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Q? ? ???ActualX9v? ?Interim&1?WY!= H>X4?3d" 3Qi TargetQiQQ3_ O  fO G i*@za$E2fY_,I!)( >|Wide upward diagonal MMd 43_ O   MMd 4E4 3Q  WestQQQ3_4E4 3Qi ActualQiQQ3_ O   MMd 4E4 3Qi InterimQiQQ3_ O  fA 9  i@za6ݢHsԠ( 33333333Dark vertical MMd 4E4D$% M`3O&Q4$% M`3O&Q4FAD\ 3Og79 3 bN#M-& 43*N#M& ! M4% MZ3O&Q 4Prevalence of restraints'4523 M  43<"  3O % M)3O&Q423 NM4444% QSM3O&Q F!Prevalence of Physical Restraints'4% M3O&Q'4% M3O&Q'4% ZM3O&Q'4% e vM3O%&Q'4%  vM3O",&Q'4% FM3O%&Q'4%  vM3O ,&Q'4% M3O&Q'4% !M3O&Q 11.9%'4% 0hM3O&Q 10.0%'4%  ZM3O&Q 10.2%'4% M3O&Q'44 -!9  9   +A''  Times New Roman4-"ArialNe----------------------------------------Times New Roman!---"Small FontsL-------------------"Systemn-'- +A-'- +A- "- $F8<8<FF8 "- "---'--- =3ETF <F<F<F<vFv<jFj<]F]<QFQ<DFD<8F8<---'--- +AT8F 8<<F8F---'--- +A---'--- '=---'--- =7E---'--- ?5E "-- $LISISLLI& "- -  5B( >>>|>|||-  - - !W]u-  -  --&P- $u]|]|uu]- &- -  5B( >>>|>Ǐ||| -- - !>v-  -  --&P- $vvv- &- -  5B( |>>>>|||- $v- - !>v-  -  --&P- $vvv- &- -  5B( >>>>||||- - !>v-  -  --&P- $vvv- &- -  5B( >>>Ǐ|>|||@@@@- - !>v-  -  --&P- $v v v- - $jjj$vvv&- -  5B( 33333333333333333333333333333333@@@@- - !?u-  -  --&P- $uuu- ---'--- =7E---'--- +A "- 8F F-CFCFCFCFCFvCvFjCjF]C]FQCQFDCDF8C8FF<-FFoo<<-----'---   F  92 I!Prevalence of Physical Restraints----'---  +A---'---  +A----'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A-----'---  Ha7J 2 ;L17.2%----'---  +A-----'---  xg 2 k10.0%----'---  +A-----'---  zi 2 m10.0%----'---  +A-----'---  zi 2 m10.0%----'---  +A-----'---  aPm 2 To14.0%----'---  +A-----'---  z+i 2 m10.0%----'---  +A-----'---  m\~ 2 `11.9%----'---  +A-----'---  yh 2 l10.0%----'---  +A-----'---  xg 2 k10.2%----'---  +A----'---  ,B  2 %0.0% 2 %2.0% 2 %4.0% 2 %6.0% 2 {%8.0% 2 o10.0% 2 c12.0% 2 V14.0% 2 J16.0% 2 =18.0% 2 120.0% ---'---  +A----'---  ,B-----'---   \  Times New RomanE-2 Baseline FY 1996-----'---  ,B-----'---  X Times New RomanE- 2 [FY 1999-----'---  ,B-----'---   Times New RomanE- 2 FY 2000-----'---  ,B-----'---   Times New RomanE- 2 FY 2001-----'---  ,B-----'---   Times New RomanE- 2 FY 2002-----'---  ,B-----'---  ) Times New RomanE- 2 FY 2003-----'---  ,B---'---  +A------'---  5 Times New RomanE-2 Prevalence of restraints-----'---  +A- "- RK-  T---'-- - T---'-- - T "- &- -  5B( >>>>||||@@@@-- !X- - - - &- _X- .2 bTarget.---'-- -  T---'-- -  T "- -    .2 Actual.---'--- T---'--- T "- &- -  5B( 333333333333333333333333 -- !- - - -&- -.2 Interim .---'---  T---'---  +A-- ' +A '  ' METAFILEPICT-! 9-!  9   +A''  Times New Roman4-"ArialNe----------------------------------------Times New Roman!---"Small FontsL-------------------"Systemn-'- +A-'- +A- "- $F8<8<FF8 "- "---'--- =3ETF <F<F<F<vFv<jFj<]F]<QFQ<DFD<8F8<---'--- +AT8F 8<<F8F---'--- +A---'--- '=---'--- =7E---'--- ?5E "-- $LISISLLI& "- -  5B( >>>|>|||-  - - !W]u-  -  --&P- $u]|]|uu]- &- -  5B( >>>|>Ǐ||| -- - !>v-  -  --&P- $vvv- &- -  5B( |>>>>|||- $v- - !>v-  -  --&P- $vvv- &- -  5B( >>>>||||- - !>v-  -  --&P- $vvv- &- -  5B( >>>Ǐ|>|||@@@@- - !>v-  -  --&P- $v v v- - $jjj$vvv&- -  5B( 33333333333333333333333333333333@@@@- - !?u-  -  --&P- $uuu- ---'--- =7E---'--- +A "- 8F F-CFCFCFCFCFvCvFjCjF]C]FQCQFDCDF8C8FF<-FFoo<<-----'---   F  92 I!Prevalence of Physical Restraints----'---  +A---'---  +A----'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A---'---  ---'---  +A-----'---  Ha7J 2 ;L17.2%----'---  +A-----'---  xg 2 k10.0%----'---  +A-----'---  zi 2 m10.0%----'---  +A-----'---  zi 2 m10.0%----'---  +A-----'---  aPm 2 To14.0%----'---  +A-----'---  z+i 2 m10.0%----'---  +A-----'---  m\~ 2 `11.9%----'---  +A-----'---  yh 2 l10.0%----'---  +A-----'---  xg 2 k10.2%----'---  +A----'---  ,B  2 %0.0% 2 %2.0% 2 %4.0% 2 %6.0% 2 {%8.0% 2 o10.0% 2 c12.0% 2 V14.0% 2 J16.0% 2 =18.0% 2 120.0% ---'---  +A----'---  ,B-----'---   \  Times New RomanE-2 Baseline FY 1996-----'---  ,B-----'---  X Times New RomanE- 2 [FY 1999-----'---  ,B-----'---   Times New RomanE- 2 FY 2000-----'---  ,B-----'---   Times New RomanE- 2 FY 2001-----'---  ,B-----'---   Times New RomanE- 2 FY 2002-----'---  ,B-----'---  ) Times New RomanE- 2 FY 2003-----'---  ,B---'---  +A------'---  5 Times New RomanE-2 Prevalence of restraints-----'---  +A- "- RK-  T---'-- - T---'-- - T "- &- -  5B( >>>>||||@@@@-- !X- - - - &- _X- .2 bTarget.---'-- -  T---'-- -  T "- -    .2 Actual.---'--- T---'--- T "- &- -  5B( 333333333333333333333333 -- !- - - -&- -.2 Interim .---'---  T---'---  +A-- ' +A '  'Level 1Level 2Level 3Level 4Level 5i&Draw Object <<=8C HKKKK     MOQSTUVWxIcgkosw{Large BulletLarge Bullet*OLE*WPC@@>>>>!>>j 1   ''  Times New Roman0---"Small Fonts,------"Systemn-'- -'- U- "- $=55==5 "- "---'--- 0<i[}= }k=kY=YG=G5=5---'--- i[ "-5= 5=5=---'--- ---'--- ---'--- 4<---'--- 2<33- 33 $HXXHH$ooo---'---33 4<---'---33  "-5= =:=}:}=k:k=Y:Y=G:G=5:5====dd------'--- !<  12 ?Fig. 1 Increase Competition  ----'--- ---'--- ----'---   2 0.0%2 w20.0%2 e40.0%2 S60.0%2 A80.0%2 /100.0%---'--- ---'---   2 JFY 2 E2002 2 qFY 2 l2003---'--- - j[---'--- i[---'--- i[ "-33RK- 33 f` . 2 fGoal.---'--- i[---'--- --'  '  'WPWin 6.0/OLE 1.0 Prefix Information MarkerMSGraph.Chart.8&ࡱ>   Root EntryFt@Ole 7CompObjdWorkbookX   !"#$%&'(+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefgh'F! 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M4523 O NM43"  bb43O b% M)3OQ4444% AX M3O&Q <Fig. 1 Increase Competition'44 h 1   ''  Times New Roman0---"Small Fonts,------"Systemn-'-BOlePart)OlePres000* -'- U- "- $=55==5 "- "---'--- 0<i[}= }k=kY=YG=G5=5---'--- i[ "-5= 5=5=---'--- ---'--- ---'--- 4<---'--- 2<33- 33 $HXXHH$ooo---'---33 4<---'---33  "-5= =:=}:}=k:k=Y:Y=G:G=5:5====dd------'--- !<  12 ?Fig. 1 Increase Competition  ----'--- ---'--- ----'---   2 0.0%2 w20.0%2 e40.0%2 S60.0%2 A80.0%2 /100.0%---'--- ---'---   2 JFY 2 E2002 2 qFY 2 l2003---'--- - j[---'--- i[---'--- i[ "-33RK- 33 f` . 2 fGoal.---'--- i[---'--- --'  '  ' METAFILEPICT(p 1   ''  Times New Roman0---"Small Fonts,------"Systemn-'- -'- U- "- $=55==5 "- "---'--- 0<i[}= }k=kY=YG=G5=5---'--- i[ "-5= 5=5=---'--- ---'--- ---'--- 4<---'--- 2<33- 33 $HXXHH$ooo---'---33 4<---'---33  "-5= =:=}:}=k:k=Y:Y=G:G=5:5====dd------'--- !<  12 ?Fig. 1 Increase Competition  ----'--- ---'--- ----'---   2 0.0%2 w20.0%2 e40.0%2 S60.0%2 A80.0%2 /100.0%---'--- ---'---   2 JFY 2 E2002 2 qFY 2 l2003---'--- - j[---'--- i[---'--- i[ "-33RK- 33 f` . 2 fGoal.---'--- i[---'--- --'  '  '*OLE*WPC@@>>>>!>>b 0 ?   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WP 7 [9] FMicrosoft Graph 2000GBiff5MSGraph.Chart.89q A@B""$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_)1Arial1Arial1Arial1.Times New Roman1.Times New Roman1.Times New Roman1Arial=X ,##0.00_ A@` $j` $jh` $jh88̙33f̙̙3f3fff3f3f33333f33333\R3&STUFY 99FY 00FY 01FY 02FY 03 Target Gz? ? ? ffffff? ffffff?  Actual 333333? Q?   WY(#= >X43d23 M NM4 3Q  EastQQQ3_4E4 3Q  TargetQ QQ3_4E4 3Q  ActualQ QQ3_4E4D $% M`3O&Q4$% M`3O&Q4FA1 3O~ C 3 b#M43*N #M! M4523 M NM43"  (3O (% M)3OQ423 M NM4444% YC M3O&Q N%Fig. 3 Increase Vendor EFT Payments'44 BOlePart2OlePres000 Z` 0 ?   ''  Times New Roman0---Times New Roman------"Systemn-'-  "--  "---'---  "- $255225 "----'--- 01uW2 p2p\2\I2I525---'--- uW52 5252---'--- ---'--- ---'--- 41---'--- 21 "-33RK- 33 $9SCSC99S$[NeNe[[N$}??}}?$:::$:::-$CDMDMCCD$eCoCoeeC---'--- 41---'---  "-52 2/2/2p/p2\/\2I/I25/52222TTvv------'--- !"  ?2 %%Fig. 3 Increase Vendor EFT Payments  ----'--- ---'--- ----'---   2 0% 2 }20% 2 j40% 2 V60% 2 C80% 2 /100% ---'--- ---'---  2 6FY 992 XFY 002 zFY 012 FY 022 FY 03---'--- - vW---'--- uW---'--- uW "-33RK- 33 c] .2 cTarget.---'--- uW---'--- uW "-RK-  rl .2 rActual.---'--- uW---'--- --'  '  ' METAFILEPICTZwhZ 0 ?   ''  Times New Roman0---Times New Roman------"Systemn-'-  "--  "---'---  "- $255225 "----'--- 01uW2 p2p\2\I2I525---'--- uW52 5252---'--- ---'--- ---'--- 41---'--- 21 "-33RK- 33 $9SCSC99S$[NeNe[[N$}??}}?$:::$:::-$CDMDMCCD$eCoCoeeC---'--- 41---'---  "-52 2/2/2p/p2\/\2I/I25/52222TTvv------'--- !"  ?2 %%Fig. 3 Increase Vendor EFT Payments  ----'--- ---'--- ----'---   2 0% 2 }20% 2 j40% 2 V60% 2 C80% 2 /100% ---'--- ---'---  2 6FY 992 XFY 002 zFY 012 FY 022 FY 03---'--- - vW---'--- uW---'--- uW "-33RK- 33 c] .2 cTarget.---'--- uW---'--- uW "-RK-  rl .2 rActual.---'--- uW---'--- --'  '  '*OLE*WPC@@>>>>!>>  +   ''  Times New Roman|-----"Small Fonts,----------------------------------------------------"Systemn-'- -'- W- "- $555 "-555LL "---'--- ---'---  1 ---'---  1 - "- "-p. `k`kQQAp.- "-$.m1p.s+p.m---'---  1 `k $k]n`kch`k]---'---  1 Q $NQTQN---'---  1 A $>ADA>---'---  1 ---'---  1 ---'--- --------'--- )J +2 MFig. 4 ACF's Electronic 2 cGrants Project ----'--- ---'--- -------------'--- r0 2 3DeveIop  2 ?&2 KImplemen   2 Wt 2 cOLDC----'--- -----------'--- \& 2 )Operate  2 5&2 AMaintain  2 MOLDC----'--- --------'--- k[4 2 ^7Implemen  2 j9t GATES  2 vNI----'--- ---'---   2 !FY00 2 ^FY01 2 FY02 2 FY03---'--- --'  '  'WPWin 6.0/OLE 1.0 Prefix Information Marker MSGraph.Chart.8.ࡱ>   Root EntryF 9R*Ole 8CompObjdWorkbook   !"#$%&'()*+,-./0123456789(F! WP 7 [10] FMicrosoft Graph 2000GBiff5MSGraph.Chart.89q A@B""$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_)1Arial1Arial1Arial1.Times New Roman1.Times New Roman1.Times New Roman1Arial=| ,##0.00_ A@` $j` $jh` $jh88̙33f̙̙3f3fff3f3f33333f33333\R3&STU FY00 FY01 FY02 FY03 East9@I@R@Y@WYJ(#= >X4?z3d 3Q  EastQQQ3_43_  NM   d 43_  NM   d 43_  NM   d 4E4 3Q  WestQQQ3_4E4 3Q NorthQQQ3_4E4D $% ~M`3O&Q4$% ~M`3O&Q4FAr3Or 3 b#M43*#M! M4523 M NM43" 3_ M NM  MMd 444% !NP?M3O| &Q R'Fig. 4 ACF's Electronic Grants Project'4%  w ~@M3O5@&Q 4DeveIop & Implement OLDC'4%  sG@M3O14&Q 2Operate & Maintain OLDC'4% } <M3OQ'4%  @M3O5(&Q &Implement GATES I'44 BOlePart:OlePres000 Fl   +   ''  Times New Roman|-----"Small Fonts,----------------------------------------------------"Systemn-'- -'- W- "- $555 "-555LL "---'--- ---'---  1 ---'---  1 - "- "-p. `k`kQQAp.- "-$.m1p.s+p.m---'---  1 `k $k]n`kch`k]---'---  1 Q $NQTQN---'---  1 A $>ADA>---'---  1 ---'---  1 ---'--- --------'--- )J +2 MFig. 4 ACF's Electronic 2 cGrants Project ----'--- ---'--- -------------'--- r0 2 3DeveIop  2 ?&2 KImplemen   2 Wt 2 cOLDC----'--- -----------'--- \& 2 )Operate  2 5&2 AMaintain  2 MOLDC----'--- --------'--- k[4 2 ^7Implemen  2 j9t GATES  2 vNI----'--- ---'---   2 !FY00 2 ^FY01 2 FY02 2 FY03---'--- --'  '  ' METAFILEPICTl l  +   ''  Times New Roman|-----"Small Fonts,----------------------------------------------------"Systemn-'- -'- W- "- $555 "-555LL "---'--- ---'---  1 ---'---  1 - "- "-p. `k`kQQAp.- "-$.m1p.s+p.m---'---  1 `k $k]n`kch`k]---'---  1 Q $NQTQN---'---  1 A $>ADA>---'---  1 ---'---  1 ---'--- --------'--- )J +2 MFig. 4 ACF's Electronic 2 cGrants Project ----'--- ---'--- -------------'--- r0 2 3DeveIop  2 ?&2 KImplemen   2 Wt 2 cOLDC----'--- -----------'--- \& 2 )Operate  2 5&2 AMaintain  2 MOLDC----'--- --------'--- k[4 2 ^7Implemen  2 j9t GATES  2 vNI----'--- ---'---   2 !FY00 2 ^FY01 2 FY02 2 FY03---'--- --'  '  'HoTABLE BdtTABLE A !  _   !XX FY2003HHSPERFORMANCEREPORTSUMMARY0 @ 0 @   TABLEOFCONTENTS  < #XDX! 7#  INTRODUCTION ""J(#. 1 P  Vm  VmF0     DEPARTMENTALMANAGEMENT #""J(#.hh!(#(##7VmFb݌ , | Ќ  !  !0  0` (#(#    ThePresidentsManagementAgenda#""J(#.0` (#` (##7!.݌  l Ќ  !  !0  0` (#(#    StrategicManagementofHumanCapital#""J(#.4` (#` (##7!݌  X Ќ  !  !0  0` (#(#    CompetitiveSourcing#""J(#. #` (#` (##8!݌  D  Ќ  !  !0  0` (#(#    ImprovingFinancialPerformance#""J(#..` (#` (##8!݌ 0  Ќ  !  !0  0` (#(#    ExpandingElectronicGovernment#""J(#..` (#` (##9!݌   Ќ  !  !}0  0` (#(#    BudgetandPerformanceIntegration#`"`"I(#.\\1` (#` (##10!}݌   Ќ  !  !c0  0` (#(#    OtherManagementIssues#`"`"I(#.&&&` (#` (##11!c~݌   Ќ  Vm  Vm>0     BUDGETANDPERFORMANCEINTEGRATIONATHHS #`"`"I(#.,,3(#(##13Vm>Z݌ | Ќ  !  ! 0  0` (#(#    HHSProgramImplementation#`"`"I(#.)` (#` (##13! 9 ݌ l Ќ  !  ! 0  0` (#(#    ResultsOrientedBudgetingandPlanningProcesses:WhereWeAreNow#`"`"I(#.R` (#` (##13!  ݌ X Ќ  !  ! 0  0` (#(#    IntegratingBudgetandPerformance:LessonsLearnedfromtheOMBPilots#`"`"I(#.V` (#` (##15! $ ݌ D Ќ  !  ! 0  0` (#(#    IntegratingBudgetandPerformance:NextSteps#`"`"I(#.  =` (#` (##15! 5 ݌ 0 Ќ  !  ! 0  0` (#(#    AddressingChallengestoBudgetandPerformanceIntegration#`"`"I(#.J` (#` (##17! - ݌ l Ќ  PERFORMANCEREPORTSUMMARY  D  IncreaseAccesstoHealthCare `"`"I(#.(25  !  !0  0` (#(#    DecreasingtheNumberofUninsuredChildrenandAdults#`"`"I(#.>>E` (#` (##25!݌   Ќ  !  !0  0` (#(#    IncreasingAccesstoQualityHealthCarefor_Underserved_ԀPopulations#`"`"I(#.S` (#` (##26!݌  Ќ  Vm  Vm0     ExpandConsumerChoicesinHealthCareandHumanServices #`"`"I(#.C(#(##29Vm݌  Ќ  !  !0  0` (#(#    FaithbasedandCommunityInitiatives#`"`"I(#.444` (#` (##29!݌ p  Ќ  Vm  Vm0     EmphasizePreventiveHealthMeasures #`"`"I(#..(#(##30Vm݌ H" Ќ  !  !u0  0` (#(#    ReducingMorbidityfromDiabetes#`"`"I(#./` (#` (##30!u݌ 8#  Ќ  !  !Y0  0` (#(#    PromotingHealthyBehaviors#`"`"I(#.RR*` (#` (##32!Yt݌ $$t! Ќ  !  !80  0` (#(#    BehaviorModificationResearch#`"`"I(#.44-` (#` (##33!8S݌ %` " Ќ  Vm  Vm0     Respondto_Bioterrorism_ԀandOtherPublicHealthEmergencies #`"`"I(#.F(#(##35Vm6݌ &8"$ Ќ  !  !-0  0` (#(#    BuildingPublicHealthInfrastructuretoRespond#`"`"I(#.``?` (#` (##35!-H݌ '(#% Ќ  !  !!0  0` (#(#    BuildingLaboratoryCapacitytoRespond#`"`"I(#.6` (#` (##36!!<݌ ($& Ќ  !  ! 0  0` (#(#    EnsuringFoodSafety#`"`"I(#. #` (#` (##37! '݌ )%' Ќ   +&)  ImproveHealthOutcomes `"`"I(#. !39  !  !J0  0` (#(#    ReducingDeaths,Incidence,andImpactofInfectiousDiseases#`"`"I(#.N` (#` (##39!Je݌  Ќ  !  !M0  0` (#(#    ImprovingOutcomesforSubstanceAbuseandMentalHealthServices#`"`"I(#.&&P` (#` (##42!Mh݌  Ќ  ImprovetheQualityofHealthCare `"`"I(#.,44 d !  !0  0` (#(#    ImprovingDrugandMedicalDeviceSafety#`"`"I(#.7` (#` (##44!݌ T  Ќ  !  !0  0` (#(#    ImprovingtheQualityofCareinNursingHomes#`"`"I(#.dd=` (#` (##45!݌ @  Ќ  !  !0  0` (#(#    IncreasingEasyAccesstoHealthInformationforConsumers#`"`"I(#.""I` (#` (##46!݌ , | Ќ  Vm  Vm0     AdvanceScienceandBiomedicalResearch #`"`"I(#.1(#(##48Vm݌  T  Ќ  !  !h 0  0` (#(#    AdvancingBasicandAppliedBiomedicalresearch#`"`"I(#.>` (#` (##48!h ݌  D  Ќ  !  ![!0  0` (#(#    ProvidingFasterAccesstoDrugTherapies#`"`"I(#.vv8` (#` (##50![!v!݌ 0  Ќ  Vm  VmH"0     ImprovetheWellbeingandSafetyofFamiliesandIndividuals #`"`"I(#.G(#(##52VmH"d"݌   Ќ  !  !<#0  0` (#(#    ProtectingChildrenandYouth#`"`"I(#.,` (#` (##52!<#W#݌   Ќ  !  !$0  0` (#(#    EnablingtheElderlytoLivewithIndependenceandDignity#`"`"I(#.I` (#` (##53!$8$݌   Ќ  Vm  Vm%0     StrengthenAmericanFamilies #`"`"I(#.&(#(##54Vm%7%݌ l Ќ  !  !%0  0` (#(#    IncreasingEconomicSelfsufficiencyofLowincomeFamilies#`"`"I(#.K` (#` (##54!% &݌ \ Ќ  !  !&0  0` (#(#    IncreasingParentalResponsibilityandIncomeSupport#`"`"I(#.44D` (#` (##55!& '݌ H Ќ  Vm  0   Vm'0(#(#    ReduceRegulatoryBurdenonProviders,Patients,andConsumers #`"`"I(#.H(#(##57  p ЀStreamliningtheRegulatoryDevelopmentProcess`"`"I(#.E57Vm'(݌ ` Ќ  !  !k)0  0` (#(#    MaximizingCollaborationwithHHSStakeholders#`"`"I(#.=` (#` (##57!k))݌ L Ќ  PERFORMANCEDATACOLLECTION `"`"I(#.%58 $ !  !*0  0` (#(#    MeasuringProgramPerformance#`"`"I(#.hh,` (#` (##58!**݌  Ќ  !  !+0  0` (#(#    HHSNational,PopulationbasedDataCollection#`"`"I(#.hh=` (#` (##59!++݌  Ќ  !  !,0  0` (#(#    VitalStatistics#`"`"I(#. ` (#` (##62!,,݌  Ќ  !  !Y-0  0` (#(#    SurveillanceSystems#`"`"I(#. #` (#` (##63!Y-t-݌  Ќ  !  !1.0  0` (#(#    NonHHSDataCollection#`"`"I(#.PP&` (#` (##64!1.L.݌ t  Ќ  !  ! /0  0` (#(#    ProgramEvaluations#`"`"I(#. "` (#` (##64! /'/݌ `! Ќ  !  !/0  0` (#(#    HHSOfficeofInspectorGeneralAuditsandReports#`"`"I(#.A` (#` (##65!//݌ L"  Ќ  !  !00  0` (#(#    InternalManagementInformationSystems#`"`"I(#.bb6` (#` (##65!00݌ 8#! Ќ  !  !10  0` (#(#    AdministrativeSystems#`"`"I(#.%` (#` (##65!11݌ $$t" Ќ  !  !20  0` (#(#    MeasuringPerformanceWithStatesandGrantees#`"`"I(#.=` (#` (##67!22݌ %` # Ќ  !  !30  0` (#(#    DeliveringInformationtoUsers#`"`"I(#.  .` (#` (##67!33݌ %L!$ Ќ  !  !s40  0` (#(#    DataVerificationandValidation#`"`"I(#.FF/` (#` (##68!s44݌ &8"% Ќ  !  !W50  0` (#(#    StatusonReportingonFY19992001PerformanceGoals#`"`"I(#.F` (#` (##69 !XXD!W5r5݌ '$#& Ќ  #XDX! 6#  ($'   8DXXdXXd8-,X,XX-Kz$  .X\XXXD.e?\eX.X\  Kz$97@$    INTRODUCTIONKz$977 7   Ќe ee.e?\XDX ee  L* XDXXXDXDXXXD  L*u8    L*u88݌̌ XDXXXDXDXXXD  P4`.XDXXXD  XDXXXD   (X(#(#(P4`9  WhoWeAreandWhatWeDoP4`9P: Ԍ   ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*;    TheDepartmentofHealthandHuman n  ServicesistheUnitedStatesgovernment'sprincipalagencyforprotectingthehealthofallAmericansandprovidingessentialhumanservices,especiallyforthosewhoareleastabletohelpthemselves.Whetheritisthroughmedicalresearch,preventingtheoutbreakofinfectiousdisease,assuringfoodanddrugsafety,administeringtheMedicareandMedicaidprograms,providingfinancialassistanceforlow-incomefamilies,oramyriadofotherimportantactivities,theDepartmentenhancesthelivesofallAmericans.L*;;݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*>    TheDepartmentwasoncecharacterized  bytheGeneralAccountingOfficeaspresenting ...oneofthemoremassiveandcomplexmanagementandprogramrelatedchallengesinthefederalgovernment.HHShasover63,000employeesandanFY2003budgetof$485billion.L*>?݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  p2<,(`~0  `..Ec  T pL@               TheDepartmentworkscloselywithofficialsfromstate,localandtribalgovernments.AndmostHHS-funded b.)1 servicesareprovidedatthelocallevelbystate,countyortribalagencies,orthroughprivatesectorgrantees.ForFY2001HHSisreportingonover300programactivitiesacrosstheDepartmentofHealthandHumanServices.Intotal,thistranslatestoover950performancemeasuresandtargets.EachoneofthesemeasuresandtargetssupportstheDepartmentsmissionofprotectingthehealthofallAmericansandgivingaspecialhelpinghandtothosewhoneedassistance.L*@A݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*"F D   HHSintendsfortheAnnualPlan/Report h= processtobeafullfledgedtoolthatmanagersatalllevelscanusetomeasurewhattheirprogramsareachievinganddeterminehowwellthoseachievementsareaccomplishingthegoalsoftheDepartment.AdesiredoutcomeoftheGovernmentPerformanceandResultsAct(GPRA)istodeveloplinkagesbetweenperformanceandbudget.Tobestlinkperformancetobudget,HHShasincorporatedtheperformancegoalsintothebudgetsubmissionsfortheHHSagenciesthatadministertheprograms.Infact,HHSwasamongthefirstFederal "(#"(#(#(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# (#(#"(#"(#departmentstoexplicitlyassociateperformancetargets!orgroupsoftargets!withaportionofthebudget.L*"FF݌̌ XDXXXDXDXXXD  pr9<,(`~0r r  `5 E4! r r   p_ .)[ ̀L* XDXXXDXDXXXD  L*L    ThegraphicabovereflectsHHSwide  FY2000performance!goalsmet,goalsnotmet,andinstanceswheredataisnotyetavailable.AsofJanuary2002,only68percentofdatawasavailablefortheFY2001reportingyear.TogainamorecompletepictureofoverallresultsacrosstheentirespanofperformancetargetsinHHS,resultsforFY2000wereselected.Pastperformanceisareliableindicatoroffutureresults,andthereadercanextrapolatefromoneyeartothenextwithsomeconfidence.AsmoredatabecomesavailableforFY2001,thisgraphicwillbeupdated.L*LL݌̌ XDXXXDXDXXXD  P4`&6XDXXXD  XDXXXD   P4`O  SummaryDocumentataGlanceP4`O#P&Ԍ  ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*P    ThisSummaryprovidesasnapshotof v performanceacrosstheDepartment. These b targetsandmeasureswereselectedbecausetheyreflecttheSecretaryspriorities,ortheycontinuethestoryofanenduringgoal.Someofthemostimportantresultswerereportingthisyearinclude:L*PnQ݌ N Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*S    Rx(`XDXXXDXDXXXD   CombatingBioterrorismR2T: XDXXXDXDXXXD  ݀?XDXXXDCentersfor ( DiseaseControlisprotectingtheNationagainstbioterrorismbymeetingitsgoalofassistingstatesincompletingvulnerabilityassessmentsanddraftingpublichealthemergencyresponseplans.Bytheendof2002,atleast48ofthe55statesandterritorieswillhavecompletedtheirvulnerabilityassessment.#XDXX?XD'U#L*ST݌ 8% " Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*_W    Rx'b"&!XDXXXDXDXXXD   IncreasingHealthCareAccessRXX: XDXXXDXDXXXD  ݀ 'b"$ ?XDXXXDHealthResourcesandServices 'N#% Administrationisincreasingaccesstohealthcarebymeetingtheirtargetofserving9.6millionlowincome,minority,anduninsuredpersonsinFY2000.Itisestimatedthat10.5millionwereservedin FY2001.#XDXX?XDY#L*_WW݌ -(+ Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*[ D   Rx(xXDXXXDXDXXXD   WelfaretoWorkR[\: XDXXXDXDXXXD  ݀?XDXXXDAdministrationfor (x+   ChildrenandFamiliesisbuildinguponthesuccessesofwelfarereformbyassistingallstatesinmeetingCongressionallyestablishedworkparticipationratesof40percentinFY2000#XDXX?XD\#.+XDXXX'X^XXD+L*[[݌  0 Ќ XDXXXDXDXXXD  /XDXXX'X^XXD]/L* XDXXXDXDXXXD  L*^ D   Formoredetailontheseandother & v2 programs,weencourageyoutoexploretheindividualagencyPlansandReportsavailableonline:www.hhs.gov/topics/planbudget.html.L*^S_݌̌ XDXXXDXDXXXD  Thisdocumentincludes: 8 8 L* XDXXXDXDXXXD  L*` D   Rx $t XDXXXDXDXXXD   DepartmentalManagementRa: XDXXXDXDXXXD  Earlyin  9 hisAdministration,thePresidentarticulatedaManagementAgenda.Thisagendaincludes:1)StrategicManagementofHumanCapital;2)CompetitiveSourcing;3)ImprovedFinancialPerformance;4)ExpandingElectronicGovernment;and5)BudgetandPerformanceIntegration.ThedetailsofHHSeffortstomeetthesechallengesiscontainedintheindividualplans.Thissectioncontainsasampleoftheseefforts.L*`na݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*d D   Additionally,DepartmentalManagement "rF alsosummarizesothermanagementissuesthatimpactoverallDepartmentwideperformance.TheyderivefromtheworkoftheHHSOfficeofInspectorGeneral,andtheGeneralAccountingOffice.L*dOe݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*f D   Rx# #pXDXXXDXDXXXD   BudgetandPerformanceIntegration #M ProjectRgX: XDXXXDXDXXXD  AkeyexpectationoftheGPRAis $N togainaclearerunderstandingofwhatgovernmentisdoingbylinkingwhatisbeingachievedtowhatisbeingspent.+XDXXX'X^XXD+ XXDL*f}g݌ D'"Q Ќ      XDX   X   #XDXXXDi#t^j>.*h~{ `E\ {tt9  t/XDXXX'X^XXDoi/L* XDXXXDXDXXXD  XL*ck       The   Administrationseekstomovebudgetandperformanceintegrationfromageneralconcepttoaspecificapplication,andindeeditisanelementofthePresidentsManagementAgenda.ThissectionhighlightsHHS   considerablesuccesses,explainsobstaclestobeovercome,andpointsadirectionforthefuture.L*ckk݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*6n    RxJXDXXXDXDXXXD   2001ReportsSummaryRn: XDXXXDXDXXXD  Thismost J detailedsectionoftheDepartmentalSummarycapturesanumberofperformancetargets.Asstatedearlier,thesetargetsandmeasureswereselectedbecausetheyreflectSecretaryThompsonspriorities,ortheycontinuethestoryofanenduringgoal.ThestoriesprovideproofthatHHStouchesthelifeofvirtuallyeveryAmerican.Thetargetsandmeasuresareorganizedaroundthe OneHHSDepartmentwideOutcomeGoals.ThisconstructionwasselectedbecauseitarticulatesthecurrentprioritiesandvisionoftheHHSleadershipteam.AcrosswalkbetweentheOutcomeGoalsandthegoalsoftheHHSStrategicPlanisincludedattheendofthissection.L*6nn݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*s    Rx)$)l$XDXXXDXDXXXD   PerformanceDataCollectionRsage: XDXXXDXDXXXD  HHS )$( programsworkcloselywithstate,local,tribal,private,andbusinesscommunitypartnerstocollectandanalyzedataforGPRAmeasurement.Wemakeuseofpopulationbaseddatacollectionsystems, 0.)- vitalstatistics,diseasesurveillance,administrativedata,andothermechanisms.Eachoftheseprogramshasstrengthsandweaknessesthatthissectiondetails.L*ss݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*v D   ThecompleteHHSFY2003 &2 PerformancePlanandReportiscomprisedofthePerformancePlansandReportspreparedbythefollowingagenciesandstaffcomponents:L*vWw݌̌ XDXXXDXDXXXD  8L 5MOQSTUVWx34L   8x23   D   AdministrationonAging(AoA)+@XDXXXX)JXXD+Ԁserves  8 8 astheprimaryfederalfocalpointandadvocacyagentforolderAmericans.Throughanetworkofstateandareaagenciesonaging,AoAfundedprogramsdelivercomprehensiveinhomeandcommunityservices;andmakelegalservices,counseling,andombudsmenprogramsavailabletoelderlyAmericans.8xYy݌̌L 4#3x5MOQSTUVWL   /XDXXXX)JX@XDy/8L 5MOQSTUVWx34L   8|23   D   AdministrationforChildrenand B Families(ACF)+@XDXXXX)JXXD+Ԁleadsthenationin C improvingtheeconomicandsocialwellbeingoffamilies,children,andcommunitiesthoughfederalgrantprogramslikeHeadStart,ChildSupportEnforcement,ChildWelfareServices,ChildCareandDevelopment,andTemporaryAssistancetoNeedyFamilies(TANF).8||݌̌L 4#3x5MOQSTUVWL   /XDXXXX)JX@XD.}/8L 5MOQSTUVWx34L   8\23   D   AgencyforHealthcareResearchand lL Quality(AHRQ)+@XDXXXX)JXXD+enhancesthequality, X M appropriateness,andeffectivenessofhealthservicesandaccesstosuchservices,throughthepromotionofimprovementsinclinicalandhealthsystempractices,includingthepreventionofdiseasesandotherhealthconditions.8\݌̌L 4#3x5MOQSTUVWL   /XDXXXX)JX@XD/8L 5MOQSTUVWx34L   823   D   CentersforMedicare&Medicaid B'"U Services(CMS)pays+@XDXXXX)JXXD+ԀMedicarebenefits; .(~#V providesstateswithmatchingfundsforMedicaidbenefits;administerstheStateChildrensHealthInsuranceProgram(SCHIP);conductsresearch,demonstrations,andoversighttoensurethesafetyandqualityofmedicalservicesandfacilities80݌  -)\ ЌL 4#3x5MOQSTUVWL   providedtoMedicarebeneficiaries;andestablishesrulesforeligibilityandbenefitpayments./XDXXXXy\X@XDÃ/8L 5MOQSTUVWx34L   8U23      CentersforDiseaseControland t Prevention(CDC)m+@XDXXXXy\XXD+onitorshealth; ` identifiesandinvestigatespublichealthproblems;promoteshealthybehaviors;anddevelopsandadvocatessoundpublichealthpoliciestopreventandcontroldisease,injury,anddisability.8U݌̌L 4#3x5MOQSTUVWL   /XDXXXX)JX@XD/8L 5MOQSTUVWx34L   8d23      FoodandDrugAdministration(FDA)+@XDXXXX)JXXD+ ^  promotesimprovementinthehealthoftheAmericanpublicbyensuringtheeffectivenessand/orsafetyofdrugs,medicaldevices,biologicalproducts,food,andcosmetics;andbyencouragingtheactiveparticipationofbusinessandthepublicinmanagingthehealthhazardsassociatedwiththeseproducts.8d݌̌L 4#3x5MOQSTUVWL   /XDXXXX)JX@XDl/8L 5MOQSTUVWx34L   823      HealthResourcesandServices  p Administration(HRSA)+@XDXXXX)JXXD+Ԁpromotesequitable  \ accesstocomprehensive,qualityhealthcareforall,withaparticularfocusonunderservedandvulnerablepopulations.8K݌̌L 4#3x5MOQSTUVWL   /XDXXXX)JX@XDލ/8L 5MOQSTUVWx34L   8~23      IndianHealthService(IHS)+@XDXXXX)JXXD+Ԁprovides 2 comprehensivehealthservicesforAmericanIndianandAlaskaNative(AI/AN)people,withopportunityformaximumtribalinvolvementindevelopingandmanagingprogramstoimprovehealthstatusandoverallqualityoflife.8~݌̌L 4#3x5MOQSTUVWL   /XDXXXX)JX@XD/8L 5MOQSTUVWx34L   8z23      NationalInstitutesofHealth(NIH), #l# through25institutes,centers,anddivisions,NIHsupportsandconductsmedicalresearch,domesticallyandabroad,intothecausesandpreventionofdiseasesandpromotestheacquisitionanddisseminationofmedicalknowledgetohealthprofessionalsandthepublic.8z݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8J23      OfficeforCivilRights(OCR)+AXDXXXX)JXXD+Ԁpromotes *B&, andensuresthatpeoplehaveequalaccesstoandopportunitytoparticipateinandreceiveservicesinallHHSprogramswithoutfacingunlawfuldiscrimination.Through .)0 preventionandeliminationofunlawfuldiscrimination,theOCRhelpsHHScarryoutitsoverallmissionofimprovingthehealthandwellbeingofallpeopleaffectedbyitsmanyprograms.8J݌̌L 4#3x5MOQSTUVWL   #XDXXAXDM#8L 5MOQSTUVWx34L   8֘23   D   OfficeofInspectorGeneral(OIG)+@XDXXXX)JXXD+  6 improvesHHSprogramsandoperationsandprotectsthemagainstfraud,waste,andabuse.Byconductingindependentandobjectiveaudits,evaluations,andinvestigationsOIGprovidestimely,useful,andreliableinformationandadvicetoDepartmentofficials,theAdministration,theCongress,andthepublic.8֘p݌̌L 4#3x5MOQSTUVWL   /XDXXXX)JX@XDݙ/8L 5MOQSTUVWx34L   8'23   D   ProgramSupportCenter(PSC)+@XDXXXX)JXXD+Ԁprovides  @ abroadrangeofadministrativeservicestoHHScomponentsandotherFederalagenciesonacompetitive,fee-for-servicebasis.PSCservicesareprovidedinthreebusinessareas:humanresources,financialmanagement,andadministrativeoperations.8'݌̌L 4#3x5MOQSTUVWL   /XDXXXX)JX@XD)/8L 5MOQSTUVWx34L   8@23   D   SubstanceAbuseandMentalHealth nH ServicesAdministration(SAMHSA)+@XDXXXX)JXXD+, ZI throughitsthreecenters,workstoimprovequalityandavailabilityofprevention,earlyintervention,treatment,andrehabilitationservicesforsubstanceabuseandmentalillness,includingcooccurringdisorders,inordertoimprovehealthandreduceillness,death,disability,andcosttosociety.8@ڟ݌̌L 4#3x5MOQSTUVWL   /XDXXX'X^X@XD|/8L 5MOQSTUVWx34L   823   D   OfficeoftheSecretary:Departmental 0"R AppealsBoard(DAB)isanindependentofficeestablishedtoprovideconflictresolutionservices.Theseservicesarebasicallyoftwotypes:1)adjudicatoryhearings,appellatereviewofdecisionsofadministrativelawjudges,andsimilarlystructuredformalandinformalreviewsofcontesteddecisions;and2)alternativedisputeresolution(ADR),includingmediationandotherconsensualprocesses andtrainingrelatedtoADR.8[݌ T,'] ЌL 4#3x5MOQSTUVWL   L* XDXXXDXDXXXD  L*U       TheAssistantSecretaryfor  AdministrationandManagement(ASAM)_providesleadershipforHHSdepartmentalmanagement,includinghumanresourcepolicy,grantsmanagement,acquisitions,anddepartmentaloperations.The_ASAM_ԀalsoservesastheoperatingdivisionheadfortheHHSOfficeoftheSecretary.L*UԦ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    OfficeofAssistantSecretaryforBudget,    TechnologyandFinance(ASBTF)advisestheSecretaryonallaspectsofbudget,informationtechnology,andfinancialmanagement,andprovidesgeneraloversightanddirectionofthebudgetaryandfinancialorganizationsandactivitiesoftheDepartment.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*~    OfficeofAssistantSecretaryfor \ PlanningandEvaluation(ASPE)providespolicyanalysisandadvice;guidestheformulationoflegislation;coordinatesstrategicandimplementationplanning;conductsregulatoryanalysisandreviewsregulations;overseestheplanningofevaluation,nonbiomedicalresearch,andmajorstatisticalactivities;andadministersevaluation,datacollection,andresearchprojectsthatprovideinformationneededforHHSpolicydevelopment.L*~݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    OfficeofPublicHealthandScience 2 (_OPHS_)providesseniorprofessionalleadershipacrossHHSonpopulation-basedpublichealthandclinicalpreventiveservicesbyprovidingscientificallysoundadviceonhealthandhealthpolicytotheSecretary,DepartmentalofficialsandothergovernmentalentitiesandcommunicatingonhealthissuesdirectlytotheAmericanpublic;conductingessentialpublichealthactivitiesthroughelevenprogramoffices,andprovidingprofessionalleadershiponcross-cuttingDepartmentalpublichealthand scienceinitiatives.L݌ +.', Ќ (#(#             (#(# XDXXXDXDXXXD  P4`XDXXXD    XDXXXD   P4`ӳ  NavigatingtheAgencyPerformance F PlansandReportsP4`ӳf:Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*I D   HHSanditsagenciesdevelopeda &vH standardizedformatthatwasfirstintroducedfortheFY2001PerformancePlansandFY1999PerformanceReports.Thisformat,showninthefigure,establishesaconsistentorderofpresentationofinformationrequiredbythelawandOfficeofManagementandBudget.L*Iȵ݌̌ XDXXXDXDXXXD  P4`"<!LXDXXXD  XDXXXD   P4`  ImprovingthePlansandReportsP4`;#"<Ԍ #Q ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*  D   Whilethedevelopmentofplansand $R reportsisadecentralizedprocess,HHShasmadeseveralimprovements:L* ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Allagencieshavealignedtheirplans '#V withthegoalsoftheAdministration,andi^B5%!`z#  `E8 tt p iemphasizedoraddedmeasuresthatreflect )$X theSecretaryspriorities.L*:݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Plansandreportsreflectourcontinuing +<'[ leadingedgelinkageofperformanceandbudget.L*݌ -)] Ќ XDXXXDXDXXXD  P4`XDXXXD  XDXXXD   P4`Ͼ  CrosswalktotheHHSStrategic  PlanP4`ϾN@Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*"    Generally,agenciesarelikelytohave ,| moreoutputgoalsthanoutcomegoals,whichreflectbroadstandards,benefitstoawidecommunity,orincidencesonanationallevel.Therehasbeenincreasedemphasisthroughoutthegovernmentandintheperformancemeasurementcommunityonoutcomegoals.Asaresult,theexamplesofperformanceinthisDepartmentSummaryareorganizedaroundasetofHHSpriorityareascalledthe OneHHSDepartmentwideOutcomeGoals.TheseflowsmoothlyfromtheHHSStrategicPlan.ThefollowingtableisacrosswalkofthesepriorityareasandthecurrentHHSStrategicPlan.TheHHSStrategicPlansubmittedtoCongressinSeptember2000isbeingrevisedtoreflectnewhealthandhumanservicespriorities.L*"݌ XDXXXDXDXXXD   :    XXD & $  CrosswalkofDepartmentwide  OutcomeGoalsandStrategicPlanGoals #XDX # < {*CZDddd Xdd Xdd X(#(#,xx",xx"+   > hXXD@@ <CurrentStrategicPlan R Goals '@" '@@D D CT$OneHHSOutcomeGoals 'R" 'ReducetheMajorThreatstoHealthandProductivityofAllAmericans '^  'ImproveHealthOutcomesEmphasizePreventiveHealthMeasures ' L# 'ImproveAccesstoHealthServicesandEnsuretheIntegrityoftheNationsHealthEntitlementandSafetyNetPrograms ' ( 'IncreaseAccesstoHealthCareExpandConsumerChoicesinHealthCareandHumanServices 'D . 'ImprovetheQualityofHealthCareandHumanServices '1 'ImprovetheQualityofHealthCare 'd 3 'ImprovetheEconomicandSocialWellBeingofIndividuals,FamiliesandCommunitiesintheUnitedStates '\8 'ImprovetheWellBeingandSafetyofFamiliesandIndividuals,especiallyVulnerablePopulationsStrengthenAmericanFamilies '? 'ImprovetheNationsPublicHealthSystems 'hA 'PrepareforandEffectivelyRespondto_Bioterrorism_ԀandotherPublichealthEmergencies 'E 'StrengthentheNationsHealthSciencesResearchEnterpriseandEnhanceItsProductivity 'I 'AdvanceScienceandMedicalResearch 'tK ' '2L 'ReduceRegulatoryBurdenonProviders,Patients,andConsumersofHHSServices#XDXhN#" nO  " XXDNote:OMBCircularA11requiresFederalagencies !(P tosummarizethefindingsandrecommendationsofagencyprogramevaluationsintheGPRAperformancereport.ThemostrecentdocumentthatincludesHHSevaluationsistheDepartmentalreporttoCongress,PerformanceImprovement2001: %!U EvaluationActivitiesoftheU.S.DepartmentofHealthandHumanServices.Itcanbefoundat B'"W 4Een:O  5  http://aspe.hhs.gov.#XDX a#6=:OQits;  7en0'$ (X#X  ($Y (X@(  *%Y Kz$  .X\XXXD.e?\eX.X\  Kz$@p p     DEPARTMENTALMANAGEMENTKz$     Ќe ee.e?\XDX ee  L* XDXXXDXDXXXD  (X@(#(#(E% ,X,XD,xX,X,XEL*    ThissectionaddressesthePresidents T ManagementAgendaandothermanagementissuesthatimpactoverallDepartmentwideperformance.L*݌̌ XDXXXDXDXXXD  P4`j z XDXXXD  XDXXXD   P4`   ThePresidentsManagementAgenda P4`n j Ԍ n  ЌXDXXDXDXXD  L* XDXXXDXDXXXD  E,X, X ,X,XD,xXEL*    PresidentBushenvisionsagovernment  Z  thathasacitizenbasedfocus,isresultsoriented,andwherepracticable,marketdriven.Toimprovethefunctioningofgovernmentandachieveefficienciesinitsoperations,thePresidenthighlightedaseriesofgovernmentwidemanagementreformsforthefederalgovernmentinthePresident'sManagementAgenda.DuringtheperiodleadinguptotheFY2003GPRAsubmission,theDepartmentcontinuedtoplacespecialemphasisonthesereforms.Theyinclude:L*O݌̌ XDXXXDXDXXXD  >kL XMOQSTUVWCh34L @  0   >k 2C3      StrategicManagementofHumanCapital>k ݌| ЌL 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >kۯ2C3      CompetitiveSourcing>kۯ*݌  ЌL 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >k 2C3      ImprovedFinancialPerformance>k ݌  ЌL 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >kۛ2C3      ExpandingElectronicGovernment>kۛ݌ A ЌL 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >k2C3      BudgetandPerformanceIntegration>k݌  h ЌL 4#3hXMOQSTUVWL @  ݀L* XDXXXDXDXXXD  L*    Workcontinuestoprogressinthesefive +"{ areasthroughouttheDepartment,andinsomecasestherearealreadyimpressiveresults.Becausesomeoftheseareareasofneworexpandedemphasis,newgoalsandmeasureshavebeendevelopedtocaptureongoingactivity.Eventhesenewgoalsandmeasuresareexpectedtoshowpositive results.L*݌ )$% Ќ XDXXXDXDXXXD  P4`D TXDXXXD   XDXXXD   P4`P   StrategicManagementofHuman D % Capital ԀP4`P 40 Ԍ̌XDXXDXDXXD  L MOQSTUVWy34LL* XDXXXDXDXXXD  L* D   ThefirstpriorityofthePresident's  ' ManagementAgendaistomakegovernmentcitizencentered.HHShasestablishedavisionofaunifiedHHS! OneDepartment!thatwillbefreeofunnecessarylayersandbecollectivelystrongtoservetheAmericanpeople.Toachievethis,HHSplanstoreduceduplicationofeffortbyconsolidatingadministrativemanagementlayers,reducethenumberofpersonneloffices,andconsolidatethepublicaffairsandlegislativeaffairsfunctions.HHSwillcontinuetoreshapeitsorganizationtomeetthestandardofexcellenceinattainingoutcomesimportanttothenation.HHSwillmakebetteruseofthecivilservice_flexibilities_Ԁcurrentlyinplacetoacquireanddeveloptalentandleadership.Somespecificinitiativesthatliveuptothechallengeinclude:L*݌̌ XDXXXDXDXXXD  8L 5MOQSTUVWxyMOQSTUVWL   ?XDXXXD823   D   SAMHSAiscompletingtwomajor < initiativesthatwillprovidethefoundationforsettingperformancegoalsfordelayeringmanagementlevelsandstreamliningtheorganization.First,aWorkforceAnalysisforPlanningandRestructuringisnearingcompletionthatwill:examinethedemographicsofthepermanentworkforce;provideinformationonSAMHSA'sseasonal,temporary,andintermittentworkforce;evaluatetheskillsoftheworkforce,andbaselinethesupervisortostaffratio.TheseanalyseswillbeusedtodevelopaStrategicWorkforcePlanthatwillfacilitatedevelopmentofappropriate performancemeasures.8f݌ ,'K ЌL MOQSTUVWxx5MOQSTUVWL   #XDXX?XDG#8L 5MOQSTUVWxxMOQSTUVWL   ?XDXXXD823         FDAismakingsignificanteffortsto  furtherdelayertheagencyandallowforamoreeffectiveandstreamlinedorganization.Specifically,FDAisalreadycommittedtoincreasingthesupervisoryspanofcontrolandconsolidatingadministrativefunctionsintheagency.8݌̌L MOQSTUVWxx5MOQSTUVWL   #XDXX?XD#8L 5MOQSTUVWxxMOQSTUVWL   ?XDXXXD823      CDChasdevelopedaRestructuringand   DelayeringPlanthatcontains14specificgoals.#XDXX?XD#K+ 4 <DL!,X, XK?XDXXXDThesegoalsinclude:improving r   supervisoryratios;increasingthespanofcontrol;reducingthenumberoforganizationalunits;increasingdelegationsofauthority;andeliminating_duplicative_administrativefunctions.8݌̌L MOQSTUVWxx5MOQSTUVWL   8L 5MOQSTUVWxxMOQSTUVWL   ', XX'823      #XDXX?XD#?XDXXXDAoA#XDXX?XD#?XDXXXDconductedanextensivereviewof p workforceandstructuralconditionsandfoundthatimprovementsarenecessaryinorganizationallayers,gradestructure,andskillmix.#XDXX?XDB#?XDXXXDAoA#XDXX?XDB#?XDXXXDhasincludedperformance  p measuresinitsGPRAplantoincreaseemployeetosupervisorratio;achieveameasurablereductionintheaveragegradeofemployees;andhirenewemployeesinconformancewithskillsrequiredintheagency'sworkforceplan.8݌̌L MOQSTUVWxx5MOQSTUVWL   /XDXXXXX?XD/L MOQSTUVWyxMOQSTUVWLP4`J ZXDXXXD   XDXXXD    P4`  CompetitiveSourcing eԀP4`rJԌ  ЌXDXXDXDXXD  L* XDXXXDXDXXXD  -,hX, X-x6B2.h~0$+  `..E$+   #P xL*H    ManytasksFederalemployees   perform!likedatacollection,administrativesupport,andpayrollservices!canbe              n.)- accomplishedinthecommercialmarketplace.Whenpotentiallycommercialtasksareconsideredforcompetition,qualityserviceandreasonablecostsareoftentheresult.InaccordancewiththeFederalActivitiesInventoryReform(FAIR)Act,HHSisassessingavarietyofactivitiesintermsoftheirpotentialforcompetition.L*Hl݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*| D   InthelastyeartheDepartmentsubmitted  6 itsthirdannualCommercialActivitiesInventoryundertheFAIRAct.TheOfficeoftheSecretaryworkedwiththeagenciestoimprovetheaccuracyandconsistencyoftheinventory.Buildingonthatsuccessandacceptingthenewchallenge,HHSagencieshavecommittedtothegoalofcompetingordirectlyoutsourcing5percentoftheirinventoryinFY2002(seeFigure1).ThegoalforFY2003willbeanadditional10percent.L*|݌̌ XDXXXDXDXXXD  P4`L \XDXXXD  XDXXXD   P4`   ImprovingFinancialPerformance 7ԀP4`LԌ C ЌXDXXDXDXXD  L* XDXXXDXDXXXD  -, X,hX-L* D   TheSecretaryhasmadethe D establishmentofaUnifiedFinancialManagementSystemaDepartmentwidemanagementpriority,consistentwithhis OneHHSapproach.TheFY2003DepartmentalManagementperformanceplanincludesaperformancemeasuretoassessprogresstowardtheachievementofthisgoal(SeeFY2003GeneralDepartmentalManagementbudgetsubmission,FinanceGoal4).Specifically,the_UFMS_Ԁwillbeimplementedtoreplacefivelegacyaccountingsystemscurrentlyusedacrosstheagenciesandstaff_componants_.The_UFMS_ԀwillintegratetheDepartmentsfinancialmanagementstructureandprovideHHSleaderswithamoretimelyandcoordinatedviewofcriticalfinancialmanagementinformation, includingmoreaccurateassessmentsofthe  ,p'W costofHHSprograms.ItpF<,(`~0  `..E^  R]M pwillalsopromote theconsolidationofaccountingoperationsandtherebyreducesubstantiallythecostofprovidingaccountingservicesthroughoutHHS.Similarly,_UFMS_,bygeneratingtimely,reliableandconsistentfinancialinformation,willenableAgencyHeadsandprogramadministratorstomakemoretimelyandinformeddecisionsregardingtheiroperations.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  -,X, X-L*     Medicareaccountsfornearlyhalfofthe ^  HHSBudget.Therefore,CMS'positiveresultsinreducingimproperpaymentsareespeciallynoteworthy.CMShasvirtuallycuttheMedicarefeeforserviceerrorrateinhalfoverthepastfewyears.L  ݌̌           XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    ThecomplexityofMedicarepayment  $ systemsandpolicies,andthenumbersofcontractors,providers,andinsurersinvolvedintheMedicarefeeforserviceprogramcreatevulnerabilities.However,CMShaskepttheerrorrateunder8percentforthepasttwoyears,andexceededitsGPRAtargetsforFY1999andFY2000(seeFigure2).ThemostrecentdataforFY2000showsanerrorrateof6.8percent,exceedingthetargetof7.0percent.ThesubstantialreductionintheerrorrateoverthepastyearsdemonstratesthattheMedicarecontractorclaimsprocessingsystemhasimproved.CMSiscommittedtofurtherreducingtheerrorratebyfocusingonpotentialareasof .)3 vulnerabilitylikethoseidentifiedbytheOfficeofInspectorGeneral.Theybelievethatbyaggressivelyaddressingspecifichighriskareastheycanmeetthegoalofreducingtheerrorrateto5percentbyFY2002.L*݌̌ XDXXXDXDXXXD  P4`  XDXXXD  XDXXXD   P4`j   ExpandingElectronicGovernment ԀP4`jf  Ԍ f 9 ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L* D   TheHHSElectronicGovernmentVision R : istouseinformationtechnologyinconcertwiththeDepartmentsprogramandmanagementprioritiestocreate OneHHS.AggregationandconsolidationofHHSinformationtechnologyinitiativeswillresultinamorecosteffectiveinformationinfrastructureandamoreunified,responsiveaccessforthepublic.HHSisattheforefrontofstreamliningthegovernmentgrantsprocessusinginformationtechnology,aswellasprovidingskillstrainingandsupporttoHHSemployeeselectronically.L*\݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*A D   DepartmentofTreasuryguidelines H establishedtargetsforconvertingtoElectronicFundsTransfer(EFT)forallfederalagencies(69percentforFY1999and75percentforFY2000).EachHHSagencyhasanautomatedprocessfortabulatingthenumberandtypesofpaymentsmade.ThisinformationisusedtocompilequarterlyEFTReports.L*A݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   HHSestablishedgoalsforgrant !R payments,salarypayments,vendorpayments,andtravelpaymentsbasedontheTreasuryguidelines.HHSmetorexceededourgoalsineveryareaexceptsalarypayments,whereHHSachieveda99percentpaymentrateagainsta100percentgoal.Inthechallengingareaofvendorpayments wherethetargethasriseneveryyearHHS (6$Z p<,(`~0l  `..Exl l -/ p            canpointtoimpressiveresults.Inthemost $   recentyear(seeFigure3)HHSexceededitstargetandincreasedthepercentageofvendorpaymentsto86percent.L*Y݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  x6B2.h~0Gx T `..Exx T 4 xL*$!    ACFcontinuestoshowexceptional J resultsdevelopingandimplementingtheGrantsAdministration,TrackingandEvaluationSystem(GATES).GATESwasdesignedtosupportdecisionmakingand            accountabilityinadecentralizedenvironment.GATESwillreplacemorethan30incompatible,outmodedlegacysystemsoperatingonavarietyofplatformstosupportgrantsadministration.Havingcompletedtheconversionandreplacementefforts(seeFigure4),allACFgrantsarenowawardedthroughGATES.InFY20022003,ACFwillimplementanextgenerationofelectronicgrantmakingusingan OnlineDataCollection(_OLDC_)InitiativetoenablegranteesandpotentialgranteestosubmittherequiredinformationovertheInternet.L*$!"݌ -)- Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*C' D   Inaddition,byexpandingelectronic - governmentthroughtechnologybasedsystems,organizationalproductivityisincreased.CDCprovidestwoexamplesofthisworkinitsdescriptionofITcapabilitiesandinitsuseoftechnologybasedlearninganddataminingtechniques.Andtohelpeffortstomeasuretheproductivityofelectronicgovernmentinitiatives,NIHhighlightsperformancemeasuresforITsystemsonits_website_. L*C''݌  8 7 Ќ XDXXXDXDXXXD  P4`: J XDXXXD  XDXXXD   P4`x*   BudgetandPerformance : 9 Integration +ԀP4`x*** &v Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*+ D   HHS'entireGovernmentPerformance ; andResultsActeffortisaimedatmorecloselyintegratingperformanceandbudget.Unlikemanyotherfederalagencies,HHShasalreadyorganizedperformancemeasuresaroundbudgetelements.Inmostcases,agencyperformancereportsincludesummarytablesthatassociateperformancegoalswithtotalfundingforthatactivity.TheDepartmentparticipatedindetaileddiscussionwithOMBonperformancebudgetlinkageatSAMHSAandHRSAthroughoutthesummerof2001,identifyingtheseveralchallengestothisactivityandexploringsolutions.AdetaileddiscussionofthefuturedirectionofthisinitiativewasprovidedinSection3,PerformanceBudgetIntegrationProject.InthecomingyearHHSwillexplore,withOMB,thefeasibilityandpotentialbenefitsthatmaybeaccruedfromintegratingprogramperformanceandfundingforfederalpublichealthgrantsto states.L*+g,݌ '^"Q Ќ XDXXXDXDXXXD  P4`XDXXXD  XDXXXD   P4`0      OtherManagementIssues 1P4`0a1TԌ T ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*[2    Finally,theHHSGPRAPlansand @ Reportsaddressanumberofimportantmanagementissuesthatcanaffectoverallperformance,orarelinkedtofraud,wasteandabuse.SomeofthemostimportantchallengesareidentifiedintheOIGslistofTopManagementChallenges.Thetablebelowidentifiestheissue,summarizesprogress,andpointstotheappropriatePlan/Reportwheremoreinformationisavailable.FormoreinformationonOIGactivitiesandreports,visithttp://oig.hhs.gov.L*[22݌ P  Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*5    Inaddition,anotherperspectiveof  overallDepartmentmanagementissuesisdetailedinGAO01748,HealthandHuman  ServicesStatusofAchievingKeyOutcomesandAddressingMajorManagementChallenges.Inmostinstancesour N performance,summarizeddirectlyfromtheGAOreportandreflectedinthenexttable,improvedsincetheGAOslastreport.L*5&6݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*8    Timelyimplementationof t recommendationsandcorrectionofmanagementdeficienciesareessentialtoimprovingtheefficiencyandeffectivenessoftheDepartmentsprogramsandoperations.HHSiscommittedtofollowinguptheserecommendations.Infact,inresponsetotherecommendationsinthe2001report,theDepartmentdevelopednewgoalsforstrategichumancapitalmanagement,andinformationsecurity.L*88݌ XDXXXDXDXXXD   XXD '^"% & "    #XDX o;# XXDManagementIssuesIdentified v& bytheHHSInspectorGeneral #XDX ;# <' ;*xZddxx"xx"CZD(#(#x,dd ,dd ,dd +   >) hXXDManagement R* Issue '@+" 'ProgramProgress 'R," 'GPRAPerformanceMeasure(s)  /" _Bioterrorism_   0 Severalactivitiesunderway '^ 2" 'CDC  3" MedicareContractors  . ~5 UnqualifiedopinionofCMSfinancialstatement;significantimprovements ' ;" 'CMS  <" ProtectionofCriticalInfrastructure  d ? Severalcoordinatedinformationtechnologyactionsinprogress '>E" 'DM ( F" PricingPrescriptionDrugs  \I Furtheranalysisrequired 'K" 'Є  pL" NursingFacilities  M Meaningfulprogress ',|O" 'CMS P" MedicarePaymentErrorRate  S Significantprogress 'LU" 'CMS ^V" MedicareManagedCare  jX Someprogress 'Y" 'CMS Z" ChildSupportEnforcement  :\ Someprogress ']" 'ACF ^" Oversightof_PPS_Implementation   Z` Monitoringandanalysisongoing ' Zb" 'CMS lc" AbusesinMedicaidPaymentSystems  x"f Newregulationsphasingin '!*h" 'CMS kL XMOQSTUVWChyMOQSTUVWL @  @XDXXXD>kGs2C3      Establishingformalandinformal ,(- coordinationprocesseswithbudget,GPRA,andfinancestaff>kGss݌ .)/ ЌL MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >k2u2C3   D   Conductingjointbudgetandplanning / activitieswithbudget,planning,andfinancestaff>k2uu݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kv2C3   D   Involvingprogrammanagerstoutilize 2 theirknowledgeofprogramstrategies,performance,costs,servicerecipientsneeds,etc.>kvaw݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kx2C3   D   IssuingjointbudgetandGPRAguidance>kx@y݌  6 ЌL MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kGz2C3   D   Holdingjointplanningmeetingsearly  7 andthroughoutthebudgetcycle>kGzz݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >k{2C3   D   Developingbudgetrequests,outputs, $ 9 andperformancegoalsandtargetssimultaneously>k{c|݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kۙ}2C3   D   Sharingdraftsofbudgetingandplanning # < documents>kۙ}~݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >k'2C3   D   Integratingperformanceinformationinto 6> presentationsattheSecretarysBudgetCouncilandCongressionalAppropriationsCommitteehearings.>k'݌̌L MOQSTUVWxhXMOQSTUVWL @  /XDXXX'X^X@XDs/L* XDXXXDXDXXXD  L*C D   Departmentlevelpracticesthathave  C fosteredtheuseofperformanceinformationinbudgetdecisionsinclude:L*C݌̌ XDXXXDXDXXXD  >kL XMOQSTUVWChxMOQSTUVWL @  @XDXXXD>k2C3   D   IntegratingtheGPRAperformance GG planning,reporting,andbudgetfunctionsatthedepartmentlevel>k݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kՄ2C3   D   IssuingjointbudgetandGPRAguidance#XDXX@XDs#@XDXXXD>kՄP݌ FJ ЌL MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kۙ2C3   D   InvolvingOMBinearlyGPRAplanning  mK sessions,includingthedevelopmentofthecommonformatdevelopedforHHSplansandreports>kۙ݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kv2C3   D   Providingtechnicalassistanceto $XO agenciesandprogramsonperformancemeasurementandbudgetlinkage>kv݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >k72C3   D   Requiringconcurrentsubmissionand 'W"R reviewofdraftsoftheagencybudgetsandperformanceplans>k7݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >k2C3   D   Includingperformanceinformationin *V%U  briefingmaterialsfortheSecretarysBudget *B&V    CouncilmeetingsandSecretarialdecisionmeetings.>kn݌̌L MOQSTUVWxhXMOQSTUVWL @  /XDXXXXy\X@XD߅/P4`XDXXXD  XDXXXD   P4`;   IntegratingBudgetand  Performance:LessonsLearnedfrom  theOMBPilots ؎P4`;?  Ԍ ?  ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*    OMBsreportonthegovernmentwide ' w performancebudgetingpilotconductedinFY2000,whichincludedFDA,identifiedthefollowingchallengestolinkingbudgetandperformance:L*|݌̌ XDXXXDXDXXXD  >kL XMOQSTUVWChxMOQSTUVWL @  >k2C3      @XDXXXD Budgetingisoftenbasedonthe 9  structureoffundingrequeststotheappropriationscommittees,andthestructuredoesnotalwayscorrespondtoperformancegoals.>kt݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >k2C3      Inmanyinstances,measuringthe ` effectsofmarginal,annualbudgetchangesonperformanceisnotpreciseormeaningful.>k݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >k2C3      Asageneralmatter,weareworkingto K movefromouralmosttotalrelianceonoutputmeasurestooutcomes.However,itismuchmoredifficulttoassociatespecificresourcelevelswithoutcomes,particularlyovershortperiodsoftime.>ku݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kJ2C3      Theabilitytoestablishclearlinkages  betweenprogramoutcomesandfundinglevelsvariesdependingonthenatureoftheprogramandthenumberofrelevantexternalfactors.>kJŘ݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >k\2C3      Delaysincollectingdataonprograms, # sometimesbecauseofnecessaryrelianceonprogrampartnersfordatacollection,presentsachallengetosynchronizationofbudgetandperformancedata(OMB2001).#XDXX@XD#@XDXXXD>k\ך݌ E'"# ЌL MOQSTUVWxhXMOQSTUVWL @  /XDXXX'XX@XD&/L* XDXXXDXDXXXD  L*    DuringtheFY2002budgetprocess, l(#$ OMBworkedwithHHSandtheHealthCentersProgramtobetterintegratebudgetandperformance.Thiscommunitybasednetworkdeliverspreventiveandprimarycareservicestothe_underserved_Ԁanduninsuredpopulationsinapproximately4,000communitiesacrossthecountry.L*݌ .0*+ Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   HHSandOMBstaffmetwithprogram + managerstodiscusstheimplicationsofaproposedmultiyearbudgetincreasewiththegoalofincreasingthenumberofpeopleservedintheHealthCenters.Thediscussionsinvolvedexploringhowvariousimplementationstrategieswouldaffectachievementofthegoal.Forexample,expandingexistingsiteswouldresultinanincreaseinthenumberofpeopleservedinthenearterm,whereasdevelopingnewsiteswouldresultinincreasesinservicesandthenumberofpeopleservedinlateryears.HHSalsoconsideredhowtherapidexpansionofserviceswouldaffecttheprogramsabilitytomaintainitscurrenthighperformanceonitsqualityofcareperformancegoals.Basedonthesediscussions,HRSAaddedanewgoaltoexpandtheinfrastructureoftheHealthCenterProgramtosupportanincreaseinservices,withspecifictargetsfornewsites,newsatellitesites,andexpandedsites.L*=݌̌ XDXXXDXDXXXD  P4`JZXDXXXD  XDXXXD   P4`   IntegratingBudgetand JC Performance:NextSteps KP4`-:6Ԍ :D ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*C D   Theoverarchingthemeofinternal &E discussionsonhowHHScouldbetterlinkbudgetandperformancewastheneedtoestablishacontinuousdialoguebetweenprogrammanagers,budgetanalysts,anddecisionmakersinouragencies,theDepartment,OMB,andCongress.Weneedtodevelopasharedunderstandingofthelogicbehindourchoiceofperformancegoals,thesignificanceofourperformancedata,anditsimplicationsforbudgetdecisions.L*C¦݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*E D   Fundamentaltolinkingbudgetand \)$R  performanceisunderstandingthe H*%S relationshipsbetweenprograminvestments,   inputs,outputs,andoutcomes.Whiletherelationshipbetweeninvestments,inputs,andoutputsisfairlystraightforward,therelationshipbetweeninvestmentsandoutcomesismorecomplex.Goodcommunicationwillensurebetterunderstandingoftheserelationshipsandthestrengthoftheconnections.Inaddition,improvedcommunicationandasharedunderstandingoftheserelationshipscangreatlymitigatethechallengestointegration,suchasthirdpartyprogramimplementation,thatwillbediscussedlaterinthispaper.L*Eĩ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*@    @XDXXXDInthemonthsahead,weplantoengage J programmanagers,budgetanalysts,anddecisionmakersinansweringthequestions:whoneedswhatinformation,when,andin  whatformat,whichwasanotherkeytheme  ofourdiscussions.Thiswillenableustoprovidetheinformationourbudgetanalystsanddecisionmakersneedtoconsiderprogramperformanceinbudgetdecisions.Specificquestionsweneedtoanswerare:#XDXX@XD#L*@݌ F Ќ XDXXXDXDXXXD  >kL XMOQSTUVWChxMOQSTUVWL @  @XDXXXD>kۨ2C3      Doourcurrentbudgets/plans/reports  containtheperformanceinformationyouneedtomakebudgetdecisions?>kۨB݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kێ2C3      Whatperformanceinformationdoyou  needthatwehavenotprovided?>kێ ݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >k-2C3      Howcanwebetterarticulatethe !   relationshipsbetweendollars,inputs,outputs,andoutcomes?>k-݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >k2C3      Havewepresenteddatainthemost $ # usefulway?Atthemostappropriatetime?>kb݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kۏ2C3      Howcanwebetterpresentperformance &"% informationforhighleveldecisionmakers(Secretaryandagencyheads)?>kۏ ݌̌L MOQSTUVWxhXMOQSTUVWL @  >kL XMOQSTUVWChxMOQSTUVWL @  >kY2C3      Haveyouidentifiedexamplesof )%( agency/programplansthathaveeffectivelylinkedbudgetandperformance?>kYԹ݌̌L MOQSTUVWxhXMOQSTUVWL @  L* XDXX@XDXDXXXD  L*    Webelievethattheperformance ,(+ informationdesiredbyvariousdecisionmakersislikelytobedifferentandinclude .)- bothperformancedataandcontextualinformation.Atsomedecisionpoints,detailedinformationwillbeneeded.Atotherdecisionpoints,asummarypresentationwillbedesired.Also,ourbudgets,plans,andreportsmaynotbetheonlyvehiclesneededtocommunicateperformanceinformationeffectively.Wemayneedtodevelopadditionalformatsforpresentingperformanceinformationinvarioussituations.#XDXXXD##@XDXXXDL*݌  8 7 Ќ @XDXX@XD@XDXX@XD  /XDXXX'XX@XD"/@XDXXXDL* XDXX@XDXDXXXD  L*. D   Basedonfeedbackfromtheusersofour J 9 performanceinformation,wewillassesstheeffectivenessofourcurrentmixofperformancegoalsandtheformatsweusetopresentthisinformationtodecisionmakers.Wewillconsiderwhetherweshouldpursuemorecompleteintegrationofourperformanceplansandreportswithourbudgetsubmissions,akeyquestionraisedinourinternaldiscussions.Wewillworktobetterintegrateprogramevaluationfindings,humancapitalneeds,andinformationtechnologyissuesinourbudgets,plans,andreports.WewillalsoworkwiththeHHSleadershipandprogramstoassurethatourplansaddressthemanagementchallengesidentifiedinthePresidentsManagementAgendaandHHSInspectorGeneralandGAOmanagementreports.L*.݌̌ @XDXXXD@XDXX@XD  L* XDXX@XDXDXXXD  L*v D   #XDXXXD#@XDXXXDAdditionally,wewillworkwithbudget D!M analystsanddecisionmakersinouragencies,theDepartment,andOMBtoidentifyadditionalresultsorientedbudgetingandplanningpracticesandwillpursuethepracticesidentifiedbyGAO.WewillcontinueourresearchintoworkpublishedbyotherssuchastheOrganizationforEconomicCooperationandDevelopment(OECD),publisherofIntegratingFinancialManagementand |*%W PerformanceManagement,whichprovided h+&X valuableperspectiveforourinternal discussions.#XDXX@XDB#L*v݌ @-(Z Ќ @XDXXXD@XDXX@XD  P4`XDXX@XD   XDXXXD   P4`i       AddressingChallengestoBudget  andPerformanceIntegration P4`i@Ԍ̌@XDXXD@XDX@XD  L* XDXX@XDXDXXXD  L*    @XDXXXDThechallengestolinkingbudgetand ,| performanceinformationthatwereidentifiedintheOMBpilot,theGAOFramework,andintheliteratureonthissubjectallapplytosomeextenttoHHSprograms.Inthissection,wefocusonafewoverarchingchallengesthatsignificantlyaffectourabilitytolinkbudgetandperformanceinformation.Thissectiondescribesthesechallenges,howwehaveaddressedthemtodate,andhowweplantocontinuetoaddressthem.#XDXX@XD#L*݌ P  Ќ @XDXXXD@XDXX@XD  L* XDXX@XDXDXXXD  L*    @XDXXXDInthecomingmonths,wewillengage  decisionmakersinidentifyingnewapproachestoaddressthesechallenges.Manyofthesechallengesaretheresultofthewayweimplementfederalprogramsorfundamentalissuesinprogramassessment.Goodcommunicationbetweentheprogrammanagers,budgetanalysts,anddecisionmakersiscriticaladdressingthesechallengesandmaximizingourabilitytolinkbudgetandperformance.#XDXX@XD(#L*݌ : Ќ @XDXXXD@XDXX@XD  L* XDXX@XDXDXXXD  L*    RxLXDXXXDXDXXXD   ThirdPartyProgramImplementationRt :   XDXXXDXDXXXD  Thirdpartyprogramimplementation,often  referredtoasthirdpartygovernment,presentssignificantchallengesforaccountabilityandlinkingbudgetandperformance.MostHHSprogramsareimplementedthroughthirdpartyadministrativeandfinancingarrangements:grants,cooperativeagreements,andcontractswithstate,local,andtribalgovernmentsandnonprofitandforprofitorganizations.L*J݌̌ @XDXXXD@XDXX@XD  L* XDXX@XDXDXXXD  L*    @XDXXXDThisprogramimplementationstructure J*%( affectsourabilitytopredictthetotaldollarsthatwillbespentonaprograminfutureyears,setnationalperformancetargetswithprecision,andarticulatethelinkbetweenhumanresourcesandresults.Italso .6*- demandsthatweinvolveprogrampartnersinthedevelopmentofnationalperformancegoals,complicatesdatacollection,andcontributestodatareportinglags.L*4݌̌ @XDXX@XD@XDXX@XD  /XDXXX'XX@XD^/L* XDXXXDXDXXXD  L* D   Keyattributesofthefunding &2 mechanismsthataffectourabilitytolinkbudgetandperformanceare:whetherthegrantoperatesasaprogramorafundingstream,theamountofflexibilityprovidedtothegranteetodetermineprogramattributes,andthevarietyofactivitiesthatcanbefunded.L*~݌̌ XDXXXDXDXXXD  8L 5MOQSTUVWxxMOQSTUVWL   @XDXXXD8m23   D   Whenthegrantoperatesasafunding  ; stream,federalfundsaremergedwithstateandlocalfunds,otherfederalgrantfunds,andMedicareandMedicaidfunds,tosupportstateorlocalactivitiesallowedunderthegrant.Formanyoftheseprograms,thefederalcontributionisonlyasmallpartofthetotaldollarsthatproduceprogramresults.However,theoutputsandoutcomesreportedbygranteesandincludedintheHHSbudgetsandperformanceplansrepresentthecombinedinvestmentsandeffortsofthemultiplefunders.Linkingthefederaldollarstotheseoutputsandoutcomespresentsanincompletepictureoftheinvestmentrequiredtoachievetheseresults.Forexample,federalprogramdollarsprovideonly27percentofthefundsthatsupporttheHealthCenterprogram.Othercontributorsinclude:Medicaid/SCHIP,34percent;state/local/otherfederal,18percent;thirdpartypayers,8percent;Medicare,7percent;andselfpay,6percent.#XDXX@XD#8m&݌ $D Q ЌL MOQSTUVWxx5MOQSTUVWL   8L 5MOQSTUVWxxMOQSTUVWL   @XDXXXD823   D   State,local,andtribalgovernmentsare V&!S frequentlygivensignificantflexibilitytodetermineeligibilityrequirementsandtypeandlevelofservicesprovidedinordertorespondtolocalneedsandpreferences.Also,manygrantsallowstatestofunda widerangeofactivitieswithgrantfunds. +.'Y Forexample,intheSocialServicesBlock     Grant,statescaninvestthegrantfundsinanycombinationofover40servicecategoriesdependingonstateneeds.Thisflexibilitytoaddresslocalissuesmakesitdifficulttoprojectthetotaldollarsthatwillbespentonaprogramanddevelopnationalperformancetargetswithprecision.8݌̌L MOQSTUVWxx5MOQSTUVWL   8L 5MOQSTUVWxxMOQSTUVWL   823      Thirdpartyprogramimplementation    alsoaffectsourabilitytosetnationaltargetsforprogramincreasesbecauseHHSprogramshavedifficultyprojectingthetotaldollarsthatwillbespentbyallfundersinafutureyear.Forexample,statescanusetheincreaseinfederalfundstosupplantthestatecontributionifthegrantdoesnotincludeamatchingfundingrequirement.Also,anincreaseinfederalfundsmaynotresultinanincreaseinstateandlocalsupportfortheprogram.#XDXX@XD#8(݌  ЌL MOQSTUVWxx5MOQSTUVWL   8L 5MOQSTUVWxxMOQSTUVWL   @XDXXXD8H23      Thirdpartyprogramimplementation  \ affectsHHSabilitytolinkitshumancapitalneedstoprogramoutputandoutcomegoals.Awidevarietyofgovernmental,nonprofit,andprivateentitiesincommunitiesacrossthecountryperformthedaytodayactivitiesthatleadtooutcomesforHHSprograms,ratherthanfederalemployees.Forexample,SAMHSAsgranteesprovidesubstanceabuseandmentalhealthservicestotheAmericanpublic,notSAMHSAsfederalemployees.Thefederalhumancapitalskillsneededinwhenprogramsareimplementedbythirdpartiesarenotthesameasfordirectserviceprovision.HHSneedsemployeeswithgrantsmanagement,technicalassistance,contracting,andcontractmanagementskills.8H݌̌L MOQSTUVWxx5MOQSTUVWL   /XDXXX'X^X@XD/L* XDXXXDXDXXXD  L*     HHSanditscomponentshavedeveloped )j$) humancapitalplanswithlongtermobjectivesandquantitativeperformancetargetsforassuringthatwehavetheskillsneededtomanageourprograms.Wecanintegratetheresultsofthisplanningprocessintoourplanstobetterarticulatethe .)/ contributionofthefederalemployeestoourprograms,however,relatingthefederalhumancapitalneedstoprogramgoalsdoesnotprovideacompletepictureoftheresourcesneededtoachievethosegoals.Formanyprograms,theinformationwehaveonthehumancapitalneedsofourprogramimplementersisnotdetailedenoughtolinktotheachievementofprogramgoalsandtargets.Requiringothergovernmentalentitiesandgranteestoprovidetheamountofdatathatwouldbeneededtocreatethislinkageisnotfeasibleforpracticalandpoliticalreasons.L* ݌̌ XDXXXDXDXXXD  8L 5MOQSTUVWxxMOQSTUVWL   @XDXXXD823   D   Accountabilityforprogramresultsis ^ > alsocomplicatedbythirdpartyprogramimplementation.Thefederalfundsarefrequentlyusedtoinfluencewhatareessentiallystateandlocalprograms.Theprioritiesofstates,tribes,localcommunities,andthefederalgovernmentarenotalwaysthesame,andtheflexibilityprovidedbythesefundingmechanismsenablesourpartnerstomakechoicesthatmaynotsupporttheachievementofnationalperformancetargets.8p݌̌L MOQSTUVWxx5MOQSTUVWL   /XDXXX'X^X@XDQ/L* XDXXXDXDXXXD  L*k D   Giventhesignificantroleourpartners K playinprogramdesignandimplementation,HHSprogramshaveengagedtheirpartnersindevelopingnationalperformancegoalstoreportonprogramobjectivesunderGPRA.L*k݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   DavidFredericksonexaminesGPRA "Q implementationinadiversesetofthirdpartyprogramimplementationsituationsatCMS,FDA,HRSA,IHS,andNIHinThe j% T PotentialoftheGovernmentPerformanceandResultsActasaTooltoManageThirdPartyGovernment.Fredericksonnotes, .(~#W  WhilethisdiversityprovidesflexibilitytoHHSeffortstoimproveAmericashealth,italsoaddsextraordinarycomplexitytotheimplementationofauniformgoalsettingandperformancemeasurementsystem,suchasGPRA.L*݌ -)] Ќ XDXXXDXDXXXD  8L 5MOQSTUVWxxMOQSTUVWL   823      Finally,thirdpartyprogram  implementationisamajorcontributortodatalagsforHHSprogramsbecauseperformancedatarollsupfromthelocalandstatelevels.Thispresentsachallengetosynchronizationofbudgetandperformancedata,whichisdiscussedfurtherinthisdocumentinthesection, PerformanceDataLags.8݌̌L MOQSTUVWxx5MOQSTUVWL   wNXXXXD @  w  HowHHShasaddressedthisissue:wF݌ r   ЌXDXXNX @  L* XDXXXDXDXXXD  L*    FormanyHHSprograms,granteesare   requiredtoreportinformationonresourcesreceivedfromothersourcestoensurestatematchingrequirementsormaintenanceofeffort.HHSprogramsusethishistoricaldataonthecontributionsofthevariouspartnerstoprojecttotalfundingandsetnationalperformancetargets.Theyalsoincludeadiscussionofthefinancialcontributionsofvariousfundingpartnersintheirperformanceplans.However,weneedtobetterarticulatetobudgetanalystsanddecisionmakersthedegreeofprecisionwithwhichprogrammanagersareabletosetnationalperformancetargetsinthisprogramimplementationenvironment.L*v݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Withregardtoaccountability,HHShas  hadsignificantsuccessinworkingwithitsprogrampartnerstodevelopandreportonnationalperformancegoals,whichhasimprovedprogrammanagementandaccountability.Forexample,theIndianHealthService(IHS)resolvedacomplexcoordinationissueconcerningtribesdiscretioninprovidingIHSfundedmedicalservicesundertheIndianSelfDeterminationAct.WhileIHScannotmandatethatthetribessubmitperformancedata,ithascreatedabottomupapproachtobudgetformulationandperformancemeasurementwithfullparticipationbytriballeaders.ThishasledtoasharedunderstandingofGPRAandtheimportanceofreportingonperformancedataintheIHSbudget.Asaresult,thetribeshavebeenvoluntarily g.). submittingperformancedata.ACFhashadsimilarsuccessinestablishingperformancemeasuresinprogramsdependentuponvoluntarysubmissionofperformancedata,i.e.theTemporaryAssistanceforNeedyFamilies(TANF),ChildCare,andtheCommunityServicesBlockGrant(CSBG)programs.L*N݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*R D   HHShasalsobeensuccessfulin  7 workingwithitsprogrampartnerstodevelopnationalperformancegoalsforprogramsthathavesignificantflexibilitytodetermineeligibilityrequirementsorhowfundsarespent.CSBGisanexampleofaprogramgivensignificantflexibilityinhowfundsarespent,andACFwasabletoworkwiththestatestodevelopacoresetofnationalperformancegoals.CMSandthestateshavedevelopedanationalperformancegoalforchildhoodimmunizations;however,becauseoftheflexibilityaffordedthestatesindesigningtheirMedicaidprograms,eachstatesetsitsownannualtarget.BecausethisistheonlynationalhealthcarequalitygoalthathasbeendevelopedforMedicaid,CMShasasetaFY2003goaltoestablishaCMS/statepartnershiptoimprovehealthcarequalityforMedicaidandSCHIPpopulationsusingperformancegoals.L*R݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*  D   Manyofthechallengeslistedhereare D!N inherentinthirdpartyimplementationoffederalprograms.However,somecanbeimpactedbypolicydecisions,suchastheinclusionofamatchingfundingrequirementinthegrant.Ourabilitytoaddresstheseissuesdependsonthesharedunderstandingbyprogrammanagersanddecisionmakersabouthowthirdpartygovernmentimpactseffortstolinkbudgetandperformance.L*  ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   RxV,'+.'XDXXXDXDXXXD   AttributionofProgramActivitiesand V,'Z  OutputstoOutcomesRbeen: XDXXXDXDXXXD  Improvedhealthand >-([      socialoutcomesfortheAmericanpeopleareinfluencedbythecombinedeffectsofmultipleHHSprograms,otherfederal,state,andlocalgovernmentprograms,nongovernmentalprograms,andothermitigatingfactors(i.e.stateoftheeconomy).Attributingachangeintheoutcometothefundingorstrategiesofanyoftheseindividualprograms!whetheritsafederal,state,oraUnitedWayprogram!requiresasophisticatedlevelofanalysisandevaluation.L*q݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Inordertolinkbudgetdecisionsto 6  programoutcomes,weneedtoknowwhatevidenceisavailableontheconnectionbetweenthefederalprogramdollars,outputs,andoutcomesandthestrengthoftheevidence.Dataonperformancegoalscanidentifypositiveornegativetrends.However,weneedtoconductprogramevaluationstodeterminewhichparticularprogramstrategyorfunderisresponsibleforachangeintheoutcome,evaluatetherelativecontributionsofmultipleprogramsandfunders,andassesstheimpactofothermitigatingfactorsontheoutcome.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Programswhoseoutcomesinclude  improvedsafetyforthepublicprovideanillustrationofthechallengesinlinkingfederalbudgetdollarstoprogramoutcomes.Howdoesonemeasurewhatwouldhavehappenedinabsenceoftheintervention?Howdoesonecorrelateabudgetincreasethatfunds100morefoodinspectionsandareducedincidenceoffoodborneillnesswhentherearesomanyinterveningfactors?Howdoesoneassessthetruecostofthesepreventioneffortswhenthefederaldollarsareusedtoinfluencethebroadersafetyeffortsofanindustry?AsOMBfoundinthe2001performancebudgetingpilot:L*}݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    FDAhasastrategicgoalofpreventing +.', unnecessaryinjuryanddeathscausedbyadversedrugreactions,injuries,medicationerrors,andproductproblems.Itisdifficult .)/ totiethisgoaltobudgetdecisionmaking.TheFDA,throughitspremarketreviewprocessandpostmarketsurveillanceandcompliancemonitoringefforts,canreducetheprobabilitythatadverseeventswilloccur.However,somerareadversedrugeffectscannotbedetecteduntiladrugbecomeswidelyusedbythegeneralpopulation.Furthermore,FDAcaninfluence,butnotcontrol,somefactorsthataffecthealthoutcomes,suchasprescribingbehaviorofhealthcareprovidersorconsumerbehavior.Forthesereasons,FDAcannotguaranteethatanewdrugwillnotcauseadverseevents,nomatterhowthoroughitspremarketreviewprocessis.(OMB2001)L*,݌̌ XDXXXDXDXXXD  wNXXXXD @  wO  HowHHShasaddressedthisissue:wO݌ "A ЌXDXXNX @  L* XDXXXDXDXXXD  L*P  D   HHSprogramsuselogicmodels, IB supportedbyevidencebasedstrategies,andprogramevaluationstoestablishthelinkbetweenprogramfundsandoutputstooutcomes.However,weacknowledgedinourrecentdiscussionsthatwecouldusethesemoreeffectivelyintheperformanceplanstoexplainthestrategiclogicbehindourperformancegoals.L*P  ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*" D   Aclearlogicmodelprovidesacredible  L linkbetweenprograminputs,outputs,intermediateoutcomes,andoutcomes.Thestrengthofanyprogramlogicmodelliesinthescientificevidencethatsupportstheassociations.TwotoolsthatHHSprogramshaveusedtostrengthenthislinkareevidencebasedstrategiesandprogramevaluations.L*"o#݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*% D   Medicalresearchhasdemonstratedthe }'"V connectionbetweenmanymedicalinterventionsandreducedmorbidityandmortality,forexample,betweenimmunizationsandreductionininfectious diseasesandaspirintherapyandareduction ,i'[ intheriskofaheartattackforthosewho     havealreadyhadone.Suchinterventionsbecomestandardsofcareandarereferredtoasevidencebasedpractices.Therefore,aprogramcanmeasurethepercentofapopulationimmunizedorthepercentofpatientswithcoronarydiseaseprescribeddailyaspirintherapyandusetheresearchasevidenceofthecausallinkbetweentheseoutputsandimprovedhealthoutcomes.Thisisaverycosteffectivewaytomeasuretheimpactofaprogrambecausethesetypesofoutputactivitiesareeasier,cheaper,andfastertomeasurethanoutcomes.ThisisanareawhereourinvestmentinNIHresearchhasmadesignificantcontributionstoprogrameffectivenessandperformancemeasurement.L*%&݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L**    Forunprovenand/ormultifaceted  interventions,programevaluationscandeterminetheextenttowhichaspecificprogram,ratherthanotherprogramsormitigatingfactors,isresponsiblefortheoutcome,andprovideevidenceofthelinkbetweenoutputs,intermediateoutcomes,andoutcomes.Programevaluationshelpusunderstandthereasonsfortheperformancetrend,identifyhowwecanaddressproblemsandreplicatesuccesses,andattributetheoutcometoouractivities.L**O+݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*-    HeadStartisconductingaprogram D!  evaluationtoestablishevidenceofacausallinkbetweenoutputsandoutcomesforthishumanservicesprogram,asmedicalresearchhasdoneforhealthprograms.Forexample,todeterminewhetherHeadStartismeetingitsoutcomegoaltoincreasechildrensschoolreadiness,HHSisundertakingasixyearstudythatexaminesimprovedqualityofservicecomparingoutcomesforHeadStartchildrentononHeadStartchildrenandtakesintoaccountvariableconditionssuchasparentingpractices,demographics,andsocioeconomicsituation.Thestudywillthendeterminethe ,.|). conditionsthatpositivelyornegativelyimpacttheoutcome.L*-s.݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*1 D   Whilestudiesliketheserequirea N1 significantinvestmentoffundsandtime,theyenableprogramstofocustheireffortsonprovenstrategiesandoutputswithestablishedcontributionstolongtermoutcomegoals.Also,byestablishingthecausallinksbetweenoutputsandoutcomes,theyenableamorecosteffectiveapproachformeasuringprogramimpactonanannualbasis.L*1s2݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*4 D   Giventheimportanceofprogram  < evaluationsinassessingprogramperformance,weneedtoensuretherelevancy,quality,andtimelydistributionofourevaluations.WealsoneedtoensurethatHHShastheanalyticalcapabilitytoprovidebudgetanalystsanddecisionmakerswithevidencebasedinformationconcerningtherelationshipbetweenourstrategies,outputs,andthedesiredoutcomes.L*415݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*7 D   Inordertoimprovethequalityof ZG programevaluationsinHHS,weconductanannualpeerreviewprocess,inwhichoutsideexpertsreviewnominatedHHSevaluationsforexcellenceinseveralmethodologicalcategories.Thereviewersprovideextensivefeedbackonthequalityoftheevaluationstoagencyevaluationofficersandprojectofficers,bothinwritingandthroughanHHSwideopenfeedbacksession.L*78݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*d: D   Inaddition,HHShasundertakena $XR planningassessmentpilotdesignedtomorecloselylinkplanningandevaluationactivities.TheinitiativewillfocusonHHSStrategicObjectives1.2,reducetheincidenceandimpactofinjuriesandviolenceinAmericansociety,and1.3,improvethedietandlevelofphysicalactivityofAmericans.Wearedevelopinglogicmodelsandconductingliteraturesearchesinordertodevelopasynthesisoftherelativeeffectivenessofthestrategies ,.|)] currentlyin  use.Whencompleted,theprojectwillprovideuswithabetterunderstandingofhowplanning,budgeting,performancemeasurement,andevaluationcanbeusedtoeffectivelydocumenthowmultipleprogramscontributetocrosscuttingoutcomes.L*d::݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*>    Rx b XDXXXDXDXXXD   LongTermNatureofInvestmentsin  b OutcomesRX?rate: XDXXXDXDXXXD  ManyHHSprogramsaddress  J  significanthealthandsocialproblemsthatrequirethelongterminvestmentsandeffortsofamultitudeofpartnersinordertoimproveoutcomes,forexample,obesity,diabetes,andeconomicselfsufficiency.Measuringtheeffectsofmarginal,annualfederalbudgetchangesonoutcomesthatmaytakedecadestoachieveisnotpreciseormeaningful.However,improvedoutcomesfortheseprogramsarecriticaltothehealthandwelfareoftheAmericanpeople,andthereisaconcernthatafocusonannualbudgetandperformancelinkagewillfosterabiasforfundingprogramsthatcanshowmoreimmediateresults.L*>.?݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*C    Forexample,anincreaseinaccessto 0 cancerscreeningcouldleadtomeasurablereductionsinmorbidityandmortalityinapopulationwithinseveralyears.However,toeffectivelyaddressthepreventionofobesity,diabetes,orcardiovasculardiseaseinapopulationcouldrequireadecadeormore.Amajordeterminantoftheseconditionswasthelifestyleofpopulation(e.g.,dietandexercisepatterns)theprevioustenyearsbeforetheplannedintervention.Whentheroleofthefamilyisfactoredintotheinfluenceonpreventivebehaviorfortheseconditions,thetimeframeforseeingmeasurablebenefitsoflifestylerelatedinterventionscanbeanentiregeneration.L*CD݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*G    Thenationsinvestmentinmedical f+&+ researchhasalonghistoryofsuccesses.However,researchisanotherareawherelinkingannualinvestmentstooutcomesis *.z). difficult.Scientificresearchisbestviewedasanenterpriseforthelongrun!toaccountfortheintrinsicdifficultiesanduncertaintiesofprobingtheunknown.Typically,theincrementaladvancesaswellasthemedicalbreakthroughsaretheresultofmultipleyearsinvestments.Discoveriesandsignificantadvancestypicallyemergeinanunevenwayovertimeandcanbedifficulttopredictinadvance.L*GH݌̌ XDXXXDXDXXXD  wNXXXXD @  w+K  HowHHSwilladdressthisissue:w+KyK݌ ^ 9 ЌXDXXNX @  L* XDXXXDXDXXXD  L*&L D   HHSprogrammanagersneedtowork  : withbudgetanalystsanddecisionmakerstoidentifywaystobetterarticulatethelinkbetweenlongtermbudgetaryinvestmentsandimprovedoutcomesfortheseprogramsinourplans.Moreuseoflogicmodelssupportedbyevidencebasedstrategiescanhelp.Furtherinvestmentinprogramevaluationcanalsohelpbyprovidingevidenceofthecausallinkbetweeninterventions(outputsandintermediateoutcomes)andtheirimpactonlongrangeoutcomes.Wealsoneedtobetterarticulatetheroleofthevariouscontributorsandinterveningfactorsthatinfluenceoutcomesfortheseprograms.L*&LL݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*O D   Anideaproposedinourdiscussionsis  K thatapossibleapproachtoaddressingthisissueistoproceedontwoparalleltracks:alongtermtrackthatdescribesthestrategicplanforaninitiative,theoutcomegoal,whowouldbehelped,etc.,andashortertermtrackinwhichwewouldpresentandreportontheincrementalstepsthatareneededtoachievetheoutcome.L*OaP݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*R D   Rx'E#}'"XDXXXDXDXXXD   PerformanceDataLagsRJSty,: XDXXXDXDXXXD  Thelengthof 'E#U timeneededtocollectandreportdataforourperformancegoalspresentsachallengetosynchronizationofbudgetandperformancedata.FormanyHHSgoals,the lagbetweentheendofthefiscalyearand ,'Z reportingofdatacanbeninemonthstotwo   years.Compoundingthis,thebudgetdevelopmentcyclebeginsabouteighteenmonthsbeforethebeginningofthefiscalyear.Therefore,themostrecentfinancialandperformancedataavailabletotheprogramtoinformtargetsettingcanbeseveralyearsold.L*R S݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*"W    Delaysinreportingongoalsoccurfor    manyreasons.Forexample:L*"WW݌̌ XDXXXDXDXXXD  L XMOQSTUVWChxMOQSTUVWL8L 5MOQSTUVWxhXMOQSTUVWL   8X23      Statesandgranteesneedtimetocollect, $  verify,evaluate,andreportdatatoHHSfollowingtheendofthereportingyear,andthenHHSprogramsmustverify,aggregate,andevaluatethedatabeforereportingtheresultsintheperformanceplans.8XY݌̌L XMOQSTUVWChx5MOQSTUVWL   8L 5MOQSTUVWxhXMOQSTUVWL   8[23      Thetimeneededtomeasureachange " frompointAtopointB.Forexample,datatoreportonCDCsgoalonthepercentoftuberculosispatientsreportedin2002whocompleteacourseoftreatmentwithin12monthsofinitiationoftreatmentwillbeavailableinJune2004.Thelastcasesreportedin2002(onDecember31)willcompletetheir12monthstreatmentperiodonDecember31,2003.ThenCDCneedssixtoninemonthstotabulate,verify,andreportthedata.8[#\݌̌L XMOQSTUVWChx5MOQSTUVWL   8L 5MOQSTUVWxhXMOQSTUVWL   8^23      Inaddition,someHHSperformance X   goalsarenotreportedonannuallybecausethedatacollectionsusedtoreportonthegoalsarenotconductedannually.Forexample,theYouthRiskBehaviorSurveillanceSystem,whichisusedtoreportonmanyHHSgoals,isconductedeveryotheryear.8^_݌̌L XMOQSTUVWChx5MOQSTUVWL   wNXXXXD @  wa  HowHHShasaddressedthisissue:wab݌ .(~#) ЌXDXXNX @  L* XDXXXDXDXXXD  L*b    Whereavailable,HHSprogramsprovide U)$* earliertrenddataforperformancegoalsandotherrelateddatatofacilitateassessmentofprogramresults.Also,seeDatatoMeasure ,i'- ProgramPerformanceinthisSummaryfor -U(. adiscussionofthedatasystemsthatsupportprogramplanningandperformance .-*0 measurementatHHSandeffortsunderwaytoenhancethetimeliness,accuracy,andcompletenessofourperformancedata.L*b1c݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*e D   Rxb:XDXXXDXDXXXD   CalculatingtheFullCostofPrograms b4 andActivitiesRfhen: XDXXXDXDXXXD  @XDXXXDFormostHHSprograms,the J 5 federalinvestmentisonlyapartofthetotaldollarsthatareinvestedtoproducetheoutputsandoutcomes.Fortheseprograms,linkingthefullcostofthefederalinvestmentintheprogramtotheoutputsandoutcomesproducedwillnotpresentacompletepictureofprogramcost.Requiringstatesandgranteestoprovidetheamountofdataneededtocompletethepictureoftotalcostsisnotfeasibleforpracticalandpoliticalreasons.#XDXX@XDg#@XDXXXDForthoseinstancesinwhichHHS n@ fundsthefullcostofprogramoutputs,however,fullcostinformationcanbeusefulforbudgetdecisionmaking.#XDXX@XDi#L*eVf݌ 2C Ќ XDXXXDXDXXXD  wNXXXXD @  wtk  HowHHSwilladdressthisissue:wtkk݌ E ЌXDXXNX @  L* XDXXXDXDXXXD  L*xl D   HHSisimplementingaUnified  F FinancialManagementSystem(_UFMS_)toreplacefivelegacysystems._UFMS_Ԁwillbecomprisedoftwoprimarysubcomponents,oneforCMSandanotherforNIHandtheremainingagencies.Wearecurrentlydeterminingthemanagementcostaccountingrequirementsforthe_UFMS_ԀthatwillsupportdecisionmakingandaccountabilitywiththecapabilityoflinkingHHSfinancialcostswithprogramperformanceandbudgetinformation.Thegoalof_UFMS_ԀistoprovidethefullHHSportionofcostsforservicesandproductsthatinfluenceprogramoutcomes,andbeastandard,efficientsystemthatcanaccruecostsspentthroughoutHHSonDepartmentalprogramsorinitiatives.ThesystemwillprovideHHSmanagerswithtimelyandrelevantHHScostinformationtohelpmonitorandimprovetheirprogram results.L*xll݌ ,g'[ Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*q       Rx(xXDXXXDXDXXXD   IncorporatingtheFY2002 (x PerformanceReportandAccountabilityReportR^rhen: XDXXXDXDXXXD  @XDXXXDTheReportsConsolidationActof H 2000andOMBscurrentguidanceonperformancereportsinA11,PartII,providesforthreeperformancereportingoptions,includingtheoptionexercisedbyHHStointegrateitsperformanceplansandreports.However,thecurrentOMBguidanceontheformandcontentofagencyfinancialstatementsrequiresthatfederalagenciesincorporatetheirFY2002performancereportswiththeirFY2002accountabilityreports.#XDXX@XDs#L*qr݌ l  Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*\v    @XDXXXDWebelievethecurrentintegrationofour ~  budgets,plans,andreportssupportstheuseofperformanceinformationinourbudgetdecisions,andweareconsideringfurtherintegrationtomakethedatamoreaccessibleandusefultoourdecisionmakers.Inaddition,theacceleratedscheduleforproducingtheaccountabilityreportwillincreaseourdifficultieswithtimelyreportingofdata.InordertomeetthetimelineforproducingtheFY2001accountabilityreport,wehadtosetacutoffdateforincludingnewdatathatwasearlierthanthatfortheperformancereports.#XDXX@XDw#L*\vv݌ z Ќ XDXXXDXDXXXD  wNXXXXD @  wBz  HowHHSwilladdressthisissue:wBzz݌ , ЌXDXXNX @  L* XDXXXDXDXXXD  L*<{    @XDXXXDIfrequiredtoincorporatethe !S performancereportintotheaccountabilityreport,HHSmaycontinuetoreportonperformanceinitsbudgetsandperformanceplanstofacilitatetheuseofperformanceinformationinbudgetdecisionmaking.However,thedifferingschedulesforthesedocumentswillmeanthattheGPRAdatareportedinthebudgetandperformanceplanswillbemorecurrentthanthatintheaccountabilityreportformanygoals.Tomeetthischallengeandtheintentofaccountingrequirements,GPRAdatareportedintheaccountabilityreportwillhavetobesupplementedwithperformanceinformationfromothersources.#XDXX@XD{#L*<{{݌ .'*. Ќ XDXXXDXDXXXD  P4`XDXXXD  XDXXXD   P4`V  ConclusionP4`VTԌ T. ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L* D   HHSiscommittedtoworkingwith @/ budgetanalystsanddecisionmakersinHHSandOMBtoensuremeaningfulperformancedatatoinformbudgetdecisions.@XDXXXDԀThedesire  T2 forbetterperformancedatatomanageprogramsandinformbudgetdecisionshasbeenakeyfactorintheimplementationofGPRAintheDepartment.IndiscussionslastFall,HHScomponentsgenerallyagreedthattheimplementationofGPRA,particularlyworkwithprogrampartnerstodevelopnationalgoalsandreportingsystems,hasprovidedHHSprogrammanagerswithbetterdatatomanageHHSprograms.HHShasalsoidentifiedmanypracticesthathavehelpedususethisinformationtoinformourbudgetdecisions.AswedevelopourFY#XDXX@XD#@XDXXXD2004budgetsand <@ performanceplans,weintendtogreatlyexpandouruseofthisinformationinbudgetdecisions.#XDXX@XDc#L*݌ C Ќ XDXXXDXDXXXD   bE (X@(9,X,X,X,hX9Kz$  .X\XXXD.e?\eX.X\  Kz$?@      INCREASEACCESSTOHEALTHCAREKz$? ˆ   Ќe ee.e?\XDX ee  P4`XhXDXXXD  XDXXXD   (X@(#(#(P4`   DecreasingtheNumberofUninsured X ChildrenandAdults SP4`5 HD Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*9    Rx\  4XDXXXDXDXXXD   StateChildrensHealthInsurance \  Program(_SCHIP_)Reac: XDXXXDXDXXXD  Theimplementationof D  _SCHIP_Ԁhasdrivenenormouschangeintheavailabilityofhealthcarecoverageforchildrenandinthewaygovernmentsponsoredhealthcareisdelivered.L*9݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Theinvestmentbystatesandterritories, V  communities,andthefederalgovernmenthasresultedinsignificantexpansionsincoverage,aswellasnewsystemsforenrollingchildren.Mailinapplicationsforchildrenarenowusedin_SCHIP_ԄfundedchildhealthprogramsandinMedicaidinmoststates,andpaperworkrequirementsimposedonfamiliesapplyingforcoveragehavebeenreducedsignificantlyinmanystates.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    CMSandthestatesexceededtheFY @ 2001goaltoenrollanadditional1,000,000childrenin_SCHIP_ԀorMedicaidovertheFY2000level.Infact,duetotheoverwhelmingsuccessoftheprogram,thestatesenrolled3,441,000childrenovertheFY2000level.L* ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Overfourmillionchildrenparticipated !> in_SCHIP_Ԅfundedcoverage(eitheraseparatechildhealthprogramoraMedicaidexpansion)inFY2001,andmanymorewereenrolledin regularTitleXIXMedicaidthroughincreasedoutreacheffortsandapplicationsimplificationstrategiesundertakenasaresultof_SCHIP_.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*͔    Rx<*%)%XDXXXDXDXXXD  ElderlyandDisabledRyeac:XDXXXDXDXXXD  Oneofour <*%' mostvulnerablepopulationsisourelderlyanddisabledMedicarebeneficiarieswhodonothavepublicorprivatesupplementalinsurance.AlthoughMedicareprovidesbeneficiarieswithabasicsetofhealth .,*, benefits,thebeneficiariesstillarerequiredtopayasignificantamountoutofpocketforpremiums,deductibles,andcoinsurance.Thiscostcanbeprohibitiveformanybeneficiaries,particularlyfortheapproximately12percentwhodonothaveprivateorpublicsupplementalinsurance.L*͔O݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*! D   Severalprogramswereenactedtohelp B 4 lowincomeMedicarebeneficiarieswiththeirMedicarecostsharingexpenses.However,asubstantialproportionofindividualseligiblefortheseprogramsarenotenrolled.CMS,inpartnershipwithotherfederalagencies,states,providers,andcommunityorganizations,conductsoutreachandenrollmentactivitiestoincreaseenrollment.L*!݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   CMSmetitsFY2001goaltoexceedthe @? nationalenrollmentrateinstatesreceivingafederalgrant,butdidnotmeetitsgoaltoincreaseenrollmentbyfourpercentagepointsinthosestateswheretheFY2000targetwasnotachieved.ThismaybebecauseasFY2001unfolded,CMSchosetofocusonanationaltechnicalassistanceandtooldevelopmentstrategyratherthanfocuslimitedresourcesonjustthreestates.InFY2002,CMSwillrefocusthisgoalonincreasingbeneficiaries'awarenessoftheireligibilityfortheseprograms.CMSisworkingwithstates,theadvocacycommunity,andotherinterestedpartiestodevelopacomprehensivestrategytoincreaseawarenessofeligibilityfor MedicareSavingsprograms.L*a݌ (#P Ќ XDXXXDXDXXXD  P4`XDXXXD  XDXXXD  P4`!      IncreasingAccesstoQualityHealth  Carefor_Underserved_ԀPopulations P4`!@Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*    Rx,|XDXXXDXDXXXD   CommunityHealthCentersReac: XDXXXDXDXXXD  The  HealthCentersformacosteffective,integratedsafetynetfor_underserved_Ԁanduninsuredchildren,adults,migrantworkers,homelessindividuals,publichousingandU.S./Mexicoborderresidentsinapproximately4,000communitiesacrossthecountry.TheHealthCentersmettheirtargettoserve9.6millionlowincome(87percent),minority(65percent),anduninsuredpersons(43percent)inFY2000andestimateserving10.5millioninFY2001.These10.5millionpersonsrepresentabout10percentofthenationsuninsured,10percentofits33millionMedicaidrecipients,and20percentofthe43million_underserved_Ԁpeople.L*f݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Thereismountingevidencethataccess  toausualandregularsourceofcarecanreduceandeveneliminatehealthstatusdisparitiesamongsubsetsofthepopulation,andHealthCenterpatientsarefarmorelikelytohaveausualandregularsourceofcarethanpoorpeopleofcolorintheNation.ThehighqualityprimaryhealthcarereceivedintheHealthCentershasbeenshowntoreducehospitalizationsandemergencyroomuse,reduceannualMedicaidcosts,andhelpspreventmoreexpensivechronicdiseaseanddisabilityforthesepopulations.Themostrecentdataindicates:L*f݌̌ XDXXXDXDXXXD  >kL XMOQSTUVWChhXMOQSTUVWL @  >kv2C3      ReductionsinMedicaidcostsfora '`"$ comparablegroupseekinghealthcareelsewhererangefrom30to34percent,accordingtoaHealthCenterMedicaidBeneficiaryEffectivenessstudy.>kv݌̌L XMOQSTUVWChhXMOQSTUVWL @  >kL XMOQSTUVWChhXMOQSTUVWL @  >kۈ2C3      HealthCenterMedicaidpatientsare22 +7') percentlesslikelytobeinappropriatelyhospitalizedthanMedicaidbeneficiarieswhoobtaincareelsewhere. >kۈ݌ .), ЌL XMOQSTUVWChhXMOQSTUVWL @  L* XDXXXDXDXXXD  L* D   Rx(xXDXXXDXDXXXD   CancerScreeningforWomenR;eac: XDXXXDXDXXXD  ݀CDCs (x, NationalBreastandCervicalCancerEarlyDetectionProgram(_NBCCEDP_)isacrossdepartmentalprogramwiththeNationalCancerInstitute,IndianHealthService,andFoodandDrugAdministrationthatprovidescancerscreeningfor_underserved_Ԁwomen,particularlylowincome,olderandracial/ethnicminoritywomen.ThroughMarch2001,theprogramhasprovidedmorethanthreemillionscreeningteststoover1.3millionwomen,diagnosed10,649breastcancers,45,154precancerouscervicallesions,andover700casesofinvasivecervicalcancer. L*݌ ` : Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*T D   CDCsperformancegoalsrelateto r< identifyingbreastandcervicalcancerattheearly,localizedstagebecauseearlydetectionsignificantlyincreasesthesurvivalrate.Inaddition,treatmentcostsforbreastcancerdiagnosedatthelocalizedversusadvancedstagemaybeasmuchas31percentlower.In2000,excludingbreastcancersdiagnosedonaninitialscreeninthe_NBCCEDP_,66percentofwomenaged40andolderwerediagnosedatthelocalizedstage.Theageadjustedrateofinvasivecervicalcancerinwomenaged20andolderwas16per100,000Paptestsprovided,excludinginvasivecervicalcancersdiagnosedonaninitialscreen. L*Tӳ݌ F!K Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*_ D   FemalepatientsatHRSAsHealth "M CentersreceivedageappropriatebreastandcervicalcancerscreeningatratesthatexceedHealthyPeople2010goals:88.5percentofusersreceiveduptodatePaptests,62.5percentreceiveduptodate_mammograms_,and80.5percentreceiveduptodateclinicalbreastexamsinFY1995.DataonFY1999 targetswillbeavailableinSeptember2002.L*_޷݌ *X%U Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*i       TheTitleXFamilyPlanningProgram  providesabroadrangeofpreventivereproductivehealthservicestoapopulationthatispredominatelylowincomeandwhohavelessaccesstohealthscreeningandpreventiveservices.In2000,TitleXclinicsprovided2.9millionPaptestsand2.8millionbreastexaminations.InFY2002,theProgramsettargetstoprovide3.0millionPaptestsand2.8millionbreastexams,orbetweensixandsevenPapsmearsandbreastexamsforevery10femaleclients.Theprogramisworkingtodevelopmeasuresthatalsomonitorthenumberofabnormaltestsandappropriatereferralsforfollowup.L*i݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*<    Rx^6XDXXXDXDXXXD   AHealthyStartforChildrenPrenatal ^ CareReac: XDXXXDXDXXXD  ݀HRSAand_OPHS_Ԁarestrongly F committedtoachievingtheHealthyPeople2010goalofgetting90percentofallpregnantwomenintoprenatalcareinthefirsttrimester.Earlyidentificationofmaternaldiseaseandrisksforcomplicationsarecriticaltoprovidingahealthystartforchildren.Theproportionofpregnantwomenenteringprenatalcareinthefirsttrimesterhasincreasedsteadilyforallpopulationgroupsoverthelastdecadefrom75.8percentin1990to83.2percentinFY1999.Progresshasslowedinrecentyearssuggestingthattheeasiestimprovementsalreadyhavebeenmade,andthatfurthergainsarelikelytobeslow.Additionalresearchisneededtoidentifynewstrategiesforgettingpregnantwomentobeginprenatalcareinthefirsttrimesterofpregnancy.Accordingly,HRSAand_OPHS_havesetFY2002andFY2003targetsat84percent.L*<݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*H    Rx|*%*T%XDXXXDXDXXXD   IHSWellBabyCareReac: XDXXXDXDXXXD  Wellchildvisits |*%) improvepostneonatalmortalityandarearecognizednationalstandardofcare.Theyalsoprovideanopportunityforeducationalinterventionswithparentsconcerningdiet ,.|)- andnutrition,injuryprevention,andpreventionoffamilyviolence.Aspartoflargereffortstoimprovechildandfamilyhealth,IHSsetagoaltoincreasetheproportionofAmericanIndian/AlaskanNative(AI/AN)childrenreceivingaminimumoffourwellchildvisitsby27monthsofage.InFY1999,38.5percentofAI/ANchildrenreceivedaminimumoffourwellchildvisits.DatatoreportontheFY2000targetofathreepercentincreasewillbeavailableinApril2002.L*H݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*3 D     Rx 6 XDXXXDXDXXXD   HealthCareAccessforHeadStart  : ChildrenReac: XDXXXDXDXXXD  ݀Becausehealthychildrenare  ; betterabletolearn,HeadStartworkstoensureeverychildisinacomprehensivehealthprogramthatincludesimmunizations,medical,dental,mentalhealth,andnutritionalservices.InFY2001,thepercentofchildreninHeadStartwhoreceiveneededmedical,dental,andmentalhealthservicesareagainbelowHeadStartsaggressivetargetlevels.L*3݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*' D   InFY2001,88percent(178,840)of DF childrenreceivednecessarymedicaltreatmentafterbeingidentifiedasneedingmedicaltreatment,lessthanthe92percenttarget.SinceHeadStartchildrenrelyprimarilyonMedicaidservices,HeadStartsuspectsthatlevelsofreimbursementstoproviders,particularlydentalhealthproviders,discouragestheprovisionofservicestoMedicaidrecipients.Asaresult,HeadStartchildrenexperiencedelaysinreceivingsuchservices.InFY2001,77percentofchildrenreceiveddentalservices,belowthe90percenttarget.DentaltreatmenttargetsmaybedifficulttoreachinthefutureasdentalprovidersacceptingMedicaidarescarceinsomecommunities.Thismayalsobeafactorinmentalhealthtreatmentforyoungchildren.InFY2001, 77percentofchildrenreceivedcarefor ,(Y emotionalorbehavioralproblems,lessthan   the83percenttarget.Inspiteoftheseobstacles,HeadStarthassethigherperformancetargetsforFY2001throughFY2003.L*'݌ ` Ќ XDXXXDXDXXXD  +@XDXXX'XXXD+  (X@(  8  Kz$  .X\XX@XD.e?\eX.X\    9,X,hX,X,X9Kz$!@@*    EXPANDCONSUMERCHOICESINHEALTHCAREAND  HUMANSERVICESKz$!   | Ќ@e ee.e?\@XDX e@e  L* XDXX@XDXDXXXD  L* @   L*a݌̌ @XDXXXD@XDXX@XD  P4`  XDXX@XD  XDXXXD   (X@(#(#(9,X,hX,X,hX9P4`&   FaithbasedandCommunity   Initiatives $P4`&:  Ԍ̌@XDXXD@XDX@XD  L* XDXX@XDXDXXXD  L*    HHSistheprincipalagencyfor & v protectingthehealthofallAmericansandprovidingessentialhumanservices,especiallyforthosewhoareleastabletohelpthemselves.WhiletheDepartmentcanpointtomanysuccessesthatimprovethelivesofAmericans,therearestillthosewhofallpreytodrugsoralcohol;areawaitingadoption;aredependentontemporaryassistancetoneedyfamilies;orotherwisedisadvantaged.L*x݌̌ @XDXXXD@XDXX@XD  L* XDXX@XDXDXXXD  L*    ThePresidentestablishedCentersfor  Faith-basedandCommunityInitiativesinfivemajorcabinetdepartments,includingHHS.Themissionofeachcenteristoevaluatepolicies,fundingprograms,andagencycommunicationsandtechnicalassistancestrategiestoensurethattheyemphasizeeffectivenessandhospitalitytofaith-andcommunity-basedorganizations.HHSiscommittedtopartneringwithfaith-basedandcommunity_caregivers_Ԁwhoareclosetothehardshipsofpeopleandtrustedbythosewhoinneed.Thegoalistoprovidealevelplayingfieldforthosegroupsthathavetraditionallybeendistantfromgovernment./XDXXX'X^XXD/+XDXXX'X^XXD+L*g݌ % ! Ќ @XDXXXD@XDXX@XD  /XDXXX'X^X@XDj/L* XDXXXDXDXXXD  L*c    Tomeetthechallengeandensurethat &F"# ourgoalsareenduring,ACF,HRSA,andSAMHSAareincludingspecificperformancemeasuresintheirGPRAplanstotracktheparticipationoffaithandcommunitybasedorganizations.ForFY2002,theseagencieswillestablishbaselinenumbersofapplicationsinselecteddirectgrantprograms.Thiswillrequireputtingin V.)+ placeacoordinatedoutreacheffort,technicalassistance,andmechanismstoassessthenumberandqualityoffaithandcommunitybasedapplications.ForFY2003,theagenciesarededicatedtoincreasingthenumberofapplicationsforthesegrantsbyasmuchas10percent.Inthisway,HHSwillbecomemorehospitabletograssrootsandsmall-scaleprograms,andleveragefromtheiruniquestrengthstomakearealdifferenceinthelivesofdisadvantagedAmericans.+XDXXX'X^XXD+L*c݌ 6 Ќ XDXXXDXDXXXD  (X@(Kz$  .X\XXXD.e?\eX.X\  Kz$f@    EMPHASIZEPREVENTIVEHEALTHMEASURESKz$f    Ќe ee.e?\XDX ee  P4`XhXDXXXD  XDXXXD   (X@(#(#(9,X,hX,X,hX9P4`   ReducingMorbidityfromDiabetes P4` \XԌ  \ ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*    Rxp  HXDXXXDXDXXXD   DiabetesR2: XDXXXDXDXXXD  Nearly16millionAmericans p  sufferfromdiabetes,andthenumberofnewcasesisincreasingbyapproximately800,000peryear.DiabetesistheseventhleadingcauseofdeathintheUnitedStatesandAmericanIndianandAlaskanNative(AI/AN)adultsarealmostthreetimesmorelikelytohavediabetesthanthegeneralpopulation.Arecentalarmingtrendistheincreaseinprevalenceoftype2diabetesin                childrenandadolescents,whichhasrisenfrom28to36percentfrom1991to1997.nr:*&`>  `  E  ePN nL*݌ h" Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Diabetesistheprimarycauseofnew # casesofblindness,nontraumaticamputations,andkidneyfailureinadults.Manyofthesecomplicationscanbepreventedordelayedwithappropriatemonitoringandtreatment.L*c݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Rx@*%)%XDXXXDXDXXXD   StateDiabetesControlPrograms @*%& (_DCPs_)R: XDXXXDXDXXXD  ݀CDCsupports_DCPs_Ԁtoeducate (+x&' healthprofessionalsandpersonswithdiabetesaboutthediseaseanditscomplications.Theprogramsalsoidentifyhighriskpopulations,improvethequalityof .(*+ diabetescare,involvecommunitiesincontrollingdiabetes,andincreaseaccesstocare!withmeasurablesuccess.Forexample,overatwoyearperiod,theNewYork_DCP_,whichcollaborateswith14regionalcommunitycoalitionsandthreediabetescentersofexcellence,reducedhospitalizationratesby35percentanddecreasedlowerextremityamputationratesby39percent.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   InFY2001,CDCmetitsgoaltohave V 6 100percentof_DCPs_Ԁadoptandimplementguidelinesforimprovingthequalityofcareforpersonswithdiabetes.Influencingpositivechangeinthepreventivecarepracticesundertakeninhealthsystemsisessentialtothetaskofreducingcomplicationsofdiabetes.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   ResultsforCDCsgoaltoincrease ,? annualeyeandfootexamsfordiabeticsshowprogressaswellasthechallengeofcollectingnationaldiabetesdata.DatafromtheFY2001BehavioralRiskFactorSurveillanceSystem(_BRFSS_)from12of16_DCPs_ԀfundedtoconductcomprehensivestatewideeffortsshowedthattheyhadachievedCDCstargetforincreasingthepercentageofdiabeticswhoreceiveannualfootexams.Althoughthedatashowedanincreaseineyeexams,thetargetwasnotmet.L*'݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Statesconductthe_BRFSS_Ԁsurvey N&!M annually,howevernotallstatesincludethequestionsondiabetescareeachyear.CDCusuallyhas_BRFSS_Ԁdatafor1012ofthe16stateseachyear.Itispossiblethatwithall16statesreporting,thetargetforeyeexamswouldbeachieved.CDCencouragesallstatestoincludethediabetesquestions regularly,andwillcontinuetoworkwiththe -(U    DCPstoinfluencethepreventivecarepracticesofhealthsystemsandtoinformprovidersandpersonswithdiabetesabouttheimportanceofannualeyeandfoot_exams.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Rx:  XDXXXDXDXXXD   DiabetesCareforAmericanIndians :  andAlaskanNativesR: XDXXXDXDXXXD  CDCcollaborates " r withIHStosupporttheNationalDiabetesPreventionCenter,whichwasestablishedto   J  addresstheseriousdiabetesepidemicinAmericanIndiansandAlaskanNatives(AI/AN).#XDXXXDs#?XDXXXDL*݌   Ќ XDXX?XDXDXXXD  /XDXXX'XXXD/L* XDXXXDXDXXXD  L*    RecentresearchconductedbyNIHhas  p  providedimportantnewtoolsthatIHSandthetribescanusetoslowtheriseofnewcasesoftype2diabetes.FourAmericanIndianCentersparticipatedintherecentNIHclinicaltrialthatcompareddietandexercisetreatmenttotreatmentwith_Metformin_Ԁinadultswithimpairedglucosetoleranceandfoundthatevenmodestlifestylechangescuttheincidenceofdiabetesbymorethanhalfamongthosemostatrisk. L*^݌ X Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*'    IHShasbeencitedasamodelof   communityinvolvementandprogrameffectivenessfortheuseoftheIHSDiabetes  CareandOutcomeAudittomeasure ~ diabetescareinAI/ANcommunities.TheDiabetesCareAuditassessesarangeofdiabetescareandeducationforapproximately80,000IHSdiabetespatients.ThesemeasureshavebeenincorporatedintotheNationalCouncilonQualityAssurance/AmericanDiabetesAssociationproposalfornationalperformancebenchmarksfordiabetescare.L*'݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*     IHSchosefouroftheDiabetesAudit ,(|#( measuresasGPRAgoalsbecauseoftheirprovenbenefitsinreducingmorbidityandmortalityfromdiabetes:increasingthepercentofpersonsdiagnosedwithdiabeteswithimprovedcontrolofbloodsugar,bloodpressure,andcholesterolandthepercentassessedforkidneyhealth.Ofparticular .)/ importanceintermsoflongtermimprovementsindiabeticmorbidity,trendsfrom19942000auditdataindicateacontinuedimprovementinbloodsugarandcholesterollevelsandassessmentsofkidneyhealth.Bloodpressurecontrolhasbeenrelativelyunchanged.L*  ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*,  D   TheimprovementincontrolofLDL  7 cholesterolislikelyduetoseveralfactors:abetterawarenessinbothprovidersandpatientsthroughtheNationalCholesterolEducationProgramefforts;increasedproviderawarenessofthegrowingproblemofcardiovasculardisease(_CVD_)inAI/ANthrougheffortstopublicizeresultsoftheStrongHeartStudy,whichshowstherateof_CVD_ԀinAI/ANisincreasingwhileitisdecreasinginthegeneralpopulation;andbetteravailabilityof_statin_Ԁdrugsinpharmacieswhichareveryeffectiveintreating_dyslipidemias_.L*,  ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Annualchangesinbloodpressure HF controlhavenotbeenstatisticallysignificantandcanbeattributedtothesamplepopulationchangingeachyear.Furthermore,thealarmingincreaseinoverweightandobeseyouthandadultsandtherisingincidenceofcardiovasculardiseaseamongpatientswithdiabetesmayhaveasignificantimpactontheoutcomesofthismeasure.TheIHSNationalDiabetesProgramisencouragingprogramstousethenewdiabetesfundingtoenhancetheirclinicalcareprograms,includingbetterbloodpressurescreeningandmoreaggressivetreatment,assessmentofcardiovascularrisk,aswellasincreasedfundstothepharmacybudgettopurchasenewer,moreeffectiveantihypertensiveagents.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*1 D   Rx~*%*V%XDXXXDXDXXXD   DiabetesCareinCommunityHealth ~*%Y  CentersR: XDXXXDXDXXXD  ݀CDCsstatebaseddiabetes f+&Z controlprogramspartnerwith HRSAs     HealthCenterstoimprovethehealthstatusofpersonswithdiabeteswhoreceivecareatthesesites.PatientsattheHealthCentershaveratesofdiabetesthatfarexceednationalratesforcomparableracial/ethnicandsocioeconomicgroups.Yet,HealthCenterpatientswithdiabetesaretwiceaslikelytohavetheir_glycohemoglobin_Ԁtestsperformedatregularintervalsthanthenationalnorm.TheHealthCentersmettheirFY1999goalof60percent,upfromthebaselineof43percentinFY1998.InFY2002,theHealthCenterswillreportontheirFY1999goaltoincrease?XDXXXDtheproportionof   diabeticswhohaveanannualdilatedeyeexamto90percentfrom57percentinFY1994.#XDXX?XD#L*1݌ \ Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*L    ݀Rx6XDXXXDXDXXXD   DiabetesCareforMedicare 6 BeneficiariesR: XDXXXDXDXXXD  ݀CMShasworkedwith "r CDC,theAmericanDiabetesAssociation,theNationalCommitteeforQualityAssurance,andotherstodevelopagoaltoincreasebiennialeyeexamsforMedicarebeneficiariesdiagnosedwithdiabetesinordertopreventblindnessassociatedwiththisdisease.CMScontractswiththePeerReviewOrganizations(independentphysicianorganizationsinthestates)toimprovetherateofeyeexamsamongdiabeticbeneficiaries.CMSsetanFY2001targetof68.3percentandreportedarateof68.1percentfortheperiodendinginFY2000,upslightlyfromthe67.8percentbaselinefortheperiodendinginFY1999.CMSwillreportFY2001datainSpringof2002.L*L݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*Y     Rx(#0(#XDXXXDXDXXXD   DiabetesResearchR!: XDXXXDXDXXXD  TheNIHResearch (#' AssessmentWorkingGroup,theindependentpanelofexpertsthatassessedNIHsperformanceonitsresearchgoalsinFY2001,citedastudythattheyfeltepitomizedpreventiveresearchinitsuseoflongterm,populationbaseddata.L*Y  ݌ 0.)- Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*# D   The20yearstudyusingacohortof - 121,000femalenursesconvincinglyshowedanincreasedriskofheartdiseaseinpersonswithdiabetes,thuscallingattentiontoaneedtodevelopappropriatepreventionandtherapeuticstrategies.Inaddition,thestudydemonstratedthatthisriskcouldbemarkedlyreducedwithexercise.L*#'$݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*8& D   Onthebasisofthisandotherreports,  6 nationaldiabetesassociationsnowrecommendaggressivemanagementofdiabeticpatientstoreducecholesterol,highbloodpressure,smoking,andobesity.Exerciseanddietplayimportantrolesindiabetesmanagementandcardiovasculardiseaseprevention.L*8&&݌̌ XDXXXDXDXXXD  P4`L\XDXXXD  XDXXXD   P4`(   PromotingHealthyBehaviors D)P4`(&)PLԌ P? ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L** D   Rxd<XDXXXDXDXXXD   TeenSmokingR*: XDXXXDXDXXXD  Multipleagenciesinthe d@ Departmentworktogethertopreventandreducesmokingamongyouth.CDCconductssurveillanceactivitiesandworkswithcommunitybasedprograms,healthcommunicationcampaigns,andschools,NIHfundsresearch,andSAMHSAconductstobaccousesurveillanceandimplementsregulationsonminorsaccesstotobacco.Otherfederaldepartments,stateandlocalgovernments,nongovernmentalorganizations(e.g.,AmericanCancerSociety,RobertWoodJohnsonFoundation),andhealthcareprovidersalsoplayasignificantroleinreducingteensmoking.L***݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*~. D   Between1991and1997,cigaretteuse % P amongyouth(grades912)increasedfrom27.5percentto36.4percent,althoughtherateofincreaseslowedfrom1995to1997.DatareleasedfromCDCsYouthRiskBehaviorSurveyinJune2000indicatethatthepercentageofyouthwhosmokedroppedslightlyto34.8percentin1999,meetingCDCsand_OPHS_jointgoaltoreduceteensmokingto34.6percentinFY1999.L*~..݌ -J)Y Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*1    Successinreducingtheyouthsmoking  rateisattributedtorestrictionsonthetobaccoindustry,increasedstatefundingfortobaccocontrolprograms,technicalassistancefromthefederalgovernmenttodetermineeffectivetobaccocontrolstrategies,andcoordinationoftobaccocontroleffortsamongpublicagenciesandnongovernmentalorganizations.L*12݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*E4    Rx : r XDXXXDXDXXXD   TobaccoSalestoMinorsR4: XDXXXDXDXXXD  SAMHSA  :  supportsthestatesinreducingretailsalesoftobaccotoyouthbyprovidingguidanceonstatelevelpolicymaking,assistingstatesinidentifyingretailers,anddevelopingretailoutletlists.Inaddition,SAMHSAprovidesguidanceonimprovingcollaborationbetweenstateandlocalauthoritiesresponsibleforcomplyingwiththerequirementsofthe_Synar_ԀAmendment.L*E44݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*8    Morestatesarecurtailingtobaccosales  tominors.InFY1997,onlyfourstateshadtobaccoretailsalesviolationsatorbelow20percent.ByFY2001,thenumberdramaticallyincreasedto30states,exceedingSAMHSAstargetof26.L*88݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*P:    Rx^XDXXXDXDXXXD   HIVPreventioninYouthR: : XDXXXDXDXXXD  HIV ^ preventioneducationprogramsinschoolshavebeendemonstratedtoreduceriskbehaviorsinyouth,includingbehaviorsthataffecttheirriskofbecominginfectedwithHIV.L*P::݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*>=    CDCfundsstateandlocaleducation  $\# agenciesandnational,nongovernmentalorganizationstoimplementHIVpreventioneducationprogramsinschools.ThepercentofhighschoolstudentsthathavebeentaughtHIVpreventioninschoolhasincreasedfrom83percentinFY1991to91percentinFY1999,meetingCDCsgoaltomaintainthepercentageat90orgreater.L*>==݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*?    InitsFY2001plan,CDCaddedthe ,(- leadinghealthindicatoronresponsiblesexualbehaviorfromHealthyPeople2010: .)/ increasetheproportionofadolescents(grades912)whoabstainfromsexualintercourseorusecondomsifsexuallyactive.L*?u@݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*CB D   FY1999dataindicatethatthe &4 proportionofalladolescentswhoabstainedorusedcondomswas85percent,movingtowardsCDCsFY2001targetof89percent.TheFY1999rateforblack/AfricanAmericanadolescentswas83percentandtherateforHispanic/Latinoadolescentswas84percent.CDCsetFY2001targetsforthesegroupsat87and88percent,respectively.L*CBB݌̌ XDXXXDXDXXXD  P4`t XDXXXD  XDXXXD   P4`D   BehaviorModificationResearch EԀP4`D}E(xtԌ (x? ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*jF D   TheNIHResearchAssessmentWorking d@ Group,theindependentpanelofexpertsthatassessedNIHsperformanceonitsresearchgoalsinFY2001notedsignificantresearchresultsthatfocusonbehaviorasawaytopreventdiseaseanddisability.L*jFF݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*H D   RxbXDXXXDXDXXXD   ExerciseRPI : XDXXXDXDXXXD  Severalstudiesdemonstrated G thatexerciseimprovesphysicalfitness,whetherinwomenseekingtoreducecoronaryheartdisease,olderpeoplewithosteoporosis,female_caregivers_Ԁexperiencingstressinducedhighbloodpressureanddisruptedsleep,orchildrenparticipatinginaskeletalstrengtheningprogramofjumping.L*H&I݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*6L D   Examinationofexerciseinducedhealth `#P benefits,however,bringstwoissuestoattention:1)physicalexercisealonemaynotprovideallthebenefitsassociatedwithanexerciseroutine,and2)exerciserequiresbehavioralmodification.L*6LL݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*mN D   Twostudiesdelineatedanimportantrole ^)$W ofexercisebydemonstratinghowsocialengagementcanprovidehealthbenefitsthat cannotbeachievedbyexercisealone.In ",r'Z onestudy,assistedwalkingforpatientswith   Alzheimersdiseaseprovidedachanceforsocialinteraction,anditwasthe30minutesofconversationthreetimesaweekthatreducedthepatientsphysicaldecline.Likewise,astudyofolderpeopleexercisingindifferentenvironmentsledtotheconclusionthatasocialsettingimprovestheparticipantspsychologicalmeasures.Thehealthbenefitsofexercisederivepartially,ifnotfully,fromaddressingsocialneedsforthesetwogroupsofpeople.L*mNN݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*R    Twootherstudiesbringtotheforefront 6  thenecessityofmodifyingbehaviorintheinterestofgoodhealth.Onestudyshowedthatintensivelifestyleinterventionwasmosteffectiveinachievingexerciseandweightcontrolgoalsinoverweightindividualsatriskfortype2diabetes.Medicationalonehadlimitedsuccessandonlyinparticularpatientpopulations.Thisstudyindicatedthatbehaviormodificationcouldbeaneffectivemeansofloweringriskofdisease.Unfortunately,differentialresponsestobehaviormodificationmaylimitsuchsuccesses:althoughbothmenandwomeninonestudyreceivedphysicalactivitycounseling,onlywomenderivedanylongtermbenefits.TheWorkingGroupnotedthatanunderstandingofwhatmotivatespeoplewillgreatlyaidpreventiveresearch.L*RS݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*V    Rx"0"XDXXXDXDXXXD   ModifyingDangerousBehaviorsin "! YoungPeopleRW : XDXXXDXDXXXD  ݀Severalstudiesassessedthe #" effectivenessofinterventionprograms,focusingondecreasingsuchdisparateoccurrencesassexualactivity,crime,highschooldropoutrates,oralcoholabuse.Eachstudyrevealedimportantfactorsthatcanpositivelyinfluencebehavior.Acommonthemeinthesestudieswastheimportanceofcommunity"eitherasanarenaforperformingserviceorientedactivitiesorasaforceforcontrollingbehaviorwithinthegroup.L*VvW݌ -)- Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*<[ D   Otherstudieshighlightedbythe - WorkingGroupidentifiedoutsideinfluencesorpersonalityvariablesthataffectdangerousbehaviors.Promotionsbycigarettecompaniesexemplifyanoutsideinfluencethatincreasedsmokinginadolescents.Rebelliousnessandrisktakingbehaviorsinfifthgraderspredictedcigarettesmokingby12thgrade.Andearlyonsetdrinkerstookmorerisks,whichidentifiedthisgroupaslikelytosustainmoreinjuries.Onlyonestudynotedapositivecorrelationbetweenapredictiveelementandpreventionofdangerousactivities:thatofvirginitypledgesbysomeadolescents.TheWorkingGroupapplaudedtheseresearchoutcomesbecauseeachidentifiedbehaviororoutsideinfluencecouldpotentiallybemanipulatedtodecreasediseaseand/ordisability.L*<[[݌ H? Ќ XDXXXDXDXXXD  (X@(  Kz$  .X\XXXD.e?\eX.X\  9,X,X,X,hX9Kz$_@@*    RESPONDTO_BIOTERRORISM_ԀANDOTHERPUBLIC  HEALTHEMERGENCIESKz$_` `  | Ќe ee.e?\XDX ee  _P4`$ t4 XDXXXD  XDXXXD   (X@(#(#(9,X,hX,X,X9P4`a   BuildingPublicHealth $ t InfrastructuretoRespond bP4`ab  `Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*c    Rx( x XDXXXDXDXXXD   StateandLocalPreparednessRRd.:  ( x XDXXXDXDXXXD  Traditionally,theresponsibilitiesofthestate d  healthdepartmentshavebeendiseasesurveillanceandmanagement,however,healthdepartmentsarenowredefiningtheirrolestorespondeffectivelytoanintentionalreleaseofbiologicalorganismsorhazardouschemicalsintoanunsuspectingpopulation.L*c(d݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*.g    CDCisassistingstateandlocalhealth N departmentscompletecomprehensiveassessmentsoftheircapacityfor_bioterrorism_Ԁpreparednessandresponse.Analysisoftheseassessmentswillallowgranteestoprioritizetheirresourcesandefforts.BytheendofFY2002,atleast48ofthe55statesandterritorieswillhavecompletedtheirvulnerabilityassessmentsand42willhavecompletedtheirdraftpublichealthemergencyresponseplans.L*.gg݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*Qj    Inaddition,state,territorial,andlocal  healthdepartmentshavebeguntobuildcriticalcommunicationlinkswithotherassetsinthehealthcareandemergencyresponsecommunity(e.g.,hospitals,emergencydepartments,acutecarecenters,police,fire,EMS,localemergencymanagementagencies)andotherfirstresponseorganizationstoassesslocalcapacitiesandcoordinateresponses.L*Qjj݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*m    Rx)%F)$XDXXXDXDXXXD   MetropolitanMedicalResponse )%% SystemRm: XDXXXDXDXXXD  ݀OPHSOfficeofEmergency *%& Preparedness(_OEP_)isresponsibleforthecoordinationandmanagementoffederalhealth,medical,andhealthrelatedsocialservicesresponseandrecoverytomajor V.)* emergencies,federallydeclareddisasters,andterroristacts.Assuch,OPHSdirects_MMRS_Ԁdevelopmentprogram,whichprovidesamechanismtoforgealocalintegratedresponsewhichlinksmultiplelocal,stateandfederalagenciesaswellasprivatehealthcareinstitutionsthatwillserveastheinitialresponderstoanyweaponofmassdestruction(_WMD_)event.InFY2000,OEPawarded25new_MMRS_contractsforsystemsdevelopment,andmodified25contractsawardedduringFY1999toincludefundingforcapabilitiestorespondto_bioterrorism_.InFY2001,_OEP_awarded25morecontractswithmetropolitanareasforcontinueddevelopmentof_MMRS_ԀandamendedcontractsawardedinFY2000toprovidefundsforabiologicalterrorismresponsecomponent.L*mm݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*%t D   Rx ZXDXXXDXDXXXD   SurveillanceandEpidemiology ? CapacityRt: XDXXXDXDXXXD  Becauseacovertbiologicalor j@ chemicalattackwillmostlikelybedetectedlocally,diseasetrackingsystemsatstateandlocalhealthagenciesmustbereadytodetectunusualpatternsofdiseaseandinjury,and_epidemiologists_Ԁattheseagenciesmusthaveexpertiseandresourcesforrespondingtoreportsofrare,unusual,orunexplainedillnesses.CDCisworkingtointegratesurveillanceforillnessesresultingfrombiologicalandchemicalterrorismintotheU.S.diseasesurveillancesystems.CDCisalsodevelopingnewmethodsforrapidlydetecting,evaluating,andreportingsuspicioushealtheventsthatmightindicate covertterroristacts.L*%tt݌ >,'O Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*Ry       InFY2001,CDCprovidedfundingfor  _bioterrorism_Ԁsurveillanceandepidemiologycoordinationtoallstatehealthdepartmentsandselectedmajormetropolitancitiesandterritoriestoenhancetheircapacitytodetect,investigateandmitigatehealththreatsposedby_bioterrorism_Ԁagents.L*Ryy݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*|    Rx b XDXXXDXDXXXD   NationalPharmaceuticalStockpile  b (_NPS_)R|: XDXXXDXDXXXD  The_NPS_Ԁwasdeployedforthefirst  J  timeinresponsetotheSeptember11thterroristattacks.CDCmobilizeda_NPS_ pushpackagetoNewYorkCitywithinsevenhoursaswellasapushpackagetoWashington,DC,followingtheattackonthePentagon.Inresponsetotheanthraxattack,_NPS_Ԁdeliveredalmost3.75milliontabletsofthreedifferentantibioticsforpostexposureprophylaxisofemployeesinaffectedbuildings,postalworkers,mailhandlers,andpostalpatrons.L*||݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*π    RxHXDXXXDXDXXXD   CommunicationSystemsRx: XDXXXDXDXXXD  Withinfour H hoursoftheattackontheWorldTradeCenter,theHealthAlertNetwork(HAN)begantransmittingemergencymessagestothetop250publichealthofficialsin50states,sevenlargecitiesandGuam.Inthemonthsthatfollowed,over67healthalerts,advisoriesandupdatesweretransmittedreachinganestimated1million_frontline_publicandprivatephysicians,nurses,labclinicians,andstateandlocalhealthofficers.UsinginstatesystemsbuiltwithCDCfunds,stateswereabletoaugmentandtailortheHANalertstotheiruniquesituations.CDCanditsHANgranteesalsoestablishedandmaintainedInternet_websites_Ԁtoprovideinformationtothepublic.SinceSeptember11,therehavebeen73millionhits,fivemillionvisits,and12millionrequestsforinformationontheCDC_bioterrorism__website_.L*πN݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    TheEpidemicInformationExchange ,(, (_Epi_ԄX),anInternet-based,secure -)- communicationsystempromoteseasier, .). moreaccurate,andreal-timereportingofsuspectoutbreaksorotheremerginghealththreats,includingthoserelatedto_bioterrorism_.AttheendofFY2001,650publichealthofficials,includingallstate_epidemiologists_,localhealthofficials,andmembersofthemilitary,participatedon_Epi_ԄX._Epi_ԄX,whichhasmedicaleditorialstaffavailable24hours/day,sevendays/week,ismoderatedforqualitybyCDCstaff.L*@݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Respondingtoideasfrompublichealth J : officials,_Epi_ԄXplanstoprovidesecurecommunicationsformultistateoutbreakresponseteams,andplanstodeveloplinksbetweendiseasesurveillanceprogramsandlocalhealthalertsystemsandimprovesoftwaretoautomatetherecognitionofsimilardiseaseoutbreaksacrossjurisdictions.L*i݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Rx \XDXXXDXDXXXD   HospitalPreparednessRJ: XDXXXDXDXXXD  ݀Aspartofthe D PresidentsHomelandSecurityinitiative,_HRSA_sHospitalPreparednessProgramwillimprovethecapacityoftheNationshospitalsandemergencydepartmentstorespondtobiological,chemicalandradiologicalterroristattacksaswellastosituationsinvolvinglargescaleormasscasualties.L* ݌̌ XDXXXDXDXXXD  P4`6"F!XDXXXD  XDXXXD    P4`:  BuildingLaboratoryCapacityto 6"N Respond P4`:Ƒ#&"#rԌ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L* D   Rx:% $ XDXXXDXDXXXD   BiologicalAgentsRW: XDXXXDXDXXXD  Becausemost :% P _bioterrorist_Ԁagentsreceivelittlepublichealthattentiononaday-to-daybasis,thenationsabilitytorapidlydiagnosetheseinfectionsislimited,bothatthenationallevelandinstateandlocalpublichealthlaboratories.CDCensuresthat_frontline_Ԁstateandlarge citypublichealthlaboratoriesareprepared +&W torapidlyandaccuratelydiagnoseagents   causingpublichealthproblemsthroughtheLaboratoryResponseNetwork.Thismultilevelnetworkofpublichealthlaboratoriesprovidesessentialdiagnosticcapabilitiesinstateandlargemetropolitanareasandcentralized,state-of-the-artnationalreferencecapacityatCDC.L*-݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Labcliniciansfromall50stateshave    beentrainedinthehandlingandtestingofcriticalbiologicagents,andmanypublichealthlaboratoriesacrossthecountryhavebeenrenovatedandupgradedtoallowadequatesafetyforimproveddiagnosisofpotential_bioterrorism_Ԁagents.Inaddition,sevennewrapidassaysweredevelopedinFY2001forrealtime_PCR_Ԁandantigendetectionforpotential_bioterrorism_Ԁagents.L*g݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*0    CDCsRapidResponseandAdvanced 4 TechnologyLaboratory(_RRAT_)canproviderapididentificationofbiologicalagentsthatarerarelyseenintheUnitedStates.OtherdiseasespecificlaboratoriesatCDCprovideadditionalresearchandsurgecapacityfordiagnostictesting.CDCandpartnershaveidentifiedthebiologicalagentsmostlikelytobeinvolvedinaterroristattackandaredevelopingrapidassaystoassistindetectingtheseagentsatthestateandlocallevels.FromSeptember11throughOctober4, X  2001,anestimated7,500laboratorysampleswereprocessedatCDC's_RRAT_Ԁandspecialtylaboratories.L*0݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*?    Rx$F ~$XDXXXDXDXXXD   ChemicalAgentsRkage: XDXXXDXDXXXD  ݀Intheeventofa $F $ chemicalterroristincident,notonlywouldtherebeaneedtoanalyzesamplesfrompersonswhowereactuallyexposedtoanagent,buttherealsocouldbeextensivedemandforservicesforpersonswhothinktheywereexposed.Toaddressthisneed,CDChasdevelopedarapidtoxicscreenthatcanidentifyupto150 differentagentsina V,', bloodsample. CDChasalsofundedfive F-(- laboratoriestoinstallnewstateoftheart 2.). laboratoryequipmenttomeasurenerveagentsinhumansamples,andgranteeshavesuccessfullycompletedaroundofproficiencytestingtodemonstratetheirunderstandingofthemethod.Inaddition,CDChasdevelopedtestingmethodsfornerveagents,nitrogenmustards,sulfurmustards,_lewisite_,hydrogencyanide,_cyanogen_Ԁchloride,_BX_,_tricothecene__mycotoxins_,ricin,heavymetals,selectedtoxicindustrialchemicals,andincapacitatingagents.L*?݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*ե D   Rx 6 XDXXXDXDXXXD   LaboratoriesandDecontamination  ; InfrastructureR~: XDXXXDXDXXXD  +@XDXXXXy\XXD+_HRSA_sHospital  < Infrastructure(LaboratoriesandDecontamination)#XDXX@XD#@XDXXXDProgram#XDXX@XDf#@XDXXXDԀwillfund n> expensesfornecessaryinfrastructureimprovementsandexpansionsforhospitallaboratorycapacity,thepurchaseofpersonalprotectiveequipment,decontaminationfacilitiesandotherequipmentfordecontaminationofbiologicalandchemicalagentssothathospitalswillbepreparedtorespondto_bioterrorism_Ԁacts#XDXX@XD#.L*եT݌ F Ќ XDXXXDXDXXXD  P4` p0XDXXXD  XDXXXD   P4`    EnsuringFoodSafety P4` $ pԌ $H ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*k D   FDAaimstodecreasethethreatof I contaminationinthefoodsupply.Theyminimizethisthreatbypayingcloseattentiontoimportedproductsatthecountryoforiginbeforeproductsareexportedandattheborderaswellasinspectinghighriskfoodestablishmentsannually.L*k݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*ɮ D   Rx"&r!% XDXXXDXDXXXD   FoodImportInspectionsRr: XDXXXDXDXXXD  ?XDXXXDImported "&r!Q foodsnowconstitutemorethan10percentoftheU.S.foodsupply,andforsomecommodities,suchasmanyfreshfruitsandvegetables,40percentormoreareimported. FDAdatashowthatthenumberofimported *&V foodentrieshasdoubledoverthepastsevenyearsandthatimportsareexpectedto increasebyanadditional30percentbyFY -(Y 2002.#XDXX?XDg#?XDXXXDPartoftheirstrategytoensurethe     safetyofimportedgoodsistoincreasethenumberofphysicalexaminationsofimportedfoods,#XDXX?XDW#?XDXXXDK+ 4 <DL!,X,hXKtargeting_violative_Ԁproducts t attheborderandpreventingtheirentry#XDXX?XDF#?XDXXXD. ` #XDXX?XDL#?XDXXXD?+ 4 <DL!X?FDAconducted12,169physicalexamsin L  FY2001.SinceSeptember11th,FDAhas 8  alteredthisgoaltodoubleimportinspectionlevelsinFY2002to24,000andagaininFY2003to48,000,focusingonhighriskportsanddevotingmoreresourcesandmanpowertoachievingthesetargets.#XDXX?XD#L*ɮH݌ $  Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  ',hXX'L*    Rx 6 XDXXXDXDXXXD   InspectionofHighriskFood   EstablishmentsR߷: XDXXXDXDXXXD  FDA,inconjunctionwith   thestates,inspectsfoodestablishmentsthatproducefoodswiththegreatestriskformicrobialcontaminationandthosefoodsrequiringspecificcomponentsforasafeandnutritiousproduct.Foodsfollowingunderthisdefinitionincludeinfantformula,medicalfoods,_scrombotoxic_Ԁseafood,molluscanshellfish,lowacidcannedandacidifiedfoods,readytoeatfoodssuchasprocessedfreshfruitsandvegetables,bakerygoods(withfilling),softandsoftripenedcheeses,cookedpastadishes,preparedsalads,andheatandserveproducts.FDAestimatesthatthereareapproximately7,000suchestablishmentsinitsestablishmentinventory.?XDXXXDԀInFY2000,FDAandstates V  inspected5,700highriskfoodestablishmentsor91percent(target90100percent).InFY2001,thefieldinspected74percentoftheidentifiedpossibleinventoryofhighriskproduct/processdomesticfirms(target90100percent).#XDXX?XDλ#Thisdecreaseisdue %.!$ toFDAredirectingresourcestocritical_BSE_relatedefforts.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*>    Rx)$)h$XDXXXDXDXXXD   DNASequenceofE.ColiR: XDXXXDXDXXXD  ݀Recently, )$( NIHinvestigatorsmappedtheDNAsequenceofthefoodbornepathogenE.coliO157:H7andcomparedittothebenign formofE.colithatwassequencedin1996. @-(, Someimportantandsurprisingdifferenceswerenotedbetweenthetwostrains.L*>݌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   E.coliO157:H7hasamuchlarger N/ genomeandcontainsapproximately1,300genesnotfoundintheharmlessstrain,includingsomegenesthatareverysimilartothoseofthebacteriumSalmonellaandtheplaguecausingorganism_Yersinia_.E.coliO157:H7alsohasagenethatencodestheextremelypotentShigatoxin,originallyfoundinthedysenterycausingmicroorganismShigella.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   SinceinfectionwithShigellaismanaged  : differentlythaninfectionwithE.coliO157:H7,itisimportanttobeabletodifferentiatebetweenthetwoorganisms.ThedevelopmentofatesttodifferentiatebetweenthetwoorganismsmaysteminpartfromtheDNAsequence.Inaddition,theDNAsequenceisapreliminarysteptowarddevelopinganeffectivevaccineagainstortreatmentfortheinfection.@XDXXXDL*݌ HC Ќ XDXX@XDXDXXXD  (X@(  Kz$  .X\XXXD.e?\eX.X\  3,X,X,hX3Kz$@@*    %  IMPROVEHEALTHOUTCOMESKz$]    Ќe ee.e?\XDX ee  P4`XhXDXXXD  XDXXXD   (X@(#(#(9,X,X,X,X9P4`Z   ReducingDeaths,Incidence,and X ImpactofInfectiousDiseases XP4`Z: HD Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  9,X,X,X,X9L*G    Rx\  4XDXXXDXDXXXD   VaccinePreventableDiseasesR): XDXXXDXDXXXD  Byall \  counts,effortsbytheCDCanditspartnerstoprotectchildrenintheU.S.fromvaccinepreventablediseasehavebeenasuccess.Casesofmostvaccinepreventablediseasesofchildhoodaredownmorethan97percentfrompeaklevelsbeforevaccineswereavailable,movingtowardtheHealthPeople             2010targetofzerocases.Vaccinecoveragelevelsforpreschoolchildrenareatanalltimehighforallracialandethnicgroups.L*G݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    pr<,(`~0 _5  ` E _5 _5 G  pNocasesofparalyticpoliodueto !V indigenoustransmissionofwildpoliovirushavebeenreportedintheU.S.since1979andonly63reportedcasesofmeaslesoccurredin2000.L*c݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*M    Only387casesofmumpswerereported &h!" inFY1999;inFY2000,theincidencewasfurtherreducedto323cases,wellunderCDCsgoalof500cases.ThisreductionislinkedtotheeffectivenessoftheMeaslesMumpsRubellavaccineanditscoveragerate.L*M݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Conjugatevaccinesforthepreventionof -R(* _Haemophilus_Ԁ_influenzae_typeb(_Hib_)are ->)+ highlyeffectiveandhaveledtonear .**, eliminationofinvasive_Hib_Ԁdisease,themaincauseofbacterialmeningitis.Thedevelopmentofthe_Hib_ԀvaccinewasrealizedthroughdecadesofworkbyNIHgovernmentscientists,alongwithcolleaguesinhospitalsanduniversitiesandvaccinedevelopersinthepharmaceuticalindustry._Haemophilus_Ԁ_influenzae_typeb(_Hib_)  3 invasivediseasehasdeclinedbymorethan99percentinchildrenunderfivesincetheintroductionofthevaccine.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*U D   However,in2000,thenumberof B8 possiblecasesreporteddidincreasefrom122casesin1999to167cases.Therefore,itispossiblethat,althoughthetotalnumberofcasesincreasedin2000,thenumberoftypebcases(both_serotyped_Ԁandnot)forwhichthevaccineiseffectivemayhaveremainedthesameordecreased.Beginningwiththe2000data,CDCwillbereportingboththenumberof_serotype_Ԁb+unknown_serotype_casesaswellasthenumberof_serotype_Ԁbcasesonlytoalleviatesomeofthisambiguity.         x L*U݌ RD Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*p D   L*p݌ XDXXXDXDXXXD  Rx,dXDXXXDXDXXXD   GlobalPolioandMeaslesEliminationR :  ,F XDXXXDXDXXXD  CDCanditsdomesticandinternational  G partnershavecommittedtoachievingtheWorldHealthOrganizations(WHO)goalofglobaleliminationofpoliomyelitisby2005.Globalpolioincidencehasdeclinedbymorethan99percentfromabout350,000casesin1988to2,867casesin2000,about250,0000liveshavebeensavedand4millioncasesofchildhoodparalysishavebeenavoided.  )d$P L* XDXXXDXDXXXD  L*s    Globally,measlescausedanestimated  880,000deathsin1999andwastheleading   causeofdeathamongchildrenunderfiveyearsofagefromavaccinepreventabledisease.Basedonsurveillancedatafor                2001,45of47countriesandterritoriesappeartohaveinterruptedmeaslestransmission.CDCanditsglobalpartnershavesetagoaltoreducethecumulativeglobalmeaslesrelatedmortalityrateby50percentbyFY2005.L*s݌̌ XDXXXDXDXXXD  /XDXXX'X^XXD/L* XDXXXDXDXXXD  L*h    rcH 84l~06 +0  ` E6 +0 +0 6 +0  RxnXDXXXDXDXXXD   SexuallyTransmittedDiseasesR :   XDXXXDXDXXXD  Workingwithothercountries,_USAID_,and  internationalandU.S.governmentagencies,CDChassetagoaltoreducethenumberofnewHIVinfectionsamong15to24year_olds_ԀinsubSaharanAfricafromanestimated2millionby2005.InFY2001,CDCstrengthenedvoluntarycounselingandtesting(_VCT_)programsin18countries(target19)andexpandedtechnicalassistanceandsupporttoimprovenationalsurveillanceprogramsforHIV,_STDs_ԀandTBto18countries(target15).L*h݌̌ XDXXXDXDXXXD  +XDXXX'X^XXD+L* XDXXXDXDXXXD  L*    CDCisalsoenhancingsupportfor *X%) programsthatprovideinterventionstopreventperinataltransmissionofHIVin13countries(target10)inFY2001.CDCwillcontinuetoidentifybarrierstotheseservicesandevaluatetheoutcomesofinterventions .). onbothinfantsandmothersandtoassesswaystoexpandpreventiontoinfantsfathersaswell.L*D݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   U.S.ratesofprimaryandsecondary :2 (P&S)syphilisdeclinedby88percentfrom1990to1999,andpreliminarydatafrom2000indicateacontinuationofthistrend.Althoughthe5.4percentdeclineinthenumberofP&Ssyphiliscasesreportedin1999islessthanthedeclineofapproximately20percentperyearsincethelastmajorsyphilisepidemicin1990,itispossiblethatthissmallerdeclineatleastpartiallyreflectsimprovedcasefindingsandreportingresultingfromthenationalsyphiliseliminationeffort._Syphillis_Ԁisextremelyconcentratedgeographically.Approximately80percentofU.S.countieshaveeliminatedsyphilis,and93percenthaveasyphilisrateof<fourper100,000inFY2000(target B >90percent).Ofthecountiesthathavenoteliminatedsyphilis,thelargestnumbersofcasesof(P&S)syphiliswerereportedfrom22.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*] D   Rx4 XDXXXDXDXXXD   Preventionof_STD_ԄRelatedInfertilityR: XDXXXDXDXXXD   4H Morethan50percentofallpreventableinfertilityamongwomenisaresultofsexuallytransmitteddiseases(_STD_),primarilychlamydiaandgonorrhea.CDCandOPHSsupportsurveillance,screening,treatmentservicesinpubliclyfundedfamilyplanningand_STD_Ԁclinicsbecausetheyrepresentsettingswiththehighestprevalenceratesforthesediseases.L*]݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*j D   Overall,therewasasmalldeclinein %2!S chlamydiaprevalenceinFY2000(5.2percent)amongwomenunderage25attendingfamilyplanningclinics.Prevalencedecreasedinfouroften_DHHS_regionsfrom1999to2000mostlikelyduetotheeffectivenessofscreeningandtreatment,whileexpansionofscreeningtopopulationswithhigherprevalencemayhavecontributedtoincreasesinsixother ..~)\ regions.Basedontherecentperformancemeasures,CDCloweredthetargetto-(. baselinein1998;thisdecreasehasbeenmaintainedovertime.8<#=݌ L XMOQSTUVWChx5MOQSTUVWL   8L 5MOQSTUVWxhXMOQSTUVWL   8?23   D   Thebaselineforregularschool N1 attendancewas70percentinFY1997;inFY2001thishadincreasedto80percent.8??݌̌L XMOQSTUVWChx5MOQSTUVWL   8L 5MOQSTUVWxhXMOQSTUVWL   8A23   D   Thebaselineforchildrenhavingmore 8 5 thanonelivingarrangementaftersixmonthsofservicewas76percentinFY1997.DatafromFY1998through2001rangefrom24to27percent,demonstratingthattheprogramhasachievedgreaterbeneficiallevelsofstabilityforchildrenintheirlivingenvironments.8AA݌̌L XMOQSTUVWChx5MOQSTUVWL   L* XDXX@XDXDXXXD  L*C D   Inaddition,positiveclinicaloutcomes ^ > arehighertowardthelatteryearsofthegrantprogramasdemonstratedinthechart(Figure1),suggestingincreasedeffectivenessofsystemsofcareastheydevelopoverthefiveyearperiod.LC\D݌̌ (#(#          (#(# @XDXXXD@XDXX@XD  @  <  h+&_ (X@(9,X,hX,X,X9  Kz$  .X\XX@XD.e?\eX.X\  Kz$G@@*    ݀IMPROVETHEQUALITYOFHEALTHCAREKz$GDH iH   Ќ@e ee.e?\@XDX e@e  GP4`XhXDXX@XD  XDXXXD   (X@(#(#(P4`@I   ImprovingDrugandMedicalDevice X Safety JP4`@II HD Ԍ̌@XDXXD@XDX@XD  L* XDXX@XDXDXXXD  L*J    FDAsadverseeventreportingstrategies  4 arepartofanHHSwideefforttopromotepatientsafetyandpreventmedicalerrors.Itskeyobjectivesareto:developacomprehensiveadverseeventreportingcapability;analyzeproblemssurfacedbythesereportssothatappropriateinterventionscanbedesigned;andeducatebothhealthprofessionalsandpatientsaboutproblemsandsolutionsassociatedwithappropriateproductuse.FDAinvestigatessafetyreportstoidentifyserious,rare,orunexpectedadverseevents,distributesdearcolleaguesletters,oreventakesregulatoryactiononcertaindrugsormedicaldevices.L*J\K݌̌ @XDXXXD@XDXX@XD  L* XDXX@XDXDXXXD  t^>.*h~1B$ H `E5 B$ Httm z  t m m L*N    Rx.~XDXXXDXDXXXD   Drug  SafetyRO: XDXXXDXDXXXD  Drug  eventreportingsystemenablesFDAtoprovidefasteraccesstodrugswhilemaintainingawatchfuleyeoncereleasedonthemarket.Thesystemhasbeenoperationalfornearlyfiveyearsandcontainsnearlytwomillionindividualsafetyreports(_ISR_).InCY m m 2000,over270,000_ISRs_Ԁwerereceivedandafterinvestigation,30percentrepresented .&*+ seriouseventsorunexpectedevents.Itisestimatedthat280,000_ISRs_ԀwerereceivedinCY2001.FDAhascontinuouslymadetechnologyimprovementstothesystem,conductingapilotprograminFY1999forelectronicsubmissionof_ISRs_,involvingmanufacturerswithapprovedproducts.FDAalsodevelopedandpiloteddataretrievalsystemtoprovidereviewerswithquickaccesstoadverseeventreportingsystemsdataandreducereviewersrelianceonhardcopyreports.InFY2000andFY2001,FDAcontinuedtheireffortstoincreaseparticipationinelectronicsubmissionof_ISRs_.L*NO݌̌ @XDXXXD@XDXX@XD  L* XDXX@XDXDXXXD  L*U D   RxjXDXXXDXDXXXD   MedicalDeviceSafetyRV: XDXXXDXDXXXD  FDAs j; comprehensiveprogramtoregulatemedicaldevicesnotonlyprovidespremarketreviewbuthasinplacetheMedicalDeviceSurveillanceNetworkSystem(_MeDSuN_),apostmarketreportingsystemwheremedicalprofessionalscanreportanyseriousadverseevents.The_MeDSuN_ԀSystemisapilotprogramthateducatesandencourageshospitalpersonneltoaccuratelyidentifyandreportinjuriesanddeathsassociatedwithmedicalproducts.FDAcanthenprovidewarningstousersorevenrecallthoseproducts._MeDSuN_ԀbecomesevenmoreimportantasFDAdecreasestheirinvolvementinreviewinglowerriskmedicaldevices.FDAaimstoexpandimplementationof_MeDSuN_Ԁto180systemsbyFY2003.InFY2001,FDArecruited25hospitalsintothereportingnetwork,fallingshortoftheirtargetof75hospitals.Thisismostlikelyduetoextendedsoftwaredevelopment,unanticipatedprogramchanges,andincreasedinformation technologysecurityrequirements.L*UaV݌ :-(S Ќ @XDXXXD@XDXX@XD  P4`XDXX@XD   XDXXXD   P4`|\   ImprovingtheQualityofCarein  NursingHomes #]P4`|\]@Ԍ̌@XDXXD@XDX@XD  L* XDXX@XDXDXXXD  L*^    TheStateSurveyandCertification ,| programensuresthatMedicareandMedicaidbeneficiariesinnursinghomesreceivequalitycareinasafeenvironment.Nursinghomepatientsareavulnerablepopulationgroup,susceptibletocomplicationsandmorbiditiesresultingfromphysicalrestraintsandpressureulcers.AspartofCMSsstatecertificationeffort,                    surveyorshavebeeninstructedtopayparticularattentiontodecreasingnursinghomesuseofphysicalrestraintsandtotheirabilitytopreventandtreatpressureulcersaskeyqualityoflifemeasures.L*^^݌̌ @XDXXXD@XDXX@XD  8L 5MOQSTUVWxhXMOQSTUVWL   p<,(`~0M/ `..EM/M/sT p8cݰ23      Physicalrestraintsrefertoanymanual p(#& method,mechanicaldevice,material,orequipmentattachedoradjacenttothepatientthattheindividualcannotremoveeasilyandthatrestrictsfreedomofmovementornormalaccesstoone'sbody.Restraintsshouldbeusedonlywhenrequiredtotreatmedicalsymptomsandshouldneverbeused .4*- asasubstituteforadequatepatientsupervision.Theuseofphysicalrestraintscancauseincontinence,pressuresores,lossofmobility,andothermorbidities.Manyprovidersandconsumersstillmistakenlyhold,however,thatrestraintsarenecessarytopreventresidentsfrominjuringthemselves.8cd݌̌L XMOQSTUVWChx5MOQSTUVWL   L* XDXX@XDXDXXXD  L*Lh D   Inordertopromotereduceduseof  6 physicalrestraints,stateandCMSsurveyorswhoconductannualinspectionsofnursinghomespaycloseattentiontonursinghomes'useofrestraintsandciteanyimproperuse.CMSwillalsobeconductingatrainingprogramwhichwillbebroadcastbysatelliteandcarriedliveovertheInternetforstatesurveyorsinthenearfuture.StatesandCMShavebeensuccessfulinreducingtheuseofrestraintsfrom17.2percentin1996to10.0percentinFY2000,meetingtheirtarget.InterimFY2001dataindicateuseofphysicalrestraintsisjustabovethe10.0percenttarget.L*Lhh݌̌ @XDXXXD@XDXX@XD  8L 5MOQSTUVWxhXMOQSTUVWL   8k23   D   Pressureulcersrefertoanylesioncaused  F bypressureresultingindamageofunderlyingtissues,oftenreferredtoasbedsores.Pressureulcersareanundesirableoutcomethatcanbepreventedinmostresidentsexceptthoseatveryhighrisk.8kl݌̌L XMOQSTUVWChx5MOQSTUVWL   L* XDXX@XDXDXXXD  L*n D   CMSsponsorsavarietyofactivitiesto  M decreasetheprevalenceofpressureulcersthroughaneducationprogram;enhancingmethodsofsurveyordetectionofpressureulcersusingqualityindicatorreports;moredetailed,uniformguidancetosurveyorstoconsistentlydetectpressureulcersandtreatmentdeficiencies;moreeffectiveenforcementprocedurestosustaincompliancewithFederalrequirements;andcampaignstoraisenationalawarenessofthissignificanthealthcareproblem.Interim FY2001dataindicatetheprevalenceof +.'Y pressureulcersis10.7percent(target9.6   percent).Theincreaseinprevalenceismostlikelyduetobetterdetectionefforts.L*n o݌̌ @XDXXXD@XDXX@XD  P4`*:XDXX@XD  XDXXXD   P4`r   IncreasingEasyAccesstoHealth * InformationforConsumers ;sP4`rsz  Ԍ̌@XDXXD@XDX@XD  L* XDXX@XDXDXXXD  L*%t    Rx .f XDXXXDXDXXXD   DisseminationofResearchFindingsRt:   . XDXXXDXDXXXD  @XDXXXDTheNIHResearchAssessmentWorking   Group,theindependentpanelofexpertsthatassessedNIHsperformanceonitsresearchgoalsinFY2001,citedseveralgroundbreakingdevelopmentsforsharinganddisseminatinginformation:/XDXXXXy\X@XDu/ԀL*%tt݌ f  Ќ @XDXXXD@XDXX@XD  8L 5MOQSTUVWxhXMOQSTUVWL   8w23      _GenBank_,theNIHhumangenome  publicinformationresource,foracceleratinggenediseasediscovery.8wcx݌̌L XMOQSTUVWChx5MOQSTUVWL   8L 5MOQSTUVWxhXMOQSTUVWL   8y23      _MEDLINE_Ԁand_MEDLINEplus_,for R providingthepublicwithaccesstopublishedresearchfindingsonanybiomedicalsubject.Approximately30percentofthe400millionannualsearchesareconductedbyconsumers.Onereviewernotedthatimprovementstothesedatabaseshave explodedthepotentialforsharinginformationworldwide.8yz݌̌L XMOQSTUVWChx5MOQSTUVWL   8L 5MOQSTUVWxhXMOQSTUVWL   8}23      NationalHeart,Lung,andBlood  Institute(_NHLBI_)_website_,fortheoverwhelmingpositiveresponseofthedisparategroupsrelatedtoheart,lung,andblooddiseaseswhenitpremiered.8}}݌̌L XMOQSTUVWChx5MOQSTUVWL   L 4#3hXMOQSTUVWLL* XDXX@XDXDXXXD  L*    RxN$#&XDXXXDXDXXXD   MedicareandYouR: XDXXXDXDXXXD  Inordertohelp N$" Medicarebeneficiariesmakemoreinformedhealthcaredecisions,CMSinitiatedtheNationalMedicare&YouEducationProgram(_NMEP_)calledMedicare&You. 'N#& Throughatollfreenumber,_website_,andhandbook,_NMEP_ԀaimstoincreaseaccesstohealthcareinformationandprovideinformationonthevarioushealthcareoptionsavailabletoMedicarebeneficiaries.InFall2000,CMSkickedoffanationalmediacampaignandimplementedanumber r.)- ofnewandexpandedservicestomakeiteasierforMedicarebeneficiariestolearnabouttheirchoices,whichincludedexpandingphoneserviceavailabilityat1800MEDICAREto24hoursaday,sevendaysaweek;introducingawebbasedMedicarePersonalPlanFinderon      www.medicare.govnn    nn  ݀tohelpconsumers $ t4 comparetheirhealthplanchoices;enablingcustomerservicerepresentativesat1800MEDICAREtoprovidemoreindepthhelptocallersonfindingthehealthplanchoicethatisbestforthem;and?XDXXXDconductinga  9 publicitycampaign.L*m݌̌ @XDXX?XD@XDXX@XD  /XDXXXXy\X@XD/L* XDXXXDXDXXXD  L* D   Thesestrategieswillsupportseveral ^ < performancegoals,includinggoalstoimprovebeneficiaryunderstandingofbasicfeaturesoftheMedicareprogramandtoincreaseadultimmunizationandmammographyrates.Withsuchstrategiesinplace,CMSisontargettoincreasethepercentageofbeneficiarieswhoseekinformationfromMedicareandreportthatinformationreceivedansweredtheirquestionsto77percentbyFY2004from67percentinFY1999.TheyarealsoontracktoincreaseawarenessamongbeneficiariesonthedifferenthealthplanoptionsavailabletothemwithinMedicareto57percentbyFY2004from47percentinFY1999.CMShasalsoincreasedthenumberofcallersand_website_Ԁvisitors,nearly18.5millioninCY2001andincreasedusersatisfactionacrosstheboard.L*5݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*6 D   Rxl% $D XDXXXDXDXXXD   CDC_Website_,TollfreeNumberRߌion.: XDXXXDXDXXXD  CDC l% Q disseminatestimely,crediblehealthinformationtohelpconsumers,providers,policymakers,andresearchersmakeinformeddecisionsaboutpersonalandpublichealth.CDCstollfreenumberprovidescallerswithimmediateaccesstoautomatedprerecordedvoicemultilingual informationonpublichealthtopicsor ,(Y automatedfaxedinformation,data,and   graphicstoanyfaxmachineuponrequest.ThetollfreenumberensuresaccesstothehearingimpairedandbypersonswithoutInternetaccess.CDCs_website_Ԁcontinuestobeoneofthemostpopulargovernment_websites_Ԁandisespeciallyimportantinprovidingtrustedhealthinformationtoconsumersandhealthprofessionals.bXoXXXDbDXbXoԀ# bD2##XDX Q#InFY  ` 2001,3.6millionvisitedtheCDC_website_Ԁorcalledthetollfreenumber,whichwasacombinedincreaseof29percentoverFY2000levels.L*6݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Rx "r XDXXXDXDXXXD   InformationonMentalHealth   TreatmentandServicesR X: XDXXXDXDXXXD  ݀SAMHSAs   KnowledgeExchangeNetwork(KEN)providesinformationaboutmentalhealthtreatmentservicestoconsumers,theirfamilies,policymakers,providersandresearchers.RequestsformaterialsandpublicationsandInternetaccesshavesignificantlyincreasedsince1996.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    InFY2001,855,113publicationswere X distributed.Thisisa55percentincreaseoverFY2000,exceedingthetargeted50percentincrease.Whilethenumberofindividualpublicationrequestshasdecreased,bulkordersareontherise.Granteesandorganizationsarerequestinglargerquantitiesofdocuments.L* ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*     ݀InFY2001,therewere1,179,718web ."~! sitecontacts,a67percentincreaseoverFY2000.SincetheSeptember11thattacks,useractivitytotheKEN_homepage_increasedfrom96,507inAugustto126,617inSeptemberand146,346inOctober.L* ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*c    UseractivityonKENsDisasterMental ,(|#( HealthServiceslinkhasalsodramaticallyincreased:August,724;September,13,531;October,7,808;November,7,429;December,4,675.Thislinkprovidesinformationonpreparednessandmentalhealthneedsthatdevelopintheaftermathofdisasters.Italsoincludesafeaturetoassist .)/ individualsinlocatingmentalhealthservicesneartheirlocality.L*c݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*P D   RxvNXDXXXDXDXXXD   SubstanceAbusePreventionand v2 TreatmentInformationRhei: XDXXXDXDXXXD  ݀SAMHSAs ^3 NationalClearinghouseforAlcoholandDrugInformation(_NCADI_)providescomprehensive,customerfriendlyinformationaboutsubstanceabuseprevention,intervention,andtreatment.L*PϞ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   SAMHSAmetitsFY2001targetfora \ : 260percentincreaseininformationrequests.CallstotheTreatment_Helpline_,whichoperates24hours,sevendaysaweek,roseto199,155.Treatmentcallstendtobelonger,yettheaverageonholdtimeacrossbothpreventionandtreatmentcallsis11seconds,whichcompareswelltoindustrystandards.L* ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*^ D   InFY2001,overallcustomer nD satisfactionwas97.5percent,exceedingthe85percenttarget.ThetargetforFY2002hasbeenraisedbasedontheseresults.L*^ݤ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*B D   DetailedresultsfromtheFY2001 DI customersatisfactionsurveyinclude:95.5percentofcustomersrequestingmaterialsforworkwereverysatisfied,99percentofcustomersrequestingmaterialsforpersonalusewereverysatisfied,90.5percentofcustomersratedthevalueoftheservicetheyreceivedasexcellent,95.5percentreceivedtheirmaterialswithintwoweeks,and85percentofcustomersreceivedeverythingfromtheirorder.L*B݌̌ XDXXXDXDXXXD   %.!U (X@(9,X,hX,X,hX9  Kz$  .X\XXXD.e?\eX.X\  *Kz$ĩ@@*    ADVANCESCIENCEANDBIOMEDICALRESEARCHKz$ĩ< a   Ќe ee.e?\XDX ee  L* XDXXXDXDXXXD  L*+ @   L*+݌̌ XDXXXDXDXXXD  ةP4`.XDXXXD  XDXXXD   (X@(#(#(P4`   AdvancingBasicandApplied  Biomedicalresearch TԀP4`6n  Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*5    Rx "Z XDXXXDXDXXXD   L n "NationalInstitutesofHealthResearch  n ProgramRޮ: XDXXXDXDXXXD  Eachyear,theNIHResearch  V AssessmentWorkingGroup,anindependentpanelofexperts,convenestoassessinformationonNIHsrecentresearchachievementsandtheextenttowhichNIHresearchhasyieldedimportantdiscoveries,knowledge,andtechnologiesthatcanbeappliedtothedevelopmentofneworimproveddiagnostics,treatments,andpreventionstrategiesmeasures.L*5݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*.    InFY2001,theWorkingGroup  concludedthatNIHhadsubstantiallyexceededitsfivequalitativeresearchgoals.SignificantadvancementsnotedintheAssessmentWorkingGroupsreportinclude:+?XDXXXXmXXD+L*.݌ P Ќ XDXX?XDXDXXXD  8L 5MOQSTUVWx34L   8z23      HumanGenome:NIHcontinuesto  produceimportantdevelopmentsingeneticsand_genomics_!fueledbytoolsthatcomeoutofthehumangenomeproject.Substantialadvancesweremadeinunderstandingthebiologyofdiseasesthataffectnearlyeveryorgansystem,includingheartdisease,cholesterolabsorptionintheintestine,autism,Parkinsonsdisease,_Fanconi_Ԁanemia(thehematologicalsystem),andinterstitiallungdisease.Progresswasmadetowardincreasingtheunderstandingofsomerarediseasesandalsointheunderstandingofcomplexconditionswhereavarietyofgenescontributetodisease.Examplesofcomplexdiseaseswhereadvancesoccurredare_Crohn_sdiseaseandtype2diabetes.8z݌̌L 4#3x5MOQSTUVWL   #XDXXXD#+?XDXXXXmXXD+8L 5MOQSTUVWx34L   823      AdultStemCells:Amongthemany +$'* areaswhereNIHsupportedresearchexceededitsgoals,researchintoadultstemcellsisoneofthemostexciting. .)- Investigatorsarelearningthatstemcellsderivedfromadulttissueshavefargreaterabilitytoassumespecializedfunctionthanwaspreviouslyknown.Stemcellresearchersappeartobeatthethresholdofanentirelynewfieldthatcarriesvasttherapeuticpotential.#XDXX?XDY#+?XDXXXXmXXD+8݌ V 3 ЌL 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8923   D   DeclineinDisabilityinOlder  5 Americans:#XDXX?XDT#The1999NationalLongTerm  6 CareSurveyindicatesthattherateofdisabilityamongolderAmericanshasdeclinedoverthepasttwodecades.Therewere7millionchronicallydisabledAmericansin1999,whichis2.3millionfewerthattherewouldhavebeenhadtheratesnotchangedsince1982.ThereductionindisabilityratewasgreaterforolderblackAmericansthanforthepopulationasawhole.Similartrendswereseeninotherstudies(SurveyofIncomeandProgramParticipation,MedicareCurrentBeneficiarySurvey,NationalHealthInformationSurvey)overthesameornearlythesametimeperiod.89ӽ݌̌L 4#3x5MOQSTUVWL   L* XDXXXDXDXXXD  L* D   AstudycalledInstrumentalActivitiesof *G DailyLivingsuggeststhatfewerolderpeoplearehavingdifficultywithroutinecareactivitiessuchashouseholdchoresanderrands,althoughthenumberwhohaveseverepersonalcaredisability(e.g.,difficultywithbathing,dressing,andeating)hasnotchanged.AnalysisofdatafromtheHealthandRetirementStudyindicatesthatseverecognitiveimpairmentinolderAmericansdeclinedfromsixpercentin1993tofourpercentin1998.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Researchersbelievethatadeclinein `+&T  disabilityreflectsimprovementsin L,'U *3     physiologicalhealth,bettertherapies,and   improvedcopingstrategies.Effortsareunderwaytounderstandlongtermeconomicconsequencesofthedeclineindisability.L*=݌̌ XDXXXDXDXXXD  +?XDXXXXmXXD+8L 5MOQSTUVWx34L   823      NewTherapies:TheWorkingGroup & notedthatmanyNIHsupportedstudieshavereachedtheexcitingpointwherepotentialtargetsfornewtherapieshavebeenidentified,openingthedoorforpracticalapproachestodiseasetreatmentandprevention.AreaswherepotentialnewtargetsfordevelopmentofpharmacologicaldrugshavebeenidentifiedincludeAlzheimer'sdisease,ischemicbrainandheart,somepostsurgicaldifficulties,hepatitisC,conditionsrelatingtocholesteroltransport,osteoporosis,osteoarthritis,malaria,andsleepingsickness.8F݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8l23      SpinalCordInjuries:Alifethreatening 4 consequenceofuppercervicalspinalcordinjuryistheinterruptionofrespiratorypathways.Currently,mechanicalventilatorsprovidetheprimarymeansoftreatingspinalcordinjuredpatientswhocannotbreatheontheirown,leadingtoasenseofisolationandalossofindependence.8l݌̌L 4#3x5MOQSTUVWL   /XDXXX'XX?XD/L* XDXXXDXDXXXD  L*    Recently,however,investigators  Z demonstratedtherecoveryofbreathingfunctioninspinalcordinjuredrodentsthroughtheadministrationof_theophylline_Ԁtoactivatealternativerespiratorymotorpathways._Theophylline_Ԁsignificantlyincreasesthespeedatwhichthebrainstemreestablishescommunicationwiththediaphragmfollowingspinalcordinjury,andthistherapyhasramificationsforboththesurvivalandthequalityoflifeforspinalcordinjuredpatients.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    NewInstrumentsandTechnologies:The )$* AssessmentWorkingGroupnotedthattheneworimprovedinstrumentsandtechnologiesinreportedinFY2001notonlyofferedinsightintoimportantandfundamentalbiologicalprocesses,butthey ,.|)/ alsopavedthewayforbetterdiagnostics,prevention,andtreatmentforhumandiseases.L*]݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*{ D   Someofthesetechnologiescontinueto :3 bebuiltuponadvancesfromFY2000.Oneprominentexampleistheuseof_microarray_technologytoanalyzegeneactivityofthousandsofgenessimultaneouslytoidentifythoseimplicatedincancersandothergeneticdisorders.L*{݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Anotheradvancethatwasdeemed $ ; significantwasintheareaofcommunications.NIHwasabletouseinformationtechnologieseffectivelytoprovidescientificdatatoawideraudienceofresearchers,aswellashealthinformationtothegeneralpublic.L*m݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*2 D   Rx6XDXXXDXDXXXD   ProtectingHumanSubjectsin 6C ResearchR: XDXXXDXDXXXD  ݀AXDXXXDTheOfficeforHumanResearch nD Protections(_OHRP_)atOPHSprovidesoversightagainstnoncompliancewithresearchsubjectprotectionsandeducatesthescientificcommunityregardingtheimportanceofprotectingresearchsubjectsthroughtheir_website_,newsletters,townhallmeetings,etc.#XDXXAXD#AXDXXXDԀSince1990,_OHRP_Ԁhas K initiated725investigations.Inadditiontoconductinginvestigations,_OHRP_ԀleadstheHumanSubjectsResearchSubcommittee,oftheCommitteeonScienceoftheNationalScienceandTechnologyCouncil,inpromotingeffectiveinteragencypartnerships.#XDXXAXD#L*2݌ $VR Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   ݀FDAsBioresearchMonitoring(_BIMO_) h% T Programinspectsdrugsponsors,clinicalinvestigators,andcontractresearchorganizationsandmonitorsinstitutionalreviewboardsandnonclinical/analyticallaboratoryfacilitiestoensurethattherightsandwelfareofhumansubjectswhoparticipateinclinicaldrugtrialsareprotectedandtoverifythatdatacollectedby theregulatedindustryareaccurate.FDAis -)] theonlygovernmentagencywithanactive   programofonsiteinspectionsandthenecessaryexpertisetoevaluatetheconductofthesestudies.FDAcompleted683_BIMO_inspectionsinFY1999,697inFY2000,and553inFY2001.Thenumberofinspectionsconductedandcompletedeachyearisdependentonthenumberofinvestigationsofnewdrugsorapplicationsreceived.L*n݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Rx& ^ XDXXXDXDXXXD   OversightofScientificMisconduct &  CasesRe: XDXXXDXDXXXD  AXDXXXDTheOfficeofResearchIntegrity   (_ORI_)atOPHSinvestigatescasesofscientificmisconductandeducatesthescientificcommunityregardingtheimportanceofresearchintegrity.InFY2001,_ORI_Ԁcompleted78percentofthe18scientificmisconductcaseswithineightmonthsofreceivingfinaldecisionfrominstitution,exceedingtheirtargetof70percent.Theaverage_ORI_Ԁprocessingtimeforthe18caseswassevenmonths.Nineofthe18closedcasesresultedinmisconductfindingsandtheimpositionofadministrativeactions.#XDXXAXD#L*;݌   Ќ XDXXXDXDXXXD  P4` \lXDXXXD  XDXXXD   P4`   ProvidingFasterAccesstoDrug  \ Therapies P4`eHԌ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*\    Rx!` XDXXXDXDXXXD   NewDrugApplications(_NDA_)R: XDXXXDXDXXXD  A !` majorobjectiveofthehumandrugsprogramistoreducethetimerequiredforFDA'sreviewofalldrugs.EmphasisisgiventothereviewofnewdrugsintendedtotreatseriousorlifethreateningdiseasessuchasAIDS,AIDSrelateddiseases,andcancer;andthoseproductsthatdemonstratethepotentialtoaddressunmetmedicalneeds.ThetimelyperformanceofhighqualitydrugreviewsinrecentyearsreflectstheimportanceofmanagerialreformsandadditionalresourcesprovidedfromuserfeesunderthePrescriptionDrugUserFeeAct(_PDUFA_).L\݌ -H)+ Ќ (#(#         (#(# XDXXXDXDXXXD  L* XDXXXDXDXXXD  prk<,(`~0 m  ` E m m  pL1ݰ D   Asaresult,reviewtimesaredecreasing.Thegraphillustratesthatapprovaltimeinmonthsforpriorityapplicationshasdecreasedfrom15monthsin1994tosixmonthsin2001,andapprovaltimeforstandardapplicationshavedecreasedfrom22.1monthsto14months.Americansnowenjoyquickeraccesstonewdrugtherapiessuchas_Gleevec_,treatmentforachronictypeofleukemiaor_Xeloda_Ԁand_Taxotere_,whichcombinedhelpinthetreatmentofbreastcancer.ApprovaltimerepresentsthetotalreviewtimeattheAgencyplusindustryresponsetimetotheAgencysrequestsforadditionalinformation.Ofthe29priority_NDA_Ԁsubmissions,28,or97percentwerereviewedwithinsixmonths(target90percent).Ofthe92standard_NDA_submissions,89,or97percentwerereviewedwithin12months(target90percent).L*1 ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Rx&"V&!XDXXXDXDXXXD   GenericDrugApplicationsRY: XDXXXDXDXXXD  ݀Itis &"U estimatedbytheCongressionalBudgetOffice thatthepurchaseofgenericdrugsreducedthecostofprescriptions(atretailprices)byroughly$8to$10billionin1994.Agenericdrugproductisonethatiscomparabletothereferencelisteddrugproductindosageform,strength,routeofadministration,quality,performance ..~)] d  dcharacteristics,andintendeduse.FDAmetitsgoalforFY2000actingon55.6percentoforiginalapplicationswithinsixmonthsafterthesubmissiondate.Thisisanincreaseofmorethan27percentoverFY1999.Oftheseapplications,severalrepresentthefirsttimeagenericwasapprovedforaproduct.L*/݌ $ t Ќ XDXXXDXDXXXD    (X@(   L   Kz$  .X\XXXD.e?\eX.X\  9,X,hX,X,hX9Kz$@@*    IMPROVETHEWELLBEINGANDSAFETYOFFAMILIES  ANDINDIVIDUALSKz$   | Ќe ee.e?\XDX ee  P4`$ t4 XDXXXD  XDXXXD   (X@(#(#(9,X,hX,X,hX9P4`   ProtectingChildrenandYouth P4` ($ tԌ  ( ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*    ChildAbuseandNeglect: ACF,in   partnershipwithstateandlocalgovernmentsadministerstheChildAbuseandNeglectprogramwhichisdesignedtoemphasizebothpreventionandintervention.Theperformancegoalistodecreasethepercentageofchildrenwithsubstantiatedreportsofmaltreatmentthathavearepeatedsubstantiatedreportofmaltreatmentwithinsixmonths.ForFY19982000performanceappearsconstantateighttoninepercent,althoughthisdatawillbesomewhatunstablesincereportingisvoluntary.Nonetheless,ACFisseekingtoimproveperformanceandhasestablishedgoalsofsevenpercentforFY2002andFY2003.L*6݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    ChildWelfare: ACF,inpartnershipwith J stateandlocalgovernments,administersprogramswhichhelpchildrenwhiletheyarelivingwiththeirownfamiliesandfindplacementsforthosewhocannotsafelyreturntotheirhomes.ProgramssuchasFosterCareandIndependentLivingprovidesafeandstableenvironmentsforthosechildrenwhocannotremainsafelyintheirownhomes.TheChildWelfareServicesandPromotingSafeandStableFamiliesprogramsprovideservicestochildrenandfamilieswithafocusonprotectingchildrenandstrengtheningfamilies.Keyperformancemeasuresfortheseprogramsare:maintainthepercentageofchildrenwhoexitcarethroughreunificationwithinoneyearofplacementat67percentand,forchildrenwhohavebeenincarelessthan12months,increasethepercentagethathadnomorethantwoplacementsettings(FY2000performanceis58percent;FY2003targetis V.)* 62percent).Theseperformancemeasuresreflecteffortstofocusonoutcomesinchildwelfare.TheyarealsobeingusedintheAnnualChildWelfareOutcomesreportandtheChildandFamilyServicesReviewsandfailuretomeetthestandardsassociatedwiththemcanresultinaStatebeingfoundnotinconformitywiththeStateplanrequirementsfortitlesIVBandIVEoftheSocialSecurityAct.TheNationalResourceCentersfundedbyACFareofferingtechnicalassistancetostatestohelpimproveservicedeliveryandcompliancewithstateplanrequirements.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*  D   Adoption: ACF,inpartnershipwithstate 9 andlocalgovernments,administersprogramswhich,whenachildcannotbereunifiedwithhis/herfamily,strivetoplacethechildpermanentlywithanadoptivefamily.TheAdoptionAssistance,AdoptionIncentivesandAdoptionOpportunitiesprogramshaveworkedinconcertwithstateandlocalinitiativestoprovideincentivesandfocusonchildrenwithspecialneeds.L* @ ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*  D   ݀Thesuccessoftheseprogramsis 0!D demonstratedbytheunprecedentedincreasesinthenumberofchildrenadoptedfromfostercare.InFY2000,50,000childreninthefostercaresystemwereadopted,nearlydoublingtheFY1995totalof26,000andexceedingtheperformancetargetof46,000.Inaddition,thepercentageofchildrenwhoexitthefostercaresystemthroughadoptionwithintwoyearsofplacementincreasedto20percent,butfellshortofthetargeted27percent,andthemedianlengthoftimeuntiladoptionisslowlydeclining.Itisexpectedthatas longertermcasesareclearedoutofthe .h)R system,thewaitingtimeforchildrentobeadoptedwillcontinuetodecrease.L* . ݌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    ACFwillstrivetocontinuetoimprove N performanceastherearecurrentlyestimatedtobe134,000childreninthefostercaresystemwhocannotreturnsafelytotheirownhomes.ByFY2003,ACFhasestablishedthegoalofplacing58,500fostercarechildrenwithadoptiveparents.Thiswillbechallengingsincemostofthesechildrenareschoolaged,insiblinggroups,orhaveaphysical,mentaloremotionaldisability.L*Q݌̌ XDXXXDXDXXXD  P4`  XDXXXD  XDXXXD   P4`   EnablingtheElderlytoLivewith   IndependenceandDignity bP4`D< Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*L    Rx(xXDXXXDXDXXXD   OlderAmericansActCommunitybased  ServicesR: XDXXXDXDXXXD  TheOlderAmericansActfocuses  onthoseeldersatriskoflosingtheirindependence.AoA,inpartnershipwithstates,AreaAgenciesonAgingandover25,000serviceprovideragencies(theAgingNetwork)providesnumerousservicestoolderAmericansincludinginformationandassistance,outreach,transportation,meals,homehealth,andadultdaycare.Inordertoprovideagreaterrangeofservicesandincreaseaccessamongtheelderlypopulation,theAgingNetworkhassuccessfullyleveragedfundsfromanumberoffundingsources.Infact,foreverydollar_AoA_Ԁcontributes,thenetworkwasabletoleverage$1.90inFY1998FY2000fromvariouscharitableandotherorganizations.Finally,theAgingNetwork,strivingtoservethemostvulnerableelderly,hassteadilyincreasedthenumberofhomedeliveredmealsprovided.InFY1999,theAgingNetworkserved134.6millionmeals,exceedingtheirtargetofserving119.0million.PreliminaryFY2000dataindicatesthattheNetworkhasincreasedthenumberofmealsprovided,serving142.4millionbutshortofthetarget,155.0million.Also,inFY2000,thenumberofcongregatemeals l.), servedwasincreasedto116.0million,exceedingthetargetof113.1millionmeals.L*L݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   RxvNXDXXXDXDXXXD   LongtermCareOmbudsmanProgramRbisd:  v/ XDXXXDXDXXXD  Thislongstanding_AoA_Ԁprogramhasenabled b0 residentsoflongtermcarefacilitiesandtheirfamiliestobeinformed longtermcareconsumersandfacilitatestheresolutionofproblemsregardingcareandconditionsinlongtermcarefacilities.ThousandsofpaidandvolunteerombudsmenworkingineveryStatehavemadeadramaticdifferenceinthelivesoflongtermcareresidents.?XDXXXDOverthe  8 pastfiveyears,_AoA_Ԁhasresolvedorpartiallyresolvedatleast70percentofcomplaints.FY2000performancewas74.1percent,whichexceededtheirtargetof70percent.L*8݌̌ XDXX?XDXDXXXD  #XDXXXD1 #L* XDXXXDXDXXXD  L*! D   Rx8XDXXXDXDXXXD   _Caregiver_ԀResearchR": XDXXXDXDXXXD  Whilesomeofthe 8? careforolderpeopleisprovidedbyhomehealthagenciesornursinghomes,muchofitisprovidedinformallyathomebyfamilyandfriends.In1997,theeconomicimpactofinformal_caregiving_Ԁwasestimatedat$196billion,comparedto$32billionforhomehealthcareand$83billionfornursinghomecare.Manyinformalhome_caregivers_dealwithcomplexanddemandingcarerequirements.L*!h"݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*& D   NIHstudieshavecontributedto  "K increasedunderstandingofstressorsandpredictorsofbadoutcomes,andhaveidentifiedpredictorsoffamilydynamicsthatareresponsivetointerventions.Maintainingthehealthofthecareprovidersaswellasthecarerecipientisconsideredcrucialtosuccessfulinformalhomecare.Currentlyfundedworkisinvestigatinghowtoencourage_caregivers_Ԁtoreachoutandobtainservicesandsupportthatmightbehelpfultothem.L*&&݌ *F&V Ќ XDXXXDXDXXXD  (X@(Kz$  .X\XXXD.e?\eX.X\  9,X,hX,X,hX9Kz$)@n n     STRENGTHENAMERICANFAMILIESKz$)-* R*   Ќe ee.e?\XDX ee  P4`XhXDXXXD  XDXXXD   (X@(#(#(9,X,hX,X,hX9P4`+   IncreasingEconomicSelf X sufficiencyofLowincomeFamilies ,P4`++ HD Ԍ  H ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*-    Rx\  4XDXXXDXDXXXD   WelfareReformTemporary \  AssistanceforNeedyFamilies(_TANF_)R-: XDXXXDXDXXXD  A D  primarygoalofthePersonalResponsibilityandWorkOpportunityReconciliationActof1996istomoverecipientsofwelfaretoworkandselfsufficiency.CongressestablishedworkparticipationperformancestandardsandaHighPerformanceBonusincentivesystemtofacilitatethisgoal.Therearepositiveresultstoreport,demonstratingtheearlysuccessoftheprogram.Welfarerollshavefallentohistoriclows;fromover12millioninAugust1996to5.4millioninJune,2001.ForFY2000,allstatesmettheCongressionallyestablishedworkparticipationrateof40percent,consistentwithACFsperformancegoal.Also,inFY2000,76percentofstateswithtwoparentworkparticipationprogramsmettheCongressionallyestablished90percentworkparticipationstandard.Theperformancegoalwasthat100percentofstateswouldmeettheparticipationstandard,however,a90percenttwoparentworkparticipationisextremelyrigorous.TheAdministrations_reauthorization_Ԁproposalwillreplacethesetwostandardswithasingleparticipationstandardforallcaseswithadults.L*--݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*4    TANF,isadministeredbyACFin &!" partnershipwithStateandlocalgovernments.WhileACFcontinuestoprojectgainsinemploymentandwages,itwillbeincreasinglychallengingtoachievethesegoals.Theeconomywillhaveanimpactongoalachievement.Inaddition,thereisconcernthattheremainingTANFpopulationmayhavemorebarrierstoemploymentthanthoseTANFbeneficiaries .&*+ whohavealreadysuccessfullyobtainedemployment.L*44݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*.7 D   Rx n XDXXXDXDXXXD   ChildCareR7: XDXXXDXDXXXD  TheChildCareand  n. DevelopmentFund(_CCDF_)wasestablishedunderthePersonalResponsibilityandWorkOpportunityReconciliationActof1996tohelpworkinglowincomefamiliesachieveandmaintaineconomicselfsufficiencyandtoimprovetheoverallqualityofchildcare.AdministeredbyACF,inpartnershipwithstateandlocalgovernments,_CCDF_Ԁunifiedfederalchildcareprograms.Thenumberofchildrenservedthroughthe_CCDF_Ԁincreasedfrom1.51millioninFY1998to1.87millioninFY2000.WhilethisperformancefallsshortofthetargetforFY2000(1.97million)itis,nonetheless,asubstantialincreaseinthenumberofchildrenservedby_CCDF_Ԁsubsidies.Otherencouragingperformanceindicatorsare:thepercentageofeligiblechildrenreceiving_CCDF_subsidieshasincreasedfrom10percentinFY1998to12percentinFY2000,andthenumberoffamiliesworkingorpursuingtrainingwiththesupportof_CCDF_Ԁsubsidieshasincreasedfrom0.8millioninFY1998to1.04millioninFY2000.Whileperformancetrendsareencouraging,itwillbeacontinuingchallengetoprovidequalitychildcaretoadditionaleligiblechildren.InFY2003,ACFprojectsthat2.2millionchildrenwillreceive_CCDF_Ԅsubsidizedchildcare,increasingthepercentofeligibles receivingservicesto14percent.L*.77݌ '#M Ќ XDXXXDXDXXXD  P4`XDXXXD  XDXXXD   P4`}?      IncreasingParentalResponsibility  andIncomeSupport @P4`}??@Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*A    Rx,|XDXXXDXDXXXD   ChildSupportEnforcementRA: XDXXXDXDXXXD  The  missionofACFsChildSupportEnforcement(_CSE_)program(establishedunderTitleIVDoftheSocialSecurityAct)istoassurethatassistanceinobtainingsupportisavailabletochildrenbyestablishingpaternityandsupportobligations,locatingparents,andenforcingsupportobligations.Workinginpartnershipwithstateandlocalgovernments,_CSE_ԀbrokenewrecordsinnationwidecollectionsinFY2001,reaching$18.9billion.Thegovernmentcollectedarecord$1.6billioninoverduechildsupportfromFederalincometaxrefundsfortaxyear2000.Morethan2.1millionfamiliesbenefittedfromthesetaxcollections.Inaddition,aprogramtomatchdelinquentparentswithfinancialrecordslocatedmorethan1.5millionaccountswithavalueinexcessof$3.1billion.Thenumberofpaternitiesestablishedoracknowledgedreachedalmost1.6millioninFY2000.Ofthese,over689,000wereestablishedthroughinhospitalacknowledgmentprogramsand867,000wereestablishedthroughthe_CSE_ԀIVDprogram.L*AA݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*G    TheGPRAperformancemeasuresused !N byACFarethesameasthoseenactedbytheChildSupportPerformanceandIncentiveActof1998inthedevelopmentoftheperformancebasedincentiveformula.Themeasuresare:statewidepaternityestablishmentpercentage;percentageofIVDcaseswithsupportorders;IVDcollectionrateforcurrentsupport;IVDarrearagecasespaying;andtotaldollarscollectedper$1ofexpenditures.ReportingprogramperformanceforFY1999andFY2000fortheseperformancemeasurescanbemisleadingsincetheperformancetargetswereestablishedusingdatacollectedunder .6*, anolderreportingsystemwithdatadefinitionswhichdifferfromthoseemployedbythecurrentsystemimplementedin1999.Forexample,programperformanceforFY2000includesthefollowing:paternityestablishmentforchildrenbornoutofwedlockwas95percent(target96percent).Regardlessofthepercentage,arecord1.6millionpaternitieswereestablished.OtherFY2000performanceinformationincludes:62percentofIVDcaseshavesupportorders;theIVDcollectionrateforcurrentsupportis56percent,payingcasesamongIVDarrearagecasesare57percentandthecosteffectivenessratiohasincreasedto$4.21.AstheIVDcaseloadincreases,maintainingorachievingmodestincreasesinthesepercentageperformancelevelswillbeachallenge.L*G6H݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*uN D   HeadStart: HeadStartisanational A programadministeredbyACFthatprovidesdevelopmentaleducation,health,nutritionandsocialservicestoAmericaslowincomechildrenagedthreetofiveandtheirfamiliesthrough1,525communitybasedorganizations.Oneofthecornerstonegoalsoftheprogramistostrengthenfamiliesastheprimarynurturesoftheirchildrenandanotheristoensurewellmanagedprogramsthatinvolveparentsindecisionmaking.L*uNN݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*Q D   InFY2001,HeadStartprograms 0"M employed55,900parents(29percentofemployees).Theperformancetargetwas30percentandhistoricaldatafromFY19982000indicatethatthepercentageofemployeeswhoareparentsrangesfrom29to31percent,averagingslightlyunder30percent.Itisimportanttonote,however,thatwhilethepercentagedecreasedslightly,theactualnumberofparentsemployedbytheHeadStartprogramsincreasedfrom50,000inFY2000to55,900inFY2001.TheFamilyandChildExperiencesSurveyf  f(FACES)alsoshowsthatHeadStartparents ,.|)Z reportahighlevelofsatisfactionwiththeprogram;over80percentindicatetheyare satisfiedor verysatisfiedforeachofeightmajorprogramareas.L*QR݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*U    Inaddition,FACESyieldedresultsin & FY2000indicatingthat66percentofHeadStartparentsreadtotheirchildrenthreetimesaweekormore.TheperformancetargetforFY2002/2003is70percent. To    enhancefamilyliteracyservices,includingneweffortstoencourageparentstoreadtotheirchildren,HeadStartrecentlyawardedagranttotheNationalCenterforFamilyLiteracy.L*UqV݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*X       4  `  h      4 L*X\Y݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD   L*fZ    L*fZZ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*[    L*[%\݌ 4 Ќ XDXXXDXDXXXD  +XDXXX'XXXD+  (X@(   \ Kz$  .X\XXXD.e?\eX.X\    9,X,hX,X,hX9Kz$l]@@*    REDUCEREGULATORYBURDENONPROVIDERS,  PATIENTS,ANDCONSUMERSKz$l]^ =^  | Ќe ee.e?\XDX ee  ]P4`$ t4 XDXXXD  XDXXXD   (X@(#(#(P4`C_   StreamliningtheRegulatory $ t DevelopmentProcess `P4`C__  `Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*`    Rx( x XDXXXDXDXXXD   ReducingAdministrativeBurdenfor ( x ResearchInstitutionsRa: XDXXXDXDXXXD  ݀#XDXXXD\#@XDXXXD_OHRP_Ԁ(Officeof `  HumanResearchProtection)atOPHSdevelopedasimplifiedAssurancesystemforinstitutionsconductingfederallysupportedorconductedhumansubjectresearch.ThenewAssurancesystem,calledafederalwideAssurance,cansignificantlyreducetheadministrativeburdenonindividualinstitutions,_OHRP_,aswellasotherFederalDepartmentsandAgencies.Reductioninburdenisgainedby:1)theincreasedsimplicityoftheformandprocess,2)increasedapprovalperiodoftheAssuranceformostinstitutions(fromaprojectbyprojectapprovaltoanapprovalperiodofthreeyears),and3)acceptanceofan_OHRP_approvedfederalwideassurancebyotherFederalDepartmentsandAgenciesoftheCommonRule,thusremovingtheneedforduplicateeffortonthebehalfofotherDepartmentsandAgencies.#XDXX@XDb#L*`fa݌   Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  3,xX,X,hX3L*cg    RxZ"!2XDXXXDXDXXXD   RegulationofMedicalDevicesR?h: XDXXXDXDXXXD  FDAis Z" workingwithstakeholderstodevelopmorestreamlineperformancestandardsasguidesinthedesignofsaferandmoreeffectivemedicalproductsandtoenhancethequalityofregulatorydecisionmaking.Useofstandardsalsohelpstoexpeditereviewsofpremarketnotificationsandincertaincases,fillastandardvoid.Forexample,thereisstandardizedprotocolforthecleaningofdevicespriortosterilizationbutnotoneforafteruseofdevice.FDAworkedwiththeAssociationfortheAdvancementofMedicalInstrumentation(_AAMI_)toinitiatestandards V.)) developmentinthatarea.The_AAMI_SterilizationStandardsCommitteehasinitiatedthedevelopmentofsuchaprotocol.Whencompleted,thisprotocolwillbeusefultohospitalsandotherswhocleanmedicaldevicespriortotheirbeingplacedbackintoservice.FDArecognized30standardsinFY2001and117standardsinFY2000foracumulativetotalof597attheendoftheyear.FDAworkscloselywithstandardsorganizationslike_AAMI_ԀandtheInternationalStandardsOrganizations(_ISO_)toimproveitsuseofconsensusstandards.L*cgh݌̌ XDXXXDXDXXXD  P4`XDXXXD  XDXXXD   P4`n   MaximizingCollaborationwithHHS 7 Stakeholders _oP4`nAo&vrԌ̌XDXXDXDXXD  L* XDXXXDXDXXXD  -, X,xX-L*=p D   RxbXDXXXDXDXXXD   RegulationofAnimalDrugsRq: XDXXXDXDXXXD  The 9 AnimalDrugsandFeedsProgramatFDAinformsandassistsproductsponsorsthroughouttheapprovalprocessstartingwithpresubmissionconferences.Thefocusistoinformandassistfirmsincomplyingwiththenewlegislationandtostreamlinetheproductreviewprocessthroughphasedreview.InsteadofwaitinguntilallstagesofproductdevelopmentarecompletedbeforecontactingFDA,phasedreviewhelpsindustrysponsorsstayoncoursethroughoutthedrugdevelopmentprocessbycommunicatingrequirements(orstandardsorcriteria)forapprovalateachstageofdevelopment.PresubmissionconferencetrackingwasestablishedinFY1999.FDAmettheirgoalsinFY2000andFY2001,conductingpresubmissionconferenceswith75percent(target73percent)ofproductsponsorsinFY2000and80percent(80percent)inFY2001.L*=pp݌ -6)N Ќ XDXXXDXDXXXD  (X@(Kz$  .X\XXXD.e?\eX.X\  3,X,hX, X3Kz$2v@     PERFORMANCEDATACOLLECTIONKz$2vv v   Ќe ee.e?\XDX ee  P4`XhXDXXXD  XDXXXD   (X@(#(#(P4`w   MeasuringProgramPerformance vxP4`wXx \XԌ  \ ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*Cy    SoundinformationisessentialtoHHS  H missionofenhancingthehealthandwellbeingofAmericans.ForeveryHHSstrategicgoal!whetherprovidingforeffectivehealthandhumanservicesorfosteringsustainedadvancesinmedicineandhealth!reliableandreadilyavailableinformationisnecessaryforplanning,decisionmaking,andmeasuringresults.TheDepartmentplaysanessentialroleinproducingdatafordecisionmakingforhealthandhumanservicesprograms,bothasadirectproducerandasapartnerindatacollectionwiththestates,grantees,andothergovernmentalagencies.L*Cyy݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*|    Generally,fortheinitialimplementation B ofGPRA,ourprogramschoiceofperformancegoalswasdrivenbytheexistingcapabilitiesofsystemsdesignedtotrackthehealthofthegeneralpopulation,supportbroadplanningobjectives,andprovideservices.Historically,programsandoperatingcomponentshavereliedupondataforprogrammanagement,policydecisionmaking,andinterventiondevelopment.GPRAreinforcedtheperspectiveofdatafordecisionmakingandencouragedstaffthroughoutHHStoreflectandrefineourdatasystems.Asaresult,ourprogramsworkextensivelywiththeirpartnersinprogramimplementationanddatacollection!state,local,andtribalgovernments,grantees,andMedicarecontractors!toidentifyenhancementstothesesystemsthatwouldimprovethetimeliness,completeness,andaccuracyofourdataandenableustomovetomoresophisticatedmeasuresofperformance.L*|h}݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*΁    Keychallengesinclude:L*΁M݌ -<)+ Ќ XDXXXDXDXXXD  8L 5MOQSTUVWx34L   8-23   D   Datasystemsneedtoproducedataona X+ moretimelybasisandwithafrequencyrelevanttotheperiodsoverwhichperformanceisbeingmeasured.8-ǃ݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8W23   D   Asthehealthsystemcontinuesto ~ 0 change,currentdatacollectionsmaynotcontinuetoproduceneededdata.8W݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8\23   D   Amajorchallengeinselectingannual  4 performancegoalsisthatmanyoftheinterventionsforcomplexchronicdiseasesorsocialproblemsrequireyearsoffocusedeffortstorealizesignificantprogress.8\݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8‰23   D   ThemajorityofHHSprogramsare : implementedatthestateandlocallevel,andobtainingreliable,systematicdataattheselevelsiscrucialinordertomonitorprogramimplementation,performance,andoutcomes.8‰\݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8123   D   Datasystemsneedtoproduce A informationwithsufficientqualityandprecisiontodetectwhatmayberelativelysmallchangesinkeyperformancegoals.81ˌ݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8e23   D   Majorchangesincomplexdata >F collectionsystemstaketime.8e݌̌L 4#3x5MOQSTUVWL   L* XDXXXDXDXXXD  L*: D   EffortsareunderwayinHHSatthe  System(_BRFSS_)R: XDXXXDXDXXXD  _BRFSS_Ԁcollectsstate ? levelinformationonhealthbehaviorsrelatedtotheleadingpreventablecausesofdeath,includingphysicalinactivity,injury,weightcontrol,alcoholconsumption,tobaccouse,andHIV/AIDS.Italsocollectsdataonpreventivehealthpracticessuchasmammographyuse.CDCuses_BRFSS_ԀdatatoreportonaperformancegoaltoincreasethepercentageofdiabeticswhoreceiveanannualeyeexamandannualfootexamandOPHS,toreduceinjurioussuicideattemptsamongyouthgrades912.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*٩ D   Rx##jXDXXXDXDXXXD   YouthRiskBehaviorSurveillance #M System(_YRBSS_)Rndat: XDXXXDXDXXXD  _YRBSS_Ԁisabiennial, z$N national,schoolbasedsurveythatmeasuresriskbehaviorsthatcontributetotheleadingcausesofmortalityandmorbidityamongyouthandadultsintheUnitedStates:behaviorsthatcontributetounintentionalandintentionalinjuries;tobaccouse;alcoholandotherdruguse;sexualbehaviorsthatcontributetoHIVinfection,othersexuallytransmitteddiseasesandunintendedpregnancy;dietarybehaviors;andphysicalg  gactivity.CDCandOPHSuse_YRBSS_Ԁdata .)Y toreportonperformancegoalsthatreducethepercentageofteenagerswhosmoke,increasethepercentageofhighschoolstudentswhohavebeentaughtaboutHIV/AIDSpreventioninschool,andincreasethepercentofadolescentswhoabstainfromsexualintercourseorusecondomsifcurrentlysexuallyactive.L*٩X݌̌ XDXXXDXDXXXD  Rx N XDXXXDXDXXXD   L* XDXXXDXDXXXD  L*X    NationalHouseholdSurveyonDrug  N  Abuse(_NHSDA_)Realt: XDXXXDXDXXXD  ݀Therecentlyexpanded  6  _NHSDA_Ԁprovidesbothnationalandstateestimatesoftheincidenceandprevalenceofdrugs,alcoholandtobacco,usepatterns,ageatfirstuse,riskfactors,treatmentanddisability.Thedatachartprogressbyage,gender,ethnicity,andrural/urbanservicesetting(atthestateandnationallevels).SAMHSAusesdatafrom_NHSDA_Ԁtotrackthetracksuccessofthenationasawholeinimprovingeffectivesubstanceabuseandmentalhealthservices,andtoinforminprogramplanningwhiletheagencyworkswithgranteesreachconsensusonasetofgoalstomeasureprogramperformanceanddevelopasystemtocollectandreportprogramleveldata.L*Xװ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*O    RxXXDXXXDXDXXXD   NationalHealthInterviewSurvey  (_NHIS_)R: nnXDXXXDXDXXXDnnggff  _NHIS_Ԁinterviewsover100,000 h personseachyeartomonitorabroadrangeofhealthissues.CDCuses_NHIS_Ԁdatatoreportonaperformancegoaltoincreasetheuseofsmokedetectorsinhomes,andOPHSagoaltoincreasephysicalactivity._HRSA_uses_NHIS_ԀandtheNationalHospitalAmbulatoryMedicalCareSurvey(_NHAMCS_)indicatorsin_HRSA_ԀsurveysthatmonitorvariousindicatorsofcareintheHealthCenters,includingperformancegoalsrelatedtomammographyandpapsmearrates.Datafromthe_HRSA_Ԁsurveysarethenbenchmarkedtonationalestimatesobtainedthrough_NHIS_Ԁand_NHAMCS_.Inaddition, CMSuses_NHIS_Ԁasasecondarydatasource @-(, foritsmammography,adultimmunization,anddiabetesgoals.L*Oε݌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*9 D   RxvNXDXXXDXDXXXD   NationalHealthandNutrition v/ ExaminationSurvey(_NHANES_)Realt: XDXXXDXDXXXD  This ^0 surveyenablessophisticatedlaboratoryandexaminationcenterstomovearoundtheU.S.toobtainstandardizedmedicalinformationfromdirectphysicalexamination,diagnosticprocedures,andlabtests.CDCuses_NHANES_Ԁdatatoreportonaperformancegoaltoreducethenumberofchildrenwithelevatedbloodleadlevels.L*9݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*3 D   Rx p XDXXXDXDXXXD   NationalHospitalDischargeSurvey  : (_NHDS_)Realt: XDXXXDXDXXXD  ݀_NHDS_Ԁobtainsinformationon  ; hospitalizations,surgery,procedures,andotherinformationfromarepresentativesampleofhospitaldischargerecords.CDCuses_NHDS_Ԁdatatoreportonagoaltoreducetheincidenceofpelvic_imflamatory_disease,and_HRSA_Ԁuses_NHDS_Ԁdatatoreportonaperformancegoaltoreducehospitalizationsforambulatorycaresensitiveconditions.L*3݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Rx.~XDXXXDXDXXXD   NationalImmunizationSurvey(_NIS_)Rp:  F XDXXXDXDXXXD  CDCutilizesthe_NIS_,atelephonebased G surveyofU.S.households,toprovidedatatoreportonperformancegoalsrelatedtochildhoodandadultimmunization.CMS,_HRSA_,and_IHS_Ԁusethe_NIS_,whichprovidesstateleveldata,andtheNationalHealthInterviewSurvey,whichprovidesnationaldata,tobenchmarkandtovalidateprogramleveldata.L*F݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Rx&"T&!XDXXXDXDXXXD   MedicareCurrentBeneficiarySurvey &"Q (_MCBS_)R: nnXDXXXDXDXXXDnnggff  ݀_MCBS_Ԁisanongoingpersonal '#R interviewsurveyofarotatingpanelof16,000Medicarebeneficiaries.ThesampleisnationallyrepresentativeoftheMedicarepopulation,and_MCBS_ԀcanbelinkedtoMedicareclaimsdata.Sampledbeneficiariesareinterviewedeveryfourmonthstoacquirecontinuousdataon ,.|)Y services,costs,payments,andinsurancecoverage.CMSwillusedatafromthe_MCBS_ԀtoreportonitsperformancegoalstoimprovebeneficiaryunderstandingofbasicfeaturesoftheMedicareprogram,improvetheeffectivenessofdisseminationofMedicareinformationtobeneficiaries,andincreaseadultimmunization.CMSalsouses_MCBS_ԀdatatochecktheconsistencyofdatafromtheMedicareConsumerAssessmentofHealthPlansStudy(_CAHPS_),whichisusedtoassessbeneficiarysatisfactionwithhealthplans.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Rx "r XDXXXDXDXXXD   NationalSurveyonChildand   AdolescentWellBeing(_NSCAW_)Ry:    XDXXXDXDXXXD  _NSCAW_,alargenationallongitudinalstudy, n followsarepresentativesampleofchildrenwhoenterthechildwelfaresystemassessingtheirsocial,emotional,cognitiveandfunctionalstatus,aswellasserviceneedsandservicesprovidedforchildrenandtheirfamiliesat12months(baseline)andat18months.Followupinterviewswillbeconductedfromstartofstudywith6100children,their_caregivers_Ԁtheircaseworkersandtheirteachers.ACFwillusethisdatatogainabetterunderstandingofperformancegoalsrelatedtofostercareandadoption.L*O݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    EnhancingandcoordinatingHHS 0 nationalpopulationbaseddatacollectionsiskeytoaddressingHHSdataneeds,andisaprimefocusoftheHHSDataCouncil.UndertheauspicesoftheHHSDataCouncil,anumberofsignificantimprovementshavebeenmadeinHHSdatasystemsandinHHSwidedataplanningandintegration.TheseimprovementsincludetheHHSSurveyIntegrationPlan,acomprehensive,departmentwideplanforaddressingcriticalneedsforraceandethnicitydata,anHHSwideinclusionpolicyforraceandethnicitydata,andHHSwidedataimprovementinitiativesinhealthsystemdata.TheCouncilhasalsodevelopedawebbaseddirectoryofallofthe .). majordatacollectionsystemswithinHHSwithlinkstoprograms.Inaddition,theHealthInsurancePortabilityandAccountabilityAct(_HIPAA_)administrativesimplificationinitiativecanbeconsideredasuccessfulmodelofpublicprivatesectorcollaborationonnationaldataobjectives.L*h݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*+ D   Eachyear,newdataneedsariseanda  6 numberofcriticaldatagapsremain.Toaddresstheseissuesinanoverallstrategicframework, theCouncilhasestablisheda ^ 9 DataStrategyCommitteetoidentifycurrentandemergingneedsfordata,assesscurrentHHSdatacapabilitiestoaddresstheseneeds,identifyopportunitiesforcostefficiencies,anddeveloprecommendationsforamultiyeardatastrategyandplanreflectingabroadcoordinatedapproachtodataplanning,investmentanddecisionmakinginHHS.ThroughtheDataStrategyCommittee,_AHRQ_,_ASPE_,_NCHS_,andCMSareworkingonamasterplanforaddressingtheneedfordataonlongtermcare,includingexpansionoflong-termcaredatatoincludeassistedlivingfacilitiesaswellasnursinghomes,andexpansionofCMS'sMedicareCurrentBeneficiarySurvey(_MCBS_)togetbetterinformationaboutpersons_transitioning_Ԁfromonesiteofcaretoanother._AHRQ_ԀalsoisworkingwithCMStousetheirMinimumDataSet(_MDS_)todevelopqualityindicatorsanddisparitymeasuresfortwocongressionallymandatedreports.L*+݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   ThetypesofimprovementstoHHS $D R national,populationbaseddatacollectionsthathavebeenidentifiedandarebeingpursuedinclude:L*!݌̌ XDXXXDXDXXXD  >kL XMOQSTUVWCh34L @  >kp2C3   D   Developingnewdatacollections,re )j$W prioritizingorredesigningexistingHHSsurveys(e.g.,integrationofrelatedefforts,contentrevisions,etc)toincludenewdatah  helementsandcontent,andeliminatingdata collectionsthatarenolongerrelevant.>kp݌ -)\ ЌL 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >k2C3      Developingnewtoolsorapproaches,   includingnewsamplingtechniques,diagnosticapproaches,andwebenabledsurveyadministration,etc.,tomakesurveysmoreresponsiveandefficient.>kW݌̌L 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >k2C3      Developingnewapproachesformaking   surveydataavailabletouserswithoutjeopardizingconfidentiality.>kw݌̌L 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >k2C3      ProvidingfundingtootherDepartments,   states,privateentities,orfoundationstobuildonexistingdatacollectionmechanisms(e.g.,supplementinganongoingsurveyconductedoutsideHHS)@XDXXXD.>k<݌ 6  ЌL 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >k2C3      Increasingsamplesizetoprovidestate, ]  countyorcommunityleveldatatoimprovetheusefulnessofthesedatatostatesforplanningandmeasurement.>k݌̌L 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >k2C3      Expandingdatacollectiontoincludeall H statesinordertoprovideaccuratenationaldata.Forexample,#XDXX@XDT#AXDXXXD atthecurrenttime,the  p onlysourceofdataforstateestimatesofteenagesexualbehaviorsistheYouthRiskBehavioralSurvey(_YRBS_),whichisconductedeverytwoyearsbythestatesandCDC.In1999,41statesandfourterritoriesparticipatedinthesurvey,limitingitsusefulnessinpreparingnationalstatistics.#XDXXAXDd#@XDXXXD >k}݌  ЌL 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >k2C3      Increasingfrequencyofdatacollections.   Forexample,theYouthRiskBehaviorSurveillanceSystem(_YRBSS_)isconductedeveryotheryear.>kt݌̌L 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >k2C3      Reducinglagtimebetweendata " collectionandreporting.>kz݌̌L 4#3hXMOQSTUVWL @  /XDXXXXy\X@XD+/P4`% $ XDXXXD  XDXXXD   P4`   VitalStatistics _P4`A]&!% Ԍ ]&!! ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*    TheNationalVitalStatisticsSystemis I'"" basedonapartnershipbetweenfederalandstateagencies,andprovidesdataonbirths,includingteenbirths,accesstoprenatalcare,maternalriskfactors,infantmortality,causesofdeath,andlifeexpectancy.Vitalstatisticsareoftenthemostcompleteand continuouspublichealthinformation - )) availableatthenational,state,andlocallevels.L*݌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*  D   HRSAsMaternalandChildHealth N, BureauusesVitalStatisticsdatatoreportonperformancegoalsrelatedtoinfantmortalityrates,includingracialdisparitiesintheserates,useofprenatalcare,lowbirthweightbabies,andteenbirthrates.OPHSusesthisdatatoreportonaperformancegoalstoreducebirthstoteens,motherswhosmokeduringpregnancy,theannualrateofsuicide,andincreaseprenatalcare.CDCusesthisdatatoreportonaperformancegoaltoreducefirerelateddeaths.L* ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*a D   Toimprovethequalityandtimelinessof  9 thesedata,CDCprovidestechnicalassistancetotheStatesandworkswiththeStatestostandardizedataelementsanddevelopconsensusonuniformconventionsforcodinganddataprocessing.CDChasreducedlagforreportingfinaldatafromthissystem,reportingfinal1998birthdatain15months,a17percentreductionfromthebaselineof18months.Inaddition,preliminary2000vitalstatisticsdatawerereleasedinJuly2001,justsevenmonthsafterdatacollectionandtwomonthsearlierthananticipated.L*a݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   CurrenttechnologyinplaceinStates, 2H hospitals,andfuneralhomesgreatlylimiteffortstomakethisdataavailableinrealtimeforperformancemonitoring,publichealthinterventionandresearch.Further,thistechnologylimitstheabilitytorapidlyadaptvitalrecordstoreflectnewneedsandapproachessuchasOMBsrevisedclassificationofraceandethnicity.CDCisworkingwiththeStatestomovetowardfullyautomated,webbasedsystemsthatcapturedataatthesourceandfacilitate improveddataquality,rapideditingand *B&T    processing,andrapiddistributionofdatatousers.L*Z݌̌ XDXXXDXDXXXD  P4`>NXDXXXD  XDXXXD   P4`   i  iSurveillanceSystems GP4`)>Ԍ  ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*     Rx V XDXXXDXDXXXD   DiseaseSurveillanceSystemsR : XDXXXDXDXXXD  ݀These  V systemsrelyoncasereportsfromphysicians,hospitals,orothersourcestoidentifyincidentcasesofdiseases.Specificdiseasesareoftenrequiredtobereportedtostatehealthagenciesunderstateauthorities.CDCworkswithstatestocollectandreportthisdataatthenationallevel.Thefollowingareexamplesofthesesystemsandhowtheyareusedtomeasureperformance:L* ݌̌ XDXXXDXDXXXD  8L 5MOQSTUVWx34L   823      TheNational_Nosocomial_ԀInfectious  SurveillanceSystemreceivesreportsfroma  selectedgroupofhospitalsontheincidenceandcharacteristicsofhospitalacquiredinfections.Datafromthissystemalertedhealthauthoritiestotheemergenceofantibioticresistantstrainsofbacteria.ThisledCDCtodevelopspecificrecommendationsregardingtheuseofantibioticsandperformancegoalstomeasureanimprovementintheappropriateuseofantibiotics.8 ݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8 23      Examplesofotherdiseasesurveillance : systemsthatprovidedataforperformancegoalsinclude,HIV/AIDSSurveillanceSystem,_STD_ԀSurveillanceSystem,_Foodborne_ԀOutbreakReportingSystem,SentinelSurveillanceforChronicHepatitisC,U.S.SentinelPhysicianSurveillanceforInfluenza,andGroupBStreptococcalDiseaseSurveillance,partoftheActiveBacterialCoreSurveillance.8 ( ݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   823      ThroughitsNationalElectronicDisease (8$' SurveillanceSystem(_NEDSS_)project,CDCisbuildinganationalintegratedsurveillancesystemtoenablerapidreportingofdiseasetrends.Thissystemcreatespublicandprivatehealthcaresectorlinkagestoincreasethevolume,accuracy, p.)- completeness,andtimelinessofthedata.Inaddition,thisnewsystemprovideslocalhealthdepartmentswithInternetaccesstopermitrapidsharingofinformationoninfectiousdiseaseoutbreaksor_bioterrorist_incidents.8݌̌L 4#3x5MOQSTUVWL   L* XDXXXDXDXXXD  L* D   Through_NEDSS_,CDCisalso  4 developingandimplementingnationaldatastandardsforsurveillanceandreporting;providingtechnicalinfrastructuresupportforstatesandlocalcommunities;andestablishinglocal,state,andregionaldemonstrationprojectsthatcreatelinkagesbetweenthepublichealthandhealthcaresystems.Theseeffortsareincreasingthespeedandreliabilityofdatacollection.L*M݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   CDChasfiveperformancegoalsrelated \? tothedevelopmentof_NEDSS_,includingelectronicreportingoflaboratoryrecordsandenhancingsecuritytoallowtransmissionofdataovertheInternet.Akeyactivityrelatedto_NEDSS_ԀhasinvolvedthecreationofaSecureDataNetwork(_SDN_).The_SDN_providesforasecureInternetconnectionandgatewayfacility.Throughasystemoftools,policyrequirements,andprocedures,the_SDN_Ԁenabled80percentofsurveillancesystemstoimplementthetransmissionofcaselevelsurveillancedataelectronicallyinFY2001.L*J݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L* D   Rx2"! XDXXXDXDXXXD   AdverseEventReportingSystemsRnga: XDXXXDXDXXXD  ݀The 2"N FDAAdverseEventReportingSystem(_AERS_)isanOraclebasedcomputerizedinformationsystemdesignedtosupporttheAgencyspostmarketingsafetysurveillanceprogramforallapproveddrugandtherapeuticbiologicproducts.FDAuses_AERS_Ԁtoreportonitsperformancegoaltoexpediteprocessingandevaluationofadversedrugevents,whichallowsforelectronicperiodicdataentryandacquisitionoffullycodedinformationfromdrug companies.L*b݌ B-(Z Ќ XDXXXDXDXXXD  j   jP4`XDXXXD  XDXXXD   P4`n   NonHHSDataCollection  P4`nTԌ T ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*     Outsidedatasourcesusedfor @ performancemeasurementinHHSinclude:L* Q!݌̌ XDXXXDXDXXXD  8L 5MOQSTUVWx34L   8`"23      TheNationalCouncilonQuality   Assurances(_NCQA_)HealthPlanEmployer z  DataInformationSet(_HEDIS_),anannual f  surveyofindividualmanagedcareplans.Thisisthenationalstandardforplanbasedmeasurementforcaredeliveredtoenrolleesinmanagedcareorganizations.MeasuresexistforbothMedicaidandMedicare+Choicemanagedcare.CMSusesdatafrom_HEDIS_andfromtheNationalHealthInterviewSurveytovalidatedataextractedfromitsNationalClaimsHistoryFile(_NCH_)foraperformancegoalondiabeticsreceivingbiennialretinaleyeexams.8`""݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8&23      DatatoreportonCDCsperformance ( goalrelatedtotheconsumptionoffolicacidamongwomenofreproductiveageiscollectedundercontractwiththeMarchofDimesBirthDefectsFoundation.Thedataiscollectedusingapoolofrespondentsthatisstatisticallysignificantandlargeenoughtoallowforappropriategeneralizationofthedatatoanationallevel.8&{'݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8)23      ACFsHeadStartprogramusesthe   NationalCenterforEducationStatistics'NationalHouseholdEducationSurvey r"  (_NHES_)andEarlyChildhoodLongitudinal ^#! Study(_ECLS_)asanationalcomparisonwith J$" informationperformancegoalsrelatedtotheFamilyandChildExperiencesSurvey(FACES)._NHES_Ԁutilizesahomebaseddatacollectionmethodtocollectinformationonearlychildhoodeducationandschoolreadinessandearlychildhoodprogramparticipation._ECLS_,whichincludesbothakindergartenandbirthcohort,providesnationaldataonchildren'sstatusatbirthandvariouspointsthereafter;children'stransitionstononparentalcare,early n.)- educationprogramsandschool;andchildren'sexperiencesandgrowththroughthefifthgrade.Additionally,itwillprovidedatatotesthypothesesabouttheeffectsofawiderangeoffamily,school,communityandindividualvariablesonchildren'sdevelopment,earlylearning,andearlyperformanceinschool.8)*݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8$023   D   AoAutilizesdatafromtheCensus  6 BureausCurrentPopulationSurveyasa r 7 benchmarkforitsservicetargetingperformancegoals.8$00݌̌L 4#3x5MOQSTUVWL   P4`  XDXXXD  XDXXXD   P4`]2   ProgramEvaluations 2P4`]22P  Ԍ P ; ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*3 D   ?XDXXXDEvaluationsconductedbyHHSare << generallyusedtoevaluateprogrameffectiveness,developperformancemeasurements,assessenvironmentalimpactsonhealthandhumanservices(i.e.,externalfactorsaffectingprogramperformance),andimproveprogrammanagement.TheresultsoftheseevaluationsareusedbyHHSprogramstoinformtheperformanceplanningprocess,assistintheinterpretationofperformancedata,andasintheexamplebelow,toreportonperformancegoals.Examplesinclude:#XDXX?XDf4#L*3<4݌ LH Ќ XDXXXDXDXXXD  8L 5MOQSTUVWx34L   8J723   D   HRSAsCommunityHealthCenter J Effectiveness,whichcomparesdatafrom  K CMSsStateMedicaidResearchFileson !L HealthCenterMedicaidusersandNational r"M HospitalDischargeSurveyforthegeneral ^#N populationtoassesstheeffectivenessofcareattheHealthCenters.ThisstudyprovidesdatatoreportonagoaltoreducetheratesofhospitalizationsforambulatorycaresensitiveconditionsintheHealthCentersMedicaidpopulationandenablesHRSAtobenchmarkagainstcareprovidedelsewhere.8J77݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8?;23   D   A1996AoAevaluationofnutrition 4+&W programsfortheelderly,whichaddressednutritionoutcomesforprogramparticipants,k  khassignificantlyinfluencedtheongoingassessmentoftheseprogramsandhas .4*[ contributedtoAoAscurrenteffortstodevelopperformanceoutcomemeasures.Stateandareaagenciesonagingroutinelymeasurethenutritionalriskofelderlyprogramparticipants,and_AoA_sPerformanceOutcomeMeasuresprojectincludesthemeasurementofchangesinnutritionalriskoverasixmonthperiodfornewclients.8?;;݌̌L 4#3x5MOQSTUVWL   P4`b r XDXXXD  XDXXXD   P4`:?   HHSOfficeofInspectorGeneral b  AuditsandReports ?P4`:??R N Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*@    ThefollowingaretwoexamplesofHHS >  programsthathaveusedtheHHSOfficeofInspectorGenerals(OIG)auditsandreviewstoassessprogramperformanceandreportonperformancegoals.L*@8A݌̌ XDXXXDXDXXXD  8L 5MOQSTUVWx34L   8B23      CMSusesOIGsannualestimateofthe P Medicarefeeforserviceerrorrateasabasisforsettingperformancegoalsandformeasuringperformance.ThepaymenterrorrateiscomputedbytheOIGaspartoftheirChiefFinancialOfficer'sActaudit.8BYC݌  ЌL 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8lE23      _HRSA_sNationalPractitionerData N Bankusesdatafromusersurveysconducted : bytheOIGtoreportonaperformancegoalmeasuringtheimpactofqueryinformationfromthedatabaseondecisionmakingbylicensingboards,hospitalsandotherhealthcareentities,andprofessionalsocieties.8lEF݌̌L 4#3x5MOQSTUVWL   P4`#("8XDXXXD  XDXXXD   P4`dH   InternalManagementInformation #(! Systems IP4`dHHx% $ Ԍ̌XDXXDXDXXD  @XDXXXDRecentlyCDCcombinedhistorical d&!# workforcedatawithtrainingdatatoestablishalargedatawarehouse,#XDXX@XDI#@XDXXXDthe <(#% WorkforceInformationZone(WIZ).WIZ ()x$& providesmanagerswitharealtimetooltoanalyzechangesinworkforcedemographics,retirementeligibility,accessions,separations,andmuchmore.Besidesprovidingcomprehensivehistoricalreportingcapabilities,thesystemalso .*, employsmultipleregressionanalysistoforecastfutureworkforcesizeandseriesdemographics.#XDXX@XDJ#@XDXXXDԀ#XDXX@XDL#@XDXXXDWIZprovidesdatatoreport . onCDCsperformancegoalstoreducethetimeittakestoclassifypositionsandthetimeinvolvedinreferringcandidatestofillpositions./XDXXXXmX@XDL/ 8 2 P4` d$ tXDXXXD  XDXXXD   P4`M   AdministrativeSystems NP4`MtN  dԌ  3 ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*XO D   Inadditiontodevelopingitsown   4 informationsystems,HHSreliesonpartnershipswithstateandlocalagencies,healthplans,andproviderstocollectandmanagedata.?XDXXXDԀGenerally,thesedatacome d 8 fromadministrativedatacollections.AsignificantnumberofHHSprogramsrelyonthesedatatomeasureperformance.#XDXX?XDP#?XDXXXDL*XOO݌ (x; Ќ XDXX?XDXDXXXD  /XDXXXXmXXDQ/L* XDXXXDXDXXXD  L*R D   Administrativedatasystemsare = generallymaintainedbyHHSstateandlocalpartnersaspartofprovidingservicesunderagrantorcontract.Thesedataarethebyproductofprocessessuchasprogramenrollment,eligibilitydetermination,claimsprocessing,payment,andserviceprovision.Forexample,theHHSgranteeswhomanageservicedeliveryprogramsmaintainadministrativesystemsthatprovideongoingdataonclients,services,andpopulationsserved.HHSprogramshaveusedthesesystemstoprovidedatatoreportongoalsmeasuringprogramperformance.HHSgranteesreportthesedataoneitheravoluntaryormandatorybasis.Tofacilitate_benchmarking_Ԁprogramperformancetonationaldatafrompopulationbaseddatacollections,theseprogramsfrequentlyuseHealthyPeople2010,_NHIS_,and_HEDIS_indicatorsasprogramperformancegoals.SeveralexamplesofadministrativedatasystemsandhowHHSprogramscurrently  usethesesystemstomeasureperformancefollow.L*RS݌̌ XDXXXDXDXXXD  8L 5MOQSTUVWx34L   8X23   D   TheMedicareNationalClaimsHistory  -\(W File(_NCH_)isa100percentsampleof -H)X Medicarefeeforserviceclaims,whichhave .4*Y beenvalidatedforcompletenessandconsistency.8XX݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8Z23      HRSAsHIV/AIDSBureauhas N developedandispilottestingaCrossTitles : DataReport.Thisreportwillreplacethe & administrativedatareportsrequiredbyeachofthemainTitlesoftheRyanWhiteCAREAct,streamliningreportingforprogramswhichparticipateinmorethanoneTitleandreducingthenumberofdataelementswhichprogramsmustreporton.8ZI[݌̌L 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8]23      _IHS_ResourceandPatientManagement   System(RPMS)collectsdataforeach   inpatientdischarge,ambulatorymedicalvisit,anddentalvisitandforcommunityhealthserviceprogramsincludinghealtheducation,communityhealthrepresentatives,environmentalhealth,nutrition,publichealthnursing,mentalhealthandsocialservices,andsubstanceabuse._IHS_Ԁusesthesedatatoreportonperformancegoalsrelatedtoclinicalservicesandpreventionactivities. 8]x^݌ 4 ЌL 4#3x5MOQSTUVWL   8L 5MOQSTUVWx34L   8a23      The_IHS_ԀDiabetesAuditisanannual F medicalrecordreviewthatassessesdiabetescareconductedinmorethan75percentofthe_IHS_Ԁandtribalfacilities,representingcaretonearly70,000AmericanIndianandAlaskanNativepeoplewithdiabetes. The 2 Auditprovidesdataforfour_IHS_performancegoalsthatarekeytoreducingmortalityandmorbidityindiabetics._IHS_hasaninitiativeunderwaytoautomatetheAuditbyextractingthedatafrom_IHS_electronicpatientrecordssystem.8aVb݌̌L 4#3x5MOQSTUVWL   L* XDXXXDXDXXXD  L*e    Becauseadministrativedatasystems &"' provideprogramleveldata,theyarekeytoHHSabilitytomeasureprogramperformance.Infact,thesesystemsprovidedatatoreportonasignificantportionofHHSperformancegoals.Frequently,ourprogramsinitialchoiceofperformancegoalswerelimitedbythecapabilitiesofthesesystems.Sincethesedataarecollected ,.|)/ byHHSpartnerswhoimplementHHSprograms!state,local,andtribalgovernments,grantees,andMedicarecontractors!HHSprogramshaveworkedinpartnershipwiththeseorganizationstoimplementenhancementstothesesystems.L*e~f݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*i D   Thetypesofimprovementsthathave  6 beenidentifiedandarebeingpursuedinclude: L*iDj݌  8 Ќ XDXXXDXDXXXD  >kL XMOQSTUVWCh34L @  >kk2C3   D   Workingwithprogrampartnersto  8 : achieveconsensusonasetofperformancegoalsthatbestmeasuresprogramperformanceandthenensuringthatasystemisinplacetocollectandreportthesedata.Theseeffortsincludeenhancingcurrentdatacollections,developingnewdatacollections,eliminatingdatacollectionsthatarenolongerrelevant,andcombiningreportingforprogramswherepossible.>kkk݌̌L 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  @XDXXXD>kkn2C3   D   Assistingthestatesinbuildingthestate [D andlocaldatacollectioninfrastructureneededtoenabletimelyandaccuratedatareportingandensurethatallstatescanreportdata,and#XDXX@XDn#providingtechnicalassistanceto  [H statesandgranteestoimprovedataquality>kkno݌̌L 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >k"q2C3   D   Developingcommondefinitions,data nJ elements,standards,anduniformcodingsothatthedatacanbereliablyusedandaggregated.>k"qq݌̌L 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >kr2C3   D   Addressingconfidentiality,policy,  !YN security,andtechnicalissuestoenableclinicalinformationsystemstoproviderealtimedataonqualityofcaremeasures.>krzs݌̌L 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >kt2C3   D   Developingthelegal,regulatory,and $D R technicalmeansthatfacilitatedatasharingacrossorganizations.>ktwu݌̌L 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >kv2C3   D     Addressingissuesrelatedtoverifying 'C#U andvalidatingdataprovidedbystatesandgrantees.>kv;w݌̌L 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >kۂx2C3   D   Workingwithstatesandgranteesto *B&X movefromvoluntarytomandatorycollectionofperformancedataunderthe PaperworkReductionAct.>kۂxx݌ -)[ ЌL 4#3hXMOQSTUVWL @  >kL XMOQSTUVWCh34L @  >kۃz2C3      Automatingdatacollectionandreporting   toreducethetimeneededtoreportaggregatednationaldataandprovidingprogramperformancedataviatheInternettofacilitateitsuse.>kۃzz݌̌L 4#3hXMOQSTUVWL @  P4`w  XDXXXD  XDXXXD   P4`|   MeasuringPerformanceWithStates w  andGrantees :}P4`|} gc Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*~    Themajorityofdatausedtoreporton  S performanceforHHSprogramsiscollectedandreportedbyHHSpartnerswhoimplementtheseprograms!state,local,andtribalgovernments,grantees!andMedicarecontractors.Intheseinstances,HHSprogramshaveworkedwiththeseorganizationstoachieveconsensusonasetperformancegoalsthatbestmeasureprogramperformanceandthenenhancecurrentdatacollectionsystemsordevelopingnewsystemstocollectandreportthedata.CMSworktodevelopachildhoodimmunizationgoalfortheMedicaidprogramhighlightsthepotentialaswellasthechallengesofenhancingthesedatacollectionsystems.L*~~݌̌ XDXXXDXDXXXD  L IMOQSTUVW,x34LL* XDXXXDXDXXXD  L*D    Rx%uXDXXXDXDXXXD   CentersforMedicareandMedicaidRset:   XDXXXDXDXXXD  CMS,workinginconjunctionwiththe  States,CDC,andtheAmericanPublicHumanServicesAssociation(_APHSA_),hasdevelopedathreestageprocesstodevelopindividualstatebaselinesandmethodologiesforreportingonaperformancegoalonimmunizationcoveragefortwoyearoldchildrenenrolledinMedicaid.BecauseMedicaidisastaterunprogramandstateshavesignificantflexibilitytosetenrollmentcriteria,itisbestforstatestodeterminehowtomeasuretheirownimmunizationratesandtodeterminetheirownperformancetargets.L*DÂ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    Themethodologieschosenbyindividual +7') stateswilldependonanumberoffactors,forexample:theservicedeliverysystemsusedinthatstate,theexistenceoffunctional .), stateorregionalregistries,andtheaveragedurationaMedicaidbeneficiaryremainsenrolledinthestateprogram.Duetothevariousdatacollectionandreportingmethodologieslikelytobeusedbyindividualstatesanddifferingdefinitionsofchildreninthevariousstates,immunizationcoveragelevelswillnotbedirectlycomparableacrossstates.However,eachstatewillmeasureitsownprogress,usingaconsistentmeasurementmethodology.CMSandCDCareprovidingtechnicalassistancetotheStatestodeveloptheirbaselinemethodologytomeasureimmunizationrates.L*a݌̌ XDXXXDXDXXXD  P4`:JXDXXXD  XDXXXD   P4`2   DeliveringInformationtoUsers ϋP4`2:Ԍ < ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L* D   InadditiontoeffortstoenhanceHHS = datacollectioncapabilities,HHSisworkingtoenhancethecapacityofHHSprogramsandthecapacityofitspartnerstoaccessandusedata.TheHHSDataCouncilhasidentifiedandispursuingthefollowingpriorities:L*݌̌ XDXXXDXDXXXD  >kL XMOQSTUVWChxIMOQSTUVWL @  >k2C3   D   Providingeasyaccesstohealthand tE humanservicesinformationviatheInternet,>kg݌̌L IMOQSTUVW,xhXMOQSTUVWL @  >kL XMOQSTUVWChxIMOQSTUVWL @  >kۘ2C3   D   Enablingusersthroughtrainingand G technicalassistance,>kۘ݌̌L IMOQSTUVW,xhXMOQSTUVWL @  >kL XMOQSTUVWChxIMOQSTUVWL @  >k-2C3   D   Buildingexpertisetotranslatedatainto  I usefulknowledge,and>k-݌̌L IMOQSTUVW,xhXMOQSTUVWL @  >kL XMOQSTUVWChxIMOQSTUVWL @  >kɓ2C3   D   Developingimprovedanalyticmethods "K andtools.>kɓD݌̌L IMOQSTUVW,xhXMOQSTUVWL @  L* XDXXXDXDXXXD  L*U D   HHSneedstodevelopimprovedanalytic $ M softwareandtechniquesfordatalinkageand  analysisoflinkedfiles,andtodevelopnewindicators,andanalyticapproachesasnewtopicsandprioritiesemerge.HHSalsoneedstodevelopimprovedtechniquestohandledifficultproblemssuchaswithsmallgeographicareasandsmallpopulation subgroups.L*Uԕ݌  ,p'U Ќ XDXXXDXDXXXD  P4`XDXXXD   XDXXXD   P4`    mlRklmn  nDataVerificationandValidation ǘP4` TԌ T ЌXDXXDXDXXD  L* XDXXXDXDXXXD  L*™    Rx@XDXXXDXDXXXD   DataDiscussionsinthePerformance  PlansandReportsRkthr: XDXXXDXDXXXD  ݀Foranygiven  performancegoal,thestrengthsandlimitationsofthedatasourceusedtoreportonthegoalcanvary,andthelevelofstatisticalreliabilityneededtoassessgoalperformanceandsupportdecisionmakingcanalsovary.L*™A݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    ToassistthereadersoftheHHS   performanceplansandreports,HHSprogramshaveidentifiedthedatasource,discussedthemeansusedtoverifyandvalidatethedata,andaddressedanysignificantdataissuesfortheperformancegoalsinplansandreports.Manyprogramsalsodiscussactivitiescompleted,underway,orplannedthatwillenabletheprogramtomovetomoresophisticatedmeasuresofperformanceand/ortoimprovethetimeliness,completeness,andreliabilityofthedata.L*݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*S    RxtLXDXXXDXDXXXD   HHSInspectorGeneralReviewof t PerformanceDataRthr: XDXXXDXDXXXD  ݀ TheHHSOfficeof \ InspectorGenerals(OIG)workwithregardtoGPRAfocusesonmeasuresrelatedtomissioncriticalissuesandareasathighriskoffraud,waste,andabuseandincludesassessmentsofdatacollectionmethodsandcontrolsoverthesystemsthatproduceperformancedata.L*SҠ݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    TheOIGreviewedACFsAdoptionand 2% " FosterCareAnalysisandReportingSystem(_AFCARS_).TheACFperformancemeasurespertainingtochildreninfostercareandchildrenadoptedundertheauspicesofastatewelfareagencyarebasedondatafromthissystem.SincestatescollectandtransmitcasemanagementinformationtoACFthroughthissystem,OIGassessedthereliabilityofthe_AFCARS_ԀdatasubmittedbytwostatesforthefirsthalfofFY1999. j.), Whilesomeerrorswerenotedintheinformationfrombothstates,theseerrorsdidnotaffectthedatausedtodevelopACFsperformancemeasuresorwerenotpervasiveenoughtoaffectreportedmeasures.TheOIGwillalsobedoingadditionalworkin_AFCARS_.L*d݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*k D   AnOIGreviewoftheOCRFY1999  4 GPRAreportfoundthattheofficedidnotaccuratelyreportperformanceresultsanddidnothaveanadequatesystemforvalidatingtheinformationpresentedinitsperformancereport.Thisconclusionwasbasedonexceptionsfoundinajudgmentalsampleof63ofthe209revieworinvestigationcasesusedtopreparetheperformancereport.L*k݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*) D   TheOIGrecommendedthatOCRissue H? guidancetoitsregionalofficestoensurethatperformanceresultsareaccuratelyandconsistentlyreported;enhanceitsdatavalidationprocesstoensurethatfutureperformanceresultsarereliable;andreviewand,whereappropriate,clarifytheexplanationsanddescriptionsofperformancemeasuresandreportedresultsinfutureperformanceplans.Inresponse,theofficeistakingstepstoimprovetheaccuracyandverificationofdatainfutureyearsreports.L*)݌̌ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*l D   Upcomingprojectsincludeareviewof ! M ACFsuseofStatesupplieddataforperformancemeasurement.TheOIGwilldeterminewhetherACFhastakenadequatestepstovalidateStatedatausedinoneormoremajorprograms.L*l݌  V&!R Ќ XDXXXDXDXXXD  L* XDXXXDXDXXXD  L*    L*'݌̌ XDXXXDXDXXXD  P4`R"bXDXXXD  XDXXXD   P4`ܱ   StatusonReportingonFY19992001 R PerformanceGoals yP4`ܱ[>Ԍ̌XDXXDXDXXD  L* XDXXXDXDXXXD  L*`    Thechartonthenextpageoutlinesthe  statusoffinalreportingonHHSFY1999,2000,and2001goals.Pleasenotethatthechartreportsonperformancetargetsforwhichwehavefinaldata;manyperformancegoalshavemultipletargets.L*`߳݌ : z  Ќ XDXXXDXDXXXD     (X@()   X  XXD.Yf R  TRP$'3 Letter LandscapeX3' Letter'3 Letter Landscape3'T zSTATUSOFFINALREPORTINGONPERFORMANCEGOALS#.Yf_##XDX@#  %eV4* Z d ddd dd dd Z..,rdd ,dd ,dd ,edd ,dd ,dd ,dd ,dd ,dd ,dd +  (  K (Operatingor o StaffComponent TA2;{" TFY1999 @6$o" @FY2000 E6$o" EFY2001 @/)o"   @ 7& 7Targets C0!R " CReportedasof2/03 @/$R " @Targets D3!R " DReportedasof2/02 @/$R " @Targets D3!R " DReportedasof2/02 0&$R" 0AoA C4    2@182@CЀ18 vlA "  2@18 2@  2@182@v18 ta2 "  2@18 2@  @@?t100% zpE "  @@ ?  2@182@z18 g]2 "  2@18 2@  2@182@gЀ18 nd2 "  2@18 2@  @@?n100% pE "  @@ ?  7@237@23 ukA "  7@23 7@  @2@u2 mc1 "  @2 @  @@d! YB?m9% QGE "  @@ d! YB? QACF C4 / o  G@47G@CЀ47 vlA/ o"  G@47 G@  G@47G@v47 ta2/ o"  G@47 G@  @@?t100% zpE/ o"  @@ ?  J@52J@z52 g]2/ o"  J@52 J@  E@42E@g42 nd2/ o"  E@42 E@  @@؉?n81% pE/ o"  @@ ؉?  O@63O@63 vlA/ o "  O@63 O@  *@13*@v13 nd2/ o!"  *@13 *@  @@ii?n21% QGE/ o""  @@ ii? QAHRQ C4  #  G@46G@CЀ46 vlA $"  G@46 G@  G@46G@vЀ46 ta2 %"  G@46 G@  @@?t100% zpE &"  @@ ?  J@52J@z52 g]2 '"  J@52 J@  J@52J@g52 nd2 ("  J@52 J@  @@?n100% pE )"  @@ ?  K@54K@54 vlA *"  K@54 K@  K@54K@v54 nd2 +"  K@54 K@  @@?n100% QGE ,"  @@ ? Q_ATSDR_ C4 #c -  &@11&@CЀ11 vlA#c ."  &@11 &@  &@11&@v11 ta2#c /"  &@11 &@  @@?t100% zpE#c 0"  @@ ?  9@259@zЀ25 g]2#c 1"  9@25 9@  9@259@g25 nd2#c 2"  9@25 9@  @@?n100% pE#c 3"  @@ ?  9@259@25 vlA#c 4"  9@25 9@  7@237@v23 nd2#c 5"  7@23 7@  @@q= ףp?n92% QGE#c 6"  @@ q= ףp? QCDC D5  7 [@110[@D110 xnB 8" [@110 [@ @[@109@[@x109 ub3 9" @[@109 @[@  @@oX?u99% {qE :"  @@ oX? `h@195`h@{195 i_3 ;" `h@195 `h@ g@189g@i189 oe3 <" g@189 g@  @@???o97% qE ="  @@ ???  k@217 k@217 xnB >"  k@217  k@ d@165d@x165 oe3 ?" d@165 d@  @@ST?o76% QGE @"  @@ ST? QCMS C4 W A  6@226@C22 vlAW B"  6@22 6@  6@226@v22 ta2W C"  6@22 6@  @@?t100% zpEW D"  @@ ?  D@40D@z40 g]2W E"  D@40 D@  C@38C@g38 nd2W F"  C@38 C@  @@ffffff?n95% pEW G"  @@ ffffff?  J@53J@54 vlAW H"  J@53 J@  C@39C@v39 nd2W I"  C@39 C@  @@+R?n74% QGEW J"  @@ +R? QDM C4 K  K@54K@C54 vlAL"  K@54 K@  K@54K@v54 ta2M"  K@54 K@  @@?t100% zpEN"  @@ ?  L@56L@z56 g]2O"  L@56 L@  J@53J@g53 nd2P"  J@53 J@  @@$I$I?n95% pEQ"  @@ $I$I?  P@67P@67 vlAR"  P@67 P@  H@49H@v49 nd2S"  H@49 H@  @@kL*g?n73% QGET"  @@ kL*g? QFDA C4  KU  Q@70Q@C70 vlA KV"  Q@70 Q@  Q@70Q@v70 ta2 KW"  Q@70 Q@  @@?t100% zpE KX"  @@ ?  N@60N@z60 g]2 KY"  N@60 N@  N@60N@g60 nd2 KZ"  N@60 N@  @@?n100% pE K["  @@ ?  P@64P@64 vlA K\"  P@64 P@  G@46G@v46 nd2 K]"  G@46 G@  @@?n72% QGE K^"  @@ ? QHRSA C4 _  Q@68Q@CЀ68 vlA`"  Q@68 Q@  N@61N@vЀ61 ta2a"  N@61 N@  @@?t90% zpEb"  @@ ?  S@76S@zЀ76 g]2c"  S@76 S@  P@67P@gЀ67 nd2d"  P@67 P@  @@^Cy 5?n88% pEe"  @@ ^Cy 5?  W@95W@95 vlAf"  W@95 W@  ?@31?@v31 nd2g"  ?@31 ?@  @@&N[?n33% QGEh"  @@ &N[? QIHS C4 ?i  ;@27;@CЀ27 vlA?j"  ;@27 ;@  :@26:@vЀ26 ta2?k"  :@26 :@  @@ %?t96% zpE?l"  @@  %?  A@34A@zЀ34 g]2?m"  A@34 A@  =@29=@g29 nd2?n"  =@29 =@  @@KKKKKK?n85% pE?o"  @@ KKKKKK?  C@38C@38 vlA?p"  C@38 C@  :@26:@v26 nd2?q"  :@26 :@  @@Q^Cy ?n68% QGE?r"  @@ Q^Cy ? QNIH C4 ys  U@86U@C86 vlAyt"  U@86 U@  U@86U@v86 ta2yu"  U@86 U@  @@?t100% zpEyv"  @@ ?  V@88V@z88 g]2yw"  V@88 V@  V@88V@g88 nd2yx"  V@88 V@  @@?n100% pEyy"  @@ ?  V@90V@90 vlAyz"  V@90 V@  V@90V@v90 nd2y{"  V@90 V@  @@?n100% QGEy|"  @@ ? QOCR C4 3}  $@10$@CЀ10 vlA3~"  $@10 $@  $@10$@vЀ10 ta23"  $@10 $@  @@?t100% zpE3"  @@ ?  3@193@zЀ19 g]23"  3@19 3@  3@193@gЀ19 nd23"  3@19 3@  @@?n100% ~oE3"  @@ ?  @6@~6 tj@3"  @6 @  @6@t6 mc13"  @6 @  @@?m100% QGE3"  @@ ? QOIG B3 m  @6@BЀ6 tj@m"  @6 @  @6@tЀ6 s`1m"  @6 @  @@?s100% yoEm"  @@ ?  @5@yЀ5 e[1m"  @5 @  @5@eЀ5 mc1m"  @5 @  @@?m100% ~oEm"  @@ ?   @8 @~8 tj@m"   @8  @   @8 @t8 mc1m"   @8  @  @@?m100% QGEm"  @@ ? Q_OPHS_ C4 '  *@13*@C13 vlA'"  *@13 *@  (@12(@v12 ta2'"  (@12 (@  @@؉؉?t92% zpE'"  @@ ؉؉?  >@30>@z30 g]2'"  >@30 >@  2@182@g18 nd2'"  2@18 2@  @@333333?n60% pE'"  @@ 333333?  <@28<@28 vlA'"  <@28 <@  0@160@v16 nd2'"  0@16 0@  @@$I$I?n57% QGE'"  @@ $I$I? QPSC C4 a  D@40D@CЀ40 vlAa"  D@40 D@  D@40D@vЀ40 ta2a"  D@40 D@  @@?t100% zpEa"  @@ ?  D@41D@z41 g]2a"  D@41 D@  D@41D@g41 nd2a"  D@41 D@  @@?n100% pEa"  @@ ?  E@42E@42 vlAa"  E@42 E@  D@40D@v40 nd2a"  D@40 D@  @@yy?n95% QGEa"  @@ yy? QSAMHSA C4   K@55K@C55 vlA"  K@55 K@  K@54K@v54 ta2"  K@54 K@  @@k߰ k?t98% {qE"  @@ k߰ k? c@157c@{157 i_3" c@157 c@  b@145 b@i145 oe3"  b@145  b@  @@ ܍?o92% qE"  @@  ܍? f@182f@182 xnB" f@182 f@ \@112\@x112 oe3" \@112 \@  @@;;?o62% TGE"  @@ ;;? TTOTAL PAU!  0X@P683 uh?U!"  0 X@  0@u672 n?U!"  0 @  @@A}|?98% {nEU!"  @@ A}|?  0@{948 uh?U!"  0 @  0ȋ@u889 ~q?U!"  0 ȋ@  @@Z )?~94% }nEU!"  @@ Z )?  0|@}1055 uh?U!"  0 |@  0@u720 ~q?U!"  0 @  @@1Y?~68%UKIU!"  @@  1Y? U