IOM: Measurement for Accountability in Public Health

By David A. Kindig, MD, PhD

I was privileged to appear last week before the Institute of Medicine (IOM) Committee on Public Health Strategies to Improve Health. The purpose of the meeting was to gather testimony for its third report (due out later this year), which will develop recommendations for funding state and local public health systems after health reform. 

In preparation for my presentation, I reviewed the first report in this series, released December 2010, called For the Public's Health: The Role of Measurement in Action and Accountability (the second report on statutes and regulations is currently under IOM review). The report has three main chapters, including: (1) Needed: An information Enterprise to Drive Knowledge and Population Health Improvement, (2) Measuring Health for Improved Decisions and Performance, and (3) Measurement and Accountability. Given the report’s strong population health message, I am focusing this post on a few of its key findings and recommendations.

• One recommendation calls on the Secretary of DHSS to integrate, align, and standardize health data and health outcome measurement at all geographic levels. This includes a summary measure of population health to estimate and track health adjusted life expectancy for the United States.  More specifically, the recommendation calls for “unified guidance to build an actionable set of additional indicators to support community decision-making with respect to local health promoting initiatives.”

• Another recommendation calls on DHSS to issue an annual report to policy makers, all health systems sectors, and the public about important trends and disparities in social and environmental factors that affect health. An additional recommendation  calls in part for advancing the use of predictive and system-based simulation models to understand the health consequences of the underlying determinants of health. This is consistent with the call for broader use of comparative effectiveness research funding to inform cost-effective allocation of resources across health care, public health, health behaviors, and the social and physical determinants of health.

• Most importantly, the last chapter (on measurement and accountability) ) identifies the need for a population health accountability framework requiring agreement among health-system stakeholders on specific plans of action for health priorities and outcomes. The report suggests two types of accountability: “contract” accountability (which follows from financial and regulatory obligations), and “compact” or “mutual” accountability (for relationships among community-based stakeholders). The report includes criteria for assessing and ensuring accountability at state and local levels; for example, organizations should have a clear charge, measurement capacity, and tools to assess and improve effectiveness and quality. While not insisting organizations have financial and administrative control over resources as suggested in a Health Outcomes Trust, the measurement and accountability framework represents a major step in this direction.

I applaud the IOM and the Robert Wood Johnson Foundation for producing this important work. Population health advocates should stay tuned for the final two reports on laws and funding, which I hope will contribute additional insights and recommendations as to what can and should be done to deliver improved outcomes through measurement and accountability.

David A. Kindig, MD, PhD, is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health.

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For further reading:

Kindig DA, Mullahy J. (2010). Comparative effectiveness – of What? Evaluating strategies to improve population health. JAMA, 304(8), 901-902.

Teutsch SM, Fielding JE. (2011). Applying comparative effectiveness research to public and population health initiatives. Health Affairs, 30, 349-355.

Comments

[George Isham, M.D.]

Dave,

Thank you for you comments on these reports. It underscores some important recommendations, that if acted upon, will move the field forward.

George