improvements to data noted over the ten years o
collaboration, including data or child maltreatment, drinking water quality, and the mental health o children.
Data gaps are noted or each ocus area are noted and include data on child homelessness, long-term poverty, disability,
and early development.
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 53/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 51
F s
Fy trctr nd chd vn rrnnt
Brth to nrrd won
Chd cr
Prnc o orn-born prnt
ln pokn t ho nd dfcty pkn
enh
adocnt brth
Chd trtnt
e crt
Chd povrty nd y nco
stb prnt poynt
Food ncrty nd dt qty
Hth cr
Hth nrnc
u orc o cr
inzton
Or hth
ph ert st
Otdoor nd ndoor r qty
Drnkn wtr qty
expor to d
Hon prob
Yoth vct o ro vont cr
Chd nd docnt njry
mortty
bhr
Rr crtt okn
acoho ,
ict dr
sx ctvty
Prptrton o ro vont cr.
et
Fy rdn to yon chdrnmth nd rdn chvnt
Hh choo cdc conn
Hh choo copton
yoth not n choo nor workn
Co nront
Hth
low brthwht
innt ortty.
eoton or bhvor dfct
Ovrwht
ath
exHibiT 4.1.5: ameRica’s cHildRen—indicaToR seT
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 54/11452 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.1.6 Kids counT
c th a e. c Ft
Link to Kids Count en leading indicators, Right Start Indicators, and City, State, Regional Proles:
http://www.kidscount.org/datacenter/compare.jsp?pc=kc
ctt: Casey collects and publishes data on the condition o kids and amilies nationally and or every state
through their network o state grantees; in some cases, these grantees provide county and city-level data. Kids Count
is updated annually, and the website provides interactive databases and display tools to create customized charts or a
wide variety o applications.
ctt: As stated on the web site: Te new KIDS COUN Data Center, launched in January 2008, contains… the most recent data available on
Education, Employment and Income, Poverty, Health, Basic Demographics, and Youth Risk Factors or the U.S., all
50 states, D.C., Puerto Rico and the U.S. Virgin Islands and eatures data or the 50 largest U.S. cities. Depending on
availability, three to ve years o trend data is currently available or most indicators. [Te] online database allows you
to generate custom reports or a geographic area (Proles) or to compare geographic areas on a topic (Ranking, Maps,
and Line Graphs).
Geographic level: Data on children and amilies at the county-level can be ound on the Community-Level
Inormation on Kids System (CLIKS). Additional inormation or many other geographies including congressional
districts, American Indian homelands, state legislative districts, etc. are available rom the 2000 Census on the KIDSCOUN Census Data Online
Number o indicators: Kids Count (10); Right Start (10) and more than 100 in the Data Center.
ct: Te oundation believes strongly in the promotion o results-based accountability through its
commitment to data-driven planning and innovations in system reorm and community building.
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 55/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 53
Rght strt
Brth, by rc
Brth to orn-born othr
Prcnt brth to thn 20 yr o
Tn brth to won who wr rdy othr
Brth to nrrd won
Brth to othr wth thn 12 yr o dcton (1989 tndrd brth crtfct)
Brth to won rcvn t or no prnt cr (1989 tndrd brth crtfct)
Brth to othr who okd drn prnncy (1989 tndrd brth crtfct)low-brthwht bb
Prtr brth
K ct dt bk - lg itr
low-brthwht bb
innt ortty
Chd dth
Tn dth ro c
Tn brth, by rop
Tn who r hh choo dropot
Tn not ttndn choo nd not workn
Chdrn vn n whr no prnt h -t, yr-rond poynt
Chdrn n povrty (100%)
Chdrn n n-prnt
F ar (t rth thrght hh):
Chdrn n irnt F
edcton
epoynt nd inco
Hth
Hth inrnc
Popton nd Fy Chrctrtc
Povrty
Yoth Rk Fctor
exHibiT 4.1.6: Kids counT—indicaToR seTs
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 56/11454 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.1.7 oldeR ameRicans 2008: Key indicaToRs oF well-beinG
c : itrg Fr agg-Rt sttt
http://agingstats.gov/agingstatsdotnet/Main_Site/Data/Data_2008.aspx
ctt: As stated in the introduction: Te Forum hopes that this report will stimulate discussions by policymakers and
the public, encourage exchanges between the data and policy communities, and oster improvements in Federal data collection
on older Americans. By examining a broad range o indicators, researchers, policymakers, service providers, and the Federal
government can better understand the areas o well-being that are improving or older Americans and the areas o well-being
that require more attention and eort.
Stated selection criteria or the indicators:• Easy to understand by a wide range o audiences.
• Based on reliable, nationwide data (sponsored, collected, or disseminated by the Federal government).
• Objectively based on substantial research that connects them to the well-being o older Americans.
• Balanced so that no single area dominates the report.
• Measured periodically (not necessarily annually) so that they can be updated as appropriate and show trends over
time.
• Representative o large segments o the aging population, rather than one particular group.
ctt: Focus areas: Five ocus areas including population (6), economics (7), health status (7), health risks and
behaviors (8), health care (10), plus one special indicator (literacy/health literacy).
Number o Indicators: 39
Number o Measures: Approximately 80
ct:
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 57/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 55
pt
Nbr o odr arcn
Rc nd thnc copoton
mrt tt
edcton ttnnt
lvn rrnnt
Odr vtrn
ePovrty
inco
sorc o nco
Nt worth
Prtcpton n th bor orc
Tot hohod xpndtr
Hon prob
Hth stt
l xpctncy
mortty
Chronc hth condton
snory prnt nd or hth
s-rportd hth tt
Dprv ypto
Fncton tton
Hth Rk bhr
Vccnton
morphy
Dt qty
Phyc ctvty
Obty
Crtt okn
ar qty
u o t
Hth cr
u o hth cr rvc
Hth cr xpndtr
Prcrpton dr
sorc o hth nrnc
Ot-o-pockt hth cr xpndtr
sorc o pynt or hth cr rvc
Vtrn’ hth cr
Nrn ho tzton
Rdnt rvc
Pron tnc nd qpnt
s Ftr
ltrcy
Hth trcy
exHibiT 4.1.7: oldeR ameRicans
4.1 General Health—National Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 58/11456 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.2 General Health—State and Local Health Reports
4.2.1 communiTies counT—seaTTle/KinG counTy, wasHinGTon
c : p Hth—stt Kg ct.
ctt: Communities Count is a partnership between public and private organizations, including the ollowing
ounding partners: City o Bellevue Parks and Community Services Department, City o Seattle Human Services
Department, King county Children and Family Commission, Public Health-Seattle and King County, Sustainable
Seattle, Te Seattle Foundation, and United Way o King County.
Te 2005 report is the third (rst report release in 2000). It provides “a common set o 38 social, health, environmentaland arts indicators or use by all city and county governments, public agencies, oundations, human service unders,
non-prot agencies, community-based organizations, and residents.” Te ollowing three stated principles guided the
project:
1. Prevention and a long-term view o change are emphasized.
2. A data-based approach inorms our understanding o what creates and sustains healthy communities and amilies.
3. Eective eorts involve citizens and experts, dierent disciplines, dierent parts o government, private and public
sectors.
ctt:
Focus areas (number o indicators): Basic Needs and Social Well-being (7), Positive Development through Lie Stages(8), Saety and Health (19), Community Strength (4), Natural and Built Environment (5), and Arts and Culture (4),
plus a description o the data on “valued conditions” relating to each ocus area.
Number o indicators: Approximately 47
Number o measures: Approximately 150
ct: Te ollowing description regarding the community input process is excerpted rom the report:
Trough an extensive process, residents expressed their opinions on what they value in their amilies and communities, what they think creates and sustains healthy people and strong neighborhoods, and what social, health and economic problems they are
concerned about. Over 1,500 King County residents participated through a random digit dial telephone survey, a series o ocus
groups, and seven public orums held across the county. Teir opinions were recorded and are expressed as “valued conditions.”
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 59/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 57
Te ollowing inormation concerning the integrity o the data was excerpted rom the report:
At the same time, technical advisors were discussing the scientic side o choosing a strong list o social and health indicators.
Tey considered the valued conditions expressed by residents and were concerned with the scientic quality o the inormation
available issues o validity, reliability, consistency o measurement, whether data are available or the county only or or smaller
areas, such as school districts, cities, regions, or or dierent age groups, ethnic groups, income levels and genders. Te indicators
selected were the most meaningul to residents and those considered most important to the overall health and wellbeing o people
and communities.
st Hth
Prcvd nhborhood ty
Cr—vont cr rt
Cr—rdr rt
Fy vonc—dotc vonc
Fy vonc—CPs rrr
motor-vhc crh dth
motor-vhc crh hoptzton
Poton n nhborhood
innt ortty
Tn brth
str
Tobcco nd coho—dt tobcco
Tobcco nd coho—yoth tobcco
Tobcco nd coho—dt coho
Tobcco nd coho—yoth coho
Phyc ctvty nd wht—ctvty
Phyc ctvty nd wht—wht
Restricted activity due to poor physical/mental health
Hth nrnc covr nd cc
ct strgth
Nhborhood oc cohon
invovnt n conty ornzton
inttton pport or conty rvc
e o cc to hop nd rvc
ntr bt ert
ar qty
Water quality
lnd covr
Frnd trtd wth chc
Cot choc
art ctr
Prtcpton n rt nd ctr
Prnc o rt nd ctr
epoynt n rt nd ctr
Fndn or rt nd ctr ctvt
exHibiT 4.2.1: communiTy counTs—indicaToR seT
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 60/11458 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.2.2 GeoRGia HealTH dispaRiTies RepoRT
c : stt Grg p Hth
http://dch.georgia.gov/vgn/images/portal/cit–1210/21/33/111684019Georgia_Health_Equity_Initiative_Health_
Disparities_Report_2008.pd
ctt: Te approach o the report is to “look holistically at the major actors that infuence dierences in health
status and their relationship to racial and ethnic characteristics.” Te report provides a statewide and county-by-county
assessment or the indicators. Each indicator is graded or each county on the basis o how much inequity (or disparity)
by race and ethnicity exists.
ctt: Four ocus areas: Social and economic well-being; Health status (disease, premature death); Quality andaccess to care; Health proessional workorce.
Number o indicators: Approximately 16
Rates or indicators are provided by race/ethnicity, graded, and compared to grouped (peer) county averages using an
inequality ratio.
Te report provides clear criteria as to the meaning o the grade and how that grade might be improved as well as
action steps—guidelines or how to use and disseminate the data.
ct: Limited or no inormation is available at the county level about disparities in groups other than Black/
White due to data limitations.
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 61/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 59
s e itr
Povrty
Prcnt o vn bow th dr povrty v
Prcnt npoyd
mdn y nco
Prcnt o ho ownr occpd
et
Prcnt thn 9th rd dctonPrcnt ntcy otd
mrtt
a-djtd dth rt
YPll (d to prtr dth)
Qt a t cr
Hth proon dvrty—phycn
Hth proon hort r (prry cr, nt hth, dnt hth)
a/r rt
Rt o nnrd
Hth cr vb or nnrd pop (ty nt cnc)
erg r htt rt
avodb rncy roo vt
avodb hoptzton
exHibiT 4.2.2: GeoRGia HealTH dispaRiTies RepoRT: indicaToR seT
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 62/11460 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.2.3 los anGeles counTy public HealTH
Report: Key Indicators o Health
c : l ag ct p Hth
Most recent publication 2007 (updated every 2 years):
http://publichealth.lacounty.gov/ha/reports/Key05Report_FINAL.pd
ctt: Purpose o the report is to monitor key health conditions and to engage a broad community o stakeholders
in health improvement work. Te ramework used is broad health determinants (including Social and Physical
Environments, Health Behaviors, Health Status, Health Outcomes). Te indicators emphasize social determinants,
especially those related to child well being and the prevention o chronic conditions, and well as health status and
outcomes.
Te criteria or the selection o indicators was based on standard criteria and involved a consensus process with health
department and key stakeholders.
ctt:
Focus areas: Social and Physical Environments, Health Behaviors, Health Status, and Health Outcomes.
Number o indicators: 60
Number o measures: Approximately 75
Disparities or each indicator are shown along with a comparative measure as to whether the indicator is statistically dierent--better or worse—in each o the sub-county areas as compared to the county average. Racial/ethnic disparities
and other important ndings by age, income or other actors are provided in the narrative.
ct: Availability o social indicators including parenting practices, child care, community conditions as well
as indicators or health behaviors, health related quality o lie, and mental health are unique because o the availability
o large local survey data. Data are more rich given that this is a large local health department and the critical
importance o providing sub-county data—eight “Service Planning Areas”, many o which are larger than most U.S.
states.
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 63/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 61
Hth bhr
acoho nd Dr u
Tobcco u
Ovrwht Chdrn
Ovrwht/ob dt
Phyc ctvty
Ntrton
s ph ertar qty
Povrty
Nhborhood ty
Pc to py
edcton
Rdn to chd
TV vwn
Prnt pport
Chd cr
Hth stt
Prcvd hth
actvty tton on dt
Dbty—dt
Dbty nd pc hth cr nd—chdrn
Hth cr a
inrnc
Rr orc o cr
Prvntv hth rvc
Prnt cr
inzton
Coorct cncr crnn
Crvc cncr crnn
morphyacc to dnt cr
Hth ot
ath
Dbt
Hyprtnon
Dpron
aiDs
syph
Tbrco
low brth wht
Tn brth
innt ortty
Cncr ortty
Brt cncr ortty
Crvc cncr ortty
ln cncr ort
Crdovcr d ortty
Dbt ortty
strok ortty
scd
unntnton njry
Hocd
exHibiT 4.2.3: los anGeles counTy Key HealTH indicaToRs
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 64/11462 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.2.4 new yoRK ciTy communiTy HealTH pRoFiles
c : n yrk ct drtt Hth mt Hg
http://www.nyc.gov/html/doh/html/data/data.shtml
ctt: Indicators or local report cards were generated based upon priorities or public health intervention. Te
measures are based upon high-quality data primarily rom the NY City Department o Health.
Te approach was to engage broad audiences with health indicators, and included a series o community meetings. Te
report is prepared to serve as a brochure suitable or dissemination to community stakeholders including the lay public.
Report cards or 42 neighborhoods, or communities, ramed around the ollowing “ake Care New York” goals:1. Have a regular doctor
2. Be tobacco ree
3. Keep your heart healthy
4. Know your HIV status
5. Get help or depression
6. Live ree o alcohol and drugs
7. Get checked or cancer
8. Get the immunizations you need
9. Make your home sae and healthy
10. Have a healthy baby
ctt:
Number o indicators: 12
Number o measures: Approximately 36
Ranked comparisons to other neighborhoods (low average, average, or above average) are provided in addition to
comparisons to sub-regions o the City and to New York City as a whole.
ct: NY City conducts a periodic health survey which makes the local data related to these goals very rich.
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 65/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 63
indicaToRs
How rdnt rt thr own hthPrtr dth
gOals:H rgr tr r thr Hcp
b T Fr
K r hrt hth
K r Hiv stt
Gt h r dr
l r h rg
Gt hk r cr
Gt it n
mk r h s Hth
H Hth b
nghrh hth hghght(hhhtd hth or n nhborhood)
measuRes
s-rportd hth ttDth rtPrtr dth (ldn YPll)
No pron doctorgo to eD whn ck or nd dvcHth nrnc tt
soknattptn to qt
Hrt d hoptztonHrt d orttyObtyDbtPhyc ctvty
HiV/aiDs cHiV ttnCondo
Pychooc dtr (-rportd)Hoptzton or nt n
Bn drnknacoho-rtd hoptzton
Dr-rtd hoptztonDr-rtd dth
Crvc cncr crnn (Pp)Brt cncr crnn (or)Coon cncr (coonocopy)Cncr dth rt (dn typ)
F ( 65+)Pnococc ( 65+)ld poonn c on chdrn
ath (dt nd chdrn)ath hoptzton (dt nd chdrn)
Prnt cr n frt trtrBrth to tnlow brth whtinnt ortty rt
exp: Rb
exHibiT 4.2.4: new yoRK ciTy communiTy pRoFiles
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 66/11464 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.2.5 new yoRK ciTy HealTH dispaRiTies RepoRT
c : n yrk ct drtt Hth mt Hghttp://nyc.gov/html/doh/downloads/pd/epi/disparities-2004.pd
ctt: Approach: Health determinants and health disparities by geographic community, income, and race/
ethnicity. Dierences that are statistically signicant are highlighted.
ctt:
Number o indicators: Approximately 20
Number o measures: Approximately 45
Analysis o neighborhood variation is conducted by categorizing neighborhoods into our groups based on average
(median) household income. Health indicators are compared in some cases or all our groups and in some cases by
showing the indicator or the highest and lowest income neighborhoods. Ratios are also used to describe the excess
burden experienced by one or the other group—usually the lowest.
Other indicators are presented or the major racial/ethnic groups. Selected indicators where signicant sub-group
dierences were observed (or possible to analyze) are shown, or example, dierences in lie expectancy among Puerto
Ricans vs. other Hispanics.
ct: Introductory material includes careul explanation about how social actors are measured and about the
relationship o income, race/ethnicity, and living in poor neighborhoods and health.
inco nd Rc/thncty
inco nd povrty
Nhborhood nco
Rc nd thncty
irton
drt Hth
HiV/aiDs
sokn
exrc, obty, nd dbt
Crdovcr dCncr
ath
innt nd trn hth
Hth bhvor on
docnt
drt th s
ph ert
acc to mdc Cr
Hon
exHibiT 4.2.5: new yoRK ciTy dispaRiTies RepoRT
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 67/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 65
4.2.6 HealTH oF wisconsin RepoRT caRd 2007
c : urt w pt Hth ittt
http://www.pophealth.wisc.edu/UWPHI/research/report_card_2007/report_card_2007.htm
ctt: Stated purpose o report:
“Overall, the health o Wisconsin residents is improving. However, the creators o the report noticed that Wisconsin’s
rankings relative to other states were dropping. Furthermore, they considered the need to understand and address
health disparities.”
ctt: Te report uses a limited number o measures (age-specic mortality and health related quality o lie basedupon poor health days). Focus is overall health and health in dierent lie stages: Inants (<1 year); children and young
adults (ages 1-24 years); working aged adults (25-64 years); and, older adults (age 65 +). Within these categories, overall
grades are assigned or health and disparity. Grades are also assigned or the same two health measures (mortality and
unhealthy days) by gender, educational attainment, type o county, and race/ethnicity.
Number o Indicators: 2
Hth Rt Qt l
unhthy dy
mrtt
a-pcfc dth rt
exHibiT 4.2.6: HealTH oF wisconsin RepoRT caRd
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 68/11466 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.2.7 THe bosTon paRadox: loTs oF HealTH caRe; noT enouGH HealTH. indicaToRs oF
HealTH, HealTH caRe and compeTiTiveness in GReaTeR bosTon.
c : n eg Hthr ittt r Th bt Ft
ctt: Unique pairing o health care economic inormation and health determinants.
Content: 30 indicators
ct: Te ollowing excerpts rom the report describe the juxtaposition o the state o the health care economy
and the state o physical well-being explored through the indicators:
“o remain competitive in our increasingly global economy, we must have the resources to invest wisely in innovation o all kinds, and that requires us to understand and meet the challenge contained within this report. Te Boston Paradox describes a
double threat—to our physical health, and also to our economic wellbeing, as the cost o a rising tide o preventable
chronic illness threatens to submerge other crucial priorities, including education, transportation and the quest or aordable
housing.
Greater Boston and the Commonwealth are vulnerable to this trend because we have an older workorce, as well as persistent
racial, ethnic and socio-economic health disparities. On the economic side, we have a cost o living that already makes Greater
Boston the most expensive place in the country to live or a amily o our. And health costs are rising aster than our
economic growth. Unless we can reverse these trends, Greater Boston will lose ground, becoming less healthy and less competitive.
How can it be that here, in the hub o American medicine, we enjoy a world-class health care system, and yet do not have enough
health? As this report details, some o the most important health strategies, are preventative, including good diet and exercise. Te
Boston Paradox demonstrates that it is now imperative or Greater Boston to become as innovative in public
health strategies as we have been in medical technologies.”
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 69/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 67
dtrt Hth
edcton
mdn inco
Cn ar
Clean Water
Conty sty: Vont Cr, Yoth Vonc
nd Dotc Vonc
Tobcco u
exrc nd FtnDt nd Ntrton
Ovrwht nd Obty
acc to Hth Cr: Hth inrnc Covr
Hth stt
Low Birth Weight
Hyprtnon
Dbt
Hrt D
Cncr
ath
sr Hth cr Fg
epoyr-ponord Hth inrnc
Cot o epoyr-ponord Hth inrnc
stt expndtr or Hth nd Hth Cr
Fdr expndtr or Hth nd Hth Cr
u o Hth Cr Fndn
Pbc Hth Pror
Phycn srvc
u Hth cr Fg
Hopt srvc
Prcrpton Dr
Ho Hth Cr
Nrn Ho srvc
Rt itr
Hth inrnc indtry
mdc nd Nrn edcton
Hth-rtd Rrch nd Tchnooy Trnr
l scnc indtr
exHibiT 4.2.7: THe bosTon paRadox: loTs oF HealTH caRe; noT enouGH HealTH.
4.2 General Health—State and Local Reports
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 70/11468 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.3 Quality o Lie (Comprehensive Indicator Systems)
4.3.1 QualiTy oF liFe FacTbooK 2008
c : Th orgt r e crt dt (oecd)
http://www.oecd.org/dataoecd/58/45/40327657.pd
4.3.2 bosTon indicaToRs pRoJecT
c Th bt Ft
Te partners or the Boston Indicators Project include: Te Boston Foundation; Te John LaWare Leadership Forum;
Te City o Boston, Tomas M. Menino, Mayor; the Boston Redevelopment Authority; and the Metropolitan Area
Planning Council.
http://www.bostonindicators.org/IndicatorsProject/Health/AtAGlance.aspx?id=3532
Comprehensive indicator system with the ollowing stated purpose:
Te Boston Indicators Project oers new ways to understand Boston and its neighborhoods in a regional context. It aims to
democratize access to inormation, oster inormed public discourse, track progress on shared civic goals, and report on change
in 10 sectors: Civic Vitality, Cultural Lie and the Arts, the Economy, Education, the Environment, Health, Housing, Public
Saety, echnology, and ransportation.
Focus areas: Te health ramework is organized around eight goals, 20 indicator areas, and approximately 40 individual
measures.
ct: Te presentation is very dierent rom more static reports. Te Boston Indicators system presents both
health data and contextual inormation (e.g., links to other inormation resources) in a navigable snapshot.
l xpctncy
innt ortty
Obty
exHibiT 4.3.1: oecd QualiTy oF liFe—HealTH indicaToRs
4.3 Quality o Lie (Comprehensive Indicator Systems)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 71/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 69
One o a our-part civic agenda is “World class human resources” which prioritizes high-quality early care and
education, and reducing obesity and its attendant disease burden.
http://www.bostonindicators.org/IndicatorsProject/SummaryReport.aspx?id=4764
Rtg th Rg’ ctt eg th
Hth str
Rrch ndn, mchtt nd tro Boton
“Right Start” rank in child health outcomes, Boston
v. 50 rt u.s. ct
u a t Hth cr
Rdnt wthot hth nrnc
mnt hth rvc cpcty or chdrn nd
dt
ln pokn t jor hopt nd hth
cntr
l Rt d mrtt
ldn c o hoptzton nd dthDr nd vonc rtd njr
Dr nd vonc rtd dth
sTD
Hptt C
aiDs ortty
et R/eth Hth drt
Hth ot
innt ortty
Brth wht
ath hoptzton
Hoptzton by rc/thncty
mortty by rc/thncty
itt Hth chr
at
adqt prnt cr
up-to-dt vccnton
scd rt on yoth
Yoth who n n rky bhvor
Yoth who rport tron rtonhp wth
prnt or dt ntor
Hth bhr
Rdnt who n n hthy bhvor
l Rt ert Hr
locton o chdrn nd rcrton r v.
xpor
p Fg r p Hth
Trnd n cty, tt, nd dr pbc hth
ndn v
exHibiT 4.3.2: bosTon indicaToRs pRoJecT: HealTH indicaToR seT
4.3 Quality o Lie (Comprehensive Indicator Systems)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 72/11470 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.3.3 JacKsonville QualiTy oF liFe pRoGRess RepoRT
c : Jk ct ct itr
http://www.jcci.org/statistics/statistics.aspx (2007)
ctt:
Framework: Quality o lie, progress. JCCI has been collecting data and tracking trends or 22 years.
Stated purpose:
Measuring progress towards building a better community.
JCCI is a nonpartisan civic organization that engages diverse citizens in open dialogue, research, consensus building, advocacy
and leadership development to improve the quality o lie and build a better community in Northeast Florida and beyond.
ctt: Over 100 indicators in nine areas o quality o lie: education, economy, natural environment, social
environment, arts and culture, health, maintaining a responsive government, moving around eciently (transportation),
and public saety.
ct: An annual survey, donated by American Public Dialogue, provides additional inormation on the
community’s perception o the quality o lie. Detailed reerence data, including charts and graphs, are also provided or
those who wish to explore these trends urther.
stg Hth ct
Dth d to hrt d (pr 100,000)
Cncr dth (pr 100,000)
Nwborn wth hthy brth wht
ery prnt cr
innt dth rt (pr 1,000)
Rc dprty n nnt dth
snor ctzn cd rt
snor who n thr nhborhood
Pop wth no hth nrnc
Jckonv hth cr rt hh qty
Nwy dnod aiDs c pr 100,000 pop
HiV/aiDs rtd dth
Rc dprty n HiV
sxy trnttd d rport
Pck o crtt od pr pron
ln cncr dth pr 100,000 pop
acoho rportd by yoth
exHibiT 4.3.3: JacKsonville QualiTy oF liFe pRoGRess RepoRT
4.3 Quality o Lie (Comprehensive Indicator Systems)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 73/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 71
4.3.4 ausTRalia’s measuRes oF pRoGRess
c : atr br sttt
http://www.abs.gov.au/AUSSAS/abs@.ns/Latestproducts/1383.0.55.001Main%20Features32008%20(Edition%20
1)?opendocument&tabname=Summary&prodno=1383.0.55.001&issue=2008%20(Edition%201)&num=&view=
Framework or “headline” dimensions o progress are individuals, the economy and economic resources, the
environment, and living together. Health is one o three indicators or the progress o individuals as measured in lie
expectancy at birth, educational attainment, and workorce participation.
(See Section 5.0, Figure 8 or a description o the ramework.)
4.3.5 canadian index oF well-beinG
http://www.atkinsonoundation.ca/ciw/
c thrgh r rt rt th atk Ft
Public launch anticipated in 2008
Te stated purpose o the Te Canadian Index o Wellbeing (CIW) is to report on the wellbeing o Canadians. Although
currently a work-in-progress, when the CIW is ully developed, it will chart and provide unique insights into how Canadians’
lives are getting better—or worse—in areas that matter: health, standard o living, quality o the environment, time use,education and skills, community vitality, civic engagement, and arts and culture. Most importantly, the CIW will shine a
spotlight on how these important areas are interconnected. How, or example, changes in income are linked to changes in health,
or how community engagement and living standards are connected.
ct:
(See Section 5.0, Figure 9 or a description o the CIW ramework.)
4.3 Quality o Lie (Comprehensive Indicator Systems)
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 74/11472 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.4 Health System Perormance
4.4.1 commonwealTH Fund sTaTe scoRecaRd on
HealTH sysTem peRFoRmance
c : Th cth F
http://www.commonwealthund.org/usr_doc/StateScorecard.pd?section=4039
ctt: Stated purpose o State Rankings:
Developed to ollow the National Scorecard on U.S. Health System Perormance , published in 2006, the State Scorecard
assesses state variation across key dimensions o health system perormance: access, quality, avoidable hospital use and
costs, equity, and healthy lives. Te ndings document wide variation among states and the potential or substantialimprovement—in terms o access, quality, costs, and lives—i all states approached levels achieved by the top states.
[Tese improvements are then translated into tangible returns, e.g., number o lives saved, and other metrics.] Leading
states outperorm lagging states on multiple indicators and dimensions; yet, all states have room to improve. Te report
presents state perormance on
32 indicators, with overall rankings as well as ranks on each dimension. Te ndings underscore the need or ederal
and state action in key areas to move all states to higher levels o perormance and value.
ctt:
Focus areas (number o indicators): Access (4); Quality (14); Potentially avoidable use o hospitals and costs o care (9);
Equity; Healthy Lives (5). otal Indicators: 32
ypes o measures:
Geographic: state
ct:
Indicators used to compare U.S. with other OECD countries summarized here:
Supplement to the Columbia journalism review march 2008
http://www.commonwealthund.org/usr_doc/CJR_insert_nal.pd?section=4039
Commonwealth und—health measures or journalists
http://www.commonwealthund.org/publications/publications_show.htm?doc_id=671629
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 75/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 73
Hth cr a
adt <65 nnrd
Chdrn nnrd
adt vtd doctor n pt 2 yr
adt—nt nd
Qt
adt 50+ rcvd prvntv crDbtc rcvd prvntv cr
Chdrn 19-35 onth rc’d vccnton
Chdrn d dnt hth vt
Chdrn oton bhvor dvopnt nd
src ptnt rcvd ntbotc
adt wth orc o cr
Chdrn dc ho
Hrt r wrttn ntrcton
Ptnt tcton
ptt a Ht
ct cr
Hopt don or pdtrc th
athtc wth n rncy roo or rnt cr
vt
mdcr hopt d or aCsC’
mdcr 30 hop rdon rt
Nrn Ho rdnt wth hopt don
Nrn Ho rdnt wth hopt rdon
wthn 90 dy
Tot n pr pr nrod poy t
prvt ctor tbhnt
Tot mdcr (a&B) rbrnt pr poy
eqt
inco v
Rc/thncty
Typ o nrnc
Hth
mortty nb to hth cr
innt orty rtBrt c ortty
Coon c ortty
adt wth ctvty tton
exHibiT 4.4.1: commonwealTH Fund sTaTe scoRecaRd on HealTH sysTem
peRFoRmance
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 76/11474 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.4.2 THe daRTmouTH aTlas oF HealTH caRe
c : drtth ittt r Hth p c prt, drtth
m sh
http://www.dartmouthatlas.org/
Executive Summary or 2008 release:
http://www.dartmouthatlas.org/atlases/2008_Atlas_Exec_Summ.pd
Full 2008 report: racking the Care o Patients with Severe Chronic Illness
ctt: Te Dartmouth Atlas is a major research eort that or more than 20 years has documented variations in
how medical resources are distributed and used in the U.S.
As stated: Te project uses Medicare data to provide comprehensive inormation and analysis about national, regional, and local
markets, as well as individual hospitals and their aliated physicians. Tese reports, used by policymakers, the media, health care
analysts and others, have radically changed our understanding o the eciency and eectiveness o our health care system. Tis
valuable data orms the oundation or many o the ongoing eorts to improve health and health systems across America.
ctt:
Major ocus areas: Conditions and procedures (medical and surgical hospital discharges), end-o-lie care (hospital
use, intensive care use), Medicare reimbursements (overall, inpatient stays, outpatient services, Part B reimbursements,
home health services, hospice services, skilled nursing acilities). [Te 2008] edition o the Dartmouth Atlas o HealthCare describes how care or Medicare beneciaries with serious chronic illness varies across U.S. states, regions and
hospitals. Te ocus is on Medicare beneciaries who have severe chronic illnesses and are in their last two years o lie.
ct: Te Dartmouth Atlas o Health Care web site was listed as one o the “op Five Health Care System
Web Resources” by ABC News, the Kaiser Family Foundation and USA oday in the special series “Prescription or
Change.” Dartmouth Atlas Data were used to launch a national campaign by the Robert Wood Johnson Foundation to
improve the quality o health care with intensive projects unded in 14 communities.
http://www.rwj.org/les/research/statedatasheet.pd
Te Atlas website provides access to all reports and publications, as well as interactive tools to allow visitors to view specic
regions and perorm their own comparisons and analyses.
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 77/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 75
exHibiT 4.4.2: daRTmouTH aTlas
Coponnt o th Bc Rport or mdcr Ptnt wth at lt On o Nn Coon Chronc
Condton:
THe meDiCaRe sPeNDiNg RePORT:
spndn pr mdcr ptnt drn th t two
yr o
Tot mdcr pndn
inptnt t o cr
Otptnt t o crskd nrn/on-tr cr cty
Ho hth cr
Hopc cr
Drb dc qpnt
THe ResOuRCe allOCaTiON RePORT:
Rorc npt pr 1,000 mdcr ptnt drn
th t two yr o
Hopt bd
intnv cr nt (iCu) bd
Hh-ntnty iCu bd
intrdt-ntnty iCu bd
F-t qvnt (FTe) phycn bor
a phycn
Prry cr phycn
mdc pct
Rtrd nr (RN) rqrd ndr propod
dr tndrd
THe PaTieNT eXPeRieNCe RePORT:
Cr drn th t x onth o
avr nbr o dy pnt n hopt pr
ptnt
avr nbr o phycn vt pr ptnt
Prcnt o ptnt n tn or or phycnTrn cr
Prcnt o dth octd wth ntnv cr
Prcnt o ptnt nrod n hopc
avr ptnt co-pynt or phycn cr nd
drb dc qpnt drn th t two
yr o
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 78/11476 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.4.3 naTional HealTHcaRe QualiTy RepoRT
c : Th ag r Hthr Qt Rrh
U.S. Department o Health and Human Services (HHS) in collaboration with an HHS-wide Interagency Work
Group
Link to report rom:
http://www.ahrq.gov/qual/qrdr07.htm
Link to PDFs
http://www.ahrq.gov/qual/nhqr07/nhqr07.pd
ctt: Te ollowing is the stated purpose o the National Healthcare Quality Report:
Since 2003, the Agency or Healthcare Research and Quality (AHRQ), together with its partners in the Department
o Health and Human Services (HHS), has reported on progress and opportunities or improving health care quality.
With this th annual National Healthcare Quality Report (NHQR), these reports will have provided more than
50,000 data points about health care quality in the United States. Has it made a dierence? Have Federal and State
governmental agencies, provider organizations, insurers, and employers made progress in improving health care quality
and saety? While every previous release o the NHQR has attempted to summarize the direction in which health care
quality is going, this th report tries to summarize the progress that has been made and the remaining challenges to
improve health care quality in this Nation.
Te NHQR is built on 218 measures categorized across our dimensions o quality—eectiveness, patient saety,
timeliness, and patient centeredness. Tis year’s report ocuses on the state o health care quality or a group o 41
core report measures that represent the most important and scientically credible measures o quality or the Nation,
as selected by the HHS Interagency Work Group. Te distillation o 42 core measures or the 2007 report provides a
more readily understandable summary and explanation o the key results derived rom the data. While the measures
selected or inclusion in the NHQR are derived rom the most current scientic knowledge, this knowledge base is
not evenly distributed across health care. Te analysis in the ollowing pages centers on measures or which data are
available rom the baseline year o 2000 or 2001 and the comparison year o 2004 or 2005.
ctt:
exHibiT 4.4.3: naTional HealTHcaRe QualiTy RepoRT
( ndctor t http://www.hrq.ov/q/nhqr07/Cor.ht)
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 79/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 77
4.4.4 naTional HealTHcaRe dispaRiTies RepoRT
c : Th ag r Hthr Qt Rrh
on behal o the U.S. Department o Health and Human Services (HHS) and in collaboration with an HHS-wide
Interagency Work Group
Link to both reports rom: http://www.ahrq.gov/qual/qrdr07.htm
ctt: Te National Healthcare Disparities Report states as its purpose the ollowing: Te NHDR provides
a comprehensive national overview o disparities in health care among racial, ethnic, and socioeconomic groups in
the general U.S. population and within specic priority populations, and it tracks the progress o activities to reduce
disparities. Te NHDR tracks disparities related to the quality o and access to health care.
Tis th report attempts to answer the ollowing question: Are we getting better at addressing disparities in the
quality o and access to health care or priority populations in America? o do this, the report examines a set o 42
measures o quality and 8 measures o access. For each measure, the 2007 NHDR attempts to present a snapshot o the
gaps between each racial, ethnic, and socioeconomic priority group and a comparison group. More importantly, where
gaps exist, this report attempts to systematically discuss whether these gaps are getting bigger or smaller.
Measures o health care quality address the extent to which providers and hospitals deliver evidence-based care or
specic services, as well as the outcomes o the care provided. Tey are organized around our dimensions o quality—
eectiveness, patient saety, timeliness, and patient centeredness—and cover our stages o care—staying healthy,getting better, living with illness or disability, and coping with the end o lie. Measures o health care access include
assessments o how easily patients are able to get needed health care and their actual use o services. Tey are organized
around two dimensions o access—acilitators and barriers to care and health care utilization.
Te NHDR is complemented by its companion report, the National Healthcare Quality Report (NHQR), which uses
the same quality measures as the NHDR to provide a comprehensive overview o the quality o health care in America.
Both reports measure health care quality and track changes over time, but with dierent orientations. Te NHQR
addresses the current state o health care quality and the opportunities or improvement or all Americans as a whole
ctt:
exHibiT 4.4.4: naTional HealTHcaRe dispaRiTies RepoRT
( ndctor t http://www.hrq.ov/q/nhdr07/Cor.ht)
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 80/11478 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.4.5 oRGanizaTion FoR economic coopeRaTion and developmenT—
HealTH caRe QualiTy index
http://www.oecd.org/document/34/0,3343,en_2825_495642_37088930_1_1_1_1,00.html
Methods report ( January 2006), including conceptual ramework:
http://www.oecd.org/dataoecd/1/34/36262514.pd
ctt: Te HCQI Project states that it will eventually represent “the largest eort, in terms o the number
o quality indicators and the number o countries, to assess international health care quality that has ever been
undertaken.” Te objective o the HCQI is to track health care quality by developing a set o indicators that are:
• Based on comparable data.
• Can be used to raise questions for further investigation in quality dierences across countries.• Build upon two pre-existing international collaborations (organized by Te Commonwealth Fund of New York (5
countries) and the Nordic Minister Council Working Group on Quality Measurement (6 countries) and currently
involves the ollowing 23 countries: Australia, Austria, Canada, Czech Republic, Denmark, Finland, France,
Germany, Iceland, Ireland, Italy, Japan, Mexico, Netherlands, New Zealand, Norway, Portugal, Slovak Republic,
Spain, Sweden, Switzerland, United Kingdom, and the United States.
Conceptual approach is reerenced in Section 5.0, Figure 6.
Te stated criteria or indicator selection (explained ully in the methods report cited above) includes three main
criteria:“…the importance o what is being measured; the scientic soundness o the measure; and, the easibility/cost o
obtaining data. [Te] methods paper reviews types o indicators, the proposed scope o the measure set, criteria or
selecting indicators and other issues such as: geographical coverage (national representativeness), overall number o
indicators to be considered, changes in the set o indicators over time and composite measures. “
ctt:
Focus: Eectiveness, Saety, and Responsiveness o health care.
Number o Indicators: 13
ct: Methods paper reviews concepts used to rame health system perormance that were considered during
the process o selecting the ocus areas and indicators (see Arah 2006).
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 81/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 79
Brt cncr rvv
morphy crnn
Crvc cncr rvv
Crvc cncr crnn
Coorct cncr rvv
Vccn prvntb d
Covr or bc vccnton
ath ortty rt
act myocrd inrcton (ami)
30-dy ortty rt
strok 30-dy c tty rt
Waiting time for femur fracture surgery
Inuenza vaccination for adults over 65
sokn rt
exHibiT 4.4.5: oecd—HealTH caRe QualiTy index
(compaRable amonG 23 counTRies)
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 82/11480 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.4.6 Five million lives
c : Th ittt r Hthr irt
In partnership with hospitals throughout the U.S.
ctt: Based upon twelve interventions to prevent medical harm, the ve million lives campaign seeks to prevent
ve million o the estimated 15 million incidents o medical harm expected to occur over a two year period.
ct: Tis is a large private system eort to improve the quality and saety o the U.S. hospital care. It is
aligned with national health care improvement initiatives rom the IOM, AHRQ, CMS, JCAHO, National Hospital
Quality Measures ( JCAHO and CMS), American Heart Association, CDC, National Patient Saety Foundation, and
others. (See IHI website or a listing o quality/saety indicators used by these organizations.)
d (trt):
1. Dpoy rpd rpon t to ptnt t rk
o crdc or rprtory rrt
2. Dvr rb, vdnc-bd cr or ct
yocrd nrcton
3. Prvnt dvr dr vnt throh dr
rconcton (rb docntton o
chn n dr ordr)
4. Prvnt cntr n ncton
5. Prvnt rc t ncton
6. Prvnt vnttor-octd pnon
7. Prvnt prr cr
8. Rdc thcn-rtnt stphyococc
r (mRsa) ncton
9. Prvnt hr ro hh-rt dcton
10. Rdc rc copcton
11. Dvr rb, vdnc-bd cr or
contv hrt r
12. gt bord on bord
p mr
Nbr o ncdnt prvntd
Nbr o hopt prtcptn
s aHRQ nd othr, or pcfc r on
ptnt ty, ctv cr, ptnt cntrd cr,
tc.
exHibiT 4.4.6: Five million lives campaiGn
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 83/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 81
4.4.7 paTienT saFeTy in ameRican HospiTals sTudy
c : HthGr
http://www.healthgrades.com/media/dms/pd/patientsaetyinamericanhospitalsstudy2006.pd
ctt: Indicators or patient deaths and errors in U.S. hospitals. First report card to evaluate and publish saety
indicators or each state and every non-ederal hospital. Study based upon research by the Agency or Healthcare
Research and Quality (AHRQ) to dene and develop methods or identiying medical error. Evaluation o patient
saety perormance used 16 Patient Saety Indicators (PSIs) developed by the AHRQ.
ctt:
Focus: 16 PSIs, a composite measure to rank states and the perormance o individual hospitals, cost o medical errors.
Ptnt ty ndctor:
accdnt pnctr or crton
Copcton o nth
Dth n ow ortty DRg
Dcbt crFr to rc
Forn body t n drn procdr
itronc pnothorx
sctd ncton d to dc cr
Pot-oprtv horrh or hto
Pot-oprtv hp rctr
Pot-oprtv phyooc nd tboc
drnnt
Pot-oprtv ponry bo or dp vnthrobo
Pot-oprtv rprtory r
Pot-oprtv p
Pot-oprtv bdon wond dhcnc
Trnon rcton
exHibiT 4.4.7: paTienT saFeTy in ameRican HospiTals sTudy
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 84/11482 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.4.8 HospiTal compaRe
c : ctr r mr m sr
http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp?dest=NAV|Home|Search|Welcome#abop
ctt: Consumer inormation about hospital quality and results on measures o eective care.
Stated purpose: [Hospital Compare is a tool that] provides you with inormation on how well the hospitals care or all their
adult patients with certain conditions or procedures. Tis inormation will help you compare the quality o care hospitals provide.
Hospital Compare was created through the eorts o the Centers or Medicare & Medicaid Services (CMS), the
Department o Health and Human Services, and other members o the Hospital Quality Alliance: Improving Care Trough Inormation (HQA). Inormation on the website has been provided by hospitals that have voluntarily agreed
to submit quality inormation or Hospital Compare to make public.
ctt: Focus o indicators is in our areas: process o care, outcomes o care, patient experiences with care, and
Medicare payment and volume. Comparisons to average o all U.S. hospitals and hospitals in state or region.
ct:
Patient ratings provided by HCAPHS survey.
• All short-term, acute care, non-specialty hospitals are invited to participate in the HCAHPS survey. Most hospitals
choose to participate.• Hospitals that treat only certain types of patients or medical problem, called specialty hospitals, are not included
in the HCAHPS survey. Examples include psychiatric hospitals or children’s hospitals. Children’s hospitals are not
included because the HCAHPS survey asks about adult care only.
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 85/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 83
Hopt Proc o Cr mr:
• Eight measures related to heart attack care
• Four measures related to heart failure care
• Seven measures related to pneumonia care
• Five measures related to surgical infection prevention
Hopt Otco o Cr mr:
• 30-day mortality (following discharge)
srvy o Ptnt’ Hopt exprnc:
(Tn topc rtd to concton, rponvn, rpct, nvronnt, pn contro, oow-p cr,
ovr rtn)
mdcr Pynt nd Vo:
• Average Medicare payments
• Range of payments—25th–75th percentiles
exHibiT 4.4.8: HospiTal compaRe (cms) indicaToR seT
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 86/11484 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.4.9 TRends and indicaToRs in THe cHanGinG HealTH caRe
maRKeTplace cHaRTbooK
c : Th Kr F Ft
http://ww.health08.org/insurance/7031/index.cm
ctt: Inormation on key trends in the health care marketplace including health spending, the structure o the
health care marketplace, and health plan and provider relationships.
ctt: Focus areas: Seven sections including rends in Health Care Spending and Costs (Including Prescription
Drugs), rends in Health Insurance Enrollment, rends in Health Insurance Premiums, rends in Health Insurance
Benets, rends in the Structure o the Health Care Marketplace, rends in Health Plan and Provider Relationships,and Implications o Health Market rends or Consumers and the Saety Net.
Number o indicators: Approximately 80.
exHibiT 4.4.9: TRends and indicaToRs in a cHanGinG HealTH caRe
maRKeTplace cHaRTbooK
( ndctor t http://www.hth08.or/nrnc/7031/t2004-t.c)
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 87/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 85
4.4.10 woRld HealTH oRGanizaTion’s woRld HealTH sTaTisTics
Includes “en statistical highlights in global public health”
c : wHo irt st
ctt:
Internationally comparative health statistics.
On-line statistics.
ctt: Focus o en Statistical Highlights: Risk Factors, National Health Accounts, Health Systems
Focus o Report: Health status (mortality, morbidity), Health Services Coverage, Risk Factors, Health Systems,Inequities in health, Demographic and socioeconomic statistics.
Number o indicators: Approximately 75.
ct: Selected statistics are comparable among over 190 countries.
Rk Ftr
Chdrn <5 tntd
Chdrn <5 ndrwht
Chdrn <5 ovrwht
Low Birth Weight newborns
Obty— > 15 yr
Drnkn wtr orc—cc to provd
sntton—cc to provd
nt Hth at
Tot xpndtr on hth (% o gDP)
Tot ovrnnt hth xpndtr (% o
ovrnnt pndn)
Pr cpt tot xpndtr on hth t
ntrnton dor rt
Hth st
Hth workorc
Hth xpndtr rto
Hth xpndtr rt
Covr o vt rtrton—dth
Hopt bd
exHibiT 4.4.10: woRld HealTH oRGanizaTion: Ten Key inTeRnaTional measuRes
(compaRable To 193 counTRies)
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 88/11486 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.4.11 HealTH caRe cosTs 101
c : Th cr Hthr Ft
http://www.chc.org/topics/healthinsurance/index.cm?itemID=133630
nt Hth sg
tt ( )
hr Gdp
r r
mjor Pror shr o Bdt
spndn n Dvopd Contr
spndn Dtrbton by Ctory
spndn sry
spndn Dtrbton by Contrbtor
Contrbtor, spndn Dt
Pynt sorc, Contrbtor Dt
Htorc Pynt sorc
sg dtrt:
r
. rt
Ot o Pockt v. Prvt inrnc
ann growth Rt
n Nton Hth spndn
spending vs. ination
Drvr o spndn growth
Ctv ipct o growth Rt
ann growth Rt by Hth spndn Ctor
Prcrpton Dr by sorc o Pynt
ipct o mdcr Prt D
ann growth: Prvt Pr v. ann
growth
ann Ot-o-Pockt spndn
exHibiT 4.4.11: HealTH caRe cosTs 101
4.4 Health System Perormance
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 89/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 87
4.5 Other—Framing Approaches/Gaps/Frameworks
4.5.1 10 Top pRioRiTies FoR pRevenTion
c : Trt r ar’ Hth
http://healthyamericans.org/docs/?DocID=126 (last accessed June 16, 2008)
ct: See Section 5.0, Figure 12
4.5.2 Good HealTH counTs: a 21sT cenTuRy appRoacH To HealTH and communiTy in
caliFoRnia—pRoToType indicaToR seT
c : Th prt ittt
http://www.preventioninstitute.org/documents/GoodHealthCounts_Final.pd (last accessed June 16, 2008)
ct: See Figure 13
exHibiT 4.5.2 cHoice: cHanGinG HealTH oppoRTuniTies in communiTy enviRonmenTs
(Exhibit 4.5.2 continues on next page)
4.5 Other—Framing Approaches/Gaps/Frameworks
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 90/11488 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.5 Other—Framing Approaches/Gaps/Frameworks
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 91/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 89
4.5 Other—Framing Approaches/Gaps/Frameworks
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 92/11490 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.5.3 enviRonmenTal public HealTH indicaToRs
c : u.s. ctr r d ctr prt, nt ctr r
ert Hth, ert Hr Hth et prgr
http://www.cdc.gov/nceh/indicators/summary.htm (last accessed June 16, 2008)
ct: See prototype indicators in Exhibit 4.5.3 attached
T:
ar, abnt (Otdoor)
ar, indoorDtr
ld (Pb)
No
Ptcd
sntn evnt
sn nd utrvot lht
Toxics and Waste
Water, Ambient
Water, Drinking
Hr itr (tt r r t
tt r hr t):Crtr potnt n bnt r
Hzrdo or toxc btnc rd n bnt r
Rdnc n non-ttnnt r (or crtr r
potnt)
motor vhc on
Tobcco ok n ho wth chdrn
Residence in a ood plain
Ptcd nd pttrn o
Rd ptcd or toxc contnnt n ood
utrvot ht
Chc p
montord contnnt n bnt nd drnknwtr
Pont-orc dchr nto bnt wtr
Contnnt n hfh nd port nd corc
fh
expor indctor (borkr o xpor)
Bood d v (n chdrn)
Hth et itr (rr rt
r rtt ttrt t r):
Crbon onoxd poonnDth ttrbtd to xtr n bnt tprtr
ld poonn (n chdrn)
No-ndcd hrn o (non-occpton)
Ptcd-rtd poonn nd n
in or condton wth pctd or confrd
nvronnt contrbton ( c or n n
pttrn)
mno
Pob chd poonn (rtn n contton or
rncy dprtnt vt)
Otbrk ttrbtd to fh nd hfh
Otbrk ttrbtd to bnt or drnkn wtrcontnnt
itrt itr (rgr r f
rg rt hr):
Pror tht ddr otor vhc on
atrnt n rtrd otor vhc
avbty o trnt
Poc tht ddr ndoor r hzrd n choo
lw prtnn to ok-r ndoor r
indoor r npcton
erncy prprdn, rpon, nd tton
trnn pror, pn, nd protocoCopnc wth ptcd ppcton tndrd
(on ptcd workr)
actvty rtrcton n bnt wtr (hth-bd)
ipntton o ntry rvy
Copnc wth oprton nd ntnnc
tndrd or drnkn wtr yt
Bo-wtr dvor
exHibiT 4.5.3: summaRy oF coRe enviRonmenTal public HealTH indicaToRssorc: envronnt Pbc Hth indctor Projct; CDC, NCeH, eHHe; Jnry 2006
4.5 Other—Framing Approaches/Gaps/Frameworks
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 93/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 91
4.5.4 eaRly cHildHood indicaToRs—pRoJecT THRive pRoToType
c : nt ctr r chh prt, c urt, m sh
s wrk
http://www.nccp.org/publications/pub_822.html (last accessed June 16, 2008)
ct: See prototype indicators in Exhibit 4.5.4 attached.
(Exhibit 4.5.4 continues on next page)
4.5 Other—Framing Approaches/Gaps/Frameworks
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 94/11492 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
4.5 Other—Framing Approaches/Gaps/Frameworks
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 95/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 93
4.5.5 biG ciTies HealTH invenToRy—THe HealTH oF uRban usa
c : nt at ct ct Hth of (naccHo)
http://www.naccho.org/pubs/product1.cm?Product_ID=202 (last accessed June 16, 2008)
ct: See Section 5.0, Figure 14
4.5 Other—Framing Approaches/Gaps/Frameworks
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 96/11494 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
FiGuRe 1: deTeRminanTs oF HealTH (evans and sToddaT, 1990)
FiGuRe 2: social deTeRminanTs—communiTy Guide (andeRson, 2003)
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 97/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 95
FiGuRe 3: liFe couRse HealTH developmenT (iom, 2004)
FiGuRe 4: eaRly expeRiences and HealTH (RwJ, 2008)
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 98/11496 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
FiGuRe 5: six Key dimensions oF HealTH caRe
(iom commiTTee on THe QualiTy oF HealTH caRe, 2001)
ethg a r th 21t-tr Hth cr st
Th cott propo x or provnt to ddr ky dnon n whch tody’ hth cr yt
ncton t r owr v thn t cn nd hod. Hth cr hod b:
• Sae—vodn njr to ptnt ro th cr tht ntndd to hp th.
• Eective—provdn rvc bd on cntfc knowd to who cod bnft nd rrnn ro provdn
rvc to tho not ky to bnft (vodn ndr nd ovr, rpctvy).
• Patient-centered —provdn cr tht rpct o nd rponv to ndvd ptnt prrnc, nd, nd
v nd nrn tht ptnt v d cnc dcon.
• Timely —rdcn wt nd ot hr dy or both tho who rcv nd tho who v cr.
•Efcient —vodn wt, ncdn wt o qpnt, pp, d, nd nry.
• Equitable—provdn cr tht do not vry n qty bc o pron chrctrtc ch ndr, thncty,
orphc octon, nd ococonoc tt.
The CIW will treat benecial activities as assets and harmful ones as decits. It will, for example:
• distinguish between good things like health and clean air, and bad things, like sickness and pollution;
• promote volunteer work and unpaid care-giving as social goods, and overwork and stress as social decits;
• put a value on educational achievement, early childhood learning, economic and personal security, a clean
nvronnt, nd oc nd hth qty; nd,
• encourage a better balance between investment in health promotion and spending on illness treatment.
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 99/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 97
FiGuRe 6: HealTH sysTem peRFoRmance—HealTH caRe QualiTy index (oecd)
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 100/11498 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
FiGuRe 7: oecd FacTbooK: QualiTy oF liFe
➚
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 101/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 99
FiGuRe 8: measuRes oF ausTRalia’s pRoGRess
Th econoy nd Th lvn
indvd econoc Rorc envronnt Tothr
Hdn Hth Nton nco Th ntr Fy, conty
dnon ndcp nd oc cohon
edcton econoc hrdhp Th r nd Cr
nd Trnn tophr
Work National wealth Oceans Democracy, governance
nd tr nd ctznhp
Hon
Prodctvty
sppntry Ctr Copttvn Concton
dnon nd lr nd opnn
Ination Transport
FiGuRe 9: canadian index oF well-beinG
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 102/114100 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
FiGuRe 10: HospiTal caRe inTensiTy index (THe daRTmouTH aTlas, 2008)
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 103/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 101
FiGuRe 11: example oF sTandaRd selecTion cRiTeRia
Fn Crtr gdn scton o ldn Hth indctor, Cott on ldn Hth indctor or Hthy
Pop 2010 (iOm, 1999)
1. Worth measuring—the indicators represent an important and salient aspect of the public’s health
2. Cn b rd or dvr popton—th ndctor r vd nd rb or th nr popton nd
dvr popton rop
3. undrtood by pop who nd to ct—pop who nd to ct on thr own bh or tht o othr hod b
b to rdy coprhnd th ndctor nd wht cn b don to prov th tt o tho ndctor;
4. inorton w vnz cton—th ndctor r o ch ntr tht cton cn b tkn t th nton,
tt, oc nd conty v by ndvd w ornzd rop nd pbc nd prvt nc;
5. acton tht cn d to provnt r known nd b—thr r provn cton (.., pron bhvor,
pntton o nw poc, tc.) tht cn tr th cor o th ndctor whn wdy ppd; nd
6. Measurement over time will reect results of action—if action is taken, tangible results will be seen indicating
provnt n vro pct o th nton’ hth.
FiGuRe 12: FRaminG example: TRusT FoR ameRica’s HealTH
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 104/114102 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
FiGuRe 13: FRaminG example: pRevenTion insTiTuTe pRoToType
CHOiCe: Chnn Hth Opportnt n Conty envronnt (sp ndctor provdd n exhbt 4.5.2)
eqtb opportnty ctor: Do vryon hv cc to opportnt?
Rc jtc
Job nd oc ownrhp
edcton
Pop ctor: ar pop connctd nd nd?
soc ntwork nd trt
Prtcpton nd wnn to ct or th coon ood
accptb bhvor nd tttd
Pc ctor: i th conty nvronnt condcv to hth?
What’s sold and how it’s promoted
look, nd ty
Prk nd opn pc
gttn rond
Hon
ar, wtr nd o
art nd ctr
mdc srvc: Do dc rvc t th nd o th conty?
Prvntv rvc
acc
Trtnt qty, d nnt, n-ptnt rvc, nd trntv dcn
Ctr coptnc
erncy rpon
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 105/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 103
FiGuRe 14: RanKinG example: biG ciTies invenToRy
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 106/114104 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
FiGuRe 15: GRades example: wisconsin
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 107/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 105
FiGuRe 16: GRades example: GeoRGia
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 108/114106 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
FiGuRe 17: use oF Gis and maps: u.s. liFe expecTancy by counTRy
FiGuRe 18: HealTH TRaJecToRies (HalFon, 2005)
5.0 Figures
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 109/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 107
6.0 Reerences
Agwunobi JO. 2006. Te Healthy People 2010 Midcourse Review (Executive Summary-Goal 1: Increase quality and years o healthy lie). U.S. Public Health Service , DHHS , Washington, D.C.
Anderson LM, Scrimshaw, SC, Fullilove, M, Fielding, JE, andthe ask Force on Community Preventive Services. 2003. TeCommunity Guide’s Model or Linking the Social Environment toHealth. Am J Prev Med 2003;24(3S).
Arah OA, Westert GP, Hurst J, Klazinga NA. 2006. A ConceptualFramework or the OECD Health Care Quality Indicators Project.Published by Oxord University Press on behal o InternationalSociety or Quality in Health Care. September 2006: pp.5-13.
Braveman P. and Egerter S. (2008) Overcoming Obstacles to Health:Report or the Robert Wood Johnson Foundation to the Commissionto Build a Healthier America. Robert Wood Johnson Foundation.Accessed June 14, 2008 rom http://www.rwj.org/les/research/obstaclestohealth.pd.
Chrvala CA and Bulger, RJ (Eds.). 1999. Institute o Medicine.Leading HealthIndicators or Healthy People 2010: Final Report.National Academy o Sciences. Washington, DC.
Community Health Status Indicators. Permission to access testsite rom Marilyn Metzler, U.S. Centers or Disease Control andPrevention (April 2008).
Simon P and Lee N. Surveillance o Childhood Overweight inLos Angeles County: Use o a School-Based Physical Fitness est-ing Program. Los Angeles County Department o Health Services.Presentation at UCLA, June 16, 2005. Accessed at www.healthychild.ucla.edu/CHNWppts/Simon%20Paul%20presentation.ppt on July 9,2008.
Evans RG and Stoddart GL. Original (1990) determinants o healthmodel accessed in Am J Public Health. 2003;93:371–379).
Ezzati M, Friedman AB, Kulkarni SC, Murray CJL. 2008. TeReversal o Fortunes: rends in County Mortality and Cross-County Mortality Disparities in the United States PLoS Medicine Vol. 5, No.4, e66 doi:10.1371/journal.pmed.0050066
Fahimi M, Link M, Schwartz DA, Levy P, Mokdad A. rackingchronic disease and risk behavior prevalence as survey participationdeclines: statistics rom the Behavioral Risk Factor SurveillanceSystem and other national surveys. Prev Chronic Dis 2008;5(3).http://www.cdc.gov/pcd/issues/2008/jul/07_0097.htm. Accessed June25, 2008.
Five Million Campaign. 2007. Alignment with National HealthcareImprovement Initiatives. Last accessed on June 14, 2008 rom http://
www.ihi.org/NR/rdonlyres/CC960DDD-2BB3-41C1-9D56--957876C9C1B/0/CampaignAlignmentWithNationalHealthcareImprovementInitiatives.pd.
Foundation or Child Development. 2007. Child Well-Being Index(CWI). Last accessed on June 14, 2008 romhttp://www.cd-us.org/initiatives/initiatives_show.htm?doc_id=463963.
Friedman M. 2005. rying hard is not good enough. How to producemeasurable improvements or customers and communities. Victoria(CA): raord Publishing.
Gallup-Healthways Well-Being Index. Last Accessed on June 15,2008 rom http://www.well-beingindex.com/index.html. Newscoverage related to the study ndings accessed on April 30, 2008 romhttp://www.reuters.com/article/latestCrisis/idUSN29370158.
GAO. 2003 (GAO-03-672SP). Key National Indicators: Assessingthe Nation’s Position and Progress. U.S. Government Accountability Oce. Washington, DC.
GAO. 2004 (GAO-05-01). Inorming our Nation. Improving How to Understand and Assess the USA’s Position and Progress. U.S.Government Accountability Oce. Washington, DC Last accessedon June 14, 2008 rom www.gao.gov/cgi-bin/getrpt?GAO-05-1.
GAO (GAO-07-497). 2007. Health Care Spending. Public Payers
Face Burden o Entitlement Program Growth, While All PayersFace Rising Prices and Increasing Use o Services. estimony Beorethe Subcommittee on Military Construction, Veterans Aairs,and Related Agencies, Committee on Appropriations, House o Representatives. Accessed at http://www.gao.gov/new.items/d07497t.pd
Halon N, Hochstein M. Lie course health development: anintegrated ramework or developing health, policy and research.Milbank Quarterly 2002;80(3):433-79.
Halon, N. 2005. Measuring the Health and Well-Being o Childrenand Youth. New Models. Presented at the Children’s Health, TeNation’s Wealth Meeting, Los Angeles, CA, June 16, 2005. Figureused by permission rom Neal Halon.
Institute o Medicine. 1997. Improving Health in the Community: ARole or Perormance Monitoring. J.S. Durch, L.A. Bailey, and M.A.Stoto, eds. Washington, D.C.: National Academy Press.
Institute o Medicine. 2001. Crossing the Quality Chasm: A New Health System or the 21st Century. Washington, DC: NationalAcademy Press.
Institute o Medicine. 2004. Children’s Health, the Nation’s Wealth.Assessing and Improving Child Health. Washington, DC: NationalAcademy Press.
Krieger N, Rehkop DH, Chen J, Waterman PD, Marcelli E,Kennedy M. 2008. Te Fall and Rise o US Inequities in PrematureMortality: 1960–2002. PLoS Medicine Vol. 5, No. 2, e46 doi:10.1371/
journal.pmed.0050046
McCannon CJ, et al. 2007. Miles to Go: An Introduction to the 5Million Lives Campaign. Te Joint Commission Journal on Quality and Patient Saety. Last accessed on June 14, 2008 rom http://
www.ihi.org/NR/rdonlyres/DA1D43DD-464A-46BC-9D1A-C290EE371DE0/0/MilestoGo.pd.
National Center or Health Statistics (NCHS). 2007. Health, UnitedStates, 2007. Hyattsville, MD. Available on-line at http://www.cdc.gov/nchs/hus.htm.
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 110/114108 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
National Committee on Vital and Health Statistics. 2002. Shapinga health statistics vision or the 21st century.: U.S. Department o Health and Human Services. Washington, D.C.Prevention Institute. 2008. Good Health Counts: A 21 st Century
Approach to Health and Community or Caliornia. Published by TeCaliornia Endowment. Los Angeles, CA.
Robert Wood Johnson Foundation. 2008. Early ChildhoodExperiences: Laying the Foundation or Health Across a Lietime.Issue Brie 1: Early Experiences and Health. Princeton, NJ. Lastaccessed on June 15, 2008 at http://www.commissiononhealth.org/PDF/095bea47-ae8e-4744-b054-258c9309b3d4/Issue%20Brie%201%20Jun%2008%20-%20Early%20Childhood%20Experiences%20and%20Health.pd.
Shonko, JP, Pillips DA, (Eds.). (2000). From neurons toneighborhoods: the science o early childhood development.
Washington (DC): National Academies Press.
Understanding Estimates o the Uninsured: Putting the Dierencesin Context (no date) at http://www.aspe.hhs.gov/health/reports/hiestimates.htm. Last accessed on June 14, 2008.
Walker, DM. 2008. U.S. Financial Condition and Fiscal Future(GAO-08-417CG). Brieng by Te Honorable David M. Walker,Comptroller General o the United States. Last accessed on May 16,2008.http://www.gao.gov/cghome/d08417cg.pd.
Wennberg, JE (personal communication). April 2008.
Wold, CM and Nicholas, W. 2007. Starting School Healthy andReady to Learn: Using Social Indicators to Improve School Readinessin Los Angeles County. Preventing Chronic Disease. 2007(4):4. U.S.Centers or Disease Control and Prevention. Available on-line at
www.cdc.gov/pcd/issues/2007/oct/07_0073.htm.
Reerences or Figures
Figure 1: Evans and Stoddart, 1990
Figure 2: Anderson, et al., 2003. Also on-line at http://www.thecommunityguide.org/social/Social-Environment.pd
Figure 3: IOM, 2003. Also on-line athttp://www.iom.edu/Object.File/Master/23/164/0.pd
Figure 4: RWJ, 2008. Also on-line at
http://www.commissiononhealth.org/PDF/095bea47-ae8e-4744-b054-258c9309b3d4/Issue%20Brie%201%20Jun%2008%20-%20Early%20Childhood%20Experiences%20and%20Health.pd
Figure 5: IOM, 2001
Figure 6: Arah, 2006
Figure 7: OECD Factbook: Quality o Lie. Last accessed on June 15,2008 at http://miranda.sourceoecd.org/vl=2462720/cl=11/nw=1/rpsv/actbook/
Figure 8: Measures o Australia’s Progress Last accessed on June 15, 2008 at http://www.abs.gov.au/AUSSAS/abs@.ns/Lookup/1383.0.55.001Main%20Features72008%20(Edition%201)?opendocument&tabname=Summary&prodno=1383.0.55.001&issu
e=2008%20(Edition%201)&num=&view=
Figure 9: Canadian Index o Well-Being Last accessed on June 15, 2008 at http://www.atkinsonoundation.ca/ciw/SkinnedFolder_1191957711895
Figure 10: Hospital Care Intensity Index Last accessed on June 15,2008 at http://cecsweb.dartmouth.edu/atlas08/datatools/hci_s1.php
Figure 11: Example o Standard Selection Criteria. Final CriteriaGuiding Selection o Leading Health Indicators. IOM 1999. (SeeChrvala, et al, 1999).
Figure 12: Framing example: rust or America’s Health Lastaccessed on June 15, 2008 at http://healthyamericans.org/
healthieramerica/10TingsBook.pd
Figure 13: Prevention Institute, 2008.
Figure 14: Big Cities Inventory. Last accessed on June 15, 2008 athttp://www.naccho.org/topics/crosscutting/documents/BCHI07COLORFINAL.pd
Figure 15: Health o Wisconsin. Last accessed on June 15, 2008 athttp://www.pophealth.wisc.edu/UWPHI/research/report_card_2007/report_card_2007.htm
Figure 16: Georgia Health Disparities Report. Last accessedon June 15, 2008 at http://dch.georgia.gov/vgn/images/portal/cit_1210/21/33/111684019Georgia_Health_Equity_Initiative_Health_Disparities_Report_2008.pd
Figure 17: Accessed on April 27, 2008 at http://www.nytimes.com/2008/04/27/weekinreview/27sack.html
Figure 18: Halon, 2005
6.0 Reerences
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 111/114
Te State of the USA • Health Indicators—A Review o Reports Currently in Use 109
Appendix A:Links to echnical Data about Data Sources
Overview Of many data sOurcesused fOr health indicatOrs:
Health, U.S. 2007 Chartbook http://www.cdc.gov/nchs/data/hus/hus07.pd#tocappi
links tO variOus data sOurces and methOds repOrts:
National Survey on Drug Abuse and HealthSubstance Abuse and Mental Health Services Administrationhttp://www.oas.samhsa.gov/nhsda/2k2nsduh/Results/appG.htmandhttp://www.icpsr.umich.edu/cocoon/SAMHDA/SUDY/21240.xml
American Community Survey http://www.census.gov/acs/www/index.html andhttp://www.childstats.gov/americaschildren/surveys.asp#acs
National Health and Nutrition Examination Survey (NHANES)http://www.childstats.gov/americaschildren/surveys.asp#nhnes
YRBS -Methodshttp://www.cdc.gov/mmwr/PDF/rr/rr5312.pd
CDC. Selected Metropolitan/Micropolitan Area Risk rends(SMAR). Atlanta,GA: US Department o Health and Human Services, CDC, NationalCenter or Chronic Disease Prevention and Health Promotion, 2004.
Available at http://apps.nccd.cdc.gov/brss-smart/index.asp.
Data Source Descriptions or Indicators used in America’s Childrenhttp://www.childstats.gov/americaschildren/surveys.asp
Data Source Descriptions or Indicators used in Older Americans2008: Key Indicators o Well-Beinghttp://agingstats.gov/agingstatsdotnet/Main_Site/Data/2008_Documents/Appendix_B.aspx
Describes dierences in health insurance estimates rom CPS,MEPS, NHIS and other sources:http://aspe.hhs.gov/health/Reports/uninsur3.htmValidity o BRFSS, NHIS measures (comparisons to NHANES):
Fahimi M, Link M, Schwartz DA, Levy P, Mokdad A. rackingchronic disease and risk behavior prevalence as survey participationdeclines: statistics rom the Behavioral Risk Factor SurveillanceSystem and other national surveys. Prev Chronic Dis 2008;5(3).http://www.cdc.gov/pcd/issues/2008/
jul/07_0097.htm. Accessed June 25, 2008.
links tO references regarding summary measures fOr health (health-relatedquality Of life, etc.):
Stewart S, Woodward RM, Rosen AB, Cutler DM. Aproposed method or monitoring U.S. population health: linkingsymptoms, impairments, and health ratings. NBER Working Papers 2007;11358:1-56. pd (270K)
Agwunobi JO. Te Healthy People 2010 Midcourse Review (ExecutiveSummary-Goal 1: Increase quality and years o healthy lie). U.S.Public Health Service , DHHS , Washington, D.C., 2006. html pd (585K)
Klementiev A. Chapter 5-An alternative measure o years o healthy lie--[rom: Estes RJ (ed.), Advancing Quality o Lie in a urbulent
World]. Social Indicators Research Series, Springer Netherlands2006;29:67?84.
Miller W, Robinson LA, Lawrence RS (Eds); Committee to evaluatemeasures o health benets or environmental, health, and saety regulation board on health care services. Valuing health or regulatory cost-eectiveness analysis. Institute o Medicine , National AcademiesPress, Washington, D.C., 2006:1-364. abstract* html* pd* (222KB)Chang CF, Nocetti D, Rubin RM. Healthy lie expectancy orselected race and gender subgroups: Te case o ennessee. South Med J 2005;98(10):977?984. abstract
Centers or Disease Control and Prevention. Health-Related Quality o Lie, Part II ? State and Local Applications [Internet]. Chronic
Disease Notes and Reports 2004;16:1-48. pd (1200KB)
Andresen EM, Recktenwald A, Gillespie K. Population estimateso utilities: the Health and Activity Limitation Index (HALEX)(Abstract)?presentation at the10th annual meeting o theInternational Society or Quality o Lie Research, Nov 12?15, 2003in Prague, Czech Republic. Qual Lie Res 2003;12(7):737.
Buescher PA, Ziya Gizlice Z. Healthy Lie Expectancy in NorthCarolina, 1996?2000. SCHS Studies; North Carolina Departmento Health and Human Services, State Center or Health Statistics,Raleigh, NC 2002; No.129: 17. pd (65K)
Gold M. Summary measures o population health and beyond: alook at U.S. ederal activities in measuring the health o populations.
WHO Conerence. Statistical Commission and Economic Commission or Europe 2000. Working paper No. 11. Ottawa Canada, 23?25. pd*(41K)
Harwell S, Spence MR. Population surveillance or physical violence among adult men and women, Montana. Am J Prev Med 2000;19(4):321?324. abstract
U.S. Department o Health and Human Services. Healthy People 2010. 2nd ed. With understanding and improving health andobjectives or improving health. 2 vols. Washington, DC: U.S.Government Printing Oce 2000. html
Te ollowing links and reerences provide additional inormation about the characteristics (e.g., technical details,
methods, quality) about data sources and health indicators.
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 112/114110 Health Indicators—A Review o Reports Currently in Use • Te State of the USA
Appendix B:Selected Indicators and Data Sources
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 113/114
8/3/2019 Wold Indicators July08
http://slidepdf.com/reader/full/wold-indicators-july08 114/114
Health Indicators A Review o Reports Currently in Use
Th stt o th usa
900 17th strt, #700
Washington, D.C. 20006
202.552.4710
www.ttoth.or