Modifications to Objectives and Subobjectives

The following discussion highlights the modifications, including changes, additions, and deletions, to this focus area's objectives and subobjectives as a result of the midcourse review.

As stated in Healthy People 2010: "Most developmental objectives have a potential data source with a reasonable expectation of data points by the year 2004 to facilitate setting 2010 targets in the mid-decade review. Developmental objectives with no baseline at the midcourse will be dropped." Accordingly, at the midcourse review some developmental objectives and subobjectives were deleted due to lack of a data source. However, the U.S. Department of Health and Human Services (HHS) and the agencies that serve as the leads for the Healthy People 2010 initiative will consider ways to ensure that these public health issues retain prominence despite their current lack of data.

Health insurance coverage for clinical preventive services (1-2) was deleted because no national-level data source was available. Data sources for counseling about health behaviors (1-3) were identified for all but one of the developmental subobjectives—vehicle restraints and bicycle helmets (1-3e), which was deleted due to a lack of data source. The wording of developmental subobjective 1-3d was changed from "excessive alcohol consumption" to "risky drinking" to reflect the data source and use an established, approved definition for excessive drinking. The age range for management of menopause (1-3h) was adjusted from 46 to 56 years of age to 45 to 57 years of age to more accurately reflect the data source.  Counseling about sexually transmitted diseases (1-3g) remained developmental.

Core competencies in health profession training (1-7) remained a developmental objective. Of the seven national health profession organizations supporting data collection, four had sufficient data sources for use: allopathic medicine, osteopathic medicine, baccalaureate nursing, and advanced practice nursing. The other three organizations are working to secure similar data for physician assistants, dentistry, and pharmacy.²

The wording of objective 1-7 was modified to more accurately capture the inclusion of sentinel core competencies in health profession training. Two sentinel core curriculum competencies—counseling for health promotion and disease prevention and cultural diversity—were selected, and eight subobjectives were created to track those competencies in the curricula for allopathic medicine, osteopathic medicine, baccalaureate nursing, and advanced practice nursing.

Delay or difficulty in getting emergency care (1-10) became measurable as data were obtained from questions added to the National Health Interview Survey.

Rapid-response prehospital emergency care (1-11) became measurable as a comprehensive data source was identified. Seven subobjectives were created to describe the components of rapid-response prehospital emergency medical services (EMS) as defined by the American Medical Association's Subcommittee on Trauma Care. Data were obtained from the National Assessment of State Trauma System Development and Disaster Readiness for Mass Casualty Events.

The data source for trauma systems (1-13) was replaced by the Federal Trauma–Emergency Medical Services System Program Survey, which is a more comprehensive Federal data source that measures the components of a State-level trauma care system. The wording of the objective was modified to reflect the measurement of system-level improvement as reflected in the new data source. Nine subobjectives were created to show the data for the selected components of a State trauma plan or system.

The wording of long-term care services (1-15) was modified from "increase the proportion of persons with long-term care needs who have access to the continuum of long-term care services" to "reduce the proportion of adults with long-term care needs who do not have access to the continuum of long-term care services." The wording of the objective was modified to accurately reflect the data source. Four subobjectives were created to identify the delivery sites for long-term care services: home health care, adult day care, assisted living, and nursing home care.

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