Doctors use vital signs as a relatively straightforward way to detect an illness or monitor a person’s health. Key ones include blood pressure, body temperature, breathing rate, and heart rate. A report from the newly christened National Academy of Medicine (formerly the Institute of Medicine) proposes using 15 “vital signs” to track how health care in the United States measures up:
- life expectancy
- overweight and obesity
- addictive behavior
- unintended pregnancy
- healthy communities
- preventive services
- access to care
- patient safety
- evidence-based care
- care that matches patient goals
- personal spending burden
- population spending burden
- individual engagement
- community engagement.
Why bother creating such a list? Health care costs in the U.S. are the highest in the world, yet people in many countries that spend less on health care are in better health overall and have better health care outcomes. In order to improve the performance of health care, we need to measure how it is doing in a logical, sustainable way. But that isn’t happening today.
Many organizations do try to measure quality, but use a vast number of measures. For example, the National Quality Forum, a nonpartisan organization aimed at improving health care, has more than 600 of these types of measures in its toolkit. And the Centers for Medicare and Medicaid Services has more than 1,700. The new report from the National Academy of Medicine, called Vital Signs, estimates that individual health systems employ on average 50 to 100 people full-time to measure performance, at costs ranging from $3.5 million to $12 million per organization per year. Factor in the number of health systems around the country, and that adds up to real money.
“If we want to know how effective and efficient our health expenditures are in order to improve health and lower costs, we need to measure the most crucial health outcomes to guide our choices and gauge impact,” said panel chair David Blumenthal, president of the Commonwealth Fund in New York City, in a statement.
The 15 measures the Vital Signs panel proposed aren’t meant to be the only ones used. Instead, they represent “the most powerful measures that have the greatest potential to positively affect the health and well-being of Americans,” said Blumenthal. They are intended to be a core set of benchmarks that assess the most important aspects of health and health care.
Some of the 15 vital signs, such as life expectancy, well-being, overweight and obesity, and addictive behavior, measure aspects of individual health. Others, such as access to care, patient safety, and evidence-based care, assess the health care system. Both types are needed to gauge the nation’s health and the quality of our health care.
These vital signs will help us answer questions about what we are doing well and where we must improve. Repeating these measurements over time will provide critical information about the trajectory of our nation’s health and the course corrections needed to improve it. Making such changes should improve our vital signs and lessen the monumental amount of money we spend on health care.