Date:  April 28, 2015




Fifteen ‘Vital Signs’ for Assessing and Monitoring Progress of the Nation’s Health Identified in New IOM Report


WASHINGTON – A new report from the Institute of Medicine presents 15 “vital signs” or core measures for tracking progress toward improved health and health care in the U.S.  The committee that carried out the study and wrote the report said the set of core measures should reduce the burden on clinicians of taking measurements, enhance transparency and comparability, and improve health outcomes nationwide.   


Health measurements are requested and required by organizations for various purposes, but many of the individual measures in use today were developed without attention to the broader context.  Measurements often overlap or are redundant and are implemented for a particular purpose and circumstance.  For example, the Centers for Medicare and Medicaid Services’ measure inventory catalogs nearly 1,700 measures, and the National Quality Forum’s measure database includes 630 measures.  While several of these measures are of high quality and provide valid and useful information, most examine slight variations of the same target information and differ enough to prevent direct comparisons among the states, institutions, or individuals, the committee said.  Moreover, measures focused only on limited component issues cannot reliably reflect the nation’s overall health system performance.


“U.S. health care costs and expenditures are the highest in the world, but health outcomes and the quality of care are below average by many measures,” said committee chair David Blumenthal, president of the Commonwealth Fund in New York City.  “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.  The proposed core set focuses on the most powerful measures that have the greatest potential to positively affect the health and well-being of Americans.”


Although not intended to replace the full range of measures in use today, the set of 15 vital signs are expected to evolve over time, keeping pace with the needs and capabilities of the health system.  The core measures are:


·         Life expectancy

·         Well-being

·         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


Renewed attempts to align health measures in order to reduce redundancies and inefficiencies may now succeed because of significant changes in the measurement environment, most notably with growing data capture capabilities from widespread use of electronic health records and other digital tools, the committee said.  The emerging health information technology infrastructure could support a real-time measurement system for routine collection of information, and it provides an opportunity to measure what matters most, enabling goals to drive measures as a replacement for measures that drive goals.


The report calls for specific actions for different stakeholder groups to help ensure the adoption and implementation of the cores measures.  In particular, the committee recommended that the secretary of the U.S. Department of Health and Human Services should use the set of core measures to sharpen the focus and consistency and reduce the number and burden of measure reporting in HHS programs.  In addition, the secretary of HHS should develop and implement a strategy for working with other federal and state agencies and national organizations to facilitate the use and application of the core measure set. 


“Leadership from stakeholders throughout the nation is key to implementing the set of core measures in the health care system,” said Victor Dzau, president of the Institute of Medicine.  “The core measurements proposed in the report would harmonize the large number of existing metrics, reduce the redundancies, and decrease the excessive burden on providers and health systems.  This opportunity to align and widely adopt these measures could help the nation progress toward better health at lower cost.”


The study was sponsored by the Robert Wood Johnson Foundation, Blue Shield of California Foundation, and California HealthCare Foundation.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  A committee roster follows.



Jennifer Walsh, Senior Media Relations Officer

Christina Anderson, Media Relations Assistant

Office of News and Public Information

202-334-2138; e-mail

Twitter: @NAS_news and @NASciences


Pre-publication copies of Vital Signs: Core Metrics for Health and Health Care Progress are available from the National Academies Press on the Internet at or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

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Committee on Core Metrics for Better Health at Lower Cost



David Blumenthal, M.D., M.P.P.
The Commonwealth Fund
New York, City


Julie Bynum, M.D., M.P.H.

Associate Professor of Medicine

The Dartmouth Institute

Dartmouth College

Lebanon, N.H.


Lori Coyner

Director of Accountability and Quality

Oregon Health Authority



Diana S. Dooley, J.D.


California Department of Health Services



Timothy G. Ferris, M.D., M.P.H.

Vice President

Population Health Management

Partners HealthCare System Inc.



Sherry Glied, Ph.D.


Robert F. Wagner Graduate School of Public Service

New York University

New York City


Larry A. Green, M.D.
Epperson-Zorn Chair for Innovation in Family Medicine
University of Colorado



George J. Isham, M.D., M.S.

Senior Adviser, HealthPartners Inc., and

Senior Fellow, HealthPartners Institute for Education and Research



Craig A. Jones, M.D.

Executive Director

Vermont Blueprint for Health



Robert Kocher, M.D.


Venrock Associates

Palo Alto, Calif.


Kevin Larsen, M.D.

Medical Director of Meaningful Use

Office of the National Coordinator for Health Information Technology

U.S. Department of Health and Human Services

Washington, D.C.


Elizabeth A. McGlynn, Ph.D.


Center for Effectiveness and Safety Research

Kaiser Permanente

Pasadena, Calif.


Elizabeth Mitchell

President and CEO

Network for Regional Healthcare Improvement



Sally Okun, R.N.

Vice President of Advocacy, Policy, and Patient Safety

Patients Like Me

Cambridge, Mass.


Lyn Paget, M.P.H.

Managing Partner

Health Policy Partners

Brookline, Mass.


Kyu Rhee, M.D., M.P.P.

Vice President and Chief Health Officer

IBM Corp.

Armonk, N.Y.


Dana Gelb Safran, Sc.D.

Senior Vice President

Performance Measurement

Blue Cross Blue Shield of Massachusetts



Lewis G. Sandy, M.D., M.B.A.

Senior Vice President

Clinical Advancement

UnitedHealth Group

Minnetonka, Minn.


David M. Stevens, M.D., F.A.A.F.M.

Associate Chief Medical Officer, and

Director, Quality Center

National Association of Community Health Centers

Bethesda, Md.


Paul C. Tang, M.D., M.S.

Vice President and Chief Innovation and Technology Officer

Palo Alto Medical Foundation

Mountain View, Calif.


Steven M. Teutsch, M.D., M.P.H.

Independent Consultant

Los Angeles




Elizabeth Malphrus, M.P.P.

Study Director


J. Michael McGinnis, M.D., M.P.P.

Senior Scholar