Overview of Health Indicators

7/30/2019 Overview of Health Indicators

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Overview of Health IndicatorsModule 1

Cheryl Wold, MPHWold and Associates

for theNational Library of

Medicine


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Looking Ahead

Module 2Will explore Community HealthStatus Indicators (CHSI), an on-line health

indicator resource. Module 3 - Case study of librarian

involvement in indicators.

Module 4Look in-depth at a few health

indicator reports and on-line tools.

Health Indicators, Part I


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Goal for Todays Presentation:

Understand the variety of health indicators, their datasources, their key attributes, context and use.

Describe health indicators Models of health

Common health indicators and data sources

How are health indicators used and compiled?- Examples of reports and on-line tools

- Resources for further reading



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Background

Presentation draws upon my experience with

developing health indicators and data.

Review of health indicators conducted for

Institute of Medicine Committee for The State

of the USA (July 2008).

http://www.stateoftheusa.org

Showed the range of content and use

associated with health indicators.

http://www.stateoftheusa.org/http://www.stateoftheusa.org/http://www.stateoftheusa.org/


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What is Health?

By far, the most accepted definition is that of the

World Health Organization:

[Health is] the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO,

1948) and the extent to which an individual or group is able to

realize aspirations and satisfy needs, and to change or cope with

the environment. Health is a resource for everyday life, not theobjective of living; it is a positive concept, emphasizing social and

personal resources as well as physical capabilities (WHO, 1984).



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What are Health Indicators? (1)

With the goal of good health in mind, think ofan indicator as

a measure that helps quantify theachievement of a goal.

-Mark Friedman



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What are Health Indicators? (2)

Power of indicators is comparisons

- over time (trends)

- geographic areas- groups of people

and the focus on the most essential domains ofhealth.



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What makes a good indicator?

Data Powerhigh quality, available data

Proxy Powercentral importance to health

Communication Powerthat the meaning istransparent.



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What are the bases for healthindicators?

Health indicators are based upon conceptual models for whatinfluences health status, based upon scientific research.

Models have evolved over time, as have definitions of health, but

trace historical improvements in health, e.g., increases in lifeexpectancy, declines in mortality due to infectious diseases.

Context is important: For example, in 1900 the leading causes of

death were Pneumonia, Tuberculosis, and Diarrhea and Enteritisas compared to Heart Disease, Cancer, and Stroke in 2006.

Source: MMWR. July 30, 1999 / 48(29);621-629

http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf

http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdfhttp://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf


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Current Conceptual Frameworks

Todays context:Rate of healthcare spending is unsustainable, and, levels ofspending not consistent with level of health. Ripe opportunities forincreasing the return on investments in health through prevention.

Burden of chronic diseases (e.g., premature mortality, costs) andComplex public health problems (e.g., violence, obesity, HIV), andhealth-related behaviors (e.g., smoking, diet, substance use)

The influence of social and environmental conditions ondetermining health outcomes, either directly or indirectlyDeep, persistent disparities in health



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Common Frameworks for HealthIndicators

1. Broad Determinants of Health- emphasizes thephysical environment, social environment, health behaviors,

medical care.

2. Life Course- emphasizes conditions/experiences earlyin life (e.g., 0-5) and interactions at developmental stages

throughout life in optimizing our health "trajectory".

3. Social Determinantsemphasizes educational,economic, and social conditions and interactions in shaping

health.



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How are health indicators used?

Indicators are powerful tools for monitoring and communicatingcritical information about population health.

Indicators are used to support planning (identify priorities, develop andtarget resources, identify benchmarks) and track progress toward broadcommunity objectives.

Engagement of partners into civic and collaborative action (build

awareness of problems and trends, generate interventions).

Inform policy and policy makers, and can be used to promoteaccountability among governmental and non-governmental agencies.



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Who compiles health indicators?

Reports are compiled at every jurisdictional level

State and local level - Health departments, foundations

and philanthropic organizations, businesses, educational,

law enforcement, human services providers, and other civicleaders, faith organizations, universities, media.

NationalFederal government/private partnerships.

InternationalOECD, WHO


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CommonHealth Indicators (1)

The most common health indicators are those related to birth and death: Life expectancy, Premature mortality (e.g., Years of Potential Life Lost or YPLLs) Age-specific death rates (e.g., infants, teens) Cause specific deaths (e.g., lung, cervical cancer)

Births to teens Very/Low birth weight Adequacy of prenatal care Social characteristics of parents (e.g, maternal educational attainment).

These are robusthigh completeness of reporting, widely available through

the National Vital Statistics System, and standardized so as to be arecomparable across states and nations.

But, also limited.



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Common Health Indicators (2)

Morbidity/Health Status

Health-related Quality of Life:

Poor health days

Self-rated health statusObesity

Body Mass Index based on self-reported height and

weight

Diabetes, asthma, and other chronic diseases.


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Common Health Indicators (3)

Health Behaviors:

Not smoking Regular physical activity Diet and nutrition Moderate or no drinking, not using drugs.

Access to Health Care

Insurance coverage

Regular source of care Avoidable hospitalizations Receipt of preventive services



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Data Sources for Common Indicators

National Vital Statistics System (Birth, Mortality)

Surveys (Behavioral Risk Factor Survey--Adults and

Youth, National Health Interview Survey,National Health

and Nutrition Examination Survey,National Survey ofChildren's Health, National Immunization Survey)

Disease Surveillance Systems

Health services administrative data (Medicare/Medicaid

Claims, hospital billing data or other required/voluntaryreporting)



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Social Indicators (1)

Physical environment: Area-based measures, e.g., income/poverty, population density

Access to public transportation, housing

Environmental pollution, e.g., air and water quality.

Social environment:

Income (individual/family) Education (e.g., high-school graduation rates, students

reading/doing math at grade level) Social support and connectedness.



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Social Indicators (2)

Child and family focused: Parental educational attainment Parent practices (e.g., breastfeeding, reading to child, regular

meal/bedtimes)

Access to services such as early developmental screening Family social environment (e.g. parent stress, depression)



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Data Sources

Social/Environmental

Social and Environmental: Census (American Community Survey, Current

Population Survey)

National Survey of Child Health Education Dept. (National Assessment of

Educational Progress)

Environmental Protection Agency (Air Quality

Monitoring data, Toxics Release Inventory)Federal sources are supplemented on the state and

local level with administrative data from e.g.,

human services, educational, and justice systems



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Gaps in Data Sources or Measures

Examples of indicators that lack of systematically collectedand standardized data:

Early life - developmental outcomes at the time of

kindergarten entry and conditions throughout childhoodand youth, e.g., obesity.

Later lifecommunity care and support, long term care,quality and availability of services.

Social environments, e.g., neighborhood characteristics,quality of social interactions.



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Health System Performance Indicators

Access (additional) Trends in health insurance enrollment, range of benefits, exclusions, premiums Rural health provider supply, linguistic or cultural barriers to getting care

Cost Total health expenditures

Health as share of Gross Domestic Product (GDP) Prescription drug costs Payments to hospitals, facilities Comparisons of resources used per patient between hospitals/areas

Quality of care Effective carereceipt of recommended screenings, treatment, readmission

rates. Patient Safetymedical error



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Data Sources for Indicators (HealthSystem Performance)

Surveys (Consumer Assessment of Health Providers and

Systems, Medical Expenditure Panel Survey)

Hospital billing records (reported to state oversight

bodies) Medicare/Medicaid Claims (Centers for Medicare and

Medicaid Services)

Voluntary reporting to Federal government (Agency for

Healthcare Research and Quality) Required reporting (Healthcare Effectiveness Data and

Information SetHEDIS)

Studies (Public/Private)



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Using the Indicators: Criteria for ReportSelection in SUSA Review

Criteria for report selection: Created from high-quality and currently available data

Used expert input and broad participatory processes Designed for dissemination to diverse audiences Represented a variety of geographic regions



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Using the Indicators: Results of

Review

The Review Identified: Types of health indicator reports

General Health Indicator (national, state, local,international)

Quality of Life--Comprehensive Indicator Systems Health System Performance

Universe of health indicators and their attributes

Data sources and disaggregation potential

Range of practices related to accessing and

presenting the indicators.

Gaps in data



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Using the Indicators: Overview of

Features/Focus Areas

Disparities

Social indicators

Ranked comparisons, benchmarks, compositemeasures

Children and families

Local health planning Comprehensive indicator systems

Health system performance



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Using the Indicators: Focus on

Disparities and Social Indicators

Disparities Georgia Health Disparities Report (State of Georgia

Public Health)http://dch.georgia.gov/vgn/images/portal/cit_1210/5/49/111684019Georgia_Health_

Equity_Initiative_Health_Disparities_Report_2008.pdf

Health of Wisconsin Report Card (Univ. of WisconsinPopulation Health Institute)http://uwphi.pophealth.wisc.edu/pha/healthiestState/reportCard/2007.htm

Social indicators Commission on a Healthier U.S., (Robert Wood Johnson

Foundation)http://www.commissiononhealth.org/WhatDrivesHealth.aspx

http://dch.georgia.gov/vgn/images/portal/cit_1210/5/49/111684019Georgia_Health_Equity_Initiative_Health_Disparities_Report_2008.pdfhttp://dch.georgia.gov/vgn/images/portal/cit_1210/5/49/111684019Georgia_Health_Equity_Initiative_Health_Disparities_Report_2008.pdfhttp://uwphi.pophealth.wisc.edu/pha/healthiestState/reportCard/2007.htmhttp://www.commissiononhealth.org/WhatDrivesHealth.aspxhttp://www.commissiononhealth.org/WhatDrivesHealth.aspxhttp://uwphi.pophealth.wisc.edu/pha/healthiestState/reportCard/2007.htmhttp://dch.georgia.gov/vgn/images/portal/cit_1210/5/49/111684019Georgia_Health_Equity_Initiative_Health_Disparities_Report_2008.pdfhttp://dch.georgia.gov/vgn/images/portal/cit_1210/5/49/111684019Georgia_Health_Equity_Initiative_Health_Disparities_Report_2008.pdf


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Source: Wisconsin County Health Rankings (2007), University of

Wisconsin, Population Health Institute.


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Using the Indicators: Focus on

Rankings, Benchmarks,Trends

Rankings / Benchmark comparisons Americas Health Rankings (United Health

Foundation, American Public Health Association,

Partnership for Prevention)http://www.americashealthrankings.org/

Big Cities (National Association of City and

County Health Officials) http://eweb.naccho.org~

State Scorecard on Health System Performance(Commonwealth Fund)

http://www.commonwealthfund.org/Content/Publicatio

ns/Fund-Reports/2009/Oct/2009-State-Scorecard.aspx

http://www.americashealthrankings.org/http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspxhttp://www.americashealthrankings.org/


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Americas Health Rankings

Source: http://www.americashealthrankings.org/glance.aspx

Health Indicators Part 1


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2009 State Scorecard Summary

of Health System Performance


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State Variation: AmbulatoryCare Quality Indicators


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Health System Performance

Focus on access to health care, costs, quality

and effectiveness, including patient safety.

State Scorecard on Health System Performance

(Commonwealth Fund)

Dartmouth Atlas (Dartmouth Medical School)

http://www.dartmouthatlas.org/interactive_map.shtm

Hospital Compare (Centers for Medicare &Medicaid Services (CMS))http://www.hospitalcompare.hhs.gov/

http://www.dartmouthatlas.org/interactive_map.shtmhttp://www.hospitalcompare.hhs.gov/http://www.hospitalcompare.hhs.gov/http://www.dartmouthatlas.org/interactive_map.shtm


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Using the Indicators Focus on Age

Groups

Age Group focus

Kids Count (Annie E. Casey Foundation)http://datacenter.kidscount.org/databook/2009/Default.aspx

Americas Children (Federal Interagency Forum onChild and Family Statistics)http://www.childstats.gov/americaschildren/index.asp

Older Americans 2008: Key Indicators of Well-

Being (Interagency Forum on Aging-relatedStatistics)http://www.agingstats.gov/agingstatsdotnet/main_site/default.aspx

http://datacenter.kidscount.org/databook/2009/Default.aspxhttp://www.childstats.gov/americaschildren/index.asphttp://www.agingstats.gov/agingstatsdotnet/main_site/default.aspxhttp://www.agingstats.gov/agingstatsdotnet/main_site/default.aspxhttp://www.childstats.gov/americaschildren/index.asphttp://datacenter.kidscount.org/databook/2009/Default.aspx


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Using the Indicators: Focus on Local

Health Reports

Planning and policy at the local level

Communities Count (Public Health - Seattle-King

County) http://www.communitiescount.org/

New York City (New York City Department ofHealth and Mental Hygiene)http://www.nyc.gov/html/doh/html/data/data.shtml#3

http://www.communitiescount.org/http://www.nyc.gov/html/doh/html/data/data.shtmlhttp://www.nyc.gov/html/doh/html/data/data.shtmlhttp://www.communitiescount.org/


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Comprehensive Indicator

Systems Focus on overall Quality of Life with health being

one of many components (e.g., economy, health,

education)

Boston Indicator Project (The Boston Foundation)http://www.bostonindicators.org/Indicators2008/

Jacksonville Quality of Life Report (JCCI)http://www.jcci.org/jcciwebsite/pages/indicators.html

Organization of Economic Cooperation and

Development (OECD) http://www.oecd.org/document/~

http://www.bostonindicators.org/Indicators2008/http://www.jcci.org/jcciwebsite/pages/indicators.htmlhttp://www.oecd.org/document/~http://www.oecd.org/document/~http://www.jcci.org/jcciwebsite/pages/indicators.htmlhttp://www.bostonindicators.org/Indicators2008/


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Boston Indicators Project

Hub of Innovation


Civic Vitali ty

Cultural L ife and the Ar ts

Economy

Education

Environment & Energy

Health

Housing

Publ ic Safety

Technology

Transportation


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Comprehensive Indicator

Systems: Use of the Index Index simplifies complex measures, but caution is

advised:

Canadian Index http://www.ciw.ca/en/Home.aspx

Child Well-being Index (Duke University and Foundationfor Child Development) http://www.fcd-us.org/initiatives/~

Well-being Index (Gallup-Healthways) http://www.well-beingindex.com/

http://www.ciw.ca/en/Home.aspxhttp://www.fcd-us.org/initiatives/initiatives_show.htm?doc_id=463963http://www.well-beingindex.com/http://www.well-beingindex.com/http://www.well-beingindex.com/http://www.well-beingindex.com/http://www.well-beingindex.com/http://www.fcd-us.org/initiatives/initiatives_show.htm?doc_id=463963http://www.fcd-us.org/initiatives/initiatives_show.htm?doc_id=463963http://www.fcd-us.org/initiatives/initiatives_show.htm?doc_id=463963http://www.ciw.ca/en/Home.aspx


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An illustration of trends in the

CIW with two domains (LivingStandards and Healthy

Populations) compared with theGDP, 1994-2008. [sic]

http://www.ciw.ca/en/TheCanadianIndexOfWellbeing/CompositeIndex.aspx

Median CIW

Average CIW

[sic]

Conclusion: IOM Framework for


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Conclusion: IOM Framework for

Health Indicators Recommended to

The State of the USA

http://books.nap.edu/openbook.php?record_id=12534&page=5

Health Indicators, Part 1
http://books.nap.edu/openbook.php?record_id=12534&page=5http://books.nap.edu/openbook.php?record_id=12534&page=5


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Further Resources and ReadingHealth Indicators

Publications:

Health Indicators: A Review of Reports Currentlyin Use (July 2008)www.cherylwold.com~

Institute of Medicine Committee Reporthttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-

Indicators-Letter-Report.aspx

Health Indicators, Part 1
http://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspxhttp://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspx


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Further Resources and Reading

Health Indicators

HSRR (Health Services and Sciences Research Resources)

[Internet]. Bethesda (MD): National Library of Medicine (US),

National Information Center on Health Services Research and

Health Care Technology (NICHSR). [cited 2010 Jan 1]

http://wwwcf.nlm.nih.gov/hsrr_search/index.cfm

Melnick, Daniel. Finding and Using Health Statistics [Internet].

Bethesda (MD): National Library of Medicine (US), National

Information Center on Health Services Research and Health Care

Technology (NICHSR); 2007. [updated 2007; cited 2010 Jan 1].http://www.nlm.nih.gov/nichsr/usestats/index.htm

http://wwwcf.nlm.nih.gov/hsrr_search/index.cfmhttp://www.nlm.nih.gov/nichsr/usestats/index.htmhttp://www.nlm.nih.gov/nichsr/usestats/index.htmhttp://wwwcf.nlm.nih.gov/hsrr_search/index.cfm


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Further Resources and Reading

Health Indicators

Braveman P and Egerter S (2008). Overcoming Obstacles to Health: Report for theRobert Wood Johnson Foundation to the Commission to Build a HealthierAmerica. http://www.rwjf.org/files/research/obstaclestohealth.pdf

Chrvala CA and Bulger RJ , eds. (1999). Institute of Medicine. Leading Indicatorsfor Healthy People 2010: Final Report. National Academy of Sciences. WashingtonDC. http://www.nap.edu/catalog.php?record_id=9436

Evans RG and Stoddart GL. Consuming research, producing policy? Am J PublicHealth. 2003;93:371-379.

Friedman, Mark (2005). Trying Hard is Not Good Enough. Trafford Publishing.Vancouver, Canada.

Government Accountability Office (2003; GAO-03-672SP). Forum on Key NationalIndicators: Assessing the Nations Position and Progress.

http://www.gao.gov/review/d03672sp.pdf Institute of Medicine (1997). Improving Health in the Community: A Role forPerformance Monitoring. http://www.nap.edu/catalog.php?record_id=5298

Robert Wood Johnson Foundation (2008). What Drives Health?http://www.commissiononhealth.org/WhatDrivesHealth.aspx.

http://www.rwjf.org/files/research/obstaclestohealth.pdfhttp://www.nap.edu/catalog.php?record_id=9436http://www.gao.gov/review/d03672sp.pdfhttp://www.nap.edu/catalog.php?record_id=5298http://www.commissiononhealth.org/WhatDrivesHealth.aspxhttp://www.commissiononhealth.org/WhatDrivesHealth.aspxhttp://www.nap.edu/catalog.php?record_id=5298http://www.gao.gov/review/d03672sp.pdfhttp://www.nap.edu/catalog.php?record_id=9436http://www.rwjf.org/files/research/obstaclestohealth.pdf


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Overview of Health Indicators