Program Performance by HHS Strategic Goal

Introduction

The Department of Health and Human Services (HHS) is one of the largest federal agencies, the Nation's largest health insurer, and the largest grant-making agency in the federal government. The Department protects and promotes the health and well-being of all Americans and provides world leadership in biomedical and public health sciences. Eight strategic goals guide HHS in accomplishing its mission of protecting and improving the health and well-being of the American public. These goals provide a focus for HHS investments and serve as a framework for the measures that track our performance.

Sound information is essential to HHS's mission of enhancing the health and well-being of Americans. For every HHS performance measure, whether providing for effective health and human services or fostering sustained advances in the sciences or public health, reliable and readily available information is necessary for planning, decision making, and measuring results. The Department plays an essential role in producing data for decision-making for health and human services programs, both as a direct producer and as a partner in data collection with the states, grantees, and other governmental agencies.

HHS's programs and its agencies rely upon data for program management, policy decision-making, and intervention development. The Government Performance and Results Act of 1993 (GPRA) emphasizes the importance of data for decision making and creates an incentive for staff throughout HHS to accurately reflect and refine our data systems. As a result, our programs work extensively with partners (state, local and tribal governments, grantees, and Medicare contractors) in program implementation and data collection. To do this, we continuously identify enhancements to our systems that improve the timeliness, completeness, and accuracy of data and enable us to move to more sophisticated performance measures.

We face several challenges in this area:

• Producing data on a more timely basis and with a frequency relevant to the periods over which performance is being measured;
• Continuously appraising and updating data systems to reflect changes in the delivery of health and human services;
• Systematically obtaining accurate, reliable data at the state and local level where many HHS programs are implemented;
• Developing appropriate performance measurement methodologies to capture the progress of program interventions on complex chronic diseases or social problems which may require years of focused efforts to produce measurable results;
• Producing information with sufficient quality and precision to detect what may be relatively small but important changes in key performance indicators; and
• Achieving major changes in complex data collection systems in a timely and affordable manner.

Throughout HHS, we are making data available to our program offices and partners for planning, decision-making, and measuring results. These efforts include developing new data collection systems, enhancing current data collection systems, eliminating systems that are no longer relevant, combining reporting where possible, and building capacity to collect data at the state and local levels.

Strategic Goal 1:
Reduce the Major Threats to the Health and Well-Being of Americans

HHS has taken significant steps to reduce health threats through prevention, promoting healthy behaviors, and building partnerships with states, communities, and health professionals. We have encouraged the use of early detection and screening services; provided support to states, tribes, and communities to help them expand and improve substance abuse prevention; and disseminated information to patients and healthcare providers about the importance of vaccinations.

Several illustrative programs at the Centers for Disease Control and Prevention (CDC) and Substance Abuse and Mental Health Services Administration (SAMHSA), detailed below, have annual performance measures that demonstrate in concrete terms how the Department has reduced threats to the health and well-being of Americans.

National Immunization Program
Centers for Disease Control and Prevention (CDC)

The Program
Immunizations are among the greatest public health achievements of the twentieth century. Vaccines are responsible for the control of many infectious diseases that were once common in this country, including diphtheria, measles, mumps, and pertussis. Today, many vaccines are available to protect children and adults against these and other life-threatening and debilitating diseases. These interventions have reduced cases of all vaccine-preventable diseases by more than 97 percent from peak levels before vaccines were available, saving lives, treatment costs, and hospitalization costs.

As childhood immunization coverage increases, the incidence of vaccine preventable diseases declines significantly. Immunization levels are at 90 percent or higher for most individual vaccines such as measles, polio, Haemophilus influenzae type b (Hib), hepatitis B, and three-doses of diphtheria-tetanus-acellular pertussis. New cases of most vaccine-preventable disease are down approximately 99 percent from peak pre-vaccine levels. Examples include:

• Measles is no longer endemic in the United States;
• One child in the U.S. was born with Congenital Rubella Syndrome in 2002;
• Only fourteen cases of rubella were reported to CDC in 2001, compared with 1,401 in 1991;
• Hib cases have dropped more than 99 percent among children younger than age five since the Hib vaccine was introduced in 1990; and
• No cases of paralytic polio due to indigenous transmission of wild polio virus have been reported in the U.S. since 1979.

CDC works with domestic and international partners to provide epidemiologic and laboratory assistance for disease tracking, vaccine for outbreak control, and other supplementary immunization activities. CDC also plays a critical role in developing immunization policy by providing technical and scientific support to policymaking advisory groups, such as the Advisory Committee on Immunization Practices (ACIP).

In 1996, the ACIP introduced the varicella vaccine to the Recommended Childhood Immunization Schedule. In 2002, varicella vaccine coverage levels reached almost 81 percent compared with a 26 percent coverage level in 1997 with no racial or ethnic gaps in coverage. Conjugate vaccines for the prevention of Hib are also highly effective. Hib is no longer the leading cause of meningitis among children younger than five years of age in the U.S. Studies of pneumococcal conjugate vaccine (PCV), prelicensure, show this vaccine to be more than 97 percent effective against invasive pneumococcal infections such as bacterial pneumonia, bloodstream infections, otitis media (ear infections), and sinusitis among children. Overall, this vaccine is projected to prevent more than one million episodes of childhood illness and approximately 120 deaths among children annually. ACIP has also added PCV to the 2001 Recommended Childhood Immunization Schedule. As this is a newly recommended vaccine, accountability for performance targets will begin in FY 2006.

Source: National Immunization Survey (NIS)
*Includes any measles-containing vaccine.
**As this is a newly recommended vaccine, accountability for performance targets will begin in 2006.

CDC has modified this measure from four doses of Diphtheria-Tetanus-acellular Pertussis (DTaP) vaccine to three because vaccine shortages have limited the availability of the fourth dose to children. ACIP recommends that if the vaccine is in short supply, or not available, the fourth dose of DTaP may be dropped. The first three doses are considered the most critical to prevent disease. Data for CY 2003 will be available in August 2004. In 2002, OMB selected the 317 Immunization Grant Program to complete the FY 2004 Program Assessment Rating Tool (PART) process. The 317 Grant Program assists state and local health departments in reducing vaccine-preventable diseases by increasing immunization rates among children.

Domestic HIV/AIDS Prevention Program
Centers for Disease Control and Prevention (CDC)

The Program
During the early 1990s, before perinatal (mother-to-child) preventive treatments were available, an estimated 1,000 to 2,000 infants were born with HIV infection each year in the U.S. Today, a dramatic reduction in perinatal HIV transmission cases has been noted in the U.S., a result of the widespread implementation of Public Health Service (PHS) recommendations made in 1994 and 1995 that included routinely counseling and voluntarily testing pregnant women for HIV, and offering zidovudine (AZT) to infected women during pregnancy and delivery, and to their infants post-partum.

CDC monitors perinatal AIDS cases in the U.S., develops recommendations for perinatal prevention, and also supports perinatal HIV prevention programs with state and local health departments, which also address perinatal prevention, in 16 jurisdictions.

Further decreasing perinatal HIV transmission is one of four strategies included in CDC's New Initiative, "Advancing HIV Prevention: New Strategies for a Changing Epidemic," announced in April 2003. To support this key strategy, CDC issued recommendations that clinicians routinely screen all pregnant women for HIV infection, using an "opt-out" approach, and that jurisdictions with statutory barriers to such routine prenatal screening consider revising them. CDC is working with partners to:

• Promote routine, voluntary prenatal testing, with right of refusal;
• Develop guidance for using rapid testing during labor and delivery or post-partum;
• Provide training in conducting prenatal HIV testing; and
• Monitor the integration of routine prenatal testing into medical practice.

Results and Explanation of Performance:

Source: CDC HIV/AIDS Case Surveillance

CDC has consistently exceeded its target for this measure since 1999. Surveillance data reported through June 2001 show sharply declining trends in perinatal AIDS cases. This decline was strongly associated with widespread zidovudine use in pregnant women who were aware of their HIV status. Recently, improved treatment has also likely delayed the onset of AIDS for HIV-infected children. With efforts to maximally reduce perinatal HIV transmission and increase treatment for those infected, declines are likely to continue. Treatment failures and missed opportunities to prevent transmission, however, may slow these declines.

Perinatal AIDS data are derived from CDC's HIV/AIDS Case Surveillance. AIDS case data are available from all states and territories using uniform name-based collection methods (no names or personal identifiers are sent to CDC; these are maintained only at the local level). Although completeness of reporting of diagnosed AIDS cases varies by area and patient population, studies indicate that reporting in most areas is more than 85 percent complete. In order to provide the best estimates of trends in incidence, HIV and AIDS surveillance data are analyzed by the date of diagnosis and are mathematically adjusted in more recent periods to adjust for reporting delays (the period of time between a diagnosis of AIDS and the arrival of a case report at CDC) and incomplete information on some cases. CDC requires a minimum of 18 months after the end of a calendar year to provide accurate estimates of trends up through that year.

In 2002, the domestic HIV/AIDS program, including perinatal HIV/AIDS prevention activities, was PARTassessed by OMB. OMB recommends improvements in the areas of performance measurement and management and oversight of grantees. In response to these recommendations, the CDC has revised prevention goals, added new annual performance measures, and strengthened oversight procedures and reporting. In 2003, during the second annual PART review, OMB has acknowledged program progress for these areas.

Substance Abuse Prevention and Treatment Block Grant Program
Substance Abuse and Mental Health Services Administration (SAMHSA)

The Program
SAMHSA's Substance Abuse Prevention and Treatment Block Grant, the cornerstone of the states' substance abuse programs, is an integral part of the President's Drug Treatment Initiative. The block grant's goal is to improve the health of the Nation by bringing effective alcohol and drug treatment and prevention services to every community through a block grant to the states.

Results and Explanation of Performance

Source: Drug and Alcohol Services Information System (DASIS) � Treatment Episode
Data Set (TEDS) is used as a proxy for this measure

The FY 2000 target for increasing the number of clients served was met. Data collected by the Treatment Episode Data Set (TEDS) information system indicated that SAMHSA served almost five percent more clients than expected during FY 2000. SAMHSA is currently assessing performance for FY 2001 and plans to increase the number of clients served by over seven percent each year.

The proxy data being reported represents treatment admissions data. Although this data is limited, it represents the best estimate available. The estimated number of clients served shows progress in increasing service delivery in support of the President's Drug Treatment Initiative.

Three major external factors could have a significant impact on performance:

• The status of the national economy and related employment figures;
• The amount of resources that states and communities have to allocate toward treating and preventing substance abuse and the collection of corresponding data; and
• Fluctuations in the supply of illegal drugs such as heroin and cocaine, as well as new addictive substances.

The improvement or deterioration in these external factors would likely impinge on performance results.

Strategic Goal 2:
Enhance the Ability of the Nation's Health Care System to Effectively Respond to Bioterrorism and Other Public Health Challenges

HHS has developed a number of initiatives and programs and has devoted numerous resources, including an increase in bioterrorism spending by more than thirteen-fold between FY 2001 and FY 2003, to protect Americans from bioterrorist attacks and other public health care challenges. The events of September 11, 2001, and subsequent anthrax attacks have reinforced HHS's role in protecting Americans from attacks on our food and health by enhancing emergency preparedness.

The following programs illustrate HHS's broad commitment to strengthening the public health infrastructure. CDC has an integral role in strengthening the local public health infrastructure to effectively respond to emergencies. The Health Resources and Services Administration (HRSA) is also enhancing hospital preparedness.

Terrorism Preparedness and Emergency Response Program
Centers for Disease Control and Prevention (CDC)

The Program
Since 1946, CDC has been responding to public health threats and emergencies. In the aftermath of the events of September 11, 2001, we have learned that the U.S. public health system is a critical element in the new war against terrorism. However, preparing the Nation to address the dangers of terrorism is a major challenge to public health and healthcare systems. CDC is leading national efforts to rapidly improve the capacity of public health to prepare for and respond to acts of terrorism, including chemical, biological, radiological, nuclear (CBRN) and mass trauma events.

To minimize illnesses and deaths associated with such an event, CDC works with partners at the federal, state, and local levels to assess our nation's capacity and ensure a timely and sufficient response to terrorist attacks and emergency events. CDC also works with the Office of Domestic Preparedness (ODP) in the Department of Homeland Security (DHS) to assess public health capacity for preparedness and emergency response and to develop, deploy, and coordinate these efforts. Within the Department, CDC collaborates with HRSA to ensure integration with the Hospital Preparedness Program and with NIH on the development of countermeasures. Health departments are now defining their roles to respond effectively to an intentional release of a terrorist agent into an unsuspecting population.

The threat of a terrorist attack demands utilization of CDC's tools and expertise: surveillance; epidemiology; laboratory capacity; and coordinated control measures. CDC has demonstrated this capability during the past year in responding to the outbreaks of West Nile virus and Severe Acute Respiratory Syndrome (SARS). The tools and expertise CDC applies to aid public health in the investigation and control of infectious disease outbreaks will also be most valuable in the event of a CBRN attack or mass trauma event. This will ensure implementation of the rapid response necessary to minimize the impact of bioterrorism agents, such as smallpox or plague. CDC's expanding role will improve the health and security of our Nation.

Results and Explanation of Performance:

Source: Semi-annual progress reports

CDC received emergency supplemental funding in February 2002 to begin the process of improving state and local capacity to respond to CBRN attacks. Intramural and extramural activities to build preparedness and readiness assessment, surveillance and epidemiology capacity, laboratory capacity, communications and information technology, health information dissemination, and education and training are in place. These activities will focus on three priorities:

• Expanding terrorism preparedness from a focus on biological hazards to all hazards (chemical, radiological, or mass trauma/conventional weapons);
• Expanding bioterrorism preparedness for all biological threat agents (categories A, B, and C); and
• Assessing effects of these investments on public health preparedness and capacities.

In FY 2004, CDC will establish a system to track progress against newly established outcome goals.

National Bioterrorism Hospital Preparedness Program
Health Resources and Services Administration (HRSA)

The Program
The purpose of the National Bioterrorism Hospital Preparedness Program is to prepare hospitals and supporting health care systems to deliver coordinated and effective care to victims of terrorism and other public health emergencies. This is one part of the larger HHS program for state and local terrorism preparedness, working in concert with CDC's Public Health Preparedness and Response for Bioterrorism Program.

As of September 11, 2001, the U.S. healthcare system lacked sufficiently adequate plans and infrastructure to respond to challenges that terrorist acts and other mass casualties may pose. A GAO (Report 03-373) investigation found widespread deficiencies in capacity, communication, and coordination elements essential to preparedness and response.

The National Bioterrorism Hospital Preparedness Program begins to address this problem by providing funding to states and other entities to upgrade the capacity of hospitals, outpatient facilities, emergency medical services systems, and poison control centers to respond to terrorist and other public health emergencies on a regional basis. This new program received initial funding in FY 2002.

Results and Explanation of Performance

Source: 2005 GPRA Plan, from states' progress reports

Surge capacity is the ability to accommodate a large and rapid increase in the number of persons requiring services. It includes addressing issues of hospital bed capacity, isolation capacity, health care personnel, pharmaceutical caches, personal protection and decontamination, mental health capacity, trauma and burn care capacity, and communications and information technology. Based on awardees' progress reports, HRSA estimates that a baseline of 59 percent of awardees (states, territories, and municipalities) have developed plans to address regional surge capacity. The goal is for at least 90 percent of the Nation's hospital regions to have developed plans for responding to a surge capacity of 500 patients per million people by FY 2004. Starting in FY 2004, HRSA will be tracking progress against newly established outcome goals.

Strategic Goal 3:
Increase the Percentage of the Nation's Children and Adults Who Have Access to Health Care Services, and Expand Consumer Choices

Bioterrorism is not the only threat facing our Nation. Disparities in health care within the U.S. population are of great concern to HHS. Working to expand health care to all, HHS has sought to create new, affordable health insurance options and expand the health care safety net.

We also aimed to strengthen and improve Medicare as well as increase the number of children enrolled in regular Medicaid or State Children's Health Insurance Program (SCHIP). In addition, the Health Centers Program in HRSA expanded access to preventive and primary care for racial/ethnic minority individuals.

Medicare Program
Centers for Medicare & Medicaid Services (CMS)

The Program
CMS administers Medicare, the Nation's largest health insurance program, which covers approximately 41 million Americans. Medicare provides health insurance to people age 65 and over, those who have permanent kidney failure, and certain people with disabilities. For nearly four decades, this program has helped pay medical bills for millions of Americans, providing them with reliable, comprehensive health benefits.

CMS's primary mission is to assure health care security for its beneficiaries. CMS also strives to encourage choice in the Medicare beneficiary community for medical coverage while maintaining high quality care.

Results and Explanation of Performance

Source: Medicare Consumer Assessment Health Plans Surveys (CAHPS)

Source: Medicare CAHPS

Beneficiaries are Medicare's primary customers. One of CMS's primary goals is to assure satisfaction in the experiences beneficiaries have in accessing care, including the care of specialists. To measure and monitor beneficiaries' experiences and satisfaction with the care they receive through Medicare, CMS developed a series of data collection activities using the Consumer Assessment Health Plans Surveys (CAHPS). CMS fields these surveys annually to representative samples of beneficiaries enrolled in each Medicare managed care plan as well as those enrolled in the original Medicare fee-for-service (FFS) plan, and provides comparable sets of specific performance measures collected in CAHPS to Quality Improvement Organizations (QIOs), health plans, and beneficiaries through various means, including the National Medicare & You Education Program (NMEP).

CMS's multi-year efforts to improve beneficiary satisfaction apply to both managed care and FFS plans. To capture more complete information for the managed care portion, we combine data from a managed care disenrollee survey with survey data from current managed care enrollees. Baselines and targets were recalculated in CY 2000 (FY 2001) to reflect this change. In order for the increase to be statistically significant, these are long-term targets with reports due at the end of the 5-year period.

CMS is meeting our FY 2003 target of improving beneficiary satisfaction by continuing to collect and share CAHPS information from beneficiaries with health plans, QIOs, and beneficiaries.

Medicaid and the State Children's Health Insurance Program (SCHIP)
Centers for Medicare & Medicaid Services (CMS)

The Program
Medicaid, a jointly financed program by the federal and state governments, is a means-tested health care program for low-income Americans, which CMS administers in partnership with the states. Over the years, Congress has incrementally expanded Medicaid well beyond the traditional population of the low-income children, families, elderly, and the blind. Today, Medicaid is the primary source of health care for a much larger population of medically vulnerable Americans, including poor families, the disabled, and persons with developmental disabilities requiring long-term care. In coordination with the Medicaid Program, the State Children's Health Insurance Program (SCHIP) has also stimulated enormous change in the availability of health care coverage for children.

SCHIP was created through the Balanced Budget Act of 1997 (BBA) to address the fact that nearly 11 million American children (one in seven) were uninsured and therefore at increased risk for preventable health problems. Many of these children were in working families that earned too little to afford private insurance on their own, but too much to be eligible for Medicaid. BBA provided funds cover the cost of insurance, reasonable costs for administration, and outreach services to get children enrolled. To make sure that funds are used to cover as many children as possible, funds must be used to cover previously uninsured children, and not to replace existing public or private coverage.

Results and Explanation of Performance

Source: Statistical Enrollment Data System and HCFA-2082

The SCHIP and Medicaid programs have made unprecedented investments to improve the quality of life for millions of vulnerable, uninsured, and low-income children. Through Title XXI of the Social Security Act, states have the option to expand their Medicaid program, establish a separate child health program, or use a combination of both. CMS's goal is to increase the number of children who are enrolled in regular Medicaid or SCHIP. During FY 2002, approximately 30 million children were enrolled in SCHIP and Medicaid, which is about 2,750,000 over the previous year's level.

In FY 2003, states are continuing to eliminate barriers that may prevent families from enrolling in Medicaid or SCHIP. For example, many states are simplifying application forms and income verification requirements. A number of states have also expanded eligibility to provide coverage to other populations (e.g., parents, families with incomes higher than the federal poverty level, etc.) as a way to increase enrollment in Medicaid and SCHIP. The states submit data through the Statistical Enrollment Data System (SEDS), which CMS personnel review every quarter.

When CMS first implemented this GPRA goal, the objective was to enroll five million children in the program by FY 2005. To meet this number, CMS set as its target an increase of enrollment of one million children over the previous year. Because CMS has exceeded this goal and is now seeing states face fiscal challenges that may affect the program's outreach and enrollment, CMS is unsure about future projections and has decided to set its FY 2003 target to increase enrollment by five percent over the previous year. We expect FY 2003 data in early CY 2004.

Health Centers Program
Health Resources and Services Administration (HRSA)

The Program
The Health Centers Program, a major component of America's health care safety net for the Nation's indigent populations, is leading a Presidential initiative to increase health care access for those Americans who are most in need. Millions of Americans are uninsured and lack access to a regular source of health care. Health Centers, operating at the community level through federal, state, and community partnerships, provide regular access to high quality, family-oriented, and comprehensive primary and preventive health care regardless of patients' ability to pay. Program grants support a variety of community-based public and private nonprofit organizations for the operation of this program. The ultimate goal of the Health Centers Program is to improve the health status of underserved and vulnerable populations and to eliminate health disparities.

To make sure the Health Centers Program is reaching needy populations, the program targets and tracks service to racial/ethnic minority groups, people of low income, and those who are uninsured.

Results and Explanation of Performance

Source: HRSA BPHC Uniform Data System

Strategic Goal 4: Enhance the Capacity and Productivity of the Nation's Health Science Research Enterprise

HHS is committed to strengthening the Nation's capacity to generate scientific discoveries that lead to improvements in health. NIH, the world's largest and most distinguished health research organization, is dedicated to advancing the understanding of biomedical and behavioral science. Central to that aim is ensuring the supply of well-trained laboratory and clinical investigators, who will generate the discoveries of the future.

Research Training and Career Development Program
National Institutes of Health (NIH)

The Program
To nurture a talent base of well-qualified and diverse investigators, NIH provides pre- and post- doctoral training support through the National Research Service Award (NRSA) and various other mechanisms of support for career development.

Pre-doctoral training. At the pre-doctoral level, students who are beginning graduate training need to learn the conceptual and theoretical aspects of their respective disciplines. NIH provides support through grants to institutions so that they, in turn, can provide broad, multidisciplinary training programs for a critical mass of students. In the first pre-doctoral years, didactic educational experiences for learning the fundamentals are supplemented with laboratory rotations that help students identify the frontiers of modern science and learn research methods. Later, once students select their dissertation projects, they operate primarily as research assistants on their mentors' research grants. Praise for NIH's approach has been extensive, including the widely cited report, Reshaping Graduate Education (National Academy of Sciences, 1995), which recommended that all federal agencies emulate this approach.

Post-doctoral training. At the post-doctoral level, NIH supports an extension and expansion of the apprenticeship approach. For individuals who continue their formal education in the biological or behavioral sciences, NIH offers training grants, fellowships, and research assistantships to fund this period of intense research activity. The primary focus at this level is the acquisition of knowledge and skills necessary to launch an independent research career.

Career development. Whether a trained investigator (post-doctorate) is just commencing an independent research career or is well-established but looking to expand into a new area, Career Development Awards provide them with support for acquiring specialized new skills.

Strategic Goal 5: Improve the Quality of Health Care Services

This goal aims to improve the quality of health care services by reducing medical errors, improving consumer and patient protection, and accelerating the development and use of electronic health information. The program discussed in this section illustrates HHS's commitment to health care research; upholding health, safety and quality standards in institutions that serve Medicare and Medicaid beneficiaries; and modernizing electronic health information to ensure patient safety and improve health care quality.

Medical Devices and Radiological Health Program
Food and Drug Administration (FDA)

The Program
The FDA Medical Devices and Radiological Health Program is responsible for ensuring the safety and effectiveness of medical devices and eliminating unnecessary human exposure to manmade radiation from medical, occupational, and consumer products. A key element of the program is the post-market reporting system that keeps the FDA informed of serious adverse events. The information collected by the system serves as the basis for corrective actions by the Agency, including warnings to users and product recalls.

The Medical Product Surveillance Network (MedSun) pilot program, launched in 1999 by the Center for Devices and Radiological Health (CDRH), is intended to play an important role in FDA's post-market surveillance efforts. MedSun is FDA's response to the FDAMA provision directing replacement of universal user facility reporting with a user facilities network that constitutes a representative profile of user reports. The goal of the MedSun is to improve the protection of the health and safety of patients, users, and others by reducing the likelihood of the occurrence of medical device related adverse events and, if they do occur, reducing the likelihood that they will be repeated. MedSun is based on the premise that a select group of highly trained reporting facilities can provide high quality, informative reports that are representative of user facility device problems nationwide.

An important by-product of MedSun is the creation of a two-way channel of communication between FDA and the user facility community. This system provides a means for an advanced warning system for gathering or providing fast, effective feedback from and to that community (FDA retains a direct channel of contact to all user-facilities in the U.S. via Public Health Advisories and Safety Alerts). By having a network in place, FDA is using this system to quickly gain input from a representative sample of user facilities (i.e., hospitals, nursing homes, and other healthcare entities), and facilities are using it to seek information from other facilities and/or from FDA.

FDA's MedWatch program estimates that there may be as many as 300,000 injuries and deaths annually associated with device use and misuse. MedSun is designed to significantly reduce this number by identifying, understanding and sharing information about problems with the use of medical devices before serious injuries or deaths occur.

CDRH and its MedSun contractors will coordinate with FDA's Center for Drug Evaluation and Research to implement a drug surveillance network based on the MedSun model that is designed to train hospital personnel to accurately identify and report injuries and deaths associated with medical products. That effort is also described in FDA's Human Drugs Program's performance plan.

Results and Explanation of Performance

Source: FY 2004 Congressional Justification (CJ) FDA Performance Plan

In FY 2002, FDA recruited, trained, and had functioning more than 80 facilities for the network, and met its performance measure. In FY 2001, FDA did not meet its performance measure of recruiting 75 hospitals because most of its effort was focused on resolving internal policy issues and addressing information technology security requirements. Specifically, FDA extended software development to accommodate internet-based reporting systems (interactive web-based forms and databases), and took steps to ensure that reporters had internet access to secure servers. Despite not making the goal, FDA still recruited over 25 hospitals.

FDA's plans for FY 2003 focus on building MedSun to a network of 180 facilities, and with increased funding in FY 2004, expanding to 240 facilities. FDA will recruit new facilities to expand to the network capacity and to replace those that choose to leave. FDA plans to use these 240 facilities to pilot:

• The effectiveness of various incentives;
• The use of the MedSun facilities as a laboratory to obtain specific medical product information; and
• The various types of feedback intended to encourage reporting by the facilities.

The Medical Products Surveillance Network is contributing to the Agency's initiative for reducing medical errors and to the overall Departmental initiative to improve the quality of health care services.

Strategic Goal 6:
Improve the Economic and Social Well-being of Individuals, Families, and Communities, Especially Those Most in Need

HHS continues to support efforts to increase the independence of low-income families, welfare recipients, the disabled, older Americans, Native Americans, and refugees. The HHS programs, detailed below, have annual performance measures that speak to improving the economic and social well-being of individuals, families, and communities.

Temporary Assistance for Needy Families
Administration for Children and Families (ACF)

The Program
ACF's Office of Family Assistance administers the Temporary Assistance for Needy Families (TANF) program directed at (1) promoting work, responsibility, and self-sufficiency, and (2) improving the economic well-being of individuals and families through state- and tribal- administered programs. TANF's purposes are fourfold:

• Provide assistance to needy families so that children can be cared for in their own homes;
• Reduce dependency by promoting job readiness, work, and marriage;
• Prevent out-of-wedlock pregnancies; and
• Encourage the formation and maintenance of two-parent families.

Results and Explanation of Performance

Source: TANF Administrative Data

Strategic Goal 7: Improve the Stability and Healthy Development of Our Nation's Children and Youth

HHS is taking significant steps to improve the development and learning readiness of preschool children through the Head Start and Child Care programs. The Child Support Enforcement Program (CSE) is working to increase the financial support provided by non-custodial parents and to encourage their involvement in the lives of their children. Child welfare and youth programs are striving to assure that vulnerable children and youths are living in safe, permanent environments. HHS programs demonstrate, through their aggressive performance goals and annual program performance achievement, the Department's commitment to this strategic goal. Evidence of strong program performance in the examples cited below illustrates improvement in the stability and development of our Nation's children and youth.

Child Support Enforcement Program
Administration for Children and Families (ACF)

The Program
ACF's Office of Child Support Enforcement (OCSE) is responsible for ensuring support for children by locating parents, establishing paternity and support obligations, and enforcing those obligations. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) provided ACF with new and effective tools for enforcing child support. ACF implements the child support provisions in PRWORA through a variety of means:

• Providing technical assistance, training, and information dissemination;
• Developing a more performance-based incentive funding structure; and
• Providing federal oversight and assistance with state-based quality assurance.

The CSE (Child Support Enforcement) program is federally funded and administered by state and local governments. The federal government pays 66 percent of state administrative costs and 90 percent of paternity laboratory costs. The federal government provides direction, guidance, technical assistance, oversight, and some critical services to states' CSE programs for activities mandated under title IV-D of the Social Security Act.

Results and Explanation of Performance

Source: State Automated Systems provide data on OCSE Form 157

Strategic Goal 8: Achieve Excellence in Management Practices

HHS is committed to improving the efficiency and effectiveness of the Department's programs and achieving the goals of the President's Management Agenda by creating an organization that is citizen-centered, market-based, and results-oriented. We have worked to reduce erroneous payments; maintain clean opinions in HHS's audited financial statements; revitalize HHS's human capital management; and improve facilities to provide safe, modern, efficient, and physically secure laboratories and support facilities in the most economical manner possible. For more detailed coverage of the President's Management Agenda, see Section I of this Report.

The following programs have annual performance measures that demonstrate results in achieving excellence in management practices, and they illustrate how HHS has made progress towards this strategic goal.

Medicare Integrity Program
Centers for Medicare & Medicaid Services (CMS)