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X*XXXԀ `  3!(#3!(#  3!(#3!(#  3!(#3!(#  8.|dd8   m>9)%`|0 ` Exqm    (#(#   `     h      p ̀ h      p      H #X*XXX*# XwXXX*   X XwTheAccessAgency# XwX ##X*XX Xw#X*XXX* 4 #X*XXX*#X*XXX* *<ddd Xdd Xdd X(#(#,xdd +  !eeeeX < !  L| MXX*#X*X ML|#AXX*FINALFY2003_GPRA_ԀANNUALPERFORMANCEPLAN,  J REVISEDFINALFY2002PERFORMANCEPLAN@@jj)AND@@FY2001_GPRA_ԀANNUALPERFORMANCEREPORT#X*XAC# %X  1'%b&!!  eeeeX 1#X*XXX*#X*XXX*@*L| MXX*Ԉ@*   p   #X*X ML|+#February,2002  +'$   ,'%        @   HEALTHRESOURCESANDSERVICESADMINISTRATION     `     h      p      x  @ FINALFY2003_GPRA_ԀANNUALPERFORMANCEPLAN,@K K REVISEDFINALFY2002ANNUALPERFORMANCEPLAN@)AND@ FY2001ANNUALPERFORMANCEREPORT̀@HH" !XX*TABLEOFCONTENTS#X*X!  #  $ t *k<*ddxdd x<(#(#k,Qdd ,9dd +   L   Section    @?Page    Introduction.................................................................................................... 4* 0   @5@4Ѐ5 4*(0   @5 @ 4 PARTIAGENCYCONTEXTFORPERFORMANCE .......................    MEASUREMENT 4*    "@9"@4Ѐ9 4*(   "@9 "@ 41.1AgencyMissionandLongTermGoals................................................... 4*  p  "@9"@4Ѐ9 4*( p  "@9 "@ 41.2Organization,Programs,Operations,StrategiesandResources.............. 5+   &@11&@5Ѐ11 5+)  &@11 &@ 51.3PartnershipsandCoordination................................................................. 5+  p  .@15.@5Ѐ15 5+) p  .@15 .@ 51.4SummaryFY2001PerformanceReport:Accountabilitythrough..........PerformanceMeasurement 5+   0@160@5Ѐ16 5+)  0@16 0@ 5   \    \  PARTIIPROGRAMPLANNINGANDASSESSMENT .................... 5+   8@248@5Ѐ24 5+)  8@24 8@ 5Introduction.................................................................................................... 5+ `  8@248@5Ѐ24 5+)`  8@24 8@ 52.12.4PrimaryCare.................................................................................. 5+    :@26:@5Ѐ26 5+)!  :@26 :@ 52.52.10HIV/AIDSPrograms..................................................................... 5+  `"  J@53J@5Ѐ53 5+) `#  J@53 J@ 52.112.17MaternalandChildHealth.......................................................... 5+ !$  U@86U@5Ѐ86 5+)!%  U@86 U@ 52.182.26HealthProfessions....................................................................... 6, #`& _@127_@6127 6,*#`' _@127 _@ 62.272.31OfficeofSpecialPrograms......................................................... 6, $( f@180f@6180 6,*$) f@180 f@ 62.322.35RuralHealth...... t ........................................................................ 6, &`!* h@199h@6199 6,*&`!+ h@199 h@ 62.36_Telehealth_.............................................................................................. 6, '", k@216k@6216 6,*'"- k@216 k@ 62.37HealthyCommunitiesInnovationInitiative.......................................... 6, )`$.  l@225 l@6225 6,*)`$/  l@225  l@ 62.38FamilyPlanning.................................................................................... 6, *%0 l@230l@6230 6,**%1 l@230 l@ 62.39ProgramManagement#X*XXX*#X*XXX*.....#X*XXX*#X*XXX*..................................................................... 6, ,`'2 n@244n@6244#X*XXX*9#X*XXX* 6,*,`'3 n@244 n@ 6 APPENDIXTOTHEPERFORMANCEPLAN ....................................... 6, d o@255o@6255 6,*d o@255 o@ 6A.1ApproachtoPerformanceMeasurement................................................. 6,  o@255o@6255 6,* o@255 o@ 6A.2ChangesandImprovementsOverPreviousYear.................................... 6,  h  q@274 q@6274 6,* h  q@274  q@ 6A.3Linkageto_HHS_Ԁand_OPDIV_ԀStrategicPlans.......................................... 6,   0q@2750q@6275 6,*  0q@275 0q@ 6A.4PerformanceMeasurementLinkageswithBudget,HumanResources,.πCostAccounting,InformationTechnology,CapitalPlanningandπProgramEvaluation 6, p@  pq@279pq@6279:0. h  pq@279  pq@ :@*0 x'XO`TXX0ӀA.5ComparisonofOriginalFY2002TargetswithRevisedFY20020  283xH  (# (# ЀTargets      ? 'XO`TX x'XO`TX?   @  - X 'XO`TX-@@vv HEALTHRESOURCESANDSERVICESADMINISTRATION  @ FINALFY2003_GPRA_ԀANNUALPERFORMANCEPLAN,@2 2 REVISEDFINALFY2002ANNUALPERFORMANCEPLAN@(AND@ FY2001ANNUALPERFORMANCEREPORTINTRODUCTION  ( x #X*XXX*# X*XXX*Asweenterthe21stcentury,unparalleledchangeintheNationshealthcaresystemisoccurring.  P  Rapidadvancesintechnologyandcommunicationsarerevolutionizingtheprovisionofhealthcarewhilenewmodelsofhealthcaredeliverycontinuallyevolve.Thus,theNationsAccessAgencymustadapt.TheHealthResourcesandServicesAdministration(_HRSA_),anAgencyoftheU.S.DepartmentofHealthandHumanServices,istheprincipalFederalAgencychargedwithincreasingaccesstobasichealthcareforthosewhoaremedically_underserved_.Since_HRSA_sestablishment,theAgencysbudgethassteadilyincreasedtoafundinglevelof$6.1billion,resourceswhichadduptohealthcareaccessformillionsofAmericansthrough_HRSA_programs._HRSA_sprogrammaticportfolioincludesarangeofprogramsorinitiativesdesignedtoincreaseaccesstocare,improvequality,andsafeguardthehealthandwell-beingoftheNationsmostvulnerablepopulations.Collectively,_HRSA_Ԁprogramsworktoimproveaccesstocareforthemorethan38.7millionAmericanswhoareuninsuredandthe40millionwholiveinmedically_underserved_Ԁareas._HRSA_supportsover700communityhealthcenters;fundsservicesforpeoplelivingwithHIV/AIDSthroughtheRyanWhiteCARE(ComprehensiveAIDSResourcesEmergency)Act;assistsStatesandhealthcareorganizationsinimprovingservicestomothersandchildren;overseestheNationalsystemthatallocatesorgans,tissue,andbonemarrowfortransplant;andworkswithacademichealthcentersandothertrainingprogramstoenhancethediversityanddistributionoftheNationshealthcareworkforce.#X*XX X*##X*XXX*Afewoftheways_HRSA_Ԁhelpedstatesandcommunitiesextendessentialhealthcareservicesto \  theirneediestcitizensinFY2001wereby:E1` hp x (#XE0  Investingmorethan$1billionincommunityhealthcentersacrossthecountrycentersthatservemillions,includingmigrantworkers,homelesspeople,andresidentsofpublichousing.Weestablishednewaccesssitesinpreviouslyunservedareasandexpandedexistingsitestoincludenewservices,particularlyintheareasoforalhealth,mentalhealth,outreach,respitecareandpharmacyservices. (#(# 0  0(#(# (#(# 0  Placingmorethan2,500primarycarecliniciansinhealthprofessionalshortageareasthroughtheNationalHealthServiceCorps.Inpartnershipwithstateandcommunityorganizations,_HRSA_shealthcentersand_NHSC_Ԁprogramsdeliverhighqualityprimarycareservicesinmorethan4,000U.S.communities. (#(#  X,'+ _00  DramaticallyreducingAIDSrelatedmortalitythroughnewdrugtreatmentregimensfortensofthousandsoflowincome,underinsuredanduninsuredpeoplelivingwithHIV/AIDS.ThetreatmentsaremadeavailablethroughstateandlocalprogramsfundedandsupportedbyHRSAsRyanWhiteCAREAct. (#(# H.` hp x (#,` XHE1` hp x (#XE0  ReachingouttolowincomeparentstoenrolltheirchildrenintheStateChildrensHealthInsuranceProgramandMedicaid,givingtheirsonsanddaughtersaccesstocriticallyimportantprimaryhealthcare. (#(# 0  0(#(# (#(# 0  Launchinganewinitiativetoscreenallnewbornsforhearinglosspriortodischargefromthenewbornnursery. 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XHInFY2001,weexpandedagencywideactivitiestoimprovehealthcareforresidentsalongtheU.S.Mexicoborderandpromotebetteroralhealthandmentalhealthnationwide.Alongtheborder,HRSAsetupnewclinicsandexpandedthecapacityofexistinghealthcenters,bringingbilingual,culturallycompetenthealthcareservicesto40,000additionalborderresidents.Thenumberofpeopleservedannuallybysome50HRSAfundedhealthclinicsitesnearthebordernowtopshalfamillion.HRSAhasawardedmorethan$3milliontoreachouttopregnantwomeninbordercommunitiestohelpthemgettheprenatalcaretheyneedtoavoidproblembirths.̀Toothdecayremainsthenationssinglemostchronicchildhooddisease.Aquarterofschoolagechildrenaccountfor80percentofalldentaldisease,whichputsthematriskforahostofrelatedillnesses.HRSAiscollaboratingwiththeCentersforMedicareandMedicaidServicestomaximizetheeffectivenessofdentalMedicaidandChildrensHealthInsurancePrograms.HRSAsupportsbetterdentalcarebyincreasingthenumberofdentistsincommunityandschoolbasedcentersandbyprovidinggreaterreimbursementstohospitaldentalclinicsanddentalschools.MedicalstaffinHRSAsupportedhealthcenterstoldusthatmanyclientssuffernotjustfromthephysicalailmentthatbroughtthemtothecenter,butfromundiagnosedmentalillnessaswell.Qualityhealthcaremeanstreatingthewholeperson,notjustthemostobvioussetofsymptoms.Asourprovidersemphasizementalhealthasanecessarypartofprimarycare,patientswillreceivebetteroverallhealthcareandreturnmorequicklytoproductivelives.ThesenewactivitiesstrengthenthenationshealthcaresafetynetandimproveAmericansqualityoflife.TheyreflectHRSAshistoricroleinhelpingcommunitiesdesigncosteffectivepublichealthstrategiesthatpaylongtermdividendsbyreducingexpensiveandpreventablehospitalizations.#X*XXX*+# 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lXX*X*XlXQXXX*XQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQX*XXXQ      #X*XXX*<#X*XXX*  h+&*  \     X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*  GPRArequiresFederalagenciestoprepare5yearStrategicPlanssettingoutlongtermgoalsand   objectives,AnnualPerformancePlanscommittingtoshorttermperformancegoals,andAnnualPerformanceReportsexplaininganddocumentinghoweffectivetheAgencysactionshavebeenatachievingthestatedgoals.HRSAsperformanceplanhasbeenpreparedinthecontextofboththeDepartmentofHealthandHumanServices(HHS)StrategicPlanandHRSAsownstrategicplan.#X*XXX*l#X*XXX* L  HealthyPeople2000/2010goalsandobjectivesalsoserveasafoundationforanumberof $ t HRSAsperformancemeasures.ItshouldbenotedthatalthoughHRSAhasleadresponsibilityforseveraloftheobjectivescontainedinHealthyPeople2000/2010,achievementofthegoals  L  representsanationaleffortinwhichHRSApartnerswithotherFederal,State,local,andcommunityhealthentities.Therefore,performancemeasureswithinHRSAsplanhavebeencraftedtoreflectthecollaborativenatureofHRSAsprogramactivities.ConcerningtheorganizationoftheFinalFY2003PerformancePlan,RevisedFinalFY2002PerformancePlanandFY2001PerformanceReport,theDepartment,withbroadconsensusofHHScomponents,decidedtoconsolidateboththeAnnualPerformancePlanandthePerformanceReportintotheannualbudgetsubmissionoftheDepartment.ToachievegreaterstandardizationandconsistencyinHHSperformanceplans,GPRArepresentativesthroughoutHHSdevelopedastandardoutlinethatallHHScomponentsareusinginpresentingannualperformanceplansandreportsinresponsetotherequirementsoftheGPRA.Theoutlineeffectivelyconstitutesan orderofpresentationofinformationrequiredbyGPRAandOMBforperformanceplansandreports.Thepresentationincludesthreesections:PartI:AgencyContextforPerformanceMeasurement;PartII:ProgramPlanningandAssessment;andAppendixtothePerformancePlan.#X*XXX*B#X*XXX*PartIIProgramPlanningandAssessment,isstructuredtoreflecttheoverallHRSAprogramstructure.Individualperformanceplansareincludedforeachsignificantprogramactivity.Accordingly,thereis,inmostcases,adirectlinkagebetweenbudgetlineitemsandcorrespondingperformanceplans.Theplansaregroupedbythemajorheadingsof:PrimaryCare,HIV/AIDSPrograms,MaternalandChildHealth,HealthProfessions,OfficeofSpecialPrograms,RuralHealth,Telehealth,FamilyPlanning,andProgramManagement.#X*XXX*#X*XXX* D!    lXX*X*XlXQXXX*XQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQX*XXXQ      ThisFinalFY2003AnnualPerformancePlan,RevisedFinalFY2002PlanandFY2001 #l! PerformanceReportforHRSAsetsoutspecificperformancegoalsfortheAgencyforFY2003andreportsonspecificperformancegoalsforFY2001.ItbuildsontheRevisedFinalFY2001andFY2002AnnualPerformancePlansubmittedtotheCongressinApril2001.ItisdesignedtocomplementandsupportthebudgetjustificationmaterialfortheAgencysFY2003budgetrequestandisanintegralpartoftheoverallHRSAbudget.PerformancegoalsthatdonothaveFY2001datayetwillbeindicatedintheplanwiththedate/yearinwhichthedatawillbeavailable.      X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*  TheAnnualPerformancePlandescribesHRSAsperformancegoals,theirlinkagetolongertermstrategicgoalsandtothebudget,anditdescribesthestepsplannedandunderwaytoaccomplish T,'+ eachgoal.Theplanalsoestablishesamethodanddatasourceformeasuringandreportingoneachgoal. lXX*X*XlXQXXX*XQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQX*XXXQ            X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*X*XXX*  HRSAhasattemptedtorespondtocommentsonpreviousversionsofthe  performanceplans.WehaveprovidedadditionalinformationoncoordinationwithotherorganizationstoreflectthefullextentofourjointeffortswithotherFederalornonfederalorganizations.Wehaveaddresseddataissuesthathavearisen,andcontinuetoworktoimprovedatasourcesforeachindividualgoal,aswellastooutlineparticulardataconcernsorlimitations.Overall,wethinkthisPlanandPerformanceReportprovidesinformationthatwillbeusefulinmakingresourceallocationdecisionsforFY2003andbeyond._00  $ t #X*XXX*ه#X*XXX* XX*PARTIAGENCYCONTEXTFORPERFORMANCE  ЀMEASUREMENT#X*X#RzQXX* $ #X*XQRzM#XX*#X*X#1.1AgencyMissionandLongTermGoals  l Themissionof_00HRSA_00ԀistoimprovetheNationshealthbyassuringequitableaccesstocomprehensive,qualityhealthcare.The_00HRSA_00ԀmissionstatementsuccinctlystateshowtheorganizationapproachesitsresponsibilitiesastheNationsAccessAgency.   !XX*_00HRSA_00ԀGoalandStrategies#X*X! #XX*   D  spqB<,(`~0 R `.(#E R RByp (# (#(#(# @  @  @  (#(# (# (##X*X#_00HRSA_00Ԁaccomplishesitsmissionby: D L 023456789Gx#L 23   232G3  0    WorkingwithStatesandcommunitieswhichformthefoundationfordeveloping !l integratedservicesystemsandtheappropriatehealthworkforcetohelpassureaccesstoessentialhighqualityhealthcare.23 ݌ (#(# Ќ  L 023456789Gxx023456789L 23   232G3  0    Assuringthatthesesystemstakeintoaccountculturalandlinguisticfactors,geographic $  location,andeconomiccircumstances.23݌ (#(# Ќ  L 023456789Gxx023456789L 23   23F2G3  0    AssistingStatesandcommunitiestoidentifyandaddressunmetserviceneedsand '"! workforcegapsinthehealthcaresystem.23Fq݌ (#(# Ќ  L 023456789Gxx023456789L 23   232G3  0    Promotingcontinuousqualityimprovementinhealthservicesdeliveryandhealth T*%$  professionseducation.XX*## 23݌@+&%(#(# Ќ  _00#X*X# L 023456789Gxx023456789L 23   232G3  0    Supportinginnovativepartnershipstopromoteeffective,integratedsystemsofcareforall   populationgroups.23݌ (#(# Ќ  L 023456789Gxx023456789L 23   23p2G3  0    Promotingtherecruitment,training,andretentionofaculturallyandlinguistically t competentanddiversehealthcareworkforce.23p݌ (#(# Ќ  AccomplishingtheHRSAmissionrequiressettingforthconcreteandchallenginggoalsandstrategiesconcerningthereductionandremovalofbarrierstocareandtheimprovementofthehealthoftheunderserved,thevulnerable,andthosewithspecialneeds.HRSAhascompletedastrategicplanningprocesswhichfocusesonitsmissionandfourstrategies,evenbeyondthenormalfiveyearplanningcycle.TheHRSAStrategicPlanidentifiesfourlongrangestrategiesthatsupportHRSAsmissiontoimprovetheNationshealthbyassuringequitableaccesstocomprehensive,qualityhealthcare.EachstrategyissupportedbystrategicobjectivesthatfocusontheactivitiesthatHRSAwillutilizetoachieveitsmission.Theselongrange,strategiesserveastheperformancemanagementframeworkoftheAgency. #X*XXX*#X*XXX* X*XXX*X*XXX*XQXXX*XQXXXQXQXXXQXQXXXQXQXXXQXQXXXQXQXXXQ X*XXXQ   /   #X*XX X*#  XHXXX*Tobestaccommodatethelinkageofperformancegoalsandmeasuresforprogramactivitiestothe H budgetrequestsfortheseprograms,HRSAincorporateditsannualperformancegoalsandmeasuresintothebudgetsubmissionsfortheHRSABureaus/Officesthatadministertheprograms.TheHRSABureaus/OfficesFY2003PerformancePlansandBudgets,bothofwhichareimportanttounderstandperformanceplanninginHRSA,containdetailedperformanceinformationforHRSAsprogramactivitiesasrequiredunderGPRA.Theycontainperformancegoalsandmeasures,themeansandstrategiesthatwillbeusedtoachievethegoals,dataverificationandvalidation,linkagetothebureau/officesbudget,anddiscussionsofcrosscuttingprograms. /    XHXXXHX*XXXHX*XXX*Ԍ   Ќ  TheDepartmentofHealthandHumanServiceshasdevelopedarevisedStrategicPlan,whichwasforwardedtotheCongressinSeptember,2000.TheoverallHRSAdirectionsandprogrameffortsareconsistentwithandsupportiveoftheDepartmentgoals,whichinclude:Goal1:0  ReducethemajorthreatstothehealthandproductivityofallAmericans.D!(#(# Goal2:0  Improvetheeconomicandsocialwellbeingofindividuals,families,andcommunitiesinthe 0"  UnitedStates. (#(# Goal3:0  Improveaccesstohealthservicesandensuretheintegrityofthenationshealthentitlement $X" andsafetynetprograms. (#(# Goal4:0  Improvethequalityofhealthcareandhumanservices.%0!$(#(# Goal5:0  Improvethenationspublichealthsystems.&"%(#(# Goal6:0  StrengthentheNationshealthscienceresearchenterpriseandenhanceitsproductivity.'#&(#(# InAppendixA.3,atableisincludedwhichprovidesillustrativeexamplesofhowHRSAperformancegoalssupportthecurrentDepartmentStrategicPlanninggoals._00 T,'+  1.2Organization,Programs,Operations,StrategiesandResources    OverviewoftheAgency    #X*XXX*#X*XXX* X*XXX*X*XXX*XQXXX*XQXXXQXQXXXQ X*XXXQ        HealthcareintheUnitedStatesisamongthefinestintheworld,butitisnotavailableto t everyone.Atatimewhenthenationenjoysunprecedentedprosperity,millionsoffamiliesstillfacebarrierstoqualityhealthcarebecauseoftheirincome,lackofinsurance,isolationorlanguageandculturaldifferences.Fillinginthegapsforindividualsandfamilieswholiveoutsidetheeconomicandmedicalmainstreamisthelongtermgoalof_00HRSA_00. ~݌̌ X*XX X* X*XX X*X*XX X*X*XXX*X*XXX*X*XXX*   The_00HRSA_00ԀStrategicPlanidentifiesfourlongrangestrategiesthatsupport_00HRSA_00smission.  L  TheselongrangestrategiesserveastheperformancemanagementframeworkoftheAgency.L 023456789Gxx023456789L 23   23 2G3  0    EliminateBarrierstoCare23 7݌$ (#(# Ќ   23   232G3  0    EliminateHealthDisparities23݌ (#(# Ќ   23   232G3  0    AssureQualityofCare23݌ (#(# Ќ   23   23t2G3  0    ImprovePublicHealthandHealthCareSystems23t݌ (#(# Ќ    _00HRSA_00ԀhasbuiltacommunitybasednetworkofqualityprimaryandpreventivehealthcareservicesthatformthefoundationoftheNationshealthcaresafetynet.Throughavastarrayofprogramsoperatinginthousandsofcommunitiesacrossthecountry,_00HRSA_00Ԁtargetsthegrowingranksofmedically_00underserved_00Ԁindividualsandfamilies,including:L 023456789Gxx023456789L 23   23l2G3  0    38.7millionAmericanswholackhealthinsurance!manyofwhomareracialand  \ ethnicminorities,23l݌ (#(# Ќ   23   232G3  0    40millionAmericanswholiveinruralandpoorurbanneighborhoodswherehealthcare   servicesarescarce,23݌ (#(# Ќ  L 023456789Gxx023456789L 23   232G3  0    AfricanAmericaninfantswhostillare2.4timesmorelikelythanwhiteinfantstodiebefore  theirfirstbirthday,23@݌ (#(# Ќ   23   23I2G3  0    800,000to900,000peoplelivingwithHIV/AIDS,bothinandoutofcare,and23It݌X (#(# Ќ   23   23J2G3  0    Over75,000Americanswhoarewaitingforanorgantransplant.23Ju݌0" (#(# Ќ  ArecentInstituteofMedicinereportconcludedthattheNationshealthcaresafetynet,whileintactfortheshortterm,isendangeredoverthelongertermbyshrinkingresources(bothfundingandavailablepractitioners)andexpandingresponsibility.Manylocalproviders,the_00IOM_00Ԁpointedout,relyonanincreasinglyuncertainandinsufficientpatchworkofgrantsandsubsidies.   `     h      p lXX*     x   X*XlX*XXX*XQXXX*XQXXXQXQXXXQ X*XXXQ     For_00HRSA_00,shoringuplocalsafetynetsiscriticaltoourmission.Byhelpinglocalprovidersremain ~(#' viable,wecanimprovethedeliveryofprimarycareto_00underserved_00Ԁindividualsandfamilies,enhanceaccesstothatcare,andimprovehealthstatusmeasuresacrosstheboard. y݌  lX X* l ll lllllll   B+&* ! XX!#X*XlB#_00HRSA_00Ԁiscurrentlyoperatingatafundinglevelof$6.1billion._00HRSA_00Ԁadministersmanycore   servicesthroughtheworkoffourmainbureausandotherkeyoffices:   --L !23456789[hx023456789L?+ 4 <DL!X?#X*XXX*x#X)XXX*#X*XXX)\# X*XXX*BureauofPrimaryHealthCare(_00BPHC_00) .Healthcentersarethebackboneofthenations t 0  safetynet.Morethan3,000sitesprovideneededprimaryandpreventivecaretoover10.5millionpoorandnearpoorAmericans.ThroughtheHealthCenterprogram,_00BPHC_00Ԁsupportscommunityhealthcenters,migranthealthcenters,healthcareforthehomelessprograms,publichousingprimarycareprograms,andschoolbasedhealthcenters.Healthcentersprovideaccesstocommunitybased,highquality,comprehensive,familyoriented,culturallyandlinguisticallycompetentprimarycareandpreventiveservices,includingmentalandbehavioralhealth,dental,andenablingservices.MorethantwothirdsofhealthcenterpatientsareuninsuredoronMedicaid,morethantwothirdsarepeopleofcolor,andmorethan85percentlivebelow200percentofthepovertylevel.Despiteservingahighriskpopulation,healthcentershavereducedhealthdisparitiesbyrace,ethnicity,andincomeforpeoplewithdiabetes,highbloodpressure,cancer,andasthma.Other_00BPHC_00Ԁprograms,includingthe340BDrugPricingprogramandStatePrimaryCareAssociationsandOffices,facilitateourcoresafetynetprograms. (#(# L "23456789\hh!23456789L 23   #X*XX X*#X)XXX*23^ 2\3  0    #X*XXX) # X*XXX*HIV/AIDSBureau(HAB). AfterMedicaid,_00HRSA_00ԀisthelargestsinglesourceofFederal h fundingforHIV/AIDShealthcareforlowincome,uninsured,and_00underinsured_00ԀAmericans.Since1991,whenCongresspassedtheRyanWhiteCAREActandplacedtheadministrationofitsprogramsin_00HRSA_00,wehaveoverseencloseto$8billioninspendingforessentialprimarycareandsupportservicesforpeopleinallStatesandTerritoriesandin51majormetropolitanareas.ThroughtheCAREAct,anestimated500,000peopleeachyearhaveaccesstoservicesandtreatmentstokeepthehumanimmunodeficiencyvirusatbayenablingthemtoliveproductivelives.CAREActfundsalsosupportthedistributionofemergingdrugtherapies,treatmentpracticesandoutcomes,andwaystoreachvulnerablepopulations.Theimpactofthenewcombinationdrugtherapiesbecameevidentin1997whenAIDSdeathsdroppedforthefirsttime.The_00HRSA_00ԄadministeredStateAIDSDrugAssistanceProgramsprovidemedicationstolowincomeindividualswithHIVdiseasewhohavelimitedornocoveragefromprivateinsuranceorMedicaid.HABisalsoworkingcloselywithCDCand_00USAID_00ԀinimplementingtheLIFEInitiative,addressingHIV/AIDSinAfricaandotherdevelopingregionsoftheworld23^  ݌ (#(# Ќ  0  TheOfficefortheAdvancementof_00Telehealth_00ԀislocatedwithinHAB.Tobridgehealthcaregapsinbothruralregionsandurbanareas,_00HRSA_00Ԁpromotes_00telehealth_00Ԁtheuseofelectronicinformationandtelecommunicationstechnologiestodiagnoseandtreatpatients.OAThasbecomeafederalleaderinthisarea,usingelectronicinformationandtelecommunicationstechnologiestosupportlongdistanceclinicalcare,patientandprofessionaleducation,publichealth,andhealthcareadministration.#X*XX X*7 # X*XXX*&4"%(#(# L '23456789\hh"23456789L 23   0,X,X4X023C2\3  0    MaternalandChildHealthBureau. _00HRSA_00sMaternalandChildHealthBureau(_00MCHB_00) ( $' fostersFederal/Statepartnershipstodevelopvitalservicesystemsandresourcesandpromotetheimprovementofservicestomeetthenationscriticalchallengesinmaternalandchildhealth,especiallyforwomenandchildrenfromlowincomeandminorityfamilies,thoseinruralorisolatedareasandforchildrenwithspecialhealthcareneeds.Eachyearmorethan20million p,'+ pregnantwomen,infantsandchildrenareservedbyoneof_00MCHB_00sprograms81percentofallinfants,21percentofallchildrenand58percentofallpregnantwomenintheUnitedStates.Ofthenearly4millionmothersgivingbirth,almosthalfreceivesomekindofprenatalorpostnatalservicethoughan_00MCH_00Ԅfundedprogram,servingapproximately53percentofAfricanAmerican,61percentofAsian/PacificIslanders,and57percentofHispanicwomenwhogavebirthin1998._00MCHB_00Ԁhasprimaryfederalresponsibilityforimprovingthehealthstatusofmothersandchildrenandhasshownsuccessesinarangeofactivitiesfromprovidingserviceswhereunmetneedsareidentifiedandincreasingimmunizationandnewbornscreening,toreducinginfantmortalityanddevelopmentallyhandicappingconditions,aswellaspreventingchildhoodaccidentsandinjuries,andadolescentpregnancy.23C݌ (#(# Ќ  --#X*XX X*#X)XXX* C  $h'23456789C ,K+ 4 <DL!,X,XK #X*XXX)# X*XXX*BureauofHealthProfessions .Programshousedin _00HRSA_00sBureauofHealthProfessions $  (_00BHPr_00)helpassureaccesstoaqualityhealthcareworkforceofprofessionalsinallgeographicareasandtoallsegmentsofourpopulation.Theseprogramsalsoputnewresearchfindingsintopractice,supportgreaterculturaldiversityinthehealthprofessionstomeettheneedsofanincreasinglydiverseNation,encouragehealthprofessionalstoservevulnerablepopulations,andmakesurethathealthprofessionscurricularespondtochangingdemandsinthehealthcaremarketplace.Theavailabilityofanadequatestaffofqualified,culturallycompetenthealthcareprofessionalsiscriticaltotheissueofaccess.Healthprofessionsgraduatesof_00HRSA_00Ԁprogramsarethreetosixtimesmorelikelytopracticein_00underserved_00Ԁareasthanthoseinprogramsnotsupportedby_00HRSA_00.Additionally,graduatesof_00BHPr_00Ԁprogramsaretwotofivetimesmorelikelytobemembersofminorityandotherdisadvantagedgroups.Morethan2,500cliniciansprovideprimaryhealthcareincommunitiesthathaveashortageofhealthprofessionalsinexchangeforscholarshipsandloanrepaymentthroughtheNationalHealthServiceCorps.#X*XX X*# X*XXX* @   ,B+ 4 <DL!4XB C  $$C ,?+ 4 <DL!X? #X*XX X*_##X)XXX*#X*XXX)$# X*XXX*OfficeofRuralHealthPolicy. Betterhealthcareserviceforthemorethan61millionpeople  wholiveinruralAmericaisthefocusof_00HRSA_00sOfficeofRuralHealthPolicy(_00ORHP_00).Almosta#X*XX X*$#XXXX*Ԁ#X*XXXZ&# X*XXX*quarteroftheNationspopulationlivesinruralareas,yetonlyaneighthofourdoctors  workthere.Becauseruralfamiliesearnlessthanurbanfamilies,manyofthehealthproblemsassociatedwithpovertyaremoreserious,includinghighratesofchronicdiseaseandinfantmortality.Also,injuriescausedbyfarmmachineryandbyworkinginjobssuchasmining,forestry,andfishingplaceuniquestrainsonruralhealthcareproviders._00ORHP_00Ԁworkswithalllevelsofgovernmentandwithprivateassociations,foundations,healthcareproviders,andcommunityleaderstoseeksolutionstotheproblemsfacedbyruralhealthcareprovidersandconsumers.B+ 4 <DL!4XB#X*XX X*&# X*XXX* %` # L (23456789&Th$L 23   H14 <DL!4XH#X*XX X*)# X*XXX*23l*2&T3  0    OfficeofSpecialPrograms. Thisofficeoverseesthenationalsystemthatallocatesorgans, %L!$ tissueandbonemarrowfortransplant.TheNationalOrganProcurementandTransplantationNetwork,whichmatchesdonororganstorecipients,helpsassureafairdistributionofavailableorganstopatientswaitingforatransplant,andworkstoguaranteethatscarceorgansarerecoveredandusedsafelyandefficiently.TheNationalMarrowDonorProgramallowsdoctorstomatchthebonemarrowofapatientneedingatransplantwiththetissuetypeofavolunteerdonor.TheOfficeofSpecialProgramsalsooverseestheOrganandTissueDonationInitiative,whichprovidesgrantstoincreaseorgandonationandreducethehighnumberofwaitinglist t,'+ deaths.TheInitiativeprovidesinformationandeducationaboutorgandonationtothegeneralpublic,professionalassociations,healthprovidersandothers.23l*$+݌ (#(# Ќ    L +23456789F\hh(23456789L 23   23/2F\3  0    OfficeofFieldOperations .Insupportofits10fieldofficesacrossthecountry,thisoffice t workstoensuredeliveryofthebestpossibleserviceto_00HRSA_00sStateandcommunitycustomers.Thenetworkoffieldofficesprovidesfrontlinetechnicalassistance,andexpeditesthedeliveryofprimarycareandpreventionhealthservicesinlocalcommunities.ThefieldstructurewasreorganizedinFY2000tomakeitmoreresponsivetoStateandlocalneeds.Thenewstructureincludesanincreaseddataandanalysiscapacitythatallowsstafftobettertracktrendsandmarketplacechangestoimprovedecisionmakingaboutthoseissuesthatmostimpactourcustomers.23//݌ (#(# Ќ   ,H+ 4 <DL!4XH  #X*XX X*+# XHXXX*InternalandExternalResources    C  $h+23456789C  _00HRSA_00Ԁwilldrawuponitscurrentrangeofresourcesinordertocarryoutitsmission,butin   additionwillincreaseinvestmentinpublichealthtrainingtoproduceneededcompetenciesinareassuchassurveillance,performancemeasurement,andsystemsanalysis.AstheAgencywithintheDepartmentofHealthandHumanServices(_00DHHS_00)thatislookedtoforinformationaboutthesizeandscopeofbarriersconfrontedby_00underserved_00,vulnerable,andspecialneedspopulations,thosecompetencieswillbecomeincreasinglynecessary.Collaborationwithseveral_00DHHS_00,otherFederalAgenciesandotherpartnerswillcontinuetobeawayofdoingbusiness.Sharingresourcesintheareasofdataandinformationisbecomingmorecommonbutwillneedtobemore_00operationalized_00inthefuture.Cooperativeagreementsandworkteamsoncross-cuttingissueshavebeenestablishedandarebeingmonitored. Trainingandprofessionalskillsdevelopmentintheareasofleadershipandfacilitatingchangeis $ beingdone._00HRSA_00Ԁwillneedtocontinuetoassurethatprogramsaredesignedtomeettheneedsofthe_00underserved_00ԀandthattheseprogramsreceivesufficientlyhighpriorityasFederalandStatebudgetdecisionsaremade.Thishasrequirednewandinnovativeeffortstoexpandmanycurrentactivitiesinordertoimproveprogramsynergy._00HRSA_00ԀhasestablishedtiestoStatesonissuesofmutualconcernandisenhancingworkingrelationshipsbetweenAgencyandState-basedhealthprograms._00HRSA_00Ԁhasleveragedexistingresourcesandhasworkedmorecreativelywithestablishedpartners,aswellasnewpartnersatthecommunity,State,andFederallevel,toassurethehighestdegreeofhealthcoveragepossibleforneedypopulations.Toassurethathealthcenters,Stateandlocalhealthdepartments,andother_00HRSA_00-supportedcommunityprovidersareadjustingtochangesinthehealthcaremarketplace,substantialtrainingandtechnicalassistancemustbemadeavailableinmanyareas,especiallyinthoseofmanagedcare,contractnegotiations,ratesetting,medicalmanagement,andutilizationreview. ?+ 4 <DL!X?1.3PartnershipsandCoordination *%)    XXH l+&*  #l3# ll# X*X l>#Amajorsourceof_00HRSA_00sstrengthisitsmanylinkagesandpartnershipswithotherFederal   agencies,States,andnationalandlocalorganizations.Forexample,workisongoingwiththeSubstanceAbuseandMentalHealthServicesAdministrationtointegratebehavioralhealthandsubstanceabusescreening,earlyintervention,referralandfollowupintoprimaryhealthcaresettingsfundedthrough_00HRSA_00Ԁgrants._00HRSA_00ԀandtheCentersforDiseaseControlarefocusedonavarietyofdiseasepreventionandhealthpromotionactivities.#X*XX X*?#XHXXX*#X*XXXHB#XHXXX* AmongthelinkageandpartnershiparrangementsthathavebeenformedwithavarietyofFederal $ t agencies,granteesandexternalpartnersarethefollowing:L 23456789[h$L 23   23~C2[3  0    _00HRSA_00ԀisformingnewlinkageswithourFederalpartnerssuchas_00ACF_00,CDC,_00SAMHSA_00Ԁand  8  CMS.#X*XXXH\B#XHXXX*23~CC݌$ (#(# Ќ   23   23@E2[3  0    _00HRSA_00sandCDCspartnershipeffortsarefocusedonavarietyofdiseasepreventionand   healthpromotionactivities,includingimmunizationeffortsandimproveddatacollectionandanalysis.#X*XXXHD#XHXXX*23@EkE݌ (#(# Ќ   23   23.G2[3  0    _00HRSA_00,CDCandCMSissueda LetterofAgreementtoStateMedicaiddirectors,State   healthofficials,andvariousprogramdirectors,encouragingthesharingofdataacrossthevariousprogramswithineachagency.Wearenowworkingwithwillingstatepartnersthathavecomeforwardtoprovidetechnicalassistanceto_00operationalize_00Ԁthisagreement.Wewillconductsomeregionalmeetingsduringthenexttwelvemonthstoshowcase ModelsThatWorkfordatasharing.#X*XXXHF#XHXXX*23.GYG݌ p(#(# Ќ   23   23XJ2[3  0    #X*XXXHI#XHXXX*_00HRSA_00Ԁiscollaboratingwith_00SAMHSA_00Ԁtointegratebehavioralhealth/substanceabuse  \ screening,earlyintervention,referralandfollowupintoprimaryhealthcaresettingsfundedthrough_00HRSA_00Ԁgrants.Thisisinrecognitionthatdepression,alcoholabuse,andinterpersonalviolenceareamongthemostprevalentproblemschallengingthehealth,bothphysicalandmental,ofAmericanstoday.Asthisactivitymovesforward,jointperformancemeasureswillbedevelopedwith_00SAMHSA_00.#X*XXXHJ#XHXXX*23XJJ݌(#(# Ќ  L w23456789F[hh23456789L 23   23ON2F[3  0    StateandlocalgovernmentsthroughsuchprogramsastheMaternalandChildHealthBlock  GrantandRyanWhiteprograms.23ONzN݌ (#(# Ќ  L x23456789V[hhw23456789L 23   23O2V[3  0    NonprofithealthorganizationssuchastheCommunityandMigrantHealthCenters.23OO݌l(#(# Ќ  L y23456789f[hhx23456789L 23   23#Q2f[3  0    Academicinstitutions,suchasthevarietyofpartnersworkingonhealthprofessionsissues.23#QNQ݌X (#(# Ќ  L z23456789[hhy23456789L 23   23R2[3  0    Foundations,suchastheRobertWoodJohnsonFoundation,theKelloggFoundation,andthe D! KaiserFamilyFoundation.23RR݌ (#(# Ќ  L {23456789&[hhz23456789L 23   23S2&[3  0    Nationalassociations,suchasthoserepresentingStateandlocalpublichealthdepartments #l! andgroupsofprimarycareproviders.23S(T݌ (#(# Ќ  L |234567896[hh{23456789L 23   23U26[3  0    BusinessgroupssuchastheWashingtonBusinessGrouponHealth.23UU݌$D #(#(# Ќ  L }23456789F[hh|23456789L 23   23V2F[3  0    NationalAcademyofPublicAdministrationPerformanceConsortiumandHealthGroup.23VV݌%0!$(#(# Ќ  Substantialworkhasbeendonetowardestablishingnewworkingrelationshipsandagreementswithsuchoutsideorganizations._00HRSA_00ԀwillcontinuetoneedtoreceiveState,localandnonprofitinputtohelpassurethatprogramsaredesignedtomeettheneedsofthe_00underserved_00.Theagencywillneedtoleverageexistingresources,workmorecreativelywithestablishedpartners,andplancloselywithnewpartnersatalllevelstoassurethehighestdegreeofcoveragepossibleforthepopulationsatneed. T,'+ _00ԇ#X*XXXHM# X*XXX*Throughitsmanyprogramsandnewinitiatives,HRSAhelpscountlessindividualslivehealthier,  moreproductivelives.Inthe21stcentury,rapidadvancesinresearchandtechnologypromise  unparalleledchangeinthenationshealthcaredeliverysystem.HRSAiswellpositionedtomeetthesenewchallengeswhileitcontinuestoprovidefirstratehealthcaretotheNationsmostvulnerablecitizens.#X*XX X*XZ#XHXXX* `  1.4SummaryFY2001PerformanceReport:Accountabilitythrough 8  ЀPerformanceMeasurement  $ t HRSAhasmadeastrongefforttobuildaperformancemanagementapproachintothewayitconductsitsbusiness.TheagencystructuredthedevelopmentofitsinternalstrategicplanningprocesstobeconsistentwiththerequirementsoftheGovernmentPerformanceandResultsAct(GPRA).ThegoalsdevelopedintheprocesshaveguidedthedevelopmentofourAnnualPerformancePlans.HRSAispleasedtoreportthatprogramsaremeetingorexceedingtheirtargetsasoutlinedinthisAnnualPerformancePlanandReport.Programs,inconjunctionwiththeirpartners,continuetofocusonimprovedcollection,analysisandreportingonperformancedata,andtheyaremakingprogresswithregardtotimelinessanddataaccuracy.Thisreportcontainsatotalof116measures,11ofwhicharedevelopmental.SixtyeightofthesemeasureshaveFY99targets.Ofthe68measures,HRSAhasFY99datafor61measures.Inaddition,programsareabletoreportFY00datafor67measuresandFY01datafor31measures.Themostcommonreasonsforthedelayinreportingdataarelaginreportingbygranteesforendofyearprogress,andperformancedataisdueinamultiyearversusyearlybasis(e.g.BPHCsHealthCenters).SpecificdiscussionaboutperformancedataislistedintheGoalByGoalSectionforeachGoal/Measure.HRSAinitiateditsGPRAperformancemeasurementeffortwithanassessmentofallprogramsandtheirreadinessformeasuringperformance,beginningwiththeGPRArequirementsasthebasisforthereview.TheAgency,usingeachmajorprogrambudgetline:L ~23456789V[hh}23456789L 23   23c2V[3  0    Identifiedbothstrengthsandweaknessesintermsofabilitytomeasureperformance.23cc݌0" (#(# Ќ  L 23456789f[hh~23456789L 23   23e2f[3  0    Assessedthecurrentavailabilityofindicatorsanddatathatcanbeusedtoensureeffective #l! managementofresources.23e/e݌ (#(# Ќ  L 23456789v[hh23456789L 23   23f2v[3  0    Identifiedkeyareaswheredevelopmentalactivitiesareneededandhavechanneledagency $D # resourcestotheseareas.23ff݌ (#(# Ќ  Technicalassistancehasbeenprovidedtoeachoftheoperatingcomponentstoenhancetheirabilitytodefineperformancegoalsandmeasures.Theagencyhasmadeasignificantcontributiontosolvingtheproblemsidentifiedasareasofresponsibility.Improvingaccesstocarefortheunderserved,expandingaccesstocareforwomenandchildren,improvingthegeographicandspecialty distributionofhealthprofessionals,andimprovingtherangeofcareoptionsforpeoplelivingwith h+&* HIV,arealltargetsthatHRSAhasaddressedandcontinuestoaddressaswemoveintothenextcentury. AccessfortheUnderserved: Accesstohealthcareforlowincome,underservedandminority t Americanscontinuestobeaproblem.Currently,some43millionunderservedpersonsresideindesignatedruralandinnercityunderservedareas.HRSAsHealthCentersandtheNationalHealthServiceCorps(NHSC)programsserve12millionofthesepeople(25percent)inmorethan4,000communitiesacrosstheNation.AnotherindicatorofbothanaccessproblemandaHRSAcontributiontohelpingsolvethatproblem,relatestothegrowinguninsuredpopulation.In2000,some38.7millionpeoplelackedhealthinsurance,ofwhommorethan10millionwerelowincome.TheHealthCenters/NHSCprogramsserve4.1millionuninsuredpersons,ofwhommorethan2millionarechildren.Thisisa50percentincreasesince1990.Althoughinadequateaccesstohealthcareisaseriousnationalproblem,thereisnosinglesolution.Inadditiontocost,thereareobstaclessuchasgeographicbarriers,culturalbarriers,andstructuraldifficultiesthatneedtobeaddressed.Forthatreason,HRSAworkshandinglovewithStateandlocalorganizationstocreatehealthcaresystemsthatrespondtothespecificneedsofpeopleinthecommunitytheyserve.UnderservedandlowincomeindividualsrelyonHRSAHealthCentersforthefullrangeofpreventiveandprimarycareservices,includingmentalhealthandsubstanceabusetreatment,casemanagement,referralstoandoversightofspecialtyandinpatientcare,andservicesthathelpthemusehealthcareservicesmosteffectively.HealthCentersnotonlyimprovethehealthofunderservedindividuals,butalsothewellbeingofthecommunitiesinwhichtheylive.Theystimulateeducationandtheneighborhoodeconomy.Theyareasignificantforcetoquellthepublichealththreatsofthe90'sviolence,childabuseandneglect,substanceabuse,andothercausesofprematuredisabilityanddeath.DuringFY2000,HRSAbegantoimplementtheHealthCareAccessfortheUninsuredProgram. \  TheCommunityAccessportionoftheprogramisdesignedtoassistcommunitiesandtheirsafetynetprovidersindevelopingintegratedhealthcaredeliverysystemsthatservetheuninsuredwithgreaterefficiencyandimprovedqualityofcare.InFY2000,23communitieswereawardedfundingtoestablishimprovednetworks.Inaddition,undertheStatePlanningGrantsportionoftheprogram,11Stateswerefundedtocarryoutstudiesthatidentifyuninsuredresidentswithineachstateandtodesignproposalsforprovidingthemaccesstohealthinsurance.AdditionalsitesforbothprogramshavebeenfundedinFY2001. WomenandChildren: ThehealthofmothersandchildrenisaprimarytargetforHRSAs (#' programs.TheMaternalandChildHealthBlockGrantistheonlyFederalprogramthatfocusesonimprovingthehealthofallmothers,adolescentsandchildren,whetherinsuredornot,throughabroadarrayofpublichealthandcommunitybasedprogramsthataredesignedandcarriedoutthroughwellestablishedFederalStatepartnerships.StateTitleVprogramssupportcapacityand \,'+ infrastructurebuilding,populationbasedandenablingservices,aswellasdirecthealthcareserviceswherenoservicesareavailable.Intheselatterroles,TitleVprogramsserveasasafetynetforuninsuredandunderinsuredchildren.BoththeMaternalandChildHealthProgramandtheHealthCenters,incooperationwithCMS,areconductingoutreacheffortstoenrollchildrenintheStateChildrensHealthInsuranceProgram(SCHIP).Theprogramhassuccessfullycoveredovertwomillionchildreninthefirstfullyearofoperation.ThereareproblemsinsomeStates,however,thataschildrenareenrolledinSCHIP,thenumberenrolledinMedicaidisdeclining.Inthesesituations,theTitleVprogramsoftenseeanincreaseintheirsafetynetfunctions.Between1995and1997,thenumberofchildrenservedunderTitleVrosefrom11.3millionto19.4millionchildren,anincreaseof8.1millionchildren.Onemeasureoflongtermprogressandsuccessinthehealthcaresystemisthecontinuingdeclineintheinfantmortalityrate.From1990to1997,theU.S.infantmortalityratedeclinedbymorethan22percent,from9.2to7.1deathsper1,000livebirths.ProgramssuchastheMaternalandChildHealthBlockGrant,theHealthCentersprogram,andtheHealthyStartInitiativehaveallcontributedtothisdecline.Animportantfactorinthisprogressisthereceiptofearlyandqualityprenatalcareforlowincome,minorityandunderservedpregnantwomen.In1998,theproportionofpregnantwomenacrosstheNationreceivingprenatalcareinthefirsttrimesterreached83percent.Despitethesesuccesses,problemsstillremain.TheinfantmortalityrateforAfricanAmericansisstillapproximatelytwicethewhiterate.Anotherareathatseemstobeshowingsomesignsofimprovementistherateofteenagepregnancy.Afteryearsofincreases,theteenbirthratedeclined12percentbetween1991and1996,accordingtotheCentersforDiseaseControlandPrevention.Theproportionofstudentswhohadsexualintercoursealsofell11percentduringthe1990's.Despitetheserecentdeclines,teenpregnancyandoutofwedlocksexualactivityremainasignificantproblemincommunitiesacrossthecountry.ProgramssuchastheMaternalandChildHealthprogramandtheAbstinenceEducationProgramaredesignedtohelpcontinuefavorabletrends. HealthProfessions :HRSAprogramsaredesignedtopromotehealthprofessionalsinareaswhere X  theyaremostneededinunderservedareas.StrategiesusedbytheHealthProfessionsprogramsforsolvingthecurrentmaldistributionproblemandthusimprovingaccesstohealthcareinclude:L 23456789[hh23456789L 23   23Ɓ2[3  0    providinginstitutionalincentivestohealthprofessionsschoolswithagoodtrackrecordfor  $\" placingtheirgraduatesinunderservedareas;23Ɓ݌ (#(# Ќ  L 23456789[hh23456789L 23   23]2[3  0    increasingthenumberofhealthcareandpublichealthprovidersfromminorityand %4!$ disadvantagedbackgrounds;23]݌ (#(# Ќ  L 23456789[hh23456789L 23   23ք2[3  0    fosteringcommunitybasededucationandtrainingespeciallyinunderservedareas;23ք݌' #&(#(# Ќ  L 23456789V[hh23456789L 23   23'2V[3  0    supportingtrainingthatisdirectedatthespecialneedsofvulnerable,underserved (#' populations;and23'R݌ (#(# Ќ  L 23456789f[hh23456789L 23   232f[3  0    enhancingservicestounderservedpopulations.23Ç݌*%)(#(# Ќ  Thehealthprofessionsprogramsaggressivelyaddresstheissueofaccesstohealthcare.Availabilityofanadequatestaffofhealthprofessionalsinunderservedareasisacriticalandoftenoverlooked X,'+ issue.WhileeffortsareunderwaytoimprovetheinsurancecoverageissuethroughprogramssuchasMedicaidandSCHIP,aproblemremainsifthereisnoqualifiedhealthcareprofessionalavailableandwillingtoprovidehealthcare.Theavailabilityofanadequatestaffofqualified,culturallycompetenthealthcareprofessionalsisequallyimportant.HealthprofessionsgraduatesofHRSAprogramsarethreetosixtimesmorelikelytopracticeinunderservedareasthanthoseinprogramsnotsupportedbyHRSA.HRSAprogramsarealsodirectedtowardincreasingthenumbersofminoritiesinthehealthprofessions.Theemphasisonminoritiesservestwomajorpurposes.First,itcontributestomovingminoritiesintothehealthprofessionsinconcertwiththeirrepresentationinthepopulation.Althoughunderrepresentedminoritiesmakeupnearly25percentoftheU.S.population,theyonlyaccountfor10percentofallhealthprofessionals.Second,datashowconclusivelythatminorityhealthprofessionalstendtopracticeinareaswherethereisinadequateaccesstohealthcare.Thus,theminorityemphasisinHRSAprogramsnotonlyservestoimproverepresentationintheworkforce,butisamajorfactorcontributingtosolvingtheaccesstohealthcareproblem.GraduatesofHRSAsBureauofHealthProfessionsTrainingProgramsaretwotothreetimesmorelikelytobeunderrepresentedminorityhealthprofessionals,thangraduatesofthoseprogramsnotsupportedbyHRSA. ExpandingCareOptionsfortheHIVPopulation :ThroughtheRyanWhiteCAREAct,an  p estimated500,000peopleeachyearhaveaccesstoservicesandtreatmentstokeepthehumanimmunodeficiencyvirusatbayandenablethemtolivenotjustsurvive.EarlyintheAIDSepidemic,itbecameclearthatthevirusspreadfasterinsomeplacesthaninothers.Inthoseareas,healthcaresystemswereoverwhelmedbythenumberofpeopleneedingtreatmentforHIV/AIDS.Today,approximately75percentofpeoplelivingwithAIDSresideinthesehardesthitareas.ThroughTitleIoftheCAREAct,HRSAissharingtheburdenwiththeseEligibleMetropolitanAreas.UnderTitleIIoftheCAREAct,fundsareprovidedtoStatestoimproveaccesstohealthcareandsupportservices.Thesefundssupportarangeofservices,helpkeephealthinsuranceinplace,andpayformedications.ThroughStateAIDSDrugAssistancePrograms(ADAP),medicationsareprovidedtolowincomeindividualswithHIVdiseasewhohavelimitedornocoveragefromprivateinsuranceorMedicaid.OneofthemosteffectivetreatmentsforHIVpositiveindividualshasbeenappropriateantiretroviraltherapy.Individualswhohaveaccesstothemostappropriatemixofpharmaceuticalshaveshownsignificantdecreasesinmortalityandmorbidity.Theimpactofnewcombinationdrugtherapieswasfirstreportedin1997whenAIDSdeathsdroppedforthefirsttime.ThenationaldeathratefromAIDSdropped42percentfrom1996to1997.Itthendeclined20percentbetween1997and1998.FundingfromtheADAPprogramhascontributedsignificantlytotheavailabilityofsuchpharmaceuticals.Giventheefficacyofthesedrugtreatments,thisexpenditurehasaveryhighpayoff. X,'+ Ї OrganProcurementandTransplantation: Anotherareaofsignificantprogresshastodowith  organprocurementandtransplantation.Thetotalnumberoforgantransplantsincreased53percentbetween1990and2000,butthenumberoftransplantcandidatesisrisingfasterthanthenumberofdonors.TheDepartmenthasrecentlylaunchedseveralnewinitiativestoaddresstheneedforincreasingorganandtissuedonationsinboththepublicandprivatesectorsofthecountry.2000datashow5,984donors,upslightlyfromtheyearbefore.Thisisnotenoughtokeepupwiththeneedfororgans,sincetherearenowmorethan79,500registrantswaitingfororgans.TheNationalInitiativehasresultedinmorepeoplehearingabouttheneedfororganandtissuedonationandmorepeoplerespondingwiththegiftoflife.Therewillneedtobeaconcertedeffortinordertomovetowardkeepingupwiththeneedfororgans. RuralHealth: AbouthalfofthemedicallyunderservedliveinruralAmerica.Somearepoorand (  uninsured,butmanyhaveinadequateaccesstocareforthesimplereasonthatnotenoughhealthprofessionalsandclinicsarecloseenoughtomeettheirroutineandurgentcareneeds.Ruralhealthoutreachprogramsaredesignedtoaddresssomeoftheseproblems,whileStateOfficesofRuralHealthprovideafocalpointwithineachStateforidentifyingandaddressingruralhealthissues.HRSAsruralhealthcommunityhealthcentersandclinicsandNationalHealthServiceCorpsprovidersareplacedinsomeofthemostdifficulttoserveareas. Telehealth: Tobridgegapsoftimeanddistancethatseparateindividualsandfamiliesfromneeded < healthcare,HRSApromotestelehealththeuseofelectronicinformationandtelecommunicationstechnologiestodiagnoseandtreatpatients.Astechnologybecomesmorewidespreadandmoresophisticated,HRSAexpectstelehealthtobridgehealthcaregapsinbothruralregionsandurbanareas. HospitalPreparedness(Bioterrorism)C!XXH    #XHX!Cj# Terroristsmaythreatenorattempttouseabiological,chemicalorradiologicalweaponagainstthe  UnitedStates.Withrespecttoterrorism,localemergencymedical,fire,policeandpublichealthagenciesstanddirectlyonthefrontlines.HowwelltheUnitedStatesrespondstosuchanattackorthreatwilldependon(1)thepreparednessoflocalcommunities,theirhospitals,outpatientfacilitiesandemergencyhealthsystemsandprovidersand(2)thepreparednessofStatesandtheFederalgovernmenttoaugmentthecapabilitiesandcapacitiesofthelocalresponsemechanisms.Therecontinuestobeinsufficientcapitalfundingbyprivateandpublicsourcestoensuretheprovisionofmedicalaswellaspublichealthservicesintheeventofabioterroristattack.#X*XXXH`\#bXHXXX*TheHRSAsHospitalPreparedness(Bioterrorism)initiativehasseveralprograms.#X*XXbXH#bXHXXX*Aspartofthe %P # PresidentsHomelandSecurityinitiative,HRSA#X*XXbXH#bXHXXX*Ԁ#X*XXbXHB#XHXXX*willfundaHospitalPreparednessProgramto %ll>   < db 5+"?<eVd 5#XHX%%&& #&&%%XXH 4e!? 4 =<*?e = T<<eV?&?  < dTTotalNewSites ;<e("B@<<eVd ;FY03:90#XHX%%&& #&&%%XXH BA FY02:#XHX%%&&u #&&%%XXH130#XHX%%&& #&&%%XXH B<e/)B<L"<e B#XHX%%&& #&&%%XXH B<</)E<M"<e B b<eVM4BF<KKN"   << db 5+"G<eVd 5#XHX%%&& #&&%%XXH 4e!G 4 =<*Ge = T<eV?&G  < dT 5+"H<eVd 5 4e!H 4 =<*He = T<<eV?&H  < dTTotalSites 7<e$"I<<eVd 7FY03:3,537#XHX%%&&#&&%%XXH J FY02:3,447#XHX%%&&#&&%%XXH `K FY01:3,317#XHX%%&&k#&&%%XXH -<e8 L<e -FY01:3,317#XHX%%&&#&&%%XXH `N FY00:3,211#XHX%%&&J#&&%%XXH -<<8 O<e -#XHX%%&&#&&%%XXH NEW P FY01DATA Q<<eV<#8 R   << dQc)ExpandedSites ;<e("d"S<<eVd ;FY03:80#XHX%%&&#&&%%XXH d"T FY02:130#XHX%%&&.#&&%%XXH <#U  B<e/)$< W<T%<e B B<</)d"X<ppU%<e B b<eVM4d"Y<ppV%   << db 5+"$`Z<eVd 5#XHX%%&&#&&%%XXH 4e!$`Z 4 =<*$`Ze = T<<eV?&$`Z  < dTTotalNeworExpandedSites ;<<e("%![<<eVd ;FY03:170#XHX%%&&#&&%%XXH %!\ FY02:260#XHX%%&&i#&&%%XXH B<<e/)T(#_<d(<<e B B<<</)%!`<ppe(<<e B b<<eVM4%!a<ppf(   <<< db 5+"+'g<<eVd 5#XHX%%&&#&&%%XXH 4e!x'"g 4 =<*x'"ge = #XHX%%&&.#&&%%XXH W<<eVB&x'"g  < dW B.2IncreaseAccessPoints    Amongnewapplicants,increasethenumberofgrantapplicantsthatarefaithbasedorcommunitybasedorganizations. 7<e$"@<<eVd 7FY03:+10% -<<<e -FY02:Baselineunderdevelopment -<eh << -B97 T<<eV?#    <e dT&&%%%%&&&&%%%%&&&&%%%%&&&&%%%%&&&:(%%%&&&:(%(%&:&:(%(%&: &M'%(%&:    )  C.FocusonTarget    Population)L 4Ԍ̌ &M'%'% &M &M'%'% &M&&%%'% &M&&%%%%&&  1.Assureaccesstopreventive   andprimarycareforlowincomeindividuals(i.e.,atorbelow200%ofpoverty)#XHX%%&&#&&%%XXH. X   7<e$"0 <<eVd 7  򀀀   Ѐ    FY03:86#XHX%%&&#&&%%XXHԀ%10.97#XHX%%&&#&&%%XXHM   FY02:86#XHX%%&&= #&&%%XXHԀ%10.11#XHX%%&& #&&%%XXH \  FY01:86#XHX%%&& #&&%%XXHԀ%9.03#XHX%%&&K!#&&%%XXH 4  FY00:86#XHX%%&&!#&&%%XXHԀ%8.26#XHX%%&&!#&&%%XXH  \  #XHX%%&&G"#&&%%XXHFY99:86#XHX%%&&"#&&%%XXHԀ%7.65#XHX%%&&"#&&%%XXH 4  #XHX%%&&7##&&%%XXH -<< <e -#XHX%%&&##&&%%XXHFY01:(8/02)#XHX%%&&##&&%%XXH 0   FY00:87%(8.35M)#XHX%%&&Q$#&&%%XXH X ! FY99:86%#XHX%%&&$#&&%%XXH 0 " FY98:86%#XHX%%&&%#&&%%XXH  # FY97:86%#XHX%%&&|%#&&%%XXH -<e $<< -B97 NEW  ' FY00DATA T<<eV?#0 )   <e dT2.Assureaccesstopreventiveandprimarycareforminorityindividuals(racialminoritiesorofHispanicorigin). 7<e$"L-<<eVd 7   - FY03:65%#XHX%%&&%#&&%%XXH - #XHX%%&&'#&&%%XXH8.29M#XHX%%&&'#&&%%XXH L / FY02:65#XHX%%&&5(#&&%%XXH% - 7.64#XHX%%&&(#&&%%XXH $t0 FY01:65%#XHX%%&&(#&&%%XXH - 6.83#XHX%%&&I)#&&%%XXH L1 FY00:65%#XHX%%&&)#&&%%XXH - 6.24#XHX%%&&)#&&%%XXH $2 FY99:65%#XHX%%&&N*#&&%%XXH - 5.79#XHX%%&&*#&&%%XXH -<e3<e -FY01:(8/02)#XHX%%&&+#&&%%XXH L7 FY00:64%(6.18M)#XHX%%&&+#&&%%XXH $8 FY99:64%#XHX%%&&+#&&%%XXH 9 FY98:64%#XHX%%&&J,#&&%%XXH : FY97:65%#XHX%%&&,#&&%%XXH -<<\;<e -B97#XHX%%&& -#&&%%XXH L =  NEW L? FY00DATA Q<<eV<#A   << dQ3.Assureaccesstopreventiveandprimarycareforuninsuredindividuals. 7<e$"<D<<eVd 7  FY03:41%#XHX%%&&-#&&%%XXH - 5.23M#XHX%%&&.#&&%%XXH dF FY02:41%#XHX%%&&A/#&&%%XXH - 4.82#XHX%%&&/#&&%%XXH <G FY01:45%#XHX%%&&/#&&%%XXH - 4.73#XHX%%&&U0#&&%%XXH H FY00:43%#XHX%%&&0#&&%%XXH - 4.10#XHX%%&&1#&&%%XXH I FY99:42%#XHX%%&&Z1#&&%%XXH - 3.80#XHX%%&&1#&&%%XXH -<etJ<e -FY01:(8/02)#XHX%%&& 2#&&%%XXH <M FY00:40%(3.86M)#XHX%%&&2#&&%%XXH N FY99:41%(3.7M)#XHX%%&&2#&&%%XXH O FY98:41%;3.5M#XHX%%&&^3#&&%%XXH tP FY97:39%#XHX%%&&3#&&%%XXH -<<LQ<e -B97#XHX%%&&)4#&&%%XXH dS  NEW U FY00DATA Q<<eV<#tW   << dQ #&M'%%%&&#&&%%'%&MII.ELIMINATEHEALTH ,|X DISPARITIES #&M'%%%&&p5# &M'%'%&M ;<e("TY<<eVd ;FY03:90%# X*X'% &M4# &M'%X X* T[ FY02:90%# X*X'% &Mq6# &M'%X X* ,\ FY01:90%# X*X'% &M6# &M'%X X*  ] FY00:80%# X*X'% &M37# &M'%X X* !^ FY99:60%# X*X'% &M7# &M'%X X* B<e/)d"_<l*<e BFY01:(9/03)# X*X'% &M7# &M'%X X*  c FY00:(9/02)# X*X'% &M8# &M'%X X* !d FY99:60%# X*X'% &M8# &M'%X X* d"e FY98:43%# X*X'% &MN9# &M'%X X* B<</)<#f<m*<e BB97# X*X'% &M9# &M'%X X* e<eVP4Th<n*   << de #&M'%'% &M5#&&%%'%&MA.UtilizationofServices  ' wi  401.Increasepercentofdiabeticuserswithuptodatetestingof_00glycohemoglobin_00Ԁ#&M'%%%&&:#?&Ou*%'%&MB#&M'%*%?&Ou;#&&%%'%&MԀ%adults "l withdiabetestestedatrecommendintervals.#&M'%%%&& <# &M'%'%&M c$n  5+")$s<eVd 5 7e$ os 7 7<$ ose 7# X*X'% &M7:# &M'%X X* W<eVB& os   < dW 5+"k*%t<eVd 5 7e$c*%t 7 7<$c*%te 7 T<<eV?&c*%t   < dT2.Increasepercentofusers withdiabeteswhohavehadanannualdilatedeyeexam. @<e-"h<<eVd @  򀀀HP  _00BPHC_00   2010:70%FY03:90% # X*X'% &M=# &M'%X X*   2000:70%FY02:90%# X*X'% &Mo@# &M'%X X*    FY01:90%# X*X'% &M@# &M'%X X* 6<e#! <e 6?  FY01:9/04# X*X'% &MTA# &M'%X X*   FY00:9/03# X*X'% &MA# &M'%X X*   FY99:9/02# X*X'% &MXB# &M'%X X*    FY94:57%# X*X'% &MB# &M'%X X* (  FY89:49%# X*X'% &MC# &M'%X X* -<< 0 <e -AB# X*X'% &MC# &M'%X X*97 ]<<eVH,    << d]3.Increasepercentofhealthcenterwomenreceivingageappropriatescreeningforcervicalandbreastcancer. ;<e("H <<eVd ;Ѐ HP  󀀀 _00BPHC_00# X*X'% &MD# &M'%X X*    2010:90%FY03:96%# X*X'% &ME# &M'%X X*   2000:85%FY02:95%# X*X'% &MF# &M'%X X*  $   FY01:94%# X*X'% &MuF# &M'%X X*  ,    FY00:92%# X*X'% &MF# &M'%X X* 4    FY99:90%# X*X'% &M_G# &M'%X X* B<e/)< <1<e BFY01:(11/03)# X*X'% &MG# &M'%X X*  (  FY00:(9/03)# X*X'% &MiH# &M'%X X* 0  FY99:(9/02)# X*X'% &MH# &M'%X X* 8  FY95:88.5%# X*X'% &M3I# &M'%X X* B<</)@ <1<e BB97# X*X'% &MI# &M'%X X* e<eVP4 "<1   << dea)UptodatePAPtests >4"H #<eVd > 7e$@ # 7 7<$@ #e 7 T<<eV?&@ #   < dTb)Uptodate_00mammograms_00 @<e-" $<<eVd @2010:70%FY03:78%2000:60%FY02:75%# X*X'% &MJ# &M'%X X* (&   FY01:70%# X*X'% &ML# &M'%X X* 0'   FY00:67.5%# X*X'% &ML# &M'%X X* 8(   FY99:65%# X*X'% &MoM# &M'%X X* 6<e#!@)<e 6FY01:(11/03)# X*X'% &MM# &M'%X X* (+ FY00:(9/03)# X*X'% &MkN# &M'%X X* 0, FY99:(9/02)# X*X'% &MN# &M'%X X* 8- FY95:62.5%# X*X'% &M5O# &M'%X X* -<<@.<e - Q<<eV<# /   << dQc)Uptodateclinicalbreastexams @<e-"1<<eVd @FY03:87%FY02:86%# X*X'% &MO# &M'%X X* (3 FY01:85.5%# X*X'% &MP# &M'%X X* 04 FY00:84%# X*X'% &M3Q# &M'%X X* 85 FY99:82.5%# X*X'% &MQ# &M'%X X* 6<e#!@6<e 6FY01:(11/03)# X*X'% &MQ# &M'%X X* (8 FY00:(9/03)# X*X'% &M~R# &M'%X X* 09 FY99:(9/02)# X*X'% &MR# &M'%X X* 8: FY95:80.5%# X*X'% &MHS# &M'%X X* -<<@;<e - Q<<eV<# <   << dQ4.IncreasepercentofHealthCenteradultswithhypertensionwhoreporttheirbloodpressureisundercontrol. @<e-"X@<<eVd @  Ӏ HP   _00BPHC_00   A 2010:50%FY03:96%# X*X'% &MS# &M'%X X* ,B 2000:50%FY02:96%# X*X'% &MU# &M'%X X* 4C   FY01:96%# X*X'% &M V# &M'%X X* <D   FY00:93%# X*X'% &MV# &M'%X X* DE   FY99:92%# X*X'% &MV# &M'%X X* 6<e#! LF<e 6T  FY01:(11/03)# X*X'% &MkW# &M'%X X* (H FY00:(9/03)# X*X'% &MX# &M'%X X* 0I FY99:(9/02)# X*X'% &MsX# &M'%X X* 8J FY95:90%# X*X'% &MX# &M'%X X* -<<@K<e -WB97# X*X'% &M9Y# &M'%X X* Z<<eVE,(M    << dZ III.ASSUREQUALITYOF !,N CARE  "O  A.AppropriatenessofCare  # P 1.Decreaseproportionof_00HC_00userswhoarehospitalizedforpotentiallyavoidableconditions.# X*X'% &MY# &M'%X X* ;<e("P'"T<<eVd ;FY03:12.0# X*X'% &MU[# &M'%X X* "4V FY02:12.5# X*X'% &M[# &M'%X X* #<W FY01:13.0# X*X'% &M@\# &M'%X X* $D X FY00:13.5# X*X'% &M\# &M'%X X* %L!Y FY99:14.0# X*X'% &M]# &M'%X X* E<e2)'T"Z<4<e EFY01:(9/07)# X*X'% &Mf]# &M'%X X* "4\ FY00:(9/05)# X*X'% &M]# &M'%X X* #<] FY99:(9/03)# X*X'% &M_^# &M'%X X* $D ^ FY98:(9/02)# X*X'% &M^# &M'%X X* %L!_ FY97:14.7/1000# X*X'% &M'_# &M'%X X* 'T"` Norm:18.9/1000# X*X'% &M_# &M'%X X* B<</) (\#a<[[4<e BB97# X*X'% &M_# &M'%X X* e<eVP4"4c<4   << yde# X*X'% &M}`# &M'%X X* >e+"0(#d<eVd > 7e$((x#de 7 7<$((x#de 7 W<eVB&((x#d  y < dW >e+")$e<eVd > 7e$)$ee 7 7<$)$ee 7 6,*)$e    < 6_00*@Ad d Pm mmmmmP<=(#(#, Pm,A mm, mm+  8<<eeV#  d8 TotalFunding:Health  Centers ($in000's) 7<ee$"<<eeVd 7FY03:$1,458,867FY02:$1,344,468# X*X'% &M$a# &M'%X X*  FY01:$1,179,404# X*X'% &M?e# &M'%X X*  FY00:$1,018,499# X*X'% &Me# &M'%X X*   FY99:$924,456# X*X'% &Mf# &M'%X X* ( FY98:$824,634# X*X'% &Mxf# &M'%X X* 0<e< 0 <ee 0Bx:page#budgetHP:HealthyPeople2000chapter# X*X'% &Mf# &M'%X X*3)'    <e< 3# X*X'% &Mg# 2.1.1ProgramDescription,ContextAndSummaryofPerformance  $   TheConsolidatedHealthCentersProgramwasselectedasapilotprogramfortheAdministrations  @  BudgetandPerformanceIntegrationInitiative.Thisplanhasmadestrongconnectionsbetweenperformanceandbudgetdecisions,sothatincreasesinfundingmaybelinkedtoincreasesinaccesstoservices.Toassistinthiseffort,wehaveaddedanewmeasuretoincreaseaccesstohealthcarebysupporting1,200newandsignificantlyexpandedcommunityhealthcentersitesoverfiveyears.HealthCentersformacosteffective,integratedsafetynetforunderservedanduninsuredchildren,adults,migrantworkers,homelessindividuals,publichousingandU.S./Mexicoborderresidentsinapproximately4,000communitiesacrossthecountry.InfiscalyearFY2001itisestimatedtheyserved10.5millionpersonswhowouldotherwiselackaccesstoprimarycareclinicians.These10.5millionpersonsrepresentabout:L 23456789[hh23456789L 23*   23Tl2[3  0 r   10%ofthenationsuninsured23Tll݌r(#r(# Ќ  L 23456789[hh23456789L 23+   23tm2[3  0 r   10%ofits33millionMedicaidrecipients23tmm݌r(#r(# Ќ  L 23456789[hh23456789L 23,   23n2[3  0 r   20%ofthe43millionunderservedpeopleinfederallydesignatedareaslackingaccessto , primarycareproviders.23nn݌ r(#r(# Ќ  Thiscommunitybasednetworkdeliverspreventiveandprimarycareservicesfortheneediest,poorest,andsickestpatientsinruralandinnercityareas,throughaFederal,State,andcommunitypartnershipapproach.#X*XX X*<#CX*XXX*Thehighqualityprimaryhealthcarereceivedintheseprogramsreduceshospitalizationsand !`! emergencyroomuse,reducesannualMedicaidcosts,andhelpspreventmoreexpensivechronicdiseaseanddisability.L c23456789\hh23456789L 23-   23r2\3  0 r   ReductionsinMedicaidcostsforacomparablegroupseekinghealthcareelsewhererangefrom $T$ 30to34%,accordingtoaHealthCenterMedicaidBeneficiaryEffectivenessstudy.23rGr݌ r(#r(# Ќ  L f23456789\hhc23456789L 23.   23s2\3  0 r   HealthCenterMedicaidpatientsare22%lesslikelytobeinappropriatelyhospitalizedthan  &\!& Medicaidbeneficiarieswhoobtaincareelsewhere.23st݌ r(#r(# Ќ    L*%* PatientsatHealthCentershaveratesofhypertensionanddiabetesthatfarexceednationalprevalence ratesforcomparableracial/ethnicandsocioeconomicgroups.Yet:L 23456789&Thhf23456789L 23/   23Ev2&T3  0 r   HealthCenterdiabeticsaretwiceaslikelytohavetheirCXCX*Ԁ#CX*XCv#glycohemoglobintestsperformedat  regularintervalsthannationalnorms,and23Evpv݌ r(#r(# Ќ  L 23456789[hh23456789L 230   23x2[3  0 r   Hypertensivesaremorethanthreetimesaslikelytoreportthattheirbloodpressureisunder J control.CXCX*23xEx݌ 6r(#r(# Ќ  #Cp#C|]D40l~r W  `E W   W | (# (#(#(##CX*XCy#C&M'%XCX* (#(# (# (##CX*X'%C&Mez#HealthCenterslowbirthweightratesapproximatethenationalaverageforallinfants.However,  healthcenterlowbirthweightratesareapproximately50%lessthanthenationalaveragebetweenAfricanAmericansandotherracial/ethnicgroups. r    "  z    *   #X*XXCX*y# CX*XXX*HealthCenterwomenarefarmorelikelytoreceiveage-appropriatebreastandcervicalcancer  screening,andtheirratesexceedtheHealthyPeople2010goals.HealthCenteruninsuredpatientsarefarlesslikelytodelay,postponeornotcomplywithtreatmentthantheNationsuninsuredwhoseekcareelsewhere.Havingaregularsourceofprimaryhealthcarehasbeenshowntohaveasmuchofaneffectonhealthstatusdisparitiesasincomeinequality.HealthCenterpatientsofcolorarefarmorelikelytohaveausualandregularsourceofcarethanpoorpeopleofcolorintheNation,whichbodeswellforeventualreductionsandeliminationsoftheirhealthstatusdisparities.#X*XXCX*V|# X*XXX*  $  PerformancegoalsfortheHealthCentersrelatetoreductionofdisparitiesandincreasesinaccess. &"! HealthCenterscontributetodecreasesinracialandincomedisparitiesfortheseconditionsbyprovidingpreventiveservicesandriskreductiontoapopulationthatis:1)largelyminority(64%),2)lowincome(87%),and3)disproportionatelyuninsured(40%).About75%ofpatientsareeitheruninsuredoronMedicaid,whichmakesthesesitesextremelyvulnerabletothemarketdrivendownwardpressureonrevenues. \+&& ЇSpecificperformanceindicatorsincludebreast/cervicalcancerscreening,diabeticcarecontent,controlofhypertension,anddecreasesinpotentiallyavoidablehospitalizations.HypertensionanddiabetesarethemostprevalentchronicconditionsamongHealthCenterusers.Monitoringperformanceinchronicdiseasemanagementfortheseconditionswillserveasamarkerforqualityofcaredeliveredat X X*Ԁ# X*X h#HealthCentersandsitesandultimatelymeasuretheirabilitytoeliminatehealthdisparitieswithin ` thepopulationserved.Breast/cervicalcancerscreeningareeffectivemeasuresforreducingfuturemorbidityandmortalityparticularlyamongpoor,minority,uninsuredindividuals.PerformanceherewillserveasamarkerforthequalityofpreventivecareandmeasureHealthCenterandsiteabilitytoreduceoreliminatedisparitiesinearlydetectionofdisease.Trackingavoidablehospitalizationsisameasureofaccess.Uninsuredpoorpeopleofracial/ethnicminoritiesaremorelikelytopostponeoravoidobtainingneededcarewhichoftenresultsinmoreexpensivehospitalizations.Avoidinghospitalizationsnotonlycontainscosts,butitindicatesthatsuchindividualsconsidertheirproviderasaregularsourceofcare.Providingsuchcaretothemostvulnerablehasbeenshowntoeliminatetheirhealthdisparities.Toprovideagreaterconnectionbetweenperformanceandbudgetdecisions,anewmeasuretoincreaseaccesstohealthcarewasdeveloped.Specificperformanceindicatorsinaccessincludethenumberofneworexpandedsites,thenumberofpersonsservedbyHealthCenters,includingtheuninsuredandtheunderinsured,andcontinuedassuranceofpreventiveandprimarycareservicestolowincome,minority,anduninsuredindividuals.TrackingindividualHealthCenterperformanceonallthesemeasuresabovewillenabletheprogramtocontinuouslyimproveitsoveralllevelofperformance.SuccessfulstrategiesemployedinHealthCenterswithratesthatfarexceedtheaveragecanbesharedwithCentersthatcoulduseimprovementintheirrates.Continuouslymonitoringandimprovingcarequalitywillresultinperformancethatmovestowardtheproposedtargets.   ProgramDataIssues: >  X X*# X*X %#DiscussionofDataSources ^!  TopreparefortheimplementationofGPRA,severalyearsagoBPHCinitiatedathreepartdata z" collectionandevaluationstrategy.First,aUniformDataSystem(UDS)wasdevelopedandimplementedtocollectaggregateadministrative,demographic,financial,andutilizationdataannuallyfromeachorganizationreceivingsupport.Thissystem,whichcombinedfivepreviouslyseparatereportingformats,isinitsfifthyearofoperationforabout700healthcentergrantees.Itisvalidatedthrougheditchecksandonsitereviewsconductedduringeachorganizationsprojectperiod.Itisusedtosupplyinformationfortheaccessperformancegoals.InFY2002,UDSwillberedesignedbasedonfeedbackfromfocusgroupscomprisedofUDScustomers.Inaddition,granteesweregiventheoptiontotransmitUDSdataforCY1999electronically,withmandatoryelectronictransmissionforCY2000.Over20%ofgranteesprovidedsuchdataforFY1999,andnearlyallgranteestransmittedelectronicallyinFY2000.Mandatoryelectronicsubmissionwilladdressthereliabilityandvalidity +'( concernsexpressedinarecentGAOreport.CY2000UDSdatawereavailableinNovember2001,  withmorerapidturnaroundanticipatedinfutureyearsastheefficiencyofelectronictransmissionimproves.Second,surveysofarepresentativesampleofhealthcenterusersandprovidervisitsweredevelopedincollaborationwiththeNationalCenterforHealthStatistics.Thesesurveysprovideindepthinformationonindividualsandthecaretheyreceive,basedonandcomparabletotheNationalHealthInterviewSurvey(NHIS)andtheNationalHospitalAmbulatoryMedicalCareSurvey,(NHAMCS),respectively.ThenationalsurveysarethesourceofmostHealthyPeople2000and2010objectives, p  whichcanbeusedastargetsforBPHCperformancegoalsfordisparityreduction.WeareworkingtolinkmeasurestoHP2010targets.InformationfromtheHealthCenterUserandVisitSurveysfieldedinFY1995areusedforbaselines;BPHCisrepeatingthesesurveysforFY2001encountersandatapproximatefiveyearintervalsthereaftertoprovidelongitudinalcomparisonsforGPRA.IncaseswhereBPHCperformancehasmetorexceedednationaltargets,individualProgramspecifictargetshavebeenestablished.Third,BPHCreorienteditsportfolioofotherevaluationefforts,shiftingfromadescriptivecasestudyapproachtotheuseofpreviouslyvalidatedsecondarydatasourcesthatenableacomparisonofusersandsimilarpopulationsofnonusers,andsystematicsamplingoforganizationsandusers.NotableamongtheseeffortsarestudiesofCommunityHealthCenterEffectivenessthatuseclaimsdatafromCMSsStateMedicaidResearchFiles(SMRF)andonsitereviewsofcontentofcare,andHospitalizationsforAmbulatoryCareSensitiveConditions,whichalsousestheSMRFfilestoexaminepotentiallyavoidablehospitalizations.Aswiththesurveys,informationfromthemwillbeusedforperformancegoalsrelatedtodisparityreduction,althoughsomeadditionalworkisneededtodevelopappropriatetargetsandbaselines.Effortshavebeenunderwaytoextracttheinformationneeded.However,limitationsofHealthCentermanagementinformationsystemshaveeitherpostponedBPHCsabilitytoreportresultsasanticipatedorinsuchcasesasdiabeticrecordextraction,hasprecludedBPHCreportingofannualdilatedeyeexaminations.InFY2000,BPHClaunchedadatagatheringinfrastructurethatwillassurethatperformancemeasuresareobtainedannually.InFY2001,itbegantodevelopteamsofdatacollectorsatsentinelsitestoobtainoutcomesdataonanannualreportingbasis.Ultimately,BPHCwillworktodevelopthedataandtrackinginfrastructureswithinservicedeliverysites(Disease/CareCollaborative:Diabetes,DepressionandAsthma,Hypertension)toassurepromptannualreportingontheperformancemeasuresandobtainhealthstatusoutcomemeasures.Theseactivitiesaredesignedtomovehealthcenterstoapaperless,hightechnologynetworkofmanagementinformationsystems.DuringFY2000and2001,asecondgroupof125HealthCenterteamsbeganthediabetescollaborativeandanadditional40begantheDepressionandAsthmacollaborative.Theoriginal83reportedHbA1cperformanceat60%withdecreasesin1%ormoreinactuallevels,whichtranslatesintoa17%reductioninmortalityforpersonswithdiabetes. X X* +`&( Ї# X*X q# 2.1.2GoalbyGoalPresentationofPerformance  ?+ 4 <DL!X?GoalI.A.1:IncreasethenumberofuninsuredandunderservedpersonsservedbyHealth  Centers,withemphasisonareaswithhighproportionsofuninsuredchildreninordertohelpimplementtheStateChildHealthInsuranceProgram. Context:   , HealthCentersplayanessentialroleintheNationssafetynet,providingprimarycaretomorethan20%ofthe43millionunderservedpeopleinfederallydesignatedunderservedareaslackingaccesstoprimarycareproviders.ArecentOIGreport"FederallyFundedHealthCentersandLowIncomeChildren'sHealthCareImprovingSCHIPEnrollmentandAdaptingtoaManagedCareEnvironment"examinedtheexperienceofFederallyfundedhealthcentersinimplementingtheStateChildren'sHealthInsuranceProgram(SCHIP)andindeliveringhealthcaretochildrencoveredbySCHIP. Ѐ?+ 4 <DL!X?TheanalysiswasoverallpositiveandstatedthathealthcenterscanserveasoneofthemostappropriateagentsforenrollingchildreninSCHIP,however,thecentersmustalsobepreparedforchangesinreimbursementmethods.TheIGhadseveralrecommendationsbothforHRSAandCMS.HRSAagreesthatthefutureviabilityofHealthCentersisdependentuponeffectivereimbursement.ThereportfoundthatHealthCentersareeffectiveatenrollingpatientsbutthosewithoutstationedeligibilityworkersweremoresuccessfulinprovidingaccesstoSCHIPandMedicaidcoveragethanthosewithoutsuchworkers.Continuedsupportforenablingservices,ofwhichoutstationedeligibilityworkersisone,willenhanceHealthCentersuccessinassuringformanyoftheirpatients. :  H  r    "  z   Indicator:Totalnumberofclientsservedinunderservedareas.  P Performance:   In2000,accordingtodataretrievedfromtheBureausUniformDataSystem(UDS):L 23456789[hh23456789L 231   232[3  0 r   730HealthCentersserved9.6millionpeoplein38millionencountersatanaveragecostper   userofabout$406dollars23݌ r(#r(# Ќ  L !23456789[hh23456789L 232   232[3  0 r   Approximately40%ofusersareundertheageof19,andmorethan1.2millionofthose " childrenareuninsured23B݌ r(#r(# Ќ  L "23456789\hh!23456789L 233   232\3  0 r   HRSAGrantdollarsrepresent26%ofHealthCenterrevenues23݌$ r(#r(# Ќ  L '23456789\hh"23456789L 234   23ʪ2\3  0 r   Medicaidrevenueshaverisenbacktothe1998levelof34%in2000whileuninsuredusers % _00 X X*WVv fb~~W{p..@X dd@Equ {{  (#(#         (#(## X*X #HealthyPeople2000/2010includesthefollowingobjectiveforadultsgenerally:Atleast50percent *  ofpeoplewithhypertensionreporttheirbloodpressureisundercontrol.Despitethefactthat_00BPHC_00Programusersaremorethanthreetimesmorelikelytoreportbloodpressureundercontrolthanacomparablenationalgroup,andthatthecurrentratefarexceedstheHP2000objective,_00BPHC_00ԀProgramtargetsare92%,93%,and96%respectively.TherepeatingoftheUserSurveyin2001willprovidefollowupdatainNovember2003._00BPHC_00Ԁhaslaunchedaspecialstudyofmedicalrecordstoassureannualestimatesofbloodpressurecontrolamonghypertensiveusersandtoassesshealthstatusoutcomesforhypertensiveusers,withresultsbySeptember2002. GoalIII.A.1DecreasetheproportionofHealthCenteruserswhoarehospitalizedforpotentially  avoidableconditions.Context:  !2 Hospitalizationsforpotentiallyavoidableconditions,otherwiseknownasambulatorycaresensitiveconditions(_00ACSC_00)arewidelyrecognizedasameasureofaccesstoprimarycare.Reducingtherateofavoidablehospitalizationsforpeopleofracial/ethnicminoritygroups,oflowincome,andwhoareuninsuredwillhelpeliminatetheirhealthstatusdisparities.Lowratesindicateaccesstoappropriateambulatoryservicesandisameasureofhighqualityofcaredelivered.Italsoindicatesfeweraccessbarriersthatcausepatientstopostponeneededservices,delayneededservices,andfailtocomplywithtreatmentregimens. Performance:  *&# Anongoingevaluationcomparing_00ACSC_00ԀhospitalizationsamongHealthCenterUsersandnonusers using_00SMRF_00ԀfilesplusreviewofdatafromtheNationalHospitalDischargeSurveyforthegeneralpopulationrevealed18.9per1000_00ACSC_00ԀhospitalizationsamongnonHealthCenteruserscomparedto14.7forHealthCenterusers.Thatis,HealthCenterMedicaidusersare22%lesslikelytobeinappropriatelyhospitalizedthanMedicaidbeneficiarieswhouseotherproviders. X X* `  (#(#pq< ,(`~1 : `..E s : : (  p r  r y]A 1-lzc( `E5 ((5 (y߼ -(#-(#   (#(#-(#-(## X*X D#Tobeascomparableasthenation,wewouldonlyhavetohaveatargetof18.9/1000tobeappropriate. "r However,_00BPHC_00ԀProgramfeelsthattheyshouldstrivetoeliminatevirtuallyallavoidablehospitalizations,sowehavesetourtargetsat14,13.5,13,12.5and12/1000,respectively,for_00FYs_001999,2000,2001,2002and2003._00BPHC_00ԀProgramwillsharestrategiesforthereductionofavoidablehospitalizationswiththeMedicaidProgramtohelpreducesuchratesamongotherMedicaidbeneficiaries._00BPHC_00Ԁwillhaveresultsfromafollowup_00ACSC_00ԀstudybySeptember2002. #X*XX X* #XHXXX* Although   _00B  P BP HC_00Ԁwantedannualestimates,thesestudiesofclaimsdataareoftenmultiyearactivitieswithsignificantlagsinthetimelinessofthedata.%4XXH *           #XHX4%.#FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport#X*XXXH# X*XXX*  2.2ProgramTitle:BlackLungClinics #X*XX X*=#XHXXX*&&%%XXH 8 #XHX%%&&#%4XXH*<dd Pm A mmA mm @A(#(#, dd , dd ,dd ,`dd +  /X T /#XHX4%C#&&%%XXHPerformanceGoals AX,!h"X ATargets AX,!h"X AActual h Performance AX,!p "X ARefer  ence =(&h"  X = I.ELIMINATEBARRIERS  ,  TOCAREA.IncreaseUtilizationfor_00Underserved_00ԀPopulations     1.ServeBlackLungclinicuserswithrespiratoryandpulmonaryimpairments,includingprovisionofmedicalandnonmedicalservices. $L  $FY03:18,000FY02:17,000#XHX%%&&#&&%%XXH T  FY01:26,000FY00:35,000FY99:35,000users  $t FY01:16,357usersFY00:26,000FY99:35,000FY98:35,000  $t% B127   NEW T + FY01DATA )4 - )   TotalFunding:BlackLung . Clinics ($in000's) $p0 $   FY2003:$6,000FY2002:$6,000FY2001:$6,000FY2000:$5,942FY1999:$4,998FY1998:$4,976  6   ӀBx:page#budget̀Px:page#performanceplaǹHP:HealthyPeoplegoal9   #&M'%%%&&#*&M'%'%&M#X*X'%&M#   2.2.1ProgramDescription,ContextandSummaryofPerformance#X*XXX*# X*XXX* ,: ProgramDescriptionandContext:    *      2      H;    TheBlackLungprogramprovidesfundingtopublicandprivateentitiesfortheoperationofclinicsthatprovidediagnosis,treatment,andrehabilitationofactiveandretiredcoalminerswithrespiratoryandpulmonaryimpairments.InadditiontotreatmentofBlackLungdiseaseanddirectlyrelatedconditions,coverageincludesprescriptiondrugs,officevisits,hospitalizations,and,withspecificapproval,durablemedicalequipment,outpatientpulmonaryrehabilitationtherapy,andhomenursingvisits. ProgramPerformance:  %8!C Since1984,BlackLungbeneficiarieshavesteadilydeclined.InFY1984,approximately100,000primarybeneficiariesfiledalmost164,000claims.Overtimethenumberofbeneficiarieswillcontinuetodecline.InFY2001,theBlackLungprogramfundedgrantsto14publicandprivateorganizationsprovidingspecializeddiagnosisandtreatmentservicesin56clinicsforthosesufferingfromBlackLungDisease.  + 'I 2.2.2GoalbyGoalPresentationofPerformance  GoalI.A.1: #X*XX X* #XHXXX* ServeBlackLungclinicuserswithrespiratoryandpulmonaryimpairments, 8 includingprovisionofmedicalandnonmedicalservices. #X*XXXH%# X*XXX* (  Context:   ` Indicator:Numberofindividualsprovidedmedicalandnonmedicalservices. Performance:  d  Dataiscollectedfromannualgranteereports.#X*XX X*&#XHXXX*TheFY2000ActualforpersonsservedthroughtheBlackLungProgram(26,000)wasanestimate   basedonaggregateinformationprovidedbygrantees.Ԁ(_00BPHC_00Ԁhassubsequentlylearnedthatthefigureswereoverestimateddueto_00definitional_00Ԁinconsistenciesamongthegrantees.ThedefinitionshavenowbeenstandardizedandtheFY01numberofpersonsis16,357.The_00BPHC_00ԀhasalsodevelopedamorereliabledatainstrumentfortheBlackLungProgramtoobtainaccurateinformationonpersonsservedbytheprogram.#X*XXXH'#EX-XXX*E>1-XEX T #EX-X1E>*##X*X-XEX*# X*XXX* #X*XX X*9+#X*XXX*  # FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  2.3ProgramTitle:NationalHansensDiseaseProgram*R<Udd dd  dd  dd `dd `<(#(#, dd , dd ,dd ,dd +  /X  p /PerformanceGoals AX,! "X ATargets AX,! "X AActualPerformance AX,! "X ARefer_00ence_00 =(&p  "  X =&M'%XX*I.ELIMINATEBARRIERS  p  TOCAREA.IncreaseUtilizationfor_00Underserved_00ԀPopulations  (  1.ProvideresidentialcareforthecurrentHDresidentialpatientsat_00Carville_00Ԁinthemostcosteffectivemannerpossible. $@ $FY03:38patientsFY02:40FY01:45FY00:52FY99:80  X FY01:42patientsFY00:53FY99:73FY98:125  `$ B121   NEW 0 ' FY01DATA )H * );1  2.Providepaymentofassistedlivingallowancesforthoselongtermresidentialpatientswillingandabletoliveindependently. $,|/ $1  FY03:50patientsFY02:53FY01:60FY00:59FY99:46  <4 h2  FY01:55patientsFY00:58FY99:60FY98:NA  D: 2B121   #&M'%'%&M+#&M'%'%&M#X*X'%&M/#&M'%XX*NEW $< FY01DATA #X*X'%&M3#&M'%XX*#&M'%'%&M{3#&M'%'%&M )<? )#X*X'%&M&4#&M'%XX*L3  3.Continuetoprovide `@ outpatientcareforHDpatientsacrossthecountry. $`B $5  FY03:3,000patientsFY02:3,000FY01:3000FY00:3000FY99:3000   G 5  FY01:3000patientsFY00:3000FY99:3000FY98:3000  !M #&M'%'%&Mh4#6&&%%'%&MB121 `N  #&M'%%%&&6#&M'%'%&MNEW hO FY01DATA#&M'%'%&M7##X*X'%&M4#&M'%XX*  &&%%'%&M ) R )7   TotalFunding:National "DS HansensDiseaseProgram ($in000's) $$$ U $$8  FY2003:$21,239FY2002:$20,890FY2001:#&M'%%%&&7#&M'%'%&M$20,903 %T X FY2000:$22,333FY1999:$23,957FY1998:$21,886  (l#[ 8  ӀBx:page#budget̀HP:HealthyPeoplegoal#X*X'%&M7##L]   9#X*XXX*9#X*XXX*    @*%^ 2.3.1ProgramDescription,ContextandSummaryofPerformance    ProgramDescriptionandContext:  8 :  TheHansensDiseaseprogramconsistsoftheNationalHansensDiseaseprogramat_00Carville_00,LouisianaandotheroutpatientcliniclocationsinthecontinentalUnitedStatesandadirectpaymenttotheStateofHawaiiDepartmentofHealth.TheseactivitiesprovideorsupporttreatmentofHansensdisease.TheprogramalsoincludesaresearchcomponentatLouisianaStateUniversity.FundingfortherenovationandmodernizationofbuildingsattheCenterisincludedinthetotalfundinglevel. ProgramPerformance: (   _00HRSA_00ԀiscompletingtherelocationoftheNationalHansensDiseaseprogramfrom_00Carville_00,LAto D  BatonRougeandhastransferredownershipofthe_00Carville_00ԀfacilitytotheStateofLouisiana.Core activities,includingadministration,research,clinicalandskillednursingcarehavebeenmovedto   BatonRouge.Somelongtermcareresidentswillremainatthe_00Carville_00Ԁfacility. 2.3.2GoalbyGoalPresentationofPerformance @    \  GoalI.A.1.#X*XXX*a:#X*XXX*ԀProvideresidentialcareforthecurrentHDresidentialpatients.#X*XXX*g@#X*XXX* (x  Context:  ` AspartofthelegislationtorestructuretheoperationoftheHansensDiseaseCenterin_00Carville_00,itwasagreedthatcontinuingcarewouldbeprovidedforthoselongtermresidentsremainingat_00Carville_00.Inaddition,anassistedlivingfacilityisbeingdevelopedintheBatonRougeareaandwillbeofferedtothecurrentlongtermresidentsat_00Carville_00Ԁasanalternativetoremainingatthehistoricfacility.Itishopedthatthesearrangementwillproveattractivetotheremainingresidentsandthattheywillelecttomovefrom_00Carville_00.Indicator:Extenttowhichresidentialcarecontinuestobeprovidedfortheremainingresidents. Performance:  # Baseline:FY98:125patientsTheoriginalestimateforFY1999wasthat80patientswouldbeinvolvedinthisoption.TheactualperformanceforFY99was73patientsdroppingto53inFY2000andto42patientsinFY2001duetoahigherdegreeofacceptanceoftheoptiontoreceiveanassistedlivingallowanceandtoliveindependently.Thecurrent42includeagroupofapproximately12residentswhorequiremoreintensivecareandwhoareinthelongtermcarecenter.  +&& DataIssues:   Dataforthisgoalisprovidedbyprogrammanagers.#X*XXX*@#X*XXX*   GoalI.A.2.#X*XXX*F#X*XXX*ԀProvidepaymentofassistedlivingallowancesforthoselongtermresidential T patientswillingandabletoliveindependently .#X*XXX*TG#X*XXX*Ԁ @  Context:  , | Thelegislationincludedinthe1998appropriationincludedaprovisiontopayanassistedlivingallowancetoresidentpatientswhoarecapableofandelecttoliveindependently.Morepatientsagreedtothisoptionthanwasoriginallyestimated.Indicator:Numberofpatientreceivingtheassistedlivingallowance. Performance:  t  TheoriginalestimateforFY1999wasthat46patientswouldacceptthisoption.TheactualFY99performancewas60patients,asmorepatientsthanexpecteddecidedtotakethestipendandliveindependently.InFY2000,thenumberwas58patientsonstipends,whichfellto55in2001duetonaturalcauses.Weareprojectingthatthisnumberwillnotgrowandwillslowlydecrease. DataIssues:    Dataforthisgoalisprovidedbyprogrammanagers. GoalI.A.3:ContinuetoprovideoutpatientcareforHDpatientsacrossthecountry . `  Context:  L TheNationalHansensDiseaseProgramincludesaregionalcareprogram.TheHansensDiseasepopulationintheU.S.approximates6,000,ofwhomabout3,000arecaredforunderthe_00NHDP_00regionalcareprogram.Dataisprovidedbyprogrammanagers.Indicator:ExtenttowhichoutpatientcareisprovidedforHDpatients. Performance:  $  ActualperformanceforFY01andFY00metthetargets.#X*XXX*,H# X*XXX*   (T#!  #X*XX X*NN#XHXXX*  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  N2.4ProgramTitle:CommunityAccessProgram*<dd dd  dd  dd dd R<U(#(#, dd , dd ,dd ,dd +  /X T /PerformanceGoals AX,!h"X ATargets AX,!h"X AActualPerformance AX,! "X AReference&&%%XXH#&M'%%%&&N#&&%%'%&M h   =(&    X =I.ELIMINATEBARRIERSTOCAREA.IncreaseUtilizationfor_00Underserved_00ԀPopulations#&M'%%%&& R##X*X'%&MQ#XHXXX*&&%%XXHԀ    1.Increasethenumberofnew   integratedhealthservicesnetworksthatareprovidingcareusingreportcardinformationtointegrateandimprovehealthservicesfortheuninsured.#&M'%%%&&FS#&&%%'%&M $$ $ FY03:N/A  T FY02:153networksFY01:116networksFY00:20networksFY99:NA#&M'%%%&&T#&&%%'%&M  $t  FY01:136CAPcommunitiesFY00:23CAPcommunitiesFY99:NA#&M'%%%&&VU#&&%%'%&M  , ! B119   T" NEWFY01ANDFY00DATA  T ( @R#&M'%%%&&U#&&%%'%&M#XHX%%&&eS# ) \ )" )&&%%XXH TotalFunding:Community @* AccessProgram  h+ ($in000's) $ p, $FY2003:$0FY2002:$105,089FY2001:#&M'%%%&&V#&&%%'%&M$125,083 P/ FY2000:$24,996FY1999:!  h2 Bx:page#budgetHP:HealthyPeoplegoal#XHX%%&&W#P5   #X*XXXH X#  X*XXX*2.4.1ProgramDescription,ContextandSummaryofPerformance 6  TheCommunityAccessProgram(CAP)beganinFY2000.ThegoaloftheCAPistoimprovethe 7 effectivenessandincreasethecapacityofthenationshealthcaresafetynet.Toachievethisgoal,theCAPassistscommunitiesandconsortiaofhealthcareproviderstodevelopandstrengthenintegratedhealthsystemsthatcoordinateservicesfortheuninsured.Integrationandcoordinationofservicesamongcommunityssafetynetprovidersareultimatelyexpectedtoresultinimprovedcareforthetargetpopulation,eliminationof_00duplicative_00Ԁandunnecessaryfunctionswithinthesystem,andsystemlevelsavingstoreinvestincareforgreaternumbersofuninsuredpeopleandnewservicestofillexistinggaps.Underthisprogram,fundsareprovidedtopublicandnotforprofitorganizationswhichrepresentcoalitionsofhealthcareproviderswhichincludethoseproviderswhohavetraditionallyservedthetargetpopulation.Grantfundsareusedtosupportavarietyofprogrammodelsthatarebuiltoneachcommunityscurrentresourcesandaredesignedtoaddresstheuniqueneedsofeachcommunity.Forexample,fundsareusedtodevelop: P+&E L 23456789Ihh23456789L 23;   ,E1` hp x (#XE #X*XX X*Y# X*XXX*23^2I3  0 F   Providernetworksandcoordinatedreferralarrangementstoprovidecomprehensiveservicesto  theuninsured.23^_݌ F(#F(# Ќ  K1` hp x (#,` XK#X*XX X*e_#\X6XXX* 23<   23a2I3  0 F   #X*X6X\X`# X*XXX*Managementinformationsystemstocoordinatepatientintake,eligibilityscreening,and/or  medicalrecordsamongthecoalitionofproviders.23a   23e2I3  0 F   #X*X6X\Xd# X*XXX*Sharedmanagementfunctionssuchasfinancialsystemsorpurchasing.23e3e݌ 4F(#F(# Ќ   ,<" ,X[2 (#,` X<Asmallproportionofthefundsmayalsobeusedtoaddressurgentservicegapssothatmoreuninsuredindividualswillhaveaccesstoafullcontinuumofcorehealthcareservices.InFY2002,itisexpectedthatfundswillbeawardedtoapproximately17newstarts.Thiswouldprovideforatotalofapproximately153CAPcommunities.NofundsarerequestedforFY2003.K" ,X[2 (# ,X[ XK   2.4.2GoalbyGoalPresentationofPerformance  L   Context:   WhiletheStateChildrens#X*XX X*e# X*XXX*ԀHealthInsuranceProgramoffersnewopportunitiesforuninsured  children,alargenumberofadults,roughly32million,areuninsured,andoftheseabout17millionhaveincomesbelow200percentoftheFederalPovertyLevel.Theburdenofcareforthelowincomeuninsuredfallsdisproportionatelyonsafetynetproviders.Atthesametime,theseprovidershavehadtoadjusttotherapidgrowthofmanagedcareinbothprivateandpublicinsuranceprograms.ApproachesforimprovinghealthservicesfortheuninsuredhavebeendevelopedinanumberofStatesandcommunities.Whiletheydifferinscopeanddesign,theysharethecommonthemesofexpandingaccesstoacomprehensiverangeofservices,shiftingthefocusofcaretomoreefficientsettingsandemphasizingprimarycare,andbuildingintegratednetworksofproviders. Performance:  p  UndertheCAPprograminFY2000,fundingwasprovidedto23organizationsforinfrastructuredevelopmentprimarilyinlocationswhichhadalreadybegunorganizedcommunitybasedeffortstocoordinateservicesprovidedtotheuninsured.InFY2001,113additionalCAPgrantswereawarded,foratotalof136communitybasedprograms.  GoalI.A.1:#X*XX X* i#XHXXX*Increasethenumberofnewintegratedhealthservicesnetworksthatare ),%$ providingcareusingreportcardinformationtointegrateandimprovehealthservicesfortheuninsured.#X*XXXH\n#Ԁ +'& _00  Some_00Ԁ136communitiesweresupportedinFY2001.Supportforexistingsystemsincludes23  granteesinitiallyfundedinFY2000;and113granteesfundedinFY2001.NofundingisproposedinFY2003. X*XXX*     i7XX*HIV/AIDSPROGRAMS#X*X7ip#   p FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport ` &M'%XX* #&M'%'%&Mp##X*X'%&Mq#TheprogramsoftheHealthResourcesandServiceAdministrations(_00HRSA_00)HIV/AIDSBureau 4  providethefocalpointfortheFederalresponsetotheprimarycareandsocialsupportneedsoftheapproximately800,000to900,000personsestimatedbytheCentersforDiseaseControlandPrevention(CDC)whoarelivingwithHIVdisease.Onethirdofthosepersonsareinmedicalcare,onethirdknowtheirHIVstatusbutarenotinmedicalcare,andonethirddonotknowtheirHIVstatus.In2001,anestimated500,000personsreceivedHIVmedicalcareandrelatedsupportiveservicesthroughtheHIV/AIDSBureausRyanWhiteComprehensiveAIDSResourcesEmergency(CARE)Actprograms,authorizedbyTitleXXVIofthePHSAct.TheHABsCAREActprogramsdemonstrateacomprehensiveandaggressiveapproachinhowgovernmenthastargeteddollarstowardthedevelopmentofaneffectiveservicedeliverysystembypartneringwithstates,heavilyimpactedmetropolitanareas,communitybasedprovidersandacademicinstitutions.TherearefourmajorTitles(orParts)oftheRyanWhiteCAREAct:TitleI,II,III,andIV.Twoadditionalprograms(PartF),theAIDSEducationTrainingCenterandtheDentalReimbursementProgramarealsoincludedintheCAREAct.TitleI(PartA)providesoutpatientandambulatoryhealthservicessupportfordisproportionatelyaffectedmetropolitanareas.Theseareasmusthaveatleast500,000residentsandhavereported2,000AIDScasesinthemostrecent5years.TitleIgrantsfundacontinuumofcareforpersonslivingwithHIV,includingavarietyofmedicalandsupportservices.TitleIIalsofundsgrantstoStatesfor EmergingCommunitiesthosereportingbetween500and1,999AIDScasesintheprevious5years.StatesandTerritoriesfundedunderTitleII(PartB)utilizeCAREActfundsforHomeandCommunityBasedCare,HealthInsuranceCoverage,StateDirectServices,andHIVCareConsortiatoimprovethequality,availabilityandorganizationofHIVhealthcareandsupportservices.PartBgrantawardsdevelopabroaderstatewideresponsetotheepidemic.AseparateearmarkunderPartBprovidescriticalfundingspecificallyforHIV/AIDStherapiesthroughtheAIDSDrugAssistanceProgram(_00ADAP_00),bringingthebenefitsofeffectiveandcostly_00antiretroviral_00pharmaceuticalswithinreachofpersonswithHIVunabletootherwiseaffordthesetherapies.TitleIII(PartC)supportsoutpatientearlyinterventionservicesforlowincome,medically_00underserved_00peopleinexistingcaresystems;planninggrantsandcapacitybuildinggrantssupportcommunitiesandhealthcareentitiesintheirplanningeffortstodevelophighqualityHIVprimarycareforindividualslivingwithHIVdisease.Communityhealthcenters,migranthealthcenters,HealthCarefortheHomelesssites,ComprehensiveHemophiliaDiagnosticandTreatmentCenters,Federallyqualifiedhealthcenters,andpublicorprivatenotforprofitprovidersarevitalprovidersofcomprehensiveprimarycareunderPartC.PartCalsoaddressesthespecificpopulationneeds,suchasthoseofreducingperinatalHIVtransmission.TitleIV(PartD)servicesfocusonthedevelopmentandoperationofprimarycaresystemsandsocialservicesforwomen,infants,children,youth,andtheiraffectedfamilymembers;andlinkingthesecaresystemswithHIVresearchandclinicaltrails.TheTitleIVprogramaddressestheneedsofthesepopulationsthrough +') perinatalandpediatricspecialitycare,andcoordinatescareforentirefamilies(familycentered)andcareforwomenofchildbearingage.PartFofthelegislationsupportsthenationalnetworkof14regionalAIDSEducationandTrainingCentersandseveralnationalresourcecentersthatconductclinicalHIVeducationandtrainingprogramsforhealthcareproviders.The_00AETC_00programaddressesspecificareasofneed,includingtheshortagesinthehealthcareworkforcerelatedtoHIV.PartFalsosupportstheDentalReimbursementProgramwhichassistsaccrediteddentalschools,postdoctoratedentalprogramsandschoolsofdentalhygienewithnonreimbursedcostsincurredinprovidingoralhealthtreatmenttopatientswithHIVdisease.ThemostrecentdataavailableontheRyanWhiteCAREActprograms(2000)indicatethatanestimated4.13millionhealthrelatedvisits(4%increaseover1999)wereprovidedbyTitleIandIIgrantees.Inaddition,TitleIIIreportedapprox.129,654clients(19%increaseover1999)servedandTitleIVreportedapprox.24,894unduplicatedwomenclients(31%increaseover1999)served.SpecificHIVhealthcareservicesprovidedbyallfourTitlesincludedambulatory/outpatientmedicalcare,provisionof_00antiretroviral_00Ԁtreatments,dentalcare,outpatientmentalhealththerapy/counseling,outpatientsubstanceabusetreatment/counseling,andhomehealthcare.Keyhealthrelatedsupportservicesincludedcasemanagement,transportation,foodbank,housingassistance/housingrelatedservices,directemergencyfinancialassistance,amongotherservices.WhilewehaveseenasignificantdeclineinHIV/AIDSdeathsinthelastseveralyears,keychallengesremainfacingtheHABandtheCAREActinthisthenewmillennium.Oftheestimated800,000to900,000personslivingwithHIV,itisestimatedthatmorethan1/3ofthosepersonsareknowledgeableoftheirHIVstatusandarenotinmedicalcare.MostdisturbingisthefactthatAIDSremainsaleadingkillerincommunitiesofcolorandthelargestincreasesinHIV/AIDSsurveillancereportsareincasesamongwomen,youth,racial/ethnicminorities,andinjectiondrugusersandtheirsexualpartners.Geographicdistributionofcasesalsopointstothegrowingneedtodevelopprimarycarecapacityin_00underserved_00Ԁurbancommunitiesaswellasinremoteand_00underserved_00ԀruralareasofthecountrywhereweseelittleornoHIVcareinfrastructure.Futureeffortswillfocusonimprovementsinkeyareassuchasdatacollection,datamanagementandthedevelopmentofaBureauwidestrategicplan.TheseeffortswillcontributesignificantlytotheBureausactivitiesrelatedtofutureperformancemeasurement.The_00HRSA_00ԀHIV/AIDSprogramsincludedinthissectioninclude:2.5AIDS:HIVEmergencyReliefGrants(PartA)2.6AIDS:HIVCareGrantstoStates(PartB)2.7AIDS:HIVEarlyInterventionServices(PartC)2.8AIDS:HIVPediatricGrants(PartD)2.9AIDSEducationandTrainingCenters(PartF)2.10AIDS:DentalReimbursementProgram(PartF)X*XXX* @)  +d&'  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport:    2.5ProgramTitle:AIDS:HIVEmergencyReliefGrants(PartA) 8  *<dd dd  dd  dd dd <(#(#,] dd ,Ddd ,dd ,dd +  /X  p /&M'%XX*PerformanceGoals AX,! "X ATargets AX,! "X AActual   Performance AX,! "X AReference =(&  "  X = I.ELIMINATEBARRIERSTO  H  ЀCARE      B.IncreaseAccessPoints   (  1.Increasethenumberofvisitsforhealthrelatedcare(primarymedical,dental,mentalhealth,substanceabuse,rehabilitativeandhomehealth)toalevelthatapproximatesinclusionofnewclients. $h $FY03:2.92MvisitsFY02:2.92MvisitsFY01:3.05MvisitsFY00:2.92MvisitsFY99:2.88Mvisits  8 FY01:(1/03)FY00:2.71MvisitsFY99:2.73MvisitsFY98:2.79MvisitsFY97:2.77MvisitsFY96:2.67Mvisits  @% B229 NEW  p + FY00DATA  0-  2@/" 2 II.ELIMINATEHEALTH 0 DISPARITIESB.IncreaseUtilizationforUnder̀servedPopulations  3 1.Serveaproportionofwomenandracial/ethnicminoritiesinTitleIfundedprogramsthatexceedtheirrepresentationinnationalAIDSprevalencedata,asreportedbytheCDC,byaminimumfivepercent(e.g.,if15percentofcurrentoverallAIDScasesareamongwomen, #X*X'%&M#i7XX*Ԁ #X*X7i#&M'%XX*serve20  ; percentwomeninTitleIprograms).#X*X'%&M#&M'%XX* 6,!!< 6WomenFY03:34%FY02:33%FY01:32%FY00:30%FY99:30%MinoritiesFY03:71%FY02:70%FY01:69%FY00:64%FY99:64% 'D*%P 'WomenFY01:(1/03)FY00:32.9%FY99:32%FY98:30.7%FY97:30.3%FY96:30.7%MinoritiesFY01:(1/03)FY00:70.4%FY99:68.9%FY98:67.7%FY97:67.8%FY96:66.5% 'L+&e '̀B229 NEW ,l FY00DATA  <n  #X*X'%&M}#&M'%XX*#&M'%'%&M#&M'%'%&M #&M'%'%&M#&M'%'%&M#X*X'%&M͘#&M'%XX* )<)$x ) TotalFunding:AIDS:HIV d  EmergencyReliefGrants(PartA) ($in000's) $h D $FY2003:$619,514FY2002:$619,514FY2001:$604,169FY2000:$546,392FY1999:$505,039FY1998:$464,736     Bx:page#budgetHP:HealthyPeoplegoal#X*X'%&M#i7XX* l   t    #X*X7iV#i7XX* #X*X7iɛ#2.5.1ProgramDescription,ContextandSummaryofPerformance    #X*XXX*_# X*XXX* ProgramDescriptionandContext:  4  TheHIVEmergencyReliefGrants,orTitleIoftheRyanWhiteCAREAct,provideambulatoryoutpatienthealthandsupportservicestoeligiblemetropolitanareas(_00EMAs_00)thataredisproportionatelyimpactedbytheHIVepidemic.#X*XX X*#X*XXX*ԀTheseareasareeligibleforTitleIformula (  grantsiftheyhavereportedmorethan2,000AIDScasesinthepreceding5years,andiftheyhaveapopulationofatleast500,000(thisprovisiondoesnotapplyto_00EMAs_00ԀfundedpriortoFY1997).#X*XXX*#GrantsincludeaformulacomponentbasedonestimatedlivingAIDScaseswithinthe_00EMA_00,a  supplementalcomponentthatiscompetitivelyawardedbasedondemonstratedneed,andMinorityAIDSfunding(formallyknownasCongressionalBlackCaucus)fundstargetedforservicestominoritypopulations.TheCentersforDiseaseControl(CDC)hasestimatedthatthereare800,000to900,000personslivingwithHIVinfection,twothirdsofwhomareawareoftheirHIVstatus.Anestimated73%oftheHIVinfectedpersonswhoknowtheirHIVstatusbutarenotinmedicalcareresideintheTitleIEligibleMetropolitanAreas(_00EMAs_00).CAREActTitleIfundsaretargetedtoprovideservicestonotonlythosewhoknowtheirstatusandareincare,buttothose(some300,000)whoremainunawareoftheirHIVstatusandresideintheTitleI_00EMA_00. X*XXX*Asrequiredthroughlegislation,localPlanningCouncilssetsserviceprioritiesandallocatefunds "! forserviceswithinan_00EMA_00,developacomprehensiveplanfortheprovisionofservices,andassesstheefficiencyofthegranteesadministrativemechanismforrapidlyallocatingfunds.Planningcouncilsalsoworkinpartnershipwiththegranteestoassessserviceneedswithinthe_00EMA_00ԀanddevelopacontinuumofcareforpeoplelivingwithHIVdiseaseandtheirfamilies.ThisrepresentativecounciliscomposedofHIVcareproviders,consumers,andpersonsrepresentingsubstanceabusetreatment,mentalhealth,Medicaid,amongotherrepresentativeswherecarecoordinationisimportant.ThePlanningCouncilmembershipmustbereflectiveofthelocalepidemicandatleast33percentofvotingmembersmustbepeoplelivingwithHIVwhoareconsumersofCAREActservices.  +#*  $,%+ #X*XX X*4#X*XXX*ProgramPerformance:   #X*XXX*e# X*XXX*Sinceitsinception,theRyanWhiteCAREActTitleIprogramhascontinuedtoprioritizeprimary  medicalcare,provisionof_00antiretroviral_00Ԁtherapies,emergencyfinancialassistance,andcasemanagementasthehighareasofneedforpersonswithHIVdisease.Recenteffortstoenhancetheprogramsabilitytoaddresstheseprioritiesmoreeffectivelyinclude:L 23456789Hhh23456789L 23?   232H3  0    Initiatingdevelopmentofhealthoutcomemeasuresforspecificfundedservicesamonggrantees;23 ݌ H(#(# Ќ   23@   232H3  0    Introducingandencouraginggranteestousea unitofservicecostmethodologytoassureboth  d costeffectivenessandaccountabilityinnegotiationofservicecontractsutilizingCAREActfunds;23݌ (#(# Ќ   23A   23{2H3  0    RequiringcoordinationbetweenCAREActgranteesinagivenareainthedevelopmentofa X  StatewideCoordinatedStatementofNeed(_00SCSN_00)tofosterareawideserviceplanninganddelivery;and23{݌ (#(# Ќ  L 23456789Hhh23456789L 23B   #X*XX X*ӧ#bXHXXX*23e2H3  0    ImplementingnewlydevelopedBureaupoliciesdesignedtoincreasecosteffectiveness,to L  improveaccesstohealthcare,andtoincreaseguidanceandtechnicalassistanceprovidedtogranteesinusingCAREActfunds.#X*XXbXH#X*XXX* 23eҮ݌$(#(# Ќ  @)2.5.2GoalbyGoalPresentationofPerformance  \ #X*XXX*'#bXHXXX*GoalI.B.1 :#X*XXbXH #X*XXX* Increasethenumberofvisitsforhealthrelatedcare(primarymedical,dental, D mentalhealth,substanceabuse,rehabilitativeandhomehealth)toalevelthatapproximatesinclusionofnewclients. #X*XXX*_#bXHXXX*  p  Context:  X ThenumberofvisitsprovidedforhealthrelatedserviceswasselectedasthebestmeasureoftheprogramgoalstoeliminatebarrierstoprimarycareandrelatedservicesforindividualsinfectedwithHIV/AIDSbyincreasingavailabilityofandaccesstocare. Performance:  ! #X*XXbXH# X*XXX*InFY2000,2.71millionvisitswerereportedby51TitleIEligibleMetropolitanArea(_00EMA_00) " grantees,including1503 d providersdoffundedandeligibleservices.Providingthecoreresponseby # metropolitanareashardesthitbytheAIDSepidemic,thesegranteesprovidedhealthcareandrelatedsupportiveservicestohundredsofthousandsofpersonslivingwithHIV/AIDS.#X*XX X*(#X*XXX*ԀInMarch d%  1999,HABPolicy9903wasreleasedsupportingtheuseofCAREActfundstosupportdiagnosticandlaboratorytests,integraltothetreatmentofHIVinfectionandrelatedcomplications(forexample,butnotlimitedto,CD4counts,viralloadtests,genotypeassays).Webelievethisimpactsthereportednumberofvisits.ThispolicyisconsistentwiththePublicHealthService GuidelinesfortheUseof_00Antiretroviral_00ԀAgentsinHIVInfectedAdultsandAdolescents.Thisnewpolicypermittingthepaymentofnecessaryandappropriatediagnosticandlaboratorycostshaveincreasedtheoverallcostandcomplexityofcare.#X*XXX*>#bXHXXX*ԀAdditionally,thedropinvisitsisrelatedto +('' _00peoplegettinghealthierduetobeneficialtreatmentsthereisadirectdecreasedcorrelationtothenumberofhealthrelatedvisitseachrequires.Theliteraturesupportsthiscorrelationbetweenimprovedhealthandthereductioninvisits.#X*XXbXH9#X*XXX*AdditionalanalysisoftheFY2000dataisbeing  conductedtoidentifyotherrationaleforwhythehealthrelatedcarevisitshavefallen9%belowtheestimatedtarget.#X*XXX*ĺ# `  GoalII.B.1:Serveaproportionofwomenandracial/ethnicminoritiesinTitleIfunded   programsthatexceedtheirrepresentationinnationalAIDSprevalencedata,asreportedbytheCDC,byaminimumfivepercent(e.g.,if15percentofcurrentoverallAIDScasesareamongwomen,serve20percentwomeninTitleIprograms). X*XXX* \   #X*XXX*=#X*XXX* Context:    DespitethereductionseeninoverallAIDSmortality,annualincidencedatashowtheproportionofAIDScasesamongwomenandminoritiescontinuetoincrease.#X*XXX*#X*XXX*Inaddition,#X*XXX*#benefitsprovidedby   newcombinationdrugs(antiretrovirals/proteaseinhibitors/HAART)havenotuniformlyreducedtheincidenceofAIDSbetweengendersoramongracial/ethnicminorities.Theproportionofwomenandracial/ethnicminoritiesservedinTitleIprogramswasselectedasthebestmeasureoftheprogramsgoaltoeliminatehealthdisparitiesamongindividualsinfectedwithHIV/AIDSbyincreasingutilizationfortraditionallyunderservedpopulations,suchascommunitiesofcolor. Performance: X*XXX*  AsshowninCHARTSII.B.1AandII.B.1B,theTitleIfundedprogramsareservingasignificantlyhigherproportionofwomenandminoritiesthanthetargetspecifiedintheindicatoritself(i.e.,fivepercenthigherthantherepresentationofwomenandracial/ethnicminoritiesamongallAIDScasesintheNation,asreportedbyCDC).#X*XXX*#&M'%XX*  ,h'' p>g<,(`~0--ip `YE-ipipp (#(# (# (#     p>j<,(`~0j0{J  `YE 0{J {J  p  x  (#(#(#(#  (#(#   (#(#   (#(#   (#(#   (#(#   (#(#   (#(#   (#(#   (#(#         10  #X*X'%&M#lXX*Data X#  (#(#sourcefor (#(#(#(#percentofwomenandminoritiesamongallU.S.AIDScasesinCentersforDiseaseControlandPreventionYearEndHIV/AIDSSurveillanceReportthroughDecember2000. (#(#   (Vol.12,No.2)#X*Xl#&M'%XX* %*!" 20  #X*X'%&M#lXX*DataforTitleIfundedprogramsrepresentsduplicatedclients.ClientsmayhavereceivedTitleIfunded & "# servicesfromanotherproviderorinanotherregionduringtheFiscalYear.#X*Xl#'"$(#(# _00 +B'( DevelopmentalPerformanceOutcomeMeasure:  AdevelopmentalperformanceindicatorthatassessesthreekeyclinicalmeasurespreviouslyhadbeenunderconsiderationforTitlesIandII.Thethreeclinicalmeasureswere:1)percentofwomenreceivingpapsmears;2)percentofclientswhoreceiveaTBskintest;and3)percentofclientswhoreceiveappropriatePCPprophylaxistreatment.UseoftwoofthethreeclinicalmeasuresisstillanticipatedbutthemeasureassessingthepercentofclientswhoreceivePCPprophylaxisisnolongerunderconsiderationforseveralreasons.First,itwasdeterminedthatassessingthemeasurewithintheCAREActTitleIandTitleIIaggregatedatasystemswouldbedifficultandburdensomeforgrantees.AccuratereportsofthemeasurewouldrequiregranteesandtheirproviderstoreportonboththenumberofHIVpositiveclientsmeetingtheclinicalcriteriaforreceiptofPCPprophylaxisaswellasthenumberofHIVclientsactuallyreceivingappropriatetherapy.Further,withtheadventofhighlyactive_00antiretroviral_00ԀtherapyandotherHIVtreatmentadvances,thenumberofHIVpositivepersonsrequiringprophylactictreatmentforPCPhasdeclineddramatically,makingitdifficulttoestablishbaselinemeasuresandtargetsfortheproposedperformanceindicator.Currently,therearenointernaldataavailableonthesemeasurestoserveasabaselineand/ortodevelopappropriatetargets.PreliminarydatahavebeensubmittedbythefivesitescollectingclientleveldataforCY2000.TitleIandIIGranteeshaveallsubmittedpreliminarydataonavoluntarybasis.Thesedataarecurrentlybeingassessedfortheircompletenessandusefulness.Beginningincalendaryear2002,allCAREActgranteeswillusethenewRyanWhiteCAREActDataReporttoreportprogramdata.ThisnewdatareportingsystemwasdevelopedtostreamlineandsimplifyreportingwhileestablishingaminimumsetofdatareportingrequirementsforallCAREActTitleprograms.AllgranteesarerequiredtoreportdataontheproposedclinicalmeasuresintheRyanWhiteCAREActDataReport.DataforCY2002willbeavailableinmid2003.Oncethedatafromthesesourcesareavailable,afinaldecisionregardingthedevelopmentofthisperformancemeasurewillbemade.GiventheimportanceofincludingoutcomesaswellasoutputmeasuresintheBureausperformanceplan,everyeffortwillbemadetodevelopthesemeasuresfurther. DataIssues: DatafortheRyanWhiteCAREActTitleI(PartA)performancemeasuresareobtainedfrom d" thefollowingsources:L 23456789Hhh23456789L 23C   232H3  0    AnnualAdministrativeReports23E݌l$!(#(# Ќ  L 23456789Hhh23456789L 23D   2372H3  0    GrantApplications237b݌% "(#(# Ќ  L 23456789Hhh23456789L 23E   23I2H3  0    Grantees'NeedsAssessments 23It݌&!#(#(# Ќ   (,$%  @FY2003PerformancePlan,RevisedFinal2002PlanandFY2001PerformanceReporti7XX*  #X*X7i#&M'%XX*2.6ProgramTitle:AIDS:HIVCareGrantstoStates(PartB)#X*X'%&M# ` i7XX* *<dd] dd ] Ddd Ddd dd <%%, dd ,dd ,dd ,dd +  /X \  /#X*X7i#&M'%XX*PerformanceGoals AX,! "X ATargets AX,! "X AActual   Performance AX,! "X AReference =(&  "  X = I.ELIMINATEBARRIERSTO 4   CAREB.IncreaseAccessPoints  d  1.Increasethenumberofvisitsforhealthrelatedcare(primarymedical,dental,mentalhealth,substanceabuse,rehabilitativeandhomehealth)toalevelthattakesaccountofnewclientsintheprogram. $T $FY03:1.56MvisitsFY02:1.56MvisitsFY01:1.45MvisitsFY00:1.53MvisitsFY99:1.22Mvisits  t FY01:(1/03)FY00:1.42MvisitsFY99:1.23MvisitsFY98:1.45MvisitsFY97:1.07Mvisits  |%   B231 NEW \ + FY00DATA  l-  #X*X'%&M"#&M'%XX*&M'%'%&M )0 ) II.ELIMINATEHEALTH @1 DISPARITIES  2  B.IncreaseUtilizationfor $3 _00Underserved_00ԀPopulations  4 1.Increasethenumberof_00ADAP_00ԀclientsreceivingHIV/AIDSmedicationsthroughState_00ADAPs_00Ԁduringatleastonemonthoftheyear. #X*X'%&M^##X*XXX*}#X*XXX*&M'%XX*  <8 #X*X'%&M#&M'%XX*#&M'%'%&M#&M'%'%&M $D9 $FY03:84,800clientsFY02:84,800clientsFY01:72,000clientsFY00:71,900clients#&M'%'%&M\#&M'%'%&M#X*X'%&M#&M'%XX* 0 B #&M'%'%&M#&M'%'%&M#X*X'%&M`#&M'%XX*  x)$K FY01: d (2/02) d  (xS FY00:  70,357 0 T clients*FY99:62,881clients*FY98:55,000clients#X*X'%&M#&M'%XX*#&M'%'%&M#&M'%'%&MԀ#X*X'%&M #&M'%XX*#&M'%'%&MK#&M'%'%&M $ Y #X*X'%&M#&M'%XX*#&M'%'%&M#&M'%'%&M*Revisednumbersbasedongranteeadjustmentstoactualperformance  j*%_ B231 #&M'%'%&Mj#&M'%'%&M#X*X'%&M(#&M'%XX* REVISED  pf FY00/FY99DATA #X*X'%&MW#&M'%XX*#&M'%'%&M#&M'%'%&M  h'"o 2.Serveaproportionofwomenand racial/ethnicminoritiesinTitleIIfundedprogramsthatexceedstheirrepresentationinnationalAIDSprevalencedata,asreportedbytheCDC,byaminimumfivepercent(e.g.,if15percentofcurrentoverallAIDScasesareamongwomen, serve20 p L percentwomeninTitleIIprograms). $L(  $WomenFY03:34%FY02:33%FY01:33%FY00:27%FY99:27%MinoritiesFY03:69%FY02:68%FY01:68%FY00:59%FY99:59%   WomenFY01:(1/03)FY00:32.5%FY99:31.2%FY98:29.4%FY97:30.3%FY96:26.3%MinoritiesFY01:(1/03)FY00:68.0%FY99:66.4%FY98:64.1%FY97:63.1%FY96:59.9%  , B231 NEW  t/ FY00DATA   1  #X*X'%&M#&M'%XX*#&M'%'%&M#&M'%'%&M #&M'%'%&M#&M'%'%&M#X*X'%&M#&M'%XX*   9 TotalFunding:AIDS:HIVCare `: GrantstoStates(PartB)  \8; ($in000's) $d@< $FY2003:$977,373FY2002:$977,373FY2001:$910,969FY2000:$823,838FY1999:$737,765FY1998:$542,784   B Bx:page#budgetHP:HealthyPeoplegoal#X*X'%&M#i7XX*hD   #i77iJ# #X*X7i7#2.6.1ProgramDescription,ContextandSummaryofPerformance  "E  ProgramDescriptionandContext:  .% G RyanWhiteCAREActTitleII(PartB) J&&H TitleIIHIVCAREActgrantstoStates(PartB)provideformulagrantsto50States,theDistrictofColumbia,theCommonwealthofPuertoRico,theVirginIslands,Guamand5newlyeligibleU.S.PacificTerritoriesandAssociatedJurisdictions(AmericanSamoa,theCommonwealthoftheNorthernMarianaIslands,theRepublicoftheMarshallIslands,theFederatedStatesof Micronesia,andtheRepublicofPalau)toprovidehealthcareandsupportservicesforpeople  +#M   livingwithHIVdisease.Theamountofthegranttothestateisbasedontheestimatedliving casesofAIDSwithinthestateinthemostrecent10calendaryearsandtheestimatedlivingcasesofAIDSwithinthestatebutoutsideofany_00EMAs_00Ԁinthestateinthemostrecent10calendaryears.Additionally,TitleIIfundsgrantstoStatesforEmergingCommunitiesthosereportingbetween500and1,999AIDScasesovertheprevious5years.Stateswithmorethan1percentofthetotalAIDScasesreportednationallyduringtheprevious2yearsmustcontributetheirownresourcestomatchtheFederalgrant.Thecurrentrequirementisonedollarforeverytwodollarsoffederalfunds.i7XX* $ t #X*X7i#AIDSDrugAssistanceProgram(_00ADAP_00)    Startingin1996,specificAIDSDrugAssistanceProgram(_00ADAP_00)fundsweremadeavailabletostatesintheirTitleIIawardsinresponsetotherapidgrowthin_00ADAP_00Ԁclientsandcosts,andtoexpandaccesstonewlyavailable_00antiretroviral_00Ԁtherapies.Additionally,_00ADAPs_00ԀareusingearmarkfundstopurchasehealthinsurancecoveragethatincludesthefullrangeofHIVtreatmentsandaccesstocomprehensiveprimarycareservicesasanothercosteffectivemeansofprovidingtherapiestoeligibleclients. ProgramPerformance:  r RyanWhiteCAREActTitleII(PartB)  InFY2001,TitleIIfundscontinuedtobeusedtosupportawiderangeofhealthcareandrelatedsupportiveservicesincluding:L 23456789Hhh23456789L 23F   232H3  0    Homeandcommunity-basedhealthcareandsupportservices;23݌(#(# Ќ  L 23456789Hhh23456789L 23G   23-2H3  0    Continuationofhealthinsurancecoverage,throughaHealthInsuranceContinuationProgram  (_00HICP_00);23-X݌ (#(# Ќ  L 23456789Hhh23456789L 23H   232H3  0    Pharmaceuticaltreatments,throughthe_00ADAP_00ԀProgram;23݌&(#(# Ќ  L 23456789Hhh23456789L 23I   232H3  0    HIVcareconsortiathatassessneeds,organizeanddeliverHIVservicesinconsultationwith B serviceproviders,andcontractforservices;and23<݌ (#(# Ќ  L 23456789Hhh23456789L 23J   232H3  0    Statedirectservices.23݌J(#(# Ќ  Overthepastfewyears,_00HRSA_00/HABimplementedadditionalrequirementsrelatedtodevelopmentofhealthoutcomes,definitionofunitofservicecost,andcoordinationbetweenCAREActgranteesinagivenareainthedevelopmentofaStatewideCoordinatedStatementofNeed(_00SCSN_00)reportedundertheTitleIreportabove.TheTitleIIprogramswerelegislativelyresponsibleforthecoordinationofthedevelopmentoftheStatewideCoordinatedStatementofNeed(_00SCSN_00)andthisresponsibility,posedasignificantchallengeforstatesinbringingtogethergranteesunderTitlesI,II,III,IV,AIDSEducationandTreatmentCenters(PartF)andDentalReimbursementPrograms(PartF)tojointlyassessandplanfortheneedsinthegranteestates.All56statesandterritoriesfileda_00SCSN_00ԀstatementwhichwasupdatedandreportedoninFY1998,andduetobecompletedagainin2001andsubmittedin2002. +&' FY2001alsosawadditionalTitleIIpolicydevelopmentandimplementationinanumberofareasinordertoincreasecosteffectiveness,accesstohealthcareandtoincreaseguidanceandtechnicalassistanceprovidedtogranteesinusingCAREActfunds.AIDSDrugAssistanceProgram(_00ADAP_00)i7XX*  #X*X7i#InFY2001,the_00ADAP_00Ԁprogramsabilitytoprovidemedicationsto_00underserved_00Ԁpopulations  , improvedsignificantlyforthemostpart.Specifically:L 23456789Hhh23456789L 23K   23p2H3  0    ThenumberofState_00ADAPs_00Ԁwithwaitinglists,remainedconstantwithninein1997and  4 ninein2001.Thetotalnumberofclientsonwaitinglistshasdecreasedfrom3,478in1998toanaverageof521in2001.23p݌ (#(# Ќ  L 23456789Hhh23456789L 23L   X)XXX*23m2H3  0    #X*XXX)#X*XXX*Thenumberof_00ADAPs_00Ԁwith26ormoredrugsontheirformularyincreasedfrom17in1997 (  to23in2001.23m݌ (#(# Ќ  L 23456789Hhh23456789L 23M   #X*XXX* #X)XXX*23_ 2H3  0    #X*XXX) #X*XXX*_00ADAPs_00Ԁthatsetfinancialeligibilityabove200percent_00FPL_00Ԁhasincreasedfrom18in1997to <  23in2001.23_  ݌ (#(# Ќ  L 23456789Ihh23456789L 23N   #X*XXX*5 #X)XXX*23 2I3  0    #X*XXX) #X*XXX*Ind2001,46State_00ADAPs_00drequiredonlyanHIVpositivediagnosisforeligibility,versus41 P programsin1997.Further,d8Stated_00ADAPs_00Ԁrequireadditionalmedicaleligibilitycriteria(CD4/Tcellcounts)in2001,versus12State_00ADAPs_00Ԁwiththisrequirementin1997.23  ݌ (#(# Ќ  L 23456789Ihh23456789L 23O   #X*XXX*l #X)XXX*232I3  0    #X*XXX)#X*XXX*From1997tod2001,thenumberofState_00ADAPs_00ԀparticipatingintheSection340BDrug P DiscountProgramincreasedfrom19to50(a263percentincrease).Savingsfromcostrecoverystrategiesincreasedfrom$24.4millionin1997to aprojected$65.5millionin2001 4 (asavingsincreaseof268%).di7XX*#i77i{#i77i23݌ (#(# Ќ  #i77ib#i77i#X*X7i #InJanuary1999,HABpolicy9901wasreleasedpursuanttoFY1999appropriationslanguage .~ supportingtheuseofAIDSDrugAssistanceProgram(_00ADAP_00)fundsforthepurchaseofhealthinsurancecoveragethatincludesthefullrangeofHIVtreatmentsandaccesstocomprehensiveprimarycareservices.Thepolicyrestrictstheannualamountspentonhealthinsurancetonomorethantheannualcostofmaintainingthatsamepopulationontheexisting_00ADAP_00.Seventeengranteesarecurrentlytakingadvantageofthenewprovisionsbypurchasinghealthinsuranceproductsforclients.Anadditionaltwogranteeshaveindicatedthattheyintendtouse_00ADAP_00Ԁfundstopurchasehealthinsuranceinthecurrentfiscalyear.HABPolicy0002,Amendment#1wasreleasedinApril2001,anddescribesTheUseofRyanWhiteCAREAct,TitleII,AIDSDrugAssistanceProgram(_00ADAP_00)FundsforAccess,Adherence,andMonitoringServices.Thispolicyallows_00ADAPs_00Ԁtoredirectareasonableportionof_00ADAP_00ԀfundstosuchservicesthatenhancetheabilityofeligiblepeoplewithHIV/AIDStogainaccessto,adhereto,andmonitortheirprogressintakingHIVrelatedmedication.Thispolicywillallowabroaderrangeofservicestobepurchasedthrough_00ADAP_00programsandmayresultinafurtherdeclineinclientnumber,astheseareenhancedservicesaffordedtoclientsalreadyenrolledin_00ADAP_00ԀandotherCAREActprograms.#X*XXX*#  N*%&    j+&' 2.6.2GoalbyGoalPresentationofPerformance  GoalI.B.1:Increasethenumberofvisitsforhealthrelatedcare(primary,medical,dental,mentalhealth,substanceabuse,rehabilitativeandhomehealth)toalevelthattakesaccountofnewclientsintheprogram.    Context:   H Thenumberofvisitsforhealthrelatedcare(primarymedical,dental,substanceabuse,mentalhealth,homehealthandrehabilitative)wasselectedasthebestmeasureoftheprogramsgoaltoeliminatebarrierstoprimarycareandrelatedservicesforindividualswithHIV/AIDSbyincreasingavailabilityofandaccesstocare.i7XX* X   #X*X7i#Performance:  f  X*XXX*InFY2000,TitleIIprogramsprovided1.42Millionvisits.#X*XXX*P#ԀTheActualPerformancefromFY99   toFY00reflectsa190,000increaseinthenumberofvisits.InMarch1999,HABPolicy9903wasreleasedsupportingtheuseofCAREActfundstosupportdiagnosticandlaboratorytestsintegraltothetreatmentofHIVinfectionandrelatedcomplications(forexample,butnotlimitedto,CD4counts,viralloadtests,genotypeassays).Webelievethisimpactsthereportednumberofvisits.ThispolicyisconsistentwiththePublicHealthService GuidelinesfortheUseof_00Antiretroviral_00ԀAgentsinHIVInfectedAdultsandAdolescents.Thisnewpolicypermittingthepaymentofnecessaryandappropriatediagnosticandlaboratorycostshaveincreasedtheoverallcostandcomplexityofcare.InFY00,thenumberofvisitswentupdramaticallybutdidntquitemeettheFY00Targetduetopeoplegettinghealthierfromthebeneficialtreatments(thereisadirectdecreasedcorrelationtothenumberofhealthrelatedvisitseachrequires).Theliteraturesupportsthiscorrelationbetweenimprovedhealthandthereductioninvisits.AdditionalanalysisoftheFY2000dataisbeingconductedtoidentifyotherrationaleforwhythehealthrelatedcarevisitshavefallen9%belowtheestimatedtarget. GoalII.B.1: Increasethenumberof_00ADAP_00Ԁclientsreceivingappropriate_00antiretroviral_00   therapy(consistentwithclinicalguidelines)throughState_00ADAPs_00Ԁduringatleastonemonthoftheyear . "  Context:  $  Thenumberof_00ADAP_00ԀclientsreceivingHIV/AIDSmedicationsthroughState_00ADAPs_00ԀduringatleastonemonthoftheyearwasselectedasameasureoftheprogramsgoaltoeliminatehealthdisparitiesamongindividualswithHIV/AIDSwhoare_00underserved_00Ԁbyincreasingavailabilityandutilizationofthesemedications.i7XX*#X*X7i&#Previously,themeasurewas thenumberofindividualsreceivingappropriate_00antiretroviral_00  +\&& therapy(consistentwithcurrentPublicHealthServicesclinicalguidelines)throughState +H'' _00ADAPs_00Ԁduringatleastonemonthoftheyear.Thismeasure,however,wasbeyondthedatamanagementandadministrativecapacityofcurrent_00ADAP_00Ԁgrantees.Asignificantportionof_00ADAP_00Ԁclientsmayreceivesupportformedicationsfromothersources,includingMedicaid,otherRyanWhiteCAREActproviders,localpharmacyassistanceprograms,privateinsurance,orthroughclinicaltrials.Additionally,itisnotuncommonfor_00ADAP_00Ԁclientstoswitchbetweensystemsinasinglereportingperiod.Theavailabledata,therefore,wouldgiveanincompletedrugtherapyhistory,anddistorttheresultsofwhetherclientsarei7XX*Ԁ#X*X7i=*#receiving"appropriate"_00antiretroviral_00ԀtherapyconsistentwiththePHStreatment p  guidelines(i.e, currentclinicalguidelines).Inaddition,_00HRSA_00Ԁdoesnothavethestatutoryauthoritytorequire_00ADAPs_00ԀtocomparetheirutilizationdatatothePHStreatmentguidelinestodetermineifclientsarereceiving"appropriate"_00antiretroviral_00Ԁtherapy"consistentwithclinicalguidelines."_00HRSA_00Ԁdoes,however,maintainan_00ADAP_00Ԁformularydatabaseinordertomonitornationalformularytrends._00HRSA_00alsoworkscontinuallywith_00ADAPs_00Ԁonformularydevelopmentinordertoensurethat,toeveryextentpossible,theappropriatedrugsareincludedoneachoftheState'sformulary.Lastly,pertheRyanWhiteCAREAct,the_00ADAP_00ԀprogramprovidestherapeuticstotreatHIVdiseaseorpreventtheseriousdeteriorationofhealtharisingfromHIVdiseaseineligibleindividuals.Therapeuticsprovidedby_00ADAPs_00Ԁinclude_00antiretrovirals_00,medicationsforthetreatmentandpreventionofopportunisticinfections,andancillaryandtertiarymedicationstoaddresssideeffectswhichmaybeexperiencedbyindividualsonHIVmedications.Theperformancemeasureforthe_00ADAP_00Ԁprogramwasthereforerevisedtoincludealltherapeuticsprovidedbytheprogram,notjust_00antiretrovirals_00. Performance:  N InFY2000,70,357personswereservedatleastonemonthoftheyearby_00ADAP_00.IncomparisonwithmonthlyfiguresfromFY1999,anadditional7,476clientswerereceiving_00antiretroviral_00Ԁtherapiesthrough_00ADAP_00ԀpermonthinFY2000.Manyclientsareenrolledin_00ADAP_00Ԁonlytemporarilywhiletheyawaitacceptanceintootherinsuranceprograms,likeMedicaid.TheactualFY00performanceof70,357clientsfell2.2%shortoftheoriginalFY00targetof71,900averageclientspermonthservedbyi7XX*Ԁ#X*X7i3#_00ADAP_00.The_00ADAP_00ԀMonthlyReport $V  (_00AMR_00)onwhichthismeasureisbased,wasimplementedinFebruary1998.ByFY2000,thesystemhadbeensuccessfullyimplementedwitharesultingimprovementintheaccuracyofthereportednumberofclientsreceivingservicesthrough_00ADAP_00Ԁeachmonth.Thisimprovementinthedatacollectionwillallowamoreaccuratedeterminationofappropriatetargetsforthismeasureinthefuture.HABPolicy9901,enactedinJanuaryof1999,hasincreasedtherangeofservicesavailableundertheCAREActs_00ADAP_00Ԁprogram.SeventeenState_00ADAPs_00Ԁuse_00ADAP_00ԀdollarstopurchasehealthinsurancethatincludesthefullrangeofHIVtreatmentsandaccesstocomprehensiveprimarycareservices. +&(  GoalII.B.2:Serveaproportionofwomenandracial/ethnicminoritiesinTitleIIfundedprogramsthatexceedtheirrepresentationinnationalAIDSprevalencedata,asreportedbytheCDC,byaminimumfivepercent(e.g.,if15percentofcurrentoverallAIDScasesareamongwomen,serve20percentwomeninTitleIIprograms).    Context:    DespitethereductionseeninoverallAIDSmortality,annuali7XX*Ԁ#X*X7i9#incidencedatashowtheproportion  4 ofAIDScasesamongwomenandminoritiescontinuetoincrease.Inaddition,benefitsprovidedbynewcombinationdrugs(_00antiretrovirals_00/proteaseinhibitors/_00HAART_00)havenotuniformlyreducedtheincidenceofAIDSbetweengendersoramongracialandethnicminorities.Theproportionofwomenandracial/ethnicminoritiesservedinTitleIIprogramswasselectedasthebestmeasureoftheprogramsgoaltoeliminatehealthdisparitiesamongindividualsinfectedwithHIV/AIDSbyincreasingutilizationfortraditionally_00underserved_00Ԁpopulations,suchascommunitiesofcolor. Performance:   AsshowninCHARTSII.B.2AandII.B.2B,theTitleIIfundedprogramsareservingasignificantlyhigherproportionofwomenandminoritiesthanthetargetspecifiedintheindicatoritself(i.e.,fivepercenthigherthantherepresentationofwomenandracial/ethnicminoritiesamongallAIDScasesintheNation,asreportedbyCDC).ThepercentageofwomenservedbyTitleIIprogramsin2000,are15.2%higherthantherepresentationofwomenreportedbytheCDC.Additionally,TitleIIfundedprogramsserved11.7%greaterpercentofminoritiesthantheCDCsnationaldatareportreflects.TitleIIprogramshaveeffectivelyexceededthisgoalofservingaproportionofwomenandminoritiesthatrepresentfiguresgreaterthan5%higherthanthenationalCDCdatareflects.  2 Ѐp><,(`~0X3  `YE3  Wt?p WW(#(# WWWW WWWW WWWW WWWW WWWW WWWW WWWWX*XXX* WWWW WWWW WWWW WWWW WWWW (#(#WW ~~(#(# ~~~~ ~~~~ ~~~~p><,(`~0G `YE~i<]p ~~~~ ~~~~ ~~~~ ~~~~ ~~~~ ~~~~ ~~~~ ~~~~ ~~~~ ~~~~ ~~~~ (#(#~~____________________________________________________________________________0   1  lXX*DatasourceforpercentofwomenandminoritiesamongallU.S.AIDScasesinCentersforDiseaseControl 'd" andPreventionYearEndHIV/AIDSSurveillanceReportthroughDecember2000.(P# (#(#   (Vol.12,No.2)#X*XlD#20  lXX*DataforTitleIIfundedprogramsrepresentsduplicateclients.#X*Xl'F#Ԁ#X*XXX*fA#X*XXX*lXX*ClientsmayhavereceivedTitleIIfunded)<%"(#(#   servicesfromanotherproviderorinanotherregionduringtheFiscalYear. +N'$ #X*XlF##X*XXX*F#DevelopmentalPerformanceOutcomeMeasure:  AdevelopmentalperformanceindicatorthatassessesthreekeyclinicalmeasurespreviouslyhadbeenunderconsiderationforTitlesIandII.Thethreeclinicalmeasureswere:1)percentofwomenreceivingpapsmears;2)percentofclientswhoreceiveaTBskintest;and3)percentofclientswhoreceiveappropriatePCPprophylaxistreatment.UseoftwoofthethreeclinicalmeasuresisstillanticipatedbutthemeasureassessingthepercentofclientswhoreceivePCPprophylaxisisnolongerunderconsiderationforseveralreasons.First,itwasdeterminedthatassessingthemeasurewithintheCAREActTitleIandTitleIIaggregatedatasystemswouldbedifficultandburdensomeforgrantees.AccuratereportsofthemeasurewouldrequiregranteesandtheirproviderstoreportonboththenumberofHIVpositiveclientsmeetingtheclinicalcriteriaforreceiptofPCPprophylaxisaswellasthenumberofHIVclientsactuallyreceivingappropriatetherapy.Further,withtheadventofhighlyactive_00antiretroviral_00ԀtherapyandotherHIVtreatmentadvances,thenumberofHIVpositivepersonsrequiringprophylactictreatmentforPCPhasdeclineddramatically,makingitdifficulttoestablishbaselinemeasuresandtargetsfortheproposedperformanceindicator.Currently,therearenointernaldataavailableonthesemeasurestoserveasabaselineand/ortodevelopappropriatetargets.PreliminarydatahavebeensubmittedbythefivesitescollectingclientleveldataforCY2000.TitleIandIIGranteeshaveallsubmittedpreliminarydataonavoluntarybasis.Thesedataarecurrentlybeingassessedfortheircompletenessandusefulness.Beginningincalendaryear2002,allCAREActgranteeswillusethenewRyanWhiteCAREActDataReporttoreportprogramdata.ThisnewdatareportingsystemwasdevelopedtostreamlineandsimplifyreportingwhileestablishingaminimumsetofdatareportingrequirementsforallCAREActTitleprograms.AllgranteesarerequiredtoreportdataontheproposedclinicalmeasuresintheRyanWhiteCAREActDataReport.DataforCY2002willbeavailableinmid2003.Oncethedatafromthesesourcesareavailable,afinaldecisionregardingthedevelopmentofthisperformancemeasurewillbemade.GiventheimportanceofincludingoutcomesaswellasoutputmeasuresintheBureausperformanceplan,everyeffortwillbemadetodevelopthesemeasuresfurther. `  DataIssues: DatafortheRyanWhiteCAREActTitleII(PartB)and_00ADAP_00Ԁperformancemeasuresare d" obtainedfromthefollowingsources:L 23456789'Ihh23456789L 23P   23!S2'I3  0    AnnualAdministrativeReports,23!SLS݌l$!(#(# Ќ  L 23456789Hhh23456789L 23Q   23?T2H3  0    GrantApplications,23?TjT݌% "(#(# Ќ  L 23456789Hhh23456789L 23R   23RU2H3  0    Grantees'NeedsAssessments,and23RU}U݌&!#(#(# Ќ  L 23456789Hhh23456789L 23S   23rV2H3  0    _00ADAP_00ԀMonthlyReport23rVV݌'#$(#(# Ќ   (,$%    FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport      2.7ProgramTitleAIDS:HIVEarlyInterventionServices(PartC)  8 i7XX**<dd dd dd dd dd <(#(#, dd ,dd ,dd ,dd +  /X F  /#X*X7i^X#&M'%XX*PerformanceGoals AX,! "X ATargets AX,! "X AActual   Performance AX,! "X AReference =(&  "  X = I.ELIMINATEBARRIERS  n  TOCARE   F   A.IncreaseUtilizationfor  N  _00Underserved_00ԀPopulations  &  1.IncreasethenumberofpeoplereceivingprimarycareservicesunderEarlyInterventionServicesprograms. $ $FY03:138,968clientsFY02:138,968clientsFY01:117,000clientsFY00:110,398clientsFY99:90,433clients  v  FY01:(1/03)FY00:129,654clientsFY99:108,945clientsFY98:105,398clientsFY97:96,451clients  v,   B233 NEW N 3 FY00DATA  ^5  #X*X'%&MY#&M'%XX*&M'%'%&M )v8 )2.IncreasethenumberofgrantapplicantsthatareFaithBasedand/orCommunityBasedOrganizations. (NewMeasure)  j<  $v= $FY03:10%overthetobeestablishedbaseline  @ FY03:(10/02)  :B B233 )2C" )]   II.ELIMINATEHEALTH 2D DISPARITIES   E  B.IncreaseUtilizationfor F _00Underserved_00ԀPopulations   G 1.IncreasethenumberofracialandethnicminoritieswhoarereceivingprimarycareservicesunderEarlyInterventionPrograms. $(j#O $`  FY03:97,277clientsFY02:97,277clientsFY01:84,179clientsFY00:77,279clientsFY99:60,000clients  *'z"Y a  FY01:(1/03)FY00:87,905clientsFY99:73,456clientsFY98:72,242clientsFY97:63,423clients  2(#d Kb  B233 NEW  #Zj FY00DATA  %j l  #X*X'%&MH^#&M'%XX*#&M'%'%&Mg^#&M'%'%&Mb  #X*X'%&M_c#&M'%XX*#&M'%'%&Mc#&M'%'%&M  B*%q c   TotalFunding:(ProgramTitle)  d  ($in000's) -#l -#X*X'%&Md#&M'%XX*d  FY2003:$194,507 d FY2002:$194,334FY2001:$186,274FY2000:$138,372FY1999:$94,270FY1998:$76,211#X*X'%&MHe#&M'%XX* +!  +#X*X'%&M-f#we&M'%XX*  Bx:page#budget d  HP:HealthyPeoplegoal#X*X'%&Mf##X*XXX*Dd#%l    %f  2.7.1ProgramDescription,ContextandSummaryofPerformance     ProgramDescriptionandContext:     TitleIIIoftheRyanWhiteCAREActauthorizesearlyinterventionserviceprogramstosupportoutpatientHIVearlyinterventionservicesforpeopleinexistingprimarycaresystems,andsupportscomprehensiveprimaryhealthcareandotherservicesforindividualswhohavebeendiagnosedwithHIVdisease.TheTitleIIIprogramalsofundstwotypesofplanninggrants.ThefirsttypearegrantsthatfundorganizationstoprepareforthedevelopmentofHIVearlyinterventionservices.Thesecondtypeofplanninggrantprovidescapacitybuildingtodevelop,enhance,orexpandtheircapabilitytoprovideHIVprimarycareservices.Theprogramspecificallytargetspreviously_00underserved_00Ԁpopulationswhichhavehadlimitedaccesstocare,includingwomen,children,adolescents,racialandethnicminorities,substanceabusersandindividualsresidinginruralareas.The311currentlyfundedTitleIIIprogramsrepresentacross-sectionofcommunity-basedandpublicorganizations.Theseprogramsprovidearangeofservicesincluding:L 23456789Ihh23456789L 23T   23l2I3  0    Riskreductioncounseling,partnerinvolvementinriskeducation,educationtoprevent  transmission,antibodytesting,medicalevaluation,andclinicalcare;23ll݌ (#(# Ќ  L 23456789Ihh23456789L 23U   23`n2I3  0    _00Antiretroviral_00Ԁtherapies;protectionagainstopportunisticinfections,andongoingmedical,   oralhealth,nutritional,_00psychosocial_00,andotherservicesforHIVinfectedclients;23`nn݌ (#(# Ќ  L 23456789'Ihh23456789L 23V   23\p2'I3  0    Casemanagementtoassureaccesstoservices,andcontinuityofcareforHIVinfected " clients;and23\pp݌ (#(# Ќ  L 234567897Ihh23456789L 23W   23q27I3  0    Addressing coepidemicsthatoccurfrequentlyinassociationwithHIVinfection,including $! tuberculosisandsubstanceabuse.23qq݌ (#(# Ќ  g  ProgramPerformance:  ' $ Sinceitsinception,theRyanWhiteCAREActTitleIII(PartC)programhasincreasedaccesstohealthcareforindividualswhoareinfectedwithHIVorwhoareatriskforHIVinfection.Theprogramsprovidebothcomprehensiveprimarycareservicesandearlyinterventionservicesaimedatpreventingand/orreducingHIVrelatedmorbidity. +$( ЇInFY2000,fundingbecameavailableforTitleIIIplanninggrantstobolsterHIV/AIDScareincommunitiesofcolorandrural_00underserved_00Ԁareastwodemographicgroupswhichhavetraditionallybeen_00underserved_00ԀandhaveanincreasingneedforHIV/AIDSpreventionandtreatment.Atotalof93planninggrantswereawardedtopublicandprivateorganizationsinFY2001;itisanticipatedthat94planninggrantswillbeavailableinFY2002.TheseplanninggrantsaredesignedtohelpcommunitiesthatlackadequateHIVcareresourcesimprovetheirabilitytodeliverprimarycaretoindividualswithHIVbystrengtheningtheirplanningandadministrativeactivities.ItisanticipatedthatasignificantproportionofthecommunitiesreceivingaplanninggrantwillsubsequentlysuccessfullysecurefundingtoprovideafullrangeofprimarycareandsocialsupportservicesforpeoplelivingwithHIV/AIDS.Thisadditionaltargetedfunding,combinedwiththecurrentprogrammaticeffortswillenabletheprogramtoachieveitsoverallgoalofprovidingprimarycareservicesto_00underserved_00ԀindividualswithHIV/AIDS.    2.7.2GoalbyGoalPresentationofPerformance  H   GoalI.A.1:IncreasethenumberofpeoplereceivingprimarycareservicesunderEarly 0 InterventionServicesprograms. Context:  T ThenumberofindividualsreceivingprimarycareservicesthroughtheEarlyInterventionServicesprogramwasselectedasthebestmeasureofachievingtheprogramsgoaltoeliminatebarrierstocareforindividualsinfectedwithHIV/AIDSbyincreasingaccesstotheseservices.   Performance:   InFY2000,TitleIIIEarlyInterventionProgramserved129,654clientsreceivingprimarycareservices,exceedingthetargetedgoalby17.4%,andrepresentinganincreaseof15.8%innewclientsservedcomparedtoFY1999.RiskexposureinformationshowsthelargestpercentageincreaseofpersonswithHIV/AIDSservedtobeamongheterosexualsandinjectiondrugusers. GoalI.A.2:IncreasethenumberofgrantapplicantsthatareFaithBasedand/orCommunityBasedOrganizations.Context: ThenumberofgrantapplicantstotheEarlyInterventionServicesProgramsthatareself &("" identifiedasaFaithBasedOrganization(_00FBO_00)and/oraCommunityBasedOrganization(_00CBO_00)wasselectedasthebestmeasuretoassessprogresstowardeliminatingbarriersfor_00FBOs_00/_00CBOs_00ԀinterestedinparticipatinginFederallyfundedhealthandhumanservicesprograms.ThisperformancemeasureisinconcertwiththeWhiteHouseInitiativeand_00HHS_00SecretarialInitiativetoensurefullparticipationbyqualified_00FBOs_00/_00CBOs_00Ԁinappropriate t+&' Federallyfundedprograms._00HRSA_00sgrantannouncementsandgrantapplicationguidanceinviteallinterestedandqualified_00FBOs_00/_00CBOs_00Ԁtoapplyfor_00HRSA_00Ԁfundingopportunities.̀ Performance: $  TheagencyproposestomeasureperformanceandprogressonthisperformancemeasureinFY @ 2003,usingFY2002performancedataasabaseline.TheproposedtargetforFY2003is10%abovethetobedeterminedbaseline.    GoalII.B.1:IncreasethenumberofracialandethnicminoritieswhoarereceivingprimarycareservicesunderEarlyInterventionPrograms.Context:  (x  DespitethereductionseeninoverallAIDSmortality,annualincidencedatashowtheproportionofAIDScasesamongwomenandminoritiescontinuetoincrease.ThenumberofracialandethnicminorityindividualswithHIV/AIDSreceivingprimarycareservicesthroughEarlyInterventionServicesprogramswasselectedasthemostappropriatemeasuretoascertainprogresstowardachievingtheprogramsgoalofeliminatingdisparitiesinhealthamongindividualsinfectedwithHIV,particularlyforthosewhohavetraditionallybeen_00underserved_00(e.g.,communitiesofcolor).   Performance:  T InFY2000,theTitleIIIEarlyInterventionProgramprovidedservicesto87,905racialandethnicminorities,exceedingthetargetedgoalby13.7%.Theactualperformancein2000reflectsanincreaseof16.5%(14,449minorityclients),comparedtoFY1999.67.8percentofTitleIIIclientsservedin2000werepeopleofcolor.ForFY2002and2003,theTitleIIIProgramproposestoincreasethepercentageofracialandethnicminoritiesamongclientsservedto70%.ThecurrentlevelofperformancereflectssignificantlyincreasedeffortsacrossalloftheRyanWhiteCAREActprogramstotargetcommunitiesofcolor.  DevelopmentalPerformanceOutcomeMeasure: !0 AdevelopmentalperformanceindicatorthatassesstwokeyclinicalmeasuresisunderconsiderationforTitleIII.Thetwoclinicalmeasuresare:1)percentofwomenreceivingpapsmears;and2)percentofclientswhoreceiveaTBskintest.Currently,therearenointernaldataavailableonthesemeasurestoserveasabaselineand/ortodevelopappropriatetargets.Beginningincalendaryear2002,allCAREActgranteeswillusethenewRyanWhiteCAREActDataReporttoreportprogramdata.ThisnewdatareportingsystemwasdevelopedtostreamlineandsimplifyreportingwhileestablishingaminimumsetofdatareportingrequirementsforallCAREActTitleprograms.AllgranteesarerequiredtoreportdataontheproposedclinicalmeasuresintheRyanWhiteCAREActDataReport.DataforCY +&' 2002willbeavailableinmid2003.Oncethedatafromthesesourcesareavailable,afinaldecisionregardingthedevelopmentofthisperformancemeasurewillbemade.GiventheimportanceofincludingoutcomesaswellasoutputmeasuresintheBureausperformanceplan,everyeffortwillbemadetodevelopthesemeasuresfurther. DataIssues: DatafortheRyanWhiteCAREActTitleIIIperformancemeasuresareobtainedfromthe   annualTitleIIIEarlyInterventionProgramDataReports.         sFY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  2.8ProgramTitle:AIDS:HIVPediatricGrants(Women,Children,Youth) *<edd dd dd dd dd <(#(#,dd , dd ,` dd ,dd +  /X  p /&M'%XX*PerformanceGoals AX,! "X ATargets AX,! "X AActual   Performance AX,! "X AReference =(&\  "  X = I.ELIMINATE  H  BARRIERSTOCAREA.IncreaseUtilizationfor_00Underserved_00Populations 1.Increasethenumberof   femaleclientsprovidedcomprehensiveservices,includingappropriateservicesbeforeorduringpregnancy,toreduceperinataltransmission. $ $FY03:32,371femaleclientsFY02:32,371femaleclientsFY01:21,884femaleclients#X*X'%&M# < XX*   #X*X<  l#&M'%XX*FY00:14,470female ! clients#X*X'%&MÔ#&M'%XX* " FY99:13,900femaleclients#X*X'%&M6#&M'%XX* p$   & FY01:(1/03)FY00:24,894 * female 0. clients   \/ FY99:18,948femaleclientsFY98:12,690femaleclients#X*X'%&M#&M'%XX*  p1 FY97:9,469femaleclients#X*X'%&M#&M'%XX*  (x2 B235 NEW (x 9 FY00DATA #X*X'%&M,#&M'%XX* )H=" ) III.ASSUREQUALITY <> OFCARE  ?  B.AssureEffectiveness @ ofCare  A 1.WithCDC,decreaseby5percentannuallythenumberofnewlyreportedAIDScasesinchildrenasaresultofperinataltransmission. $#4G $FY03:152childrenFY02:160childrenFY01:151childrenFY00:161childrenFY99:214children  $#tO FY01:(1/03)FY00:177childrenFY99:171childrenFY98:235childrenFY97:310children  4% Y B235 NEW !d_ FY00DATA  $#ta  #X*X'%&MƗ#&M'%XX* )D'"e" ) TotalFunding:HIV d PediatricGrants(Women,ChildrenandYouth)     $in000's $  $FY2003:$70,990FY2002:$70,990FY2001:$64,995FY2000:$50,990FY1999:$45,985FY1998:$40,803     Bx:page#budgetHP:HealthyPeoplegoal t   #X*X'%&M# }* Amongthesewomen3,113wereage13to19,3,220were2024yearsold,and18,558were   25yearsofageandolder.   2.8.1ProgramDescription,ContextandSummaryofPerformance     ProgramDescriptionandContext:    TitleIVoftheRyanWhiteCAREActdevelopsandsupportsprogramsthatprovidecoordinated,comprehensive,familycenteredsystemsofcareandenhancedaccesstoclinicalandotherresearchactivitiesforchildren,youth,womenandfamiliesinfectedwithandaffectedbyHIV/AIDS.ManyoftheTitleIVclientpopulationsrequireintensivecasemanagement,childandrespitecare,anduniquemodelsofdirectservicedelivery.Inadditiontoprovidingcommunitybasedmedicalandsocialsupportservices,thesesystemsofcaremustassurethatclientshaveaccesstoresearchandclinicaltrials.AspecialfocusoftheTitleIVprogramistohelpidentifyHIVpositivepregnantwomen,connectthemwithcarethatcanimprovetheirhealth,andpreventperinataltransmission.Innovativemodelsfundedunderthisprogrammustorganize,arrangefor,anddelivercomprehensiveservicestothesepopulationsmaximizingandutilizingallexistingongoingsystemsofcare.TitleIVprogramsservetheuniqueandvaryingneedsoftheirspecificserviceareasbyutilizingextensiveandculturallycompetentoutreachtoprovideaccesstoaseamlesssystemofcareforallclientpopulations.ProjectareasfundedunderTitleIVinclude:L 23456789GIhh23456789L 23X   23 2GI3  0    GrantsforCoordinationofHIVServicesandAccesstoResearchforChildren,Youth, "t# WomenandFamilies;23 6݌ (#(# Ќ   23Y   2322GI3  0    CommunitiesofColorChildrensInitiative;232]݌$|%(#(# Ќ   23Z   232GI3  0    AdolescentInitiativeGrants;and23?݌%&(#(# Ќ   23[   232GI3  0    ContinuousQualityImprovementInitiative(tobeimplementedinFY2001).   ! 23݌&'(#(# Ќ  ProgramPerformance:  )!) Sinceitsinception,theTitleIVprogramhasprovidedprimarycareandsupportservicesto children,youth,womenandfamilieslivingwithHIVdisease,usingafamilycenteredapproach. +#+ Theprogramconductstargetedoutreachactivitiestoidentify,enroll,andprovideservicestothispopulation.Specificexamplesofsuccessfulprogrammaticeffortsinclude: L 23456789WIhh23456789L 23\   23 2WI3  0    EnhancingservicestomaintainHIVinfectedpeopleincare,particularlypostnatalfemales,to  ensurethattheyarenotlosttoHIVtreatmentandfollowupafterdelivery;23 6݌ (#(# Ќ   23]   23v2WI3  0    Targetingoutreachinitiativestoreachandenrollincaresoontobedischargedincarcerated  femalepopulations;23v݌ (#(# Ќ   23^   232WI3  0    Supportingandstrengtheningadolescentservicescomponentsforprogramswithaparticular   focusontheenrollmentofHIVinfectedadolescentsintoprimarycarewhichincludesdisclosureissues,substanceabusetreatment,mentalhealthservices,andpreventionservicesinthepackageofservicesoffered;and23ҫ݌ (#(# Ќ   23_   232WI3  0    Targetoutreachinitiativestoreach,recruit,andretainincarenonparentalHIVinfected   females.23ȭ݌ (#(# Ќ  2.8.2GoalbyGoalPresentationofPerformance     GoalI.A.1:Increasethenumberoffemaleclientsprovidedcomprehensiveservices, T includingappropriateservicesbeforeorduringpregnancy,toreduceperinataltransmission.Context:  d Thenumberoffemaleclientsreceivingcomprehensiveservices,includingappropriateservicesbeforeorduringpregnancytoreduceperinataltransmission,wasselectedasthebestwaytomeasuretheTitleIVprogramsgoalofeliminatingbarrierstocareforHIVinfectedchildren,adolescents,womenandfamiliesthroughincreasingutilizationofcareamongthistraditionally_00underserved_00Ԁpopulation. Performance:  h InFY2000,therewasanapproximate24%increaseinthenumberofwomenreceivingcomprehensiveservices,includingappropriateservicesbeforeorduringpregnancytoreduceperinataltransmission,throughtheTitleIVprogram,comparedtoFY1999. GoalIII.B.1:Decreaseby5percentannuallythenumberofnewlyreportedAIDScasesinchildrenasaresultofperinataltransmission  0%   Context:  h'"" ThenumberofreportedAIDScasesinchildrenasaresultofperinataltransmissionwasselectedasthebestmeasureoftheTitleIVprogramsperinatalHIVtransmissionreductionactivities.Theseactivitiesinclude:1)improvingaccessforHIVpositivepregnantwomentonewtherapiesthathavehighsuccessratesinpreventingthetransmissionofHIVtonewborns;2)facilitatingparticipationinclinicaltrialsthatprovidethesewomenaccesstostateofthearttreatments;and 4,'' 3)successfullyidentifyingincreasingnumbersofHIVpositivepregnantwomenbeforeorearlyintheirpregnancyandprovidingeffectivecounselingregardingmedicationstodecreaseriskofperinataltransmission. Performance:   BasedonnationaldatafromtheCentersforDiseaseControlandPrevention,pediatricAIDScasesasaresultofperinataltransmissionappearstohavestabilized.BetweenFY1999and2000,therewasa3.4%increaseinmothertochildHIVperinataltransmission.CDChasreducedtheirFY2000targetto161tobetterrepresentthesuccessfulreductionofperinatalHIVtransmission.TheFY2002and2003targetscontinuetoreflectthe5%reductioninnewlyreportedAIDScasesinchildrenasaresultofperinataltransmission,buildingofftherevisedbaselinenumberof177childreninFY00.Theincreaseinpregnantwomenreceivingprenatalcareandtheuseoftherapies(_00Zidovidine_00)hasresultedinthereductionoftransmissionofHIVinfectiontonewborns. DevelopmentalPerformanceOutcomeMeasure:  t AdevelopmentalperformanceindicatorthatassesstwokeyclinicalmeasuresisunderconsiderationforTitleIV.Thetwoclinicalmeasuresare:1)percentofwomenreceivingpapsmears,and2)percentofclientswhoreceiveaTBskintest.TwoadditionaldevelopmentalperformanceindicatorsthatassessprogramoutcomesarebeingconsideredforTitleIV:1)percentofpregnantclientswhoreceived_00antiretroviral_00ԀmedicationstopreventtransmissionofHIVtotheirchildren,and2)percentofchildrenwhoareHIVpositiveborntoclients.Currently,therearenointernaldataavailableonthesemeasurestoserveasabaselineand/ortodevelopappropriatetargets.Beginningincalendaryear2002,allCAREActgranteeswillusethenewRyanWhiteCAREActDataReporttoreportprogramdata.ThisnewdatareportingsystemwasdevelopedtostreamlineandsimplifyreportingwhileestablishingaminimumsetofdatareportingrequirementsforallCAREActTitleprograms.AllgranteesarerequiredtoreportdataontheproposedperformanceindicatorsintheRyanWhiteCAREActDataReportDataforCY2002willbeavailableinmid2003.Oncethedatafromthesesourcesareavailable,afinaldecisionregardingthedevelopmentofthisperformancemeasurewillbemade.GiventheimportanceofincludingoutcomesaswellasoutputmeasuresintheBureausperformanceplan,everyeffortwillbemadetodevelopthesemeasuresfurther. DataIssues: %8!"  DatafortheRyanWhiteCAREActTitleIVperformancemeasuresaretheannualTitleIVData 'T"# ReportandtheYearEndCDCHIV/AIDSSurveillanceReports(&M'%XX*CDCHIV/AIDSSurveillance '@#$ report,Vol.12,No.1,EstimatedpediatricAIDSincidencesbyyearofdiagnosis,1992throughDecember2000,UnitedStates).#X*X'%&M# )%&  * &'   @ FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport    2.9ProgramTitle:AIDSEducationandTrainingCenters  8 *<deddd  dd  ` dd ` dd <(#(#,2 dd ,Cdd ,dd ,dd +  /X T /&M'%XX*PerformanceGoals AX,!h"X ATargets AX,!h"X AActual h Performance AX,!p "X AReference#X*X'%&M#&M'%XX* =(&h"  X = IV.IMPROVEPUBLIC  ,  HEALTHANDHEALTHCARESYSTEMSB.PromoteEducationandTrainingofthePublicHealthandHealthCareWorkforce  D  1.Increaseproportionof_00AETC_00traininginterventionsprovidedtominorityhealthcareproviders.#X*X'%&M+#&M'%XX* (NewMeasure) #X*X'%&M#&M'%XX* $ 1.Increasethenumberofminorityhealthcareandsocialserviceproviderswhoreceivetrainingin_00AETCs_00. (Measureto  bedeleted). #X*X'%&M9#&M'%XX* d  #X*X'%&MR#&M'%XX* $t $FY03:41%FY02:41%FY01:40%#X*X'%&M#&M'%XX* d % FY00:117,000providersFY99:107,582providers#X*X'%&MA#&M'%XX*  t1 FY01:(2/03)dFY00:(2/02)FY99:41%FY98:37%#X*X'%&M#&M'%XX* ,|< FY00:(2/02)dFY99:44,788providers**(basedonrevisedapproachtocounting)FY98:89,549providersFY97:88,817providers  !$I B237 )DW" ) TotalFunding:AIDS @#X EducationandTrainingCenters $in000's $%H![ $FY2003:$35,295FY2002:$35,295FY2001:$31,598FY2000:$26,644FY1999:$19,994FY1998:$17,216  h(#a Bx:page#budgetHP:HealthyPeoplegoal#X*X'%&Ml# H$c P% d     2.9.1ProgramDescription,ContextandSummaryofPerformance  +&f  ProgramDescriptionandContext:   TheNationalAIDSEducationandTrainingCenters(_00AETC_00)Programisanetworkof14regionalcenters(withmorethan75localperformancesites)thatconducttargeted,multidisciplinaryHIVeducationandtrainingforhealthcareproviders.Themissionofthesecentersistoincreasethenumberofhealthcareproviderswhoareeffectivelyeducatedandmotivatedtocounsel,diagnose,treatandmedicallymanageindividualswithHIVinfectionandtoassistinthepreventionofhighriskbehaviorswhichmayleadtoinfection.Severalnational,crosscuttingcomponentsofthe_00AETC_00ԀprogramsupportandcomplementtheregionaltrainingcentersincludingtheNationalMinorityAIDSEducationTrainingCenter(_00NMAETC_00),NationalResource_00AETC_00,NationalHIV/AIDSCliniciansConsultationCenter,andtheNationalEvaluation_00AETC_00.The_00NMAETC_00ԀisheadquarteredatHowardUniversityinWashington,D.C.withadditionalsitesathistoricallyBlackcollegesanduniversities(_00HBCUs_00)inordertoincreasethenumberofminorityproviderswhoareeducatedtotreatminoritypatientswithAIDS.The_00AETC_00ԀrepresentstheBureauseffortstobuildthepoolofavailableHIVcaretrainedprofessionals. ProgramPerformance:  P DuringFY1998andthroughFY2000the_00AETC_00Ԁprogramfocusedonfurtherrefinementofitseffortsinseveralareasincludingclinicalconsultationandindividualized handsontraining.ClinicalconsultationwasaddedasanintegralpartoftheCentersresponsibilitytoassurethatproviderswouldreceiveeducationandtrainingtargetedatmanagementofcomplexclinicalsituationsthatoccurintheirdailyclinicalwork.Thisactivitywassupplementedbythe_00HRSA_00/_00AETC_00ԀNationalHIVTelephoneConsultationServicewhichprovidesgeneralsupporttoHIVcareprovidersnationwide.ThisserviceprovidesaresourcetoobtaintimelyandappropriateresponsestoclinicalquestionsrelatedtotreatmentofpersonswithHIVinfectionand/orpossiblehealthcareworkerexposuretoHIVandother_00bloodborne_00Ԁpathogens.Inaddition,the_00AETC_00Ԁprogramsincorporatedmore handsonexperienceandrevisedtheirtrainingformattoincorporateaninteractiveworkshopenvironmentinsteadofusingprimarilyalectureformat.Duetochangeinemphasisfromlargedidacticconferencestointensive,oneononetraining,thetotalnumberofproviderstrainedshowsreducednumberinFY1999.However,thosetrainedreceivedmoreintensive,longitudinaltrainingthatwillbetterequipthemtoproviderbettercareinthecomplexandrapidlychangingfieldofHIVcare.InFY1999,severalnational_00AETC_00ԀCenters,the_00AETC_00ԀResourceCenter,the_00AETC_00ԀEvaluationCenters,andtheNationalMinority_00AETC_00,wereestablished.The_00AETC_00ԀResourceCenterisawebbasedHIV/AIDStrainingresourcethatwasestablishedtoincreasesharingofinformationanddecreaseduplicationintrainingresourcedevelopmentactivitiesamongthecurrentlyfunded_00AETCs_00.The_00AETC_00ԀEvaluationCenterwasestablishedtoimproveassessmentofthe_00AETC_00programseducationaloutcomes.TheNationalMinority_00AETC_00Ԁwaschargedwithincreasingthepooloftrainedminorityhealthcareprofessionals. ,,|')  2.9.2GoalbyGoalPresentationofPerformance    GoalIV.B.1:Increaseproportionof_00AETC_00Ԁtraininginterventionsprovidedtominority 8 healthcareproviders.(CURRENT)GoalIV.B.1:Increasethenumberofminorityhealthcareandsocialserviceproviderswhoreceivetrainingin_00AETCs_00.(PREVIOUS)   ,  Context:   d GiventheincreasingproportionofAIDScasesamongracialandethnicminoritiesmorethan68percentofclientscurrentlyreceivingcareandservicesundertheCAREActareminoritiesimprovingtheclinicaleducationandtrainingforminorityprovidersiscriticalinmanagingtheincreasingnumberofcasesamongcommunitiesofcolor.Thepercentageof_00AETC_00ԀtraininginterventionsprovidedtominorityhealthcareproviderswasselectedasthebestmethodtomeasuretheprogramsgoalofpromotingtheeducationandtraininginHIVcaretohealthcareworkforceservingmedically_00underserved_00Ԁpopulations.Atraininginterventionisdefinedasaninteractionbetweenaminorityhealthcareproviderandan_00AETC_00ԀtrainerforthepurposesofreceivingclinicalconsultationorothertypesoftrainingrelatedtotheprovisionofHIV/AIDSrelatedhealthcareservices.Previously,aduplicatedcountofminorityprovidersreceivingtrainingthroughthe_00AETC_00programhadbeenusedasameasureofprogramperformance.MeasuringthepercentageoftraininginterventionsprovidedtominorityhealthprovidersseemedamoreaccurateandappropriatemethodtomeasuretheprogramsprogressintrainingtheseprovidersinHIV/AIDScounseling,careandtreatment.Thisrevisedmeasurewillallowtheprogramtomeasuretheproportionofthoseinterventionsprovidedtominorityhealthproviders.Theproportionofminorityhealthcareprovidersreceivingtraininginterventionsfrom_00AETC_00Ԁwillremainat41%inFY03.Thetargetisbasedontheproportionofminorityprovidersinthehealthcaresystem. Performance:  ! Asthemeasurewasrecentlyrevisedfromnumberofminorityproviderstopercentageoftraininginterventionstominorityproviders,FY1998isthebaselineyearofdatacollection.PerformanceundertheinitialmeasureshowsanreducednumbertrainedforFY1999.Thisisbecausetheemphasischangedfromlargedidacticconferencestooneononetraining.InshiftingtothenewmeasureforFY2001,andindeterminingthetargetperformanceforfutureyears,aconservativeestimatebasedonbestprofessionaljudgementwasused.Itisanticipatedthattheseestimatedtargetsmayberevisedinfutureyearsbasedonactualprogramperformance.    *%&   FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport2.10ProgramTitle:AIDS:DentalServicesProgram * <"dd2 dd 2 Cdd Cdd dd <(#(#,} dd ,dd ,dd ,dd +  /X  p /&M'%XX*PerformanceGoals AX,! "X ATargets AX,! "X AActual   Performance AX,! "X AReference =(&  "  X = III.ASSUREQUALITYOF  H  CARE      A.PromoteAppropriatenessof  (  Care    1.Increasethenumberofpersonsforwhomaportionoftheir_00unreimbursed_00Ԁoralhealthcostswerereimbursed. $@  $FY03:29,800persons*FY02:29,800persons*FY01:29,800personsFY00:46,000persons#X*X'%&M#&M'%XX* 0 FY99:66,000persons#X*X'%&M#&M'%XX* 8   @ FY02:(1/03)FY01:29,000personsFY00:29,000personsFY99:46,000persons  H& B239 #X*X'%&ML#&M'%XX*NEW (x - FY01DATA )8/" ) TotalFunding:AIDS:Dental 0 ServicesProgram $in000's $2 $FY2003:$13,498FY2002:$13,498FY2001:$9,999FY2000:$7,999FY1999:$7,798FY1998:$7,762  ,8 Bx:page#budgetHP:HealthyPeoplegoal#X*X'%&M9#;    *PerformancereflectsactivitiesfortheDentalReimbursementProgramonly.TheCommunity 4; DentalPartnershipProgramwillbedevelopedwithadditionalfundingandanewperformancemeasurewillbecreated,whentheprogramhasbeenfullyconceptualized,toreflectthenewprogramsperformance. 2.10.1ProgramDescription,ContextandSummaryofPerformance  "0@  ProgramDescriptionandContext:  %h B TheDentalReimbursementProgram(_00DRP_00),fundsinstitutionswithaccrediteddentaleducationprograms,locatedin28statesplustheDistrictofColumbiaandPuertoRico,thatprovideoralhealthcaretopeoplewithHIVdisease.Theprogramisintendedtoassistsuchinstitutionsbyoffsettingthenonreimbursedcosttheyincurinprovidingcaretothispopulation,thusstimulatingtheircontinuedcommitmenttotrainingnewgenerationsofdentalproviderswhoare preparedtomanagetheoralhealthneedsofpeoplewithHIVdisease.The_00DRP_00Ԁpartially  * &H  reimbursesaccrediteddentalschools,othergraduatedentaleducationprograms,andschoolsof dentalhygieneforthedocumenteduncompensatedcoststheyhaveincurredinprovidingoralhealthcaretoHIVinfectedpatients.AwardstakeintoaccountthenonreimbursedoralhealthcostsforHIVpatientsincurredforeachinstitutionascomparedtothetotal_00unreimbursed_00ԀcostsforHIVpatientsincurredforalleligibleapplicants.Thiscareincludesdiagnostic,preventive,oralhealth,educationandhealthpromotion,restorative,periodontal,_00prosthodontic_00,endodontic,oralsurgery,andoralmedicineservices.ByoffsettingthecostofnonreimbursedHIVcare,thedualgoalsof:1)improvingaccesstooralhealthcare;and2)trainingnewgenerationsofdental,dentalhygienestudents,anddentalresidentscanmanagetheoralhealthcareofpersonswithHIV.OralhealthiscriticaltotheoverallhealthstatusofpeoplewithHIVdisease;oralmanifestationsareoftentheearliestclinicalsignsofHIVinfection,andmaybeindicatorsofdiseaseprogression.OralhealthcareisroutinelyrankedasatophealthcareneedintheHIVneedsassessmentsincommunitiesacrossthenation.Severalcharacteristicsmakethe_00DRP_00ԀdifferentfromallotherCAREActprograms,includingthese:L 023456789Gxh23456789L 23`   23K2G3  0    The_00DRP_00Ԁisaretrospectivepaymentprogram,notaprospectivecompetitivegrant;awards 8 consistofsingleoneyearlumpsumpayment.23Kv݌ (#(# Ќ   23a   232G3  0    Applicantsdonotclaimfundingforindirectornonservicerelated,programsupporttype @ expenses,ascanallotherCAREActgrantrecipients.23݌ (#(# Ќ   23b   232G3  0    Institutionalparticipationinthe_00DRP_00Ԁisvoluntary,andfluctuatesfromyeartoyear.23)݌H(#(# Ќ   23c   23(2G3  0    Thescopeoforalhealthservicesavailableintheseinstitutionsisvariable.Someinstitutions d thatparticipateinthe_00DRP_00Ԁprovidecomprehensiveoralhealthcare,whilesomeprovideonlyspecialtycare,suchasoralandmaxillofacialsurgery,orpediatricdentistryforchildrenandadolescents.Theparticularfocusofanyaccrediteddentaleducationprogramdeterminesthenatureoftheserviceprovided.23(S݌ (#(# Ќ   23d   232G3  0    The_00DRP_00Ԁisuniqueinthatitinseparablylinkshealthservicedeliverywiththeeducationand 0  trainingofnewgenerationsofproviderswhoarebetterabletomanagethehealthcareofpeoplewithHIV;nootherCAREActprogramdoesboth.23݌ (#(# Ќ   23e   23r2G3  0    The2000_00Reauthorization_00ԀoftheRyanWhiteCAREActexpandedtheeligibleparticipation $#t inthe_00DRP_00Ԁtoincludeaccrediteddentalhygieneprograms.Itisnotknowhowmanyofthe262accrediteddentalhygieneprogramswillchoosetoparticipateinfuturefundingcycles.23r݌ (#(# Ќ  P 23456789WIhx023456789P ProgramPerformance:  4'"# In2001,theDentalReimbursementProgramawardsmet75%ofthetotalnonreimbursedcostsreportedby74participatinginstitutionsinsupportoforalhealthcare.Theseinstitutionsreportedprovidingcaretoapproximately29,000HIVpositiveindividuals,forwhomnootherfundedsourcewasavailable. InFY2000,thedemographiccharacteristicsofpatientswhowere +d&' caredforbyinstitutionsparticipatinginthe_00DRP_00Ԁwere:34%women,62%minority.TheFY ,T'( 2001demographicinformationisbeingaggregatedandanalyzedforearly2002release.Therefore,the_00DRP_00Ԁservedasignificantlyhigherproportionofwomenandminoritiesthentherepresentationofwomenandracial/ethnicminoritiesamongallAIDScasesinthenation,asreportedbyCDC.CDCreports17.3%ofAIDScasesin2000wereamongwomenand57%ofAIDScasesin2000wereamongracial/ethnicminorities.  ` 2.10.2GoalbyGoalPresentationofPerformance   0   (#(#  GoalIII.A.1 : Increasethenumberofpersonsforwhomaportionoftheir_00unreimbursed_00   oralhealthcostswerereimbursed.      Context:  H  AstherateofHIVrelatedmortalityslows,thenumberofpeoplelivingwithHIVwhoareinneedofcontinuingandregularoralhealthservicescontinuetogrow.Thenumberofpersonsforwhomaportionoftheir_00unreimbursed_00ԀoralhealthcostswerereimbursedwasselectedasthebestmeasureoftheprogramsgoalofassuringappropriateandqualityoralhealthcareservicesforthoseHIVinfectedindividualswhorequirethoseservicesbutarewithoutthefinancialmeanstoaffordthem. Performance:  8 AnewreportingsystemwasinitiatedfortheDentalReimbursementProgramin1999.TheFY T 2000performanceof29,000personswillserveasthebaselineforthismeasure.ThenewreportingsystemwasfullyimplementedinFY2000.ThepersonsservedfromFY2000toFY2001appeartobestable,accordingtothedatareportingsystem.InFY1999andpreviousyears,theinstitutionsparticipatinginthe_00DRP_00ԀestimatedthenumberofHIVinfectedpersonsserved.BeginninginFY2000,the_00DRP_00ԀrequiredparticipationinstitutionstoprovideexactnumbersofHIVinfectedpersonsservedintheproceedingyear.Thetotalpercentof_00unreimbursed_00ԀoralhealthcarecostsfortheDentalServicesProgramfundedincreaseto75%in2001,from64%in2000.InFY2002,therewillbeafocusonmaintainingthecurrentlevelofclientsservedandservicesreimbursedbytheprogram.  #  GoalIII.A.2.PerformancegoalforthenewCommunityDentalPartnershipProgramwill  bedevelopedwhentheprogramhasbeenfullyconceptualized.Context: TitleXXVI,SubpartII,(b),(5)describesthisnewprogramasdentalschoolsandprograms @ partneringwithcommunitybaseddentiststoprovideoralhealthcaretopatientswithHIVdiseasein_00underserved_00Ԁareas.The_00RFA_00ԀwillbedevelopedandawardsanticipateswillbemadebySeptember2002.    DataIssues:   <  ThedatasourceforthisperformancegoalistheDentalServiceProgramGrantApplications.BeginningwiththeFY2000reportingyear,anewreportingsystemwhichmoreaccuratelymeasuresthenumberofbeneficiarieswithintheprogramandthelevelof_00unreimbursed_00Ԁcostsincurredbytheparticipatinginstitutionswasimplemented.         bXHXXX*b%4XbXH  MATERNALANDCHILDHEALTH#bXHX4b%#  FY2003PerformancePlan,FinalFY2002PlanandFY2001PerformanceReport  p  ThemissionoftheMaternalandChildHealthBureau(_00MCHB_00)istoprovideleadershipandtowork,inpartnershipwithStates,communities,publicprivatepartners,andfamiliestostrengthenthematernalandchildhealth(_00MCH_00)infrastructure,assuretheavailabilityanduseofmedicalhomes,andbuildtheknowledgeandhumanresources,inordertoassurecontinuedimprovementinthehealth,safetyandwellbeingofthe_00MCH_00Ԁpopulation.The_00MCH_00ԀpopulationincludesallAmericaswomen,infants,children,adolescentandtheirfamilies,includingfathersandchildrenwithspecialhealthcareneeds(_00CSHCN_00).TheBureaudrawsuponnearlyacenturyofcommitmentandexperience.Earlyeffortsarerootedin_00MCHB_00spredecessor,theChildrensBureau,establishedin1912.MajorprogrameffortsoftheBureauinclude:2.110  MaternalandChildHealthBlockGrantTitleV(x(#(# 0   2.11a  UniversalNewbornHearingScreeningandEarlyIntervention#X*XXbXH#bXHXXX*D(#(# 2.11b  Trauma/EmergencyMedicalServices#X*XXbXH#bXHXXX*   !  ` 0   2.12  TraumaticBrainInjury#X*XXbXH-#bXHXXX*|(#(# 0   2.13  HealthyStart#X*XXbXH#bXHXXX*(#(# 2.140  HospitalPreparedness(_00Bioterrorism_00)(#(# 2.150  EmergencyMedicalServicesforChildren (#(# 2.160  PoisonControlCenters<(#(# 2.170  AbstinenceEducationProgram#X*XXbXHp#bXHXXX*X(#(# #X*XXbXH #4 O  5  6lO  7 bXHXXX* #X*XXbXH #bXHXXX*   @  @`  @  @   #X*XXbXH` #bXHXXX*  (T#! rPFY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  %  4 O  5  6!O!  7 "2.11ProgramTitle:MaternalandChildHealthBlockGrantTitleV  8 * dd} dd } dd dd dd  <"(#(#, bR@, bR@,bR@,bb@+  7<<"  p C7dd  PerformanceGoals 8040 A<<,! C << CAd 80d  Targets 80Ӏ A<<,! C << CAd  80d  ActualPerformance 80 A<<<,!  C"<< CAd  80d  Reference      80 T<<?' C"  <<< CTd 80d I.ELIMINATE  0 BARRIERSTOCARE     A.IncreaseUtilizationfor    UnderServedPopulations     1.Increasethenumberof   childrenservedbyTitleV.#X*XXbXH #bXHXXX* |   80 ;<<,!h C<< C;d 80d 80FY03:25MFY02:24.5MFY01:24M#X*XXbXH(#bXHXXX* ;<<,!l C<< C;d 80d 80FY01:(1/03)FY00:(2/02)FY99:23.0millionFY98:21.6millionFY97:20.2million#X*XXbXH6)#bXHXXX* ?<<<,!,(C<< C?d 80dB 80198 T<<?' .C  <<< CTd 80d2.Increasethepercentof_00CSHCN_00ԀintheStateprogramwithasourceofinsuranceforprimaryandspecialtycare. 80 ;<<,!<4C<< C;d 80dFY03:92%FY02:91%FY01:90% 80 ;<<,!P9C<< C;d 80dFY01:(1/03)FY00:(2/02)FY99:87%FY98:85%FY97:83% 80 ?<<<,!AC<< C?d 80dB198 80 T<<?'XDC  <<< CTd 80d3.Increasethepercentofinfantsborntopregnantwomenwhoreceivedprenatalcarebeginninginthefirsttrimester. 80 ;<<,!!$JC<< C;d 80dFY03:84%FY02:84%FY01:90%* 80 ;<<,!"QC<< C;d 80dFY01:(4/03)FY00:(4/02)FY99:83.2%FY98:83%FY97:82.5% 80 ?<<<,!#YC<< C?d 80dB198HP16  L] #X*XXbXHX*#bXHXXX* T<<?'!$_C  <<< CTddII.ELIMINATEHEALTHDISPARITIES  `  A.Reduce L Incidence/PrevalenceofDiseaseandMorbidity/Mortality    1.Decreasetheratiooftheblackinfantmortalityrateto thewhiteinfantmortalityrate. ;<<,!p  C<< C;dd FY03:2.1to1FY02:2.1to1FY01:2.1to1 80 ;<<,!\ C<< C;d 80d FY01:(9/03)FY00:(9/02)FY99:(2/02)FY98:2.4to1FY97:2.3to1FY96:2.4to1FY95:2.4to1(corrected) 80 ?<<<,!H(C<< C?d 80dB198HP16 #X*XXbXHn1#bXHXXX* 80 T<<?'p 3C  <<< CTd 80d III.ASSUREQUALITY X5 OFCAREB.AssureEffectivenessofCare  l8 1.Decreasetheinfantmortalityrate 80 ;<<,!D:C<< C;d 80d FY03:6.9/1000FY02:6.9/1000FY01:6.9/1000FY00:7.0/1000 80 ;<<,!DC<< C;d 80d FY01:(7/03)FY00:(7/02)FY99:7.1/1000FY98:7.2/1000FY97:7.2/1000FY96:7.3/1000FY95:7.6/1000 80 ?<<<,!hRC<< C?d 80dB198HP16  XX #X*XXbXHu5#bXHXXX* T<<<?'0ZC  <<< CTddTotalFunding:MaternalandChildHealthBlockGrant  "^ ($in000's) 80 =<<<,!#_C<<< C=d 80dFY2003:$731,531FY2002:$731,531FY2001:$709,151FY2000:$704,131FY1999:$694,777FY1998:$687,087(FundingtotalsexcludeTraumaticBrainInjury) 80 C<<<<0!<'"hC<<< CCd 80dBx:page#budgetHP:HealthyPeoplefocusarea 80:0.!kC   <<<< : 80*Seediscussionofperformanceforthismeasurebelow.  8(#k   *`%m PY     2.11.1ProgramDescription,ContextandSummaryofPerformance   8   G"G" 8   ProgramDescriptionandContext: G"G" ThepurposeoftheMaternalandChildHealthBlockGrantProgram,authorizedunderTitleVoftheSocialSecurityAct,istoimprovethehealthofallmothersandchildren,includingchildrenwithspecialhealthcareneeds.ItoperatesthroughapartnershipwithStateMaternalandChildHealth(_00MCH_00)andChildrenwithSpecialHealthCareNeeds(_00CSHCN_00)programs.Itsupportscorepublichealthfunctionssuchasresourcedevelopment,capacityandsystemsbuilding,populationbasedfunctionssuchaspublicinformationandeducation,knowledgedevelopment,outreachandprogramlinkage,technicalassistancetocommunities,andprovidertraining.TitleVhasthreecomponents:formulablockgrantsto59StatesandTerritories,SpecialProjectsofRegionalandNationalSignificance(_00SPRANS_00),andCommunityIntegratedServiceSystems(CISS)grants.In1999,theprogramservedover27millionindividuals,including2.2millionpregnantwomen,and23millionchildren,ofwhomnearly1millionwerechildrenwithspecialhealthcareneeds(Source:TitleVInformationSystem,TitleVBlockGrantFY1999AnnualReport). Asthe H onlyFederalprogramthatfocusessolelyonimprovingthehealthofallmothers,adolescentsandchildren,whetherinsuredornot,TitleVhasfarreachingimpact.Theprogramservesapproximately81percentofallinfants,21percentofallchildren,and58percentofallpregnantwomen._00MCH_00Ԁblockgrantfundssupportawidearrayofservices,mostofwhichfallwithinfourareas:        C * $h23456789C  DirectHealthCare 󀄀Basichealthcareservicesareprovidedtoindividualclientsgenerally  onaoneononebasisbetweenhealthcareprofessionalsandpatientsinaclinic,office,oremergencyroom.Drbid        (#(#K(#          EnablingServices 󀄀Theseserviceshelpthoseinneedgainaccesstothecarethatisavailable \  tothem.Forthedisadvantaged,thegeographicallyisolated,orforthosewithspecialhealthneeds,thesekindsofservicesmaymeanthedifferencebetweenwhethertheyactuallyreceivecareornot.Typesofservicesincludetransportationtocare,translationservices,respitecareforfamilycaregivers,andhealtheducationprograms.qFrbid                  PopulationbasedServices 󀄀Mostofthesearepreventiveservicesthatareavailableto %8!$ everyone.Examplesincludeimmunizations,childinjurypreventionprograms,leadpoisoningpreventionactivities,andnewbornscreeningprograms.Hrbid        ]        ]  InfrastructureBuilding 󀄀Theseactivitiesformthefoundationofall_00MCH_00Ԅfundedservices. )$( Activitiesmightinclude:evaluation,monitoring,planning,policydevelopment,qualityassurance,trainingandresearch. x+&* wJrbid        ]InFY2003,activitiesfundedundertheUniversalNewbornHearingScreeningandEarlyInterventionProgram,andtheTrauma/EmergencyMedicalServicesProgramwillbefundedwithinthe_00MCH_00ԀBlockGrant. ProgramPerformance:#X*XXbXH^9#bXHXXX*  ` Aninitialsetof_00MCHB_00Ԁ_00GPRA_00Ԁmeasureshasbeenidentifiedtomeasurethenationalimpactofthe_00MCH_00ԀStateBlockGrantprogram.ThesemeasuresarebasedonthecoresetofmeasuresthattheStatesstartedreportingonunderthenewPerformancePartnershipwiththeStatesinFY1998.The_00MCHB_00Ԁ_00GPRA_00Ԁmeasuresforthe_00MCH_00ԀStateBlockGrantprogrameitheraggregateandusetheStatereportedcoremeasuresdataor,forvitalstatisticsmeasures,themostrecentCDCdata,toassesstheoverallperformanceoftheStateBlockGrantprogram. #X*XXbXHnM#bXHXXX*Forsomemeasures,therelationshipbetweenbudgetresourcesandperformanceinthe_00MCH_00   BlockGrantisrelativelystraightforward,e.g.,increasesinthenumbersofthepopulationservedbyTitleV(womenandinfants,children).Forothermeasures,therelationshipisinterdependentwithMedicaidandotherprograms,e.g.,increasesinthepercentof_00CSHCN_00Ԁwithasourceofinsuranceforprimaryandspecialtycare.TheattainmentofsuchgoalsisdirectlyorindirectlytiedtotheamountofTitleVfundingatboththenationalandStatelevel.Forotherperformancemeasures,suchasreducingtheinfantmortalityrate,therelationshipbetweenbudgetresourcesandperformanceismorecomplicated.Infantmortalityisacomplexproblem,withmanymedical,socialandeconomicdeterminants.Nevertheless,someofitsdeterminants,suchaslowbirthweight,_00SIDs_00,respiratorydistressandcomplicationsofpregnancy,canbeaddressedthroughimprovedaccess,newbornscreeningandotherhealthcareservicesthataredirectlyaffectedbyTitleVbudgetresources.Althoughcontinuedresearchisneededtodeterminetherelativeimpactofallthemajordeterminantsofhealthoutcomesforwomen,childrenandfamilies,itisclearthat#X*XXbXHP#bXHXXX*theTitleVprogramplaysanimportantpartinassuringthatinterventionsareavailableto  increasetimelyentryintoprenatalcareandreduceinfantmortalityandimproveother_00MCH_00outcomes.#X*XXbXHBV#bXHXXX*    $D # r[     2.11.2GoalbyGoalPresentationofPerformance#X*XXbXHzW#bXHXXX*  #X*XXbXH^X#bXHXXX*]%  GoalI.A.1:IncreasethenumberofchildrenservedbyTitleV.%X  t ] Context:  L  TheprimaryobjectiveofTitleVoftheSocialSecurityActis toimprovethehealthofallmothersandchildren,especiallyunderservedpopulations.IncreasingthenumberofchildrenservedbyTitleViscentraltoaccomplishingthispurpose.Thisoccursthroughprovisionofdirecthealthcare,enablingservices,populationbasedservices,andinfrastructurebuildingactivities.#X*XXbXHX#bXHXXX*  8  Indicator:ThenumberofchildrenservedbyTitleV. Performance:    ThenumberofchildrenservedbyTitleVhasbeenincreasingsteadilysince1997,andisconsistentwithtargetsforFY01andFY02.ThetargetforFY03is25million. #X*XXbXH8[#bXHXXX*]GoalI.A.2:%  Increasethepercentof_00CSHCN_00ԀintheStateprogramwithasourceof 4 ]insuranceforprimaryandspecialtycare.%\   p  Context:  H _00CSHCN_00Ԁaredisproportionatelylowincome,andbecauseofthis,theyareathigherriskofbeinguninsured.Moreover,becausetheirneedsforhealthservicesextendbeyondthoserequiredbyhealthychildren,theyaremorelikelytoincurcatastrophicexpenses.Sincechildrenaremorelikelytoobtainhealthcareiftheyareinsured,thismeasureisanimportantindicatorofaccesstocare.    Indicator:Thepercentof_00CSHCN_00ԀintheStateprogramwithasourceofinsuranceforprimaryandspecialtycare. Performance:  0"  Thenumberof_00CSHCN_00Ԁwithasourceofinsuranceforprimaryandspecialtycarehasbeenincreasingsteadilysince1997,andisconsistentwithtargetsforFY01andFY02.ThetargetforFY03is92%.#X*XXbXH\#bXHXXX*] %  GoalI.A.3%a:Increasethepercentofinfantsborntopregnantwomenreceivingcare '#& ]beginninginthefirsttrimester.  (#'  Context:  |*%) Earlyidentificationofmaternaldiseaseandrisksforcomplicationsofpregnancyorbirtharethe h+&* primaryreasonforfirsttrimesterentryintoprenatalcare.Thiscanhelpassurethatwomenwithcomplexproblemsandwomenwithchronicillnessorotherrisksareseenbyspecialists.Earlyhighqualityprenatalcareiscriticaltoimprovingpregnancyoutcomes.CDCfinalnatalitydataareusedforthisperformancemeasure.Indicator:Thepercentofinfantsborntopregnantwomenreceivingcarebeginninginthefirsttrimester. Performance:   ` #X*XXbXHfa# X*XXX*_00HRSA_00ԀisstronglycommittedtoachievingtheHealthyPeople2010goalofgetting90%ofall  L  pregnantwomenintoprenatalcareinthefirsttrimester.However,whiletheproportionofpregnantwomenenteringprenatalcareinthefirsttrimesterhasincreasedsteadilyforallpopulationgroupsoverthelastdecade(from75.8%in1990),progressinrecentyearshasbeenmfslow.In1999(themostrecentyearforwhichdataareavailable#X*XX X*e# X*XXX*)onlyabout83.2%ofpregnant   womenenteredprenatalcareinthefirsttrimester(NationalVitalStatisticsReports:Vol49,No.1.Births:FinalDatafor1999).#X*XX X*Rg# X*XXX*Thedecreasingrateofincreaseinrecentyearssuggeststhatthe   easiestimprovementsmayalreadyhavebeenmade,andthatfurthergainsarelikelytobeslow.Researchhasshownthatthelikelihoodofseekingprenatalcareisinfluencedbyavarietyoffinancial,social,andpsychologicalfactors.Medicaidprogramexpansionshavebeensystematicallyaddressingeligibilityandfinancialbarriers.However,socialandpsychologicalfactors(suchasawarenessof,and_00wantedness_00Ԁof,thepregnancy)remainmoredifficulttoaddressprogrammatically.Additionalresearchisneededtoidentifynewstrategiesforgettingpregnantwomentobeginprenatalcareinthefirsttrimesterofpregnancy.Accordingly,_00HRSA_00sexpectationsoffurtherincreasesintheneartermaremodest.TheFY02targethasbeenrevisedto84%andthe03performancetargetisretainedat84%.#X*XX X*Mh#bXHXXX*    ]%  GoalII.A.1%l:Decreasetheratiooftheblackinfantmortalityratetothewhiteinfant]mortalityrate.    Context:  X  WhiletheU.S.hasmadesignificantprogressinreducingtheoverallinfantmortalityrate,thereisstillsignificantdisparityintherateforselectedracialgroups.ThedisparityforBlackinfantmortalityismorethantwicetheWhiterate.NationalCenterforHealthStatistics#X*XXbXHPl#bXHXXX*Ԁ(_00NCHS_00)final #l! deathdataareusedforthisperformancemeasure.Indicator:Theratiooftheblackinfantmortalityratetothewhiteinfantmortalityrate,basedonracespecificinfantmortalityratesreportedby_00NCHS_00.  &"%   #X*XXbXHn#bXHXXX*Performance:  (#'  #X*XXbXH=p# X*XXX*TheBlack/WhiteInfantMortalityRatiowas2.4in1998(NationalVitalStatisticsReports,Vol )$( 48,No.11,July24,2000).Itremainssubstantiallyhigherthantheperformancetargetforfiscalyear2001.AlthoughinfantmortalityrateshavedeclinedforbothBlacksandWhitesinrecent h+&* years,theproportionaldiscrepancybetweenBlacksandWhitesremainslargelyunchanged.Researchhassuggestedthathigherratesofverylowbirthweight, maycontributeto,butdonot  fullyexplain,racialdifferencesininfantmortalityrates.AdditionalresearchisneededtoidentifyfactorsresponsiblefortheBlackinfantmortalitydisparity,andthemosteffectivestrategiesforaddressingit.Accordingly,_00HRSA_00sexpectationsofprogressonthismeasureintheneartermremainmodest.#X*XX X*p#bXHXXX* TheFY02targetof2.1to1isretainedforFY03.  L  %  e]GoalIII.B.1%t:Decreasetheinfantmortalityrate s#s#Ks#  ` ]e Context:   8  Allcountriesoftheworldmeasuretheinfantmortalityrateasanindicatorofgeneralhealthstatus.TheU.S.hasmadeprogressinreducingthisrate,buttherateofdeclinehasslowedinthelast10years.Race/ethnicity,maternalage,education,smoking,andpluralityareallfactorsthatcontributetotheinfantmortalityrate._00NCHS_00Ԁfinaldeathdataareusedforthisperformancemeasure.Indicator:Theinfantmortalityrate,asreportedby_00NCHS_00. Performance:  4 Theoverallinfantmortalityratewas7.1perthousandlivebirthsin1999(NationalVitalStatisticsReports,Vol.49,No.03,(PHS)20011120).PerformanceforthisgoalisnotinconsistentwiththeTargetforFY01.ThetargetforFY01isrepeatedforFY02andisbeingmaintainedatthesamelevelforFY03.#X*XXbXHgt#bXHXXX*Infantmortalityisacomplexproblem,butsomeofits 4 determinants,suchaslowbirthweight,_00SIDs_00,respiratorydistressandcomplicationsofpregnancyareaddressedthroughimprovedaccessnewbornscreeningandotherhealthcareservicesprovidedbytheTitleVprogram.Infantmortalityisalsoknowntobeaffectedbysocioeconomicfactors,andmayactuallyincreaseduringaneconomicdowntown.ThissituationisunlikelytoimproveaslongasStaterevenueshortfallscontinue.#X*XXbXH(y#bXHXXX*Givencurrenttechnologyandchildbearing  patterns(includingincreasingnumbersofbirthstowomenover40,andincreasingratesofmultiplebirth),itmaynotbepossibletoreduceoverallinfantmortalitymuchfurtherinthenearterm.#X*XXbXH{#bXHXXX*TheTitleVprogramremainsoneofthebestinterventionsavailabletoincreasetimely D! entryintoprenatalcareandreduceinfantmortalityandcontinuedresearchisneededtoaddressaccesstoservicesproblems.#X*XXbXH|#bXHXXX* #l!  DataIssues:  $D # DataforthemeasuresspecifiedabovearetabulatedeitherfromtheStateBlockGrantannualreportandapplication,orfrom_00NCHS_00Ԁvitalstatisticsdata.TheMaternalandChildHealthBlockGrantprogramguidanceprovidesforanapplicationandannualreportprocessthatisuniformforallStatesandjurisdictions,capturesallthedatarequiredintheTitleVlegislation,andincorporatestheprinciplesofPerformancePartnerships.Asacomplementtotheguidance,anelectronicreportingprogram(_00ERP_00)wasdevelopedthatallows h+&* theStatestosubmittheirapplicationsandannualreportselectronically.The_00ERP_00Ԁcapturesallofthequalitativeprogrammaticinformationaswellasthequantitativedatanecessaryforperformancemeasurement,andhasbeenenthusiasticallyreceivedbytheStates.InFY2000,_00MCHB_00ԀreceivedOMBapprovalforarevisedandenhancedguidancethatincludesthehealthstatusindicatorsusedbytheStatesinconductingtheirneedsassessments.Thenewguidanceisbeingaccompaniedbyanimprovedandenhanced_00ERP_00. DataLimitationsandPlannedImprovements:  $ t SignificantimprovementsinthequalityofdatahavealreadybeenaccomplishedbythestandardizationofdefinitionsandformatsimposedbothinthenewPerformancePartnershipandbythenewelectronicreportingformat.Onefeatureoftheelectronicreportingformatrequiresthattherawdataforratesandratiosbeentered,andallcalculationsaredonebytheprogram.Onedifficultyfacing_00MCHB_00ԀisthatdifferentStateshavedifferentdatacapabilities.ThisleadstotheresultthatsomekindsofdataarecollectedbysomeStatesonaperiodicbasiseverytwoorthreeyears,forexamplewhileotherkindsofdatamayvaryincurrencyacrossStatessothatnotallStatesreportdatafromthesameyearatthesametime._00MCHB_00ԀcontinuestoprovideintensiveadditionalassistancetotheStatesinachievingstandarddatacapabilities.#X*XXbXH}#bXHXXX*.#X*XXbXH #bXHXXX* p   H  #X*XXbXHd#XHXXX*FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  2.11aProgramTitle:UniversalNewbornHearingScreeningandEarlyIntervention   * dd bR@  bR@ bR@bb@{#{#, bR@, bR@,bR@,`bb@+  7<<" ` C7d @ d  PerformanceGoals 80 A<<,!$C << CAd 80d  Targets 80 A<<,!$C << CAd  80d  ActualPerformance 80 A<<<,!  C"<< CAd 80d  Reference 80 T<<?'$ C   <<< CTd 80dIII.ASSUREQUALITYOFCAREA.PromoteAppropriatenessofCare   4  1.Increasethepercentageofnewbornswhohavebeenscreenedforhearingimpairmentbeforehospitaldischarge. 80 ;<<,! C<< C;d 80dFY03:90%FY02:85%FY01:75% 80 ;<<,! !C<< C;d 80dFY01:(5/02)FY00:50%FY99:34%FY98:20% 80 ?<<<,!l,C<< C?d 80dB209 80 HP28 T<<<?'X 0C  <<< CTd 80d TotalFunding:Universal 2 NewbornHearingScreening  4 ($in000's) 80 =<<<,!5C<<< C=d 80dFY2003:$FY2002:$10,018FY2001:$8,018FY2000:$3,374FY1999:n/aFY1998:n/a 80 C<<<<0!h<C<<< CCd 80dBx:page#budgetHP:HealthyPeoplefocusarea 40:0.?C   <<<< : 402.11a.1ProgramDescription,ContextandSummaryofPerformance P@ ProgramDescriptionandContext:  (xB #X*XXXHׇ# R X*XXX*Everyday,33babies(or12,000eachyear)arebornintheUnitedStateswithpermanenthearing dC loss.With3ofevery1,000newbornshavingahearingloss,itisthemostfrequentlyoccurringbirthdefect. #X*XX X*# X*XXX*Earlyhearinglossisassociatedwithdelayedlanguage,speech,andlearningdevelopment,and !G canleadtoeducationaldeficitsandbehavioralproblems.#X*XX X*# X*XXX*Abouthalfofallbabiesbornwith "H hearinglossdonothaveanidentifiableriskfactorforit,whichmayresultindelayedidentificationandtreatment.#X*XX X*# X*XXX*InMarch1993,aNationalInstitutesofHealth(NIH)Consensus $J DevelopmentConferencerecommendedthatallbabiesbescreenedforhearinglossbeforebeingdischargedfromthehospital,asameanstospeeddiagnosisandtreatment,andtherebyimprovelanguageoutcomesinthesechildren.#X*XX X*# X*XXX*The_00UNHS_00ԀprogramwasauthorizedinOctober2000#X*XX X*# X*XXX*Ԁspecificallytoaddressthisproblem. $)t$O Section3999Mofthe#X*XX X*# X*XXX*PublicHealthServiceAct#X*XX X*>#XHXXX*ԀauthorizedtheimplementationofanEarly *`%P HearingDetectionandIntervention(_00EHDI_00)program._00EHDI_00Ԁhasthreebasiccomponents:  *L&Q  +8'R  newbornhearingscreening,audiologicaldiagnosis,andearlyintervention.First,all#X*XXXH# X*XXX*Ԁnewborns  withinaStatearescreenedforhearinglosspriortohospitaldischarge.Infantsnotpassingthescreeningtestarethenreferredtoappropriatediagnosticevaluationbeforethreemonthsofageand,whennecessary,childrenwithhearinglossareenrolledinearlyinterventionprogramsbysixmonthsofage.Ideally,theseservicesaredeliveredinacommunitybasedsystemofcarethatisanchoredinamedicalhome,andincludesfamilytofamilysupport.#X*XX X*;#XHXXX*Currently,32StateshaveenactedlegislativemandatesrequiringnewbornhearingscreeningforallbabiesborninthoseStates.Stateswithalreadyenactedlegislationaccountfornearly75percentofallbirthsintheU.S.annually.ThemajorityoftheseStatesrequirefullimplementationbyDecember2002,butarealreadywellontheirway.#X*XXXHh# X*XXX*Ԁ#X*XX X*#XHXXX*Thereisalsosome  8  screeninggoingoninStatesthatdonothavelegislationrequiringuniversalnewbornhearingscreening.#X*XXXHH# X*XXX*Theexpectationisthatwhenthedataareavailablefor2001,75percentofallinfants   bornintheU.S.willbescreenedatbirth,and85percentbytheendof2002.ThebulkofthefundingforthisinitiativeiscomingfromStatesandfromthirdpartypayers.#X*XX X*# X*XXX*   #X*XX X*y# X*XXX*However,whileuniversalnewbornhearingscreeningprogramsaregrowingatarapidpace,the p diagnosisandinterventioncomponentsoftheprogramcontinuetobeamajorchallenge.Insomeareas,asmanyas60percentreceivenofollowupafterdiagnosticconfirmation.Also,linkagesbetweenscreeningprograms,theinfant#X*XX X*ѡ# X*XXX*#X*XX X*k#smedicalhome,familysupport,andearly 4 interventionprogramsarenotyetwellestablishednationwide._00EHDI_00Ԁfundsarealsousedtobuildinfrastructurecapacitytostrengthenthoselinkagesinordertoassuretimelyprovisionofservicestoinfantsidentifiedatriskofsignificanthearingloss.̀TheprogramprovidescompetitivegrantstoStates,andsupportsaTechnicalAssistanceCenteravailabletoallinvolvedentities.CollaborationwithCDCandNIH(_00NIDCD_00)isongoing.InApril2000,theMaternalandChildHealthBureauawardedgrantsto22Statestoassistwiththeplanning,development,implementation,andrefinementofearlyhearingdetectionandinterventionprograms.Anadditional25StateswereawardedgrantsinFiscalYear2001.ThisinitiativeprovidescriticalsupporttoState_00EHDI_00Ԁprogramsbyprovidingfundsto:(1)developandexpandstatewideuniversalnewbornhearingscreeningprograms,(2)linkscreeningprogramstointerventionwithinthecommunityservicesystem,(3)monitortheimpactofearlydetectionandinterventiononchildren,families,andsystems,and(4)providetechnicalassistance._00EHDI_00Ԁisarelativelynewprogram.Dataandtrackingsystems,whenfullydeveloped,willreport:2f 3  thenumberofinfantsscreened;2g 3  thenumberofinfantslinkedtoamedicalhome;2h 3  thenumberofinfantswithan_00audiologic_00Ԁdiagnosisby3monthsofage;2i 3  thenumberenrolledinaprogramofearlyinterventionby6monthsofage;and2j 3  thenumberlinkedtofamilytofamilysupport. h+&* ЇXHXXX*WhilenofundingisrequestedforthisprograminFY2003,assuringnewbornhearingscreening  remainsanimportant_00MCH_00Ԁfunctionandwillbefundedunderthe_00MCH_00ԀBlockGrant.#X*XXXHG#XHXXX*   2.11a.2GoalbyGoalPresentationofPerformance ` %  GoalIII.A.1%: Increasethepercentageofnewbornswhohavebeenscreenedforhearing 8  impairmentbeforehospitaldischarge. 򀀀 ( x ]Context:     }   T  ]Increasingthepercentageofnewbornswhohavebeenscreenedforhearingimpairmentbeforehospitaldischargeisthefirststeptowardimprovingtheearlydiagnosisandtreatmentofinfantswithhearingimpairment.Indicator:Thepercentageofnewbornswhohavebeenscreenedforhearingimpairmentbeforehospitaldischarge .   #X*XXXH#XHXXX*Performance:  h Performancetodateisconsistentwithtargets.#X*XXXHƯ# X*XXX*Stateswithalreadyenactedlegislationaccount T forover75percentofallbirthsintheU.S.annually.ThemajorityoftheseStatesrequirefullimplementationbyDecember2002,butarealreadywellontheirway.#X*XX X*]# X*XXX*ԀTheexpectationisthat, ,| bytheendof2001,75percentofallinfantsbornintheU.S.willbescreenedatbirth,and85percentbytheendof2002.#X*XX X*#XHXXX*ThetargetforFY03is90%.#X*XXXHx#XHXXX* T #X*XXXHֲ#bXHXXX*   DataIssues:DataCollectionandValidation:   DataforthenewperformancegoalisavailablefromtheNationalCenterforHearingAssessmentandManagement(_00NCHAM_00).ItisalsoreportedannuallybytheStatesintheTitleVStateBlockGrantAnnualReportandApplication,asPerformanceMeasure#10. DataLimitationsandPlannedImprovements:  <"  Thenationaldataobtainedfrom_00NCHAM_00ԀareatleastasgoodasthedatareportedbytheStatesannually.#X*XXbXH-#XHXXX* $h" #X*XXXH#bXHXXX*  %T #  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   0   )#)#  2.11bProgramTitle:Trauma/EmergencyMedicalServices   *dd bR@  bR@ bR@`bb@`)#)#,` bR@,A bR@,rbR@,bb@+  7<<" ` C7d @ d  PerformanceGoals 80 A<<,!$C << CAd9`  ,X[ X9 80d  $` X$ Targets 80 A<<,!$C << CAd  *` ` X* 80d  $` X$ Actual  $   Performance 80 A<<<,!  C"<< CAd$ ` X$ 80d  ! ` X! Reference 80 O<<:'$ C   <<< COd 80d IV.IMPROVEPUBLIC  p HEALTHANDHEALTHCARESYSTEMS   4   C.PromoteSystems   andInfrastructureDevelopment    1.Conductanationalneedsassessmentinall50States. 80(Developmental) ;<<,!XC<< C;d'` ' 80d$` X$FY03:0FY02:0(activitycompleted)FY01:1 80 ;<<,!l$C<< C;d*` ` X* 80d$` X$FY01:(3/02) 80 ?<<<,!D1C<< C?d$ ` X$ 80d! ` X!B 80211HP:110AccesstoEMS O<<<:'T :C  <<< CO2.IncreasethenumberofStatesmeetingall8essentialcriteriaoftraumasystemdevelopment. =<<<,!T>C<<< C=FY03:9FY02:7FY01:NA @<<</!xAC<<< C@FY02:(10/02)FY01:NAFY00:NAFY99:5 ?<<<<,!FC<<< C?B211HP1 T<<<?'xIC  <<<< CTd 80dTotalFunding:Trauma/EmergencyMedicalServices($in000's) 80 =<<<,!4NC<<< C=d'` ' 80d$` X$FY2003:$FY2002:$3,521FY2001:$3,020FY2000:0FY1999:0 80 C<<<<0! UC<<< CCd-` ` X- 80d'` X'ӀBx:page#budget̀Px:page#performanceplaǹHP:HealthyPeoplefocusarea &C0:0.4ZC   <<<< : &C0 2.11b.1ProgramDescription,ContextandSummaryofPerformance  "[  '  TraumaEMSsystemsareanintegralcomponentofourNationspublichealthinfrastructureand |$] safetyresourcetothepublicinallstates.Suchsystemsaregenerallymanagedthroughanofficeinthestategovernment.EMSservicesarecurrentlyprovidedtothepublicbyprivatelyorpubliclymanagedagencies.Dependinguponthelocalresourcesandpopulationtobeserved,EMSservicesmaybeprovidedbypaidprovidersorvolunteers.Guidelinesforcare(specificprotocols,hospitaldestinationguidelines,andqualityassurancemeasures)varybyjurisdictionandavailableresources.Becauseofthisvariation,thecapabilityofdifferenttypesofEMSsystemstorespondingeneraltoemergenciesislargelyunknown. +,'e #X*XXbXH #bXHXXX*Section1232ofthePublicHealthServiceActauthorizestheAdministratorof_00HRSA_00Ԁto  implementagrantprogramtoconductandsupportresearch,training,evaluations,anddemonstrationprojects;fosterthedevelopmentofappropriate,modernsystemsofsuchcarethroughthesharingofinformationamongagenciesandindividualsdirectlyinvolvedinthestudyandprovisionofsuchcare;toprovidetechnicalassistancetoStateandlocalagencies,andtosponsorworkshopsandconferencesontraumacareandemergencymedicalservices.FundingwasprovidedinFY2001tobeginthedevelopmentofaprogramofneedsassessment,technicalassistanceandqualityimprovementprogramsfortraumaandemergencymedicalservicessystems.#X*XXbXHw#bXHXXX*Thedeliveryofhighqualitytraumacareisaparticularchallengeinmanyruralareas.Becauseruralhighway,farming,logging,andmininginjuriesoftenareveryserious,andthedistanceinvolvedintransportinginjuredindividualstocarefacilitiesslowstreatment,theprobabilitythatruralpatientswillsufferlastinginjuryordeathisgreaterthaninurbanareas.Thisprogrameffortisdesignedtosupportjointeffortsof_00HRSA_00Ԁ(includingtheMaternalandChildHealthBureauandtheOfficeofRuralHealthPolicy)andtheNationalHighwayTrafficSafetyAdministration(_00NHTSA_00).Improvedqualitywillreducedeathanddisabilitywhilesavinghealthcaredollars.Fundingwouldbeutilizedtoconductneedsassessments,includingassessmentofStateEMSsystemswithrespecttotheimplementationofthe_00NHTSA_00s EMSAgendafortheFutureinitiative,withspecialemphasisgiventoworkingwithStateEMSDirectorsandemergencyphysicianstoenhanceawarenessofrelevantEMSissues.FundswillbeusedtosupportqualityimprovementinitiativesinEMSandtoprovidetechnicalassistancetoStates.Specifically,theprogramisintendedtoaccomplishthefollowinglongtermgoals:    ' A. EnsureregionaltraumasystemdevelopmentandEMSplanning.   ' B. Improveemergencytrainingprogramsforhealthprofessionals.  0 ' 0 ')#')# '  ' C. Ensurethatmedicaldirectionisavailableandappropriateintheprehospital l setting.  )# )#  ' D. Improvedatacollectionsystemsanddataanalysismethodology. D!  ' E. IntegratetraumapreventionintothemissionofEMSproviders. 0"   ' StartinginFY2003,theintentistocontinuetheseactivitiesaspartofthe_00MCH_00ԀBlockGrant.  $D #  2.11b.2GoalbyGoalPresentationofPerformance   0 '  %  GoalIV.C.1%: Conductneedsassessmentsinareasconsideredofhighestneed  Ѐ(Developmental) ')#')# Context: Duringthefirstyearofthisprogram(FY2001),the EMSAgendafortheFuture L  wasassessedtomakeadeterminationastowhichcomponentsoftheagendashouldbeaddressedinthefirstandproposedsecondyearsoffunding._00HRSA_00Ԁwillworkwith_00NHTSA_00,Statesandtrauma/emergencyservicesassociationstodefinewhichtasksreceivefirstpriority,includingdevelopmentofappropriateguidelinesandprovisionoftechnicalassistancetoStates,demonstrationgrants,informationcollectionandsharingamongStateagencies,andtrainingprogramsforhealthprofessionals.Indicator:Completionofaneedsassessmentinall50States. Performance :Workisongoingonaneedsassessment.    '  '  d  %  GoalIV.C.2%ԀIncreasethenumberofStatesmeetingall8essentialcriteriaoftrauma d systemdevelopment#X*XXbXH#bXHXXX*. P Context: Thedevelopmentoftraumasystemsisbasedontheconceptthatimprovedoutcomefrominjury d canbeachievedwhencriticalprehospitalandhospitaltreatmentcomponentsareorganizedintoasystemofcare.#X*XXbXH#  <  Indicator:ThenumberofStatesmeetingeightessentialcriteria.   Performance: Themostrecentdatashowed5statesmeetingthecriteria.   bXHXXX*rP  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  2.12TraumaticBrainInjuryProgram   * dd` bR@` A bR@A rbR@rbb@)#)#, bR@, bR@,bR@,bb@+  7<<" ` C7d @ d  PerformanceGoals 80 A<<,!$C << CAd 80d  Targets 80 A<<,!$C << CAd  80d  ActualPerformance 80 A<<<,!  C"<< CAd 80d  Reference 80 T<<?'$ C   <<< CTd 80dIV.IMPROVEPUBLICHEALTHANDHEALTHCARESYSTEMSB.PromoteEducationandTrainingofthePublicHealthandHealthCareWorkforce    1.IncreasethenumberofStateswitheducationalandtrainingmaterials,andprogramsforconsumers,familiesandprofessionals. 80 ;<<,!0C<< C;d 80dFY03:30FY02:28FY01:15FY00:11FY99:7 80 ;<<,!0)C<< C;d 80dFY01:25FY00:11FY99:7(corrected)FY98:0 80 ?<<<,!l8C<< C?d 80dB204 80 NEW X @ FY01DATA T<<?'`BC  <<< CTd 80d C.PromoteSystemsand |D InfrastructureDevelopment  TF 1.IncreasethenumberofStateswith_00TBI_00Ԁcorecapacitythatincludes:aStateActionPlan,StatewideNeedsAssessment,designatedStateagencystaff,andStateAdvisoryBoard. 80 ;<<,!!NC<< C;d 80dFY03:42FY02:42FY01:35FY00:30FY99:25 80 ;<<,!@WC<< C;d 80dFY01:35FY00:29FY99:25FY98:17 80FY97:14 ?<<<,! bC<< C?d 80dB204 80 #X*XXbXH#bXHXXX*NEW f FY01DATA T<<<?'<hC  <<< CTd 80d TotalFunding: #dj TraumaticBrainInjuryProgram  $< l ($in000's) 80 =<<<,!%(!mC<<< C=d 80dFY2003:$7,499FY2002:$7,499FY2001:$5,000FY2000:$5,000FY1999:$4,998FY1998:$2,991 80 C<<<<0!'#tC<<< CCddӀBx:page#budget̀HP:113,114:0.|% xC   <<<< :  ,P'{ 2.12.1ProgramDescription,ContextandSummaryofPerformance    ProgramDescriptionandContext:  8 #X*XXbXHd# X*XXX*ThepurposeoftheTraumaticBrainInjury(_00TBI_00)DemonstrationGrantProgram,authorizedby T Section1252ofthePublicHealthServiceAct,istoimproveaccesstohealthandotherservicesforindividualswith_00TBI_00Ԁandtheirfamilies.The_00TBI_00ԀstateGrantProgramequipsStateswithseedmoneytobeginworkontheintegrationofservices,theestablishmentofpolicy,andtheprocurementoffinancialsupporttobringaboutsystemschange.ThischangeisachievedbyexpandingandimprovingStateandlocalcapacitytocareforindividualswith_00TBI_00Ԁandtheirfamilies.Tothisend,StatesworktostrengthenStateinfrastructure,improvecommunitysupportsandservices,developandevaluatemodelapproachestointegrating_00TBI_00Ԁservicesintothebroaderservicedeliverysystem,andgeneratesupportfromlocalandprivatesourcesforsustainingtheireffortsafterthegrant#X*XX X*/# X*XXX*scompletion.Theprogramalso#X*XX X*# X*XXX*makesgrantstoprotection P  andadvocacysystemsforthepurposeofenablingsuchsystemstoprovideservicestoindividualswithtraumaticbraininjury,including1)information,referrals,advice;2)individualandfamilyadvocacy;3)legalrepresentation;and4)specificassistanceinselfadvocacy.#X*XX X*# X*XXX* d Traumaticbraininjuryissuddenphysicaldamagetothebrain,oftencausedbymotorvehicleaccidents,falls,sportsinjuries,violentcrimes,andchildabuse._00TBI_00Ԁcanresultinphysical,behavioral,and/ormentalchanges,dependingontheareasofthebrainthatareinjured._00TBI_00ԀistheleadingcauseofdeathanddisabilityamongyoungpeopleintheUnitedStates.Approximately200,000Americansdieeachyearfromtraumaticinjuries.Anadditionalhalfmillionarehospitalized.About10percentofthesurvivingindividualshavemildtomoderateproblemsthatthreatentheirabilitytoliveindependently.Another200,000haveseriousproblemsthatmayrequire_00institutionalization_00Ԁorsomeotherformofclosesupervision(http://www.nidcd.nih.gov/health/pubsvsl/tbrain.htm#X*XX X*{# X*XXX*).  Thenumberofpeoplesurviving_00TBI_00Ԁhasincreasedsignificantlyinrecentyearsbecauseofmoreeffectiveemergencycare;transportationtospecializedtreatmentfacilities,andacutemedicalmanagement.Currently,anestimated5.3millionAmericansarelivingwiththeeffectsof_00TBI_00.Thedirectmedicalcostsfortreatmentof_00TBI_00Ԁhavebeenestimatedtobeover$4.5billionannually.Although_00TBI_00Ԁcancausechronicphysicalimpairments,oftentheindividualhasmoredisabilityduetoproblemswithcognition,emotionalfunctioning,andbehaviorinconnectionwithinterpersonalrelationships,school,orwork.Theresultisfrequentlyadramaticchangeintheindividual#X*XX X*B#slifecourse,profounddisruptionofthefamily,andhugemedicalandrelated '"$ expensesoveralifetime.Rehabilitationeffortscanrequireyearsoftreatment,startinginthehospital,andextendingthroughformalinpatientandoutpatientrehabilitationtoavarietyofdaytreatmentorresidentialprograms. p+&( Pg     TheprogramisdesignedtoemphasizeactivitiesbyStatesthatimplementStatewidesystemsthatensureaccesstocomprehensiveandcoordinatedservicesforindividualswith_00TBI_00Ԁandtheirfamilies,including:prehospitalcare;emergencydepartmentcare;acutehospital X*XXX*care,  rehabilitation;transitionalservices;educationandemployment;andlongtermcommunitysupport.Thecognitiveandcommunicationproblemsof_00TBI_00Ԁarebesttreatedearly;oftenbeginningwhiletheindividualisstillinthehospital#X*XX X*#.Longertermrehabilitationmaybeperformedindividually,   ingroups,orboth,dependingontheneedsoftheindividual.Thistherapyoftenoccursinarehabilitationfacilitydesignedspecificallyforthetreatmentofindividualswith_00TBI_00.Thegoalofrehabilitationistohelpaffectedindividualsprogresstothemostindependentleveloffunctioningpossible.Therapyfocusesonregaininglostskills,aswellaslearningwaystocompensateforabilitiesthathavebeenpermanentlychangedbecauseof_00TBI_00.  рAccordingtoarecentGeneralAccountingOffice(GAO)studyofservices,adultswith_00TBI_00oftenhavepermanentdisabilitythatrequireslong-termsupportiveservicestoremaininthecommunity.InananalysisofelevenStates,thegapbetweenthenumberofindividualswith_00TBI_00receivinglong-termservicesandtheestimatednumberofdisabledadultswith_00TBI_00Ԁremainswide.The_00HRSA_00Ԁ_00TBI_00ԀprogramparticipatesactivelyininteragencycollaborativeactivitieswithCDC,NIH,theDepartmentofEducation/OfficeofSpecialEducationandRehabilitationServicesAdministration,theVeteran'sAdministration,andtheAdministrationonDevelopmentalDisabilities.TheprogramhasaTechnicalResourceCenter,andaSteeringCommittee.TheSteeringCommitteemeetstwiceeachyear.AllStates(includingthesevennotcurrentlyreceivinggrantfunding)areinvitedtoattendtheannualgranteemeeting,whichprovidesavenueforoutreach,technicalassistance,networking,andstrategicplanning.Indicatorsofprogramsuccessinclude:thenumberofStateswitha_00TBI_00Ԁadvisoryboard,andaleadagencywithautonomyintheState;anassessmentofneedsandresources;aStateActionPlan;collaborativepartnershipswithotherStateagencies,disabilitygroups,andadvocacyorganizations;acoordinatedsystemofcare;datatosupporttheintegrationof_00TBI_00Ԁsupportsandservicesintothebroaderservicedeliverysystem;multiplefundingstreams;mechanismsofevaluation;andpolicyandlegislationenactedtosupportthecareofindividualswith_00TBI_00.Measuringtheeffectsofthe_00TBI_00Ԁprogramonhealthoutcomessuchasareducednumberofdeaths,oradecreaseindisabilityresultingfromparticipationina_00TBI_00Ԁprogramwouldrequireaseriesofcarefullydesignedprospectivelongitudinalstudiestolookatarangeofdifferenttypesofinjuries,andtreatmentmodalities.  + '( _002.12.2GoalbyGoalPresentationofPerformance   ] %  GoalIV.B.1% : IncreasethenumberofStateswitheducationalandtrainingmaterials,and 8 ]programsforconsumers,familiesandprofessionals.  T  Context:  <  IncreasingthenumberofStateswitheducationalandtrainingmaterials,andprogramsforconsumers,familiesandprofessionalswillincreasetheknowledgebaseandimprovecaredeliveryforTBIpatients.Indicator:NumberofStateswitheducationalandtrainingmaterialsandprograms. ' Performance:    FY2001actualperformanceof25farexceedsthetargetof15.BothinFY2000andFY1999performancemettheirtargets.bXHXXX*ԀItisexpected,ifpresenttrendscontinue,thatcurrenttargetswill  bemetthrough2002.ThetargetforFY03is30.] %  GoalIV.C.1%': IncreasethenumberofStateswithTBIcorecapacityplanningthat 8 includes:aStateActionPlan,aStatewideNeedsandResourcesAssessment,designatedStateagencystaff,andaStateAdvisoryBoard.#X*XXbXHg #bXHXXX*  ] Context:  H ThefollowingcomponentsofTBIcorecapacityarecriticaltoassuringincreasedqualityofcareforTBIpatients.L 23456789Ih$*L 23k   ]232I3  0 '   AStateActionPlan23݌l'"'" Ќ   23l   23Y2I3  0 '   AStatewideNeedsandResourcesAssessment23Y݌8 '"'" Ќ   23m   2372I3  0 '   AdesignatedStateagencystaff237b݌T!'"'" Ќ   23n   23 2I3  0 '   AStateAdvisoryBoard23 5݌p"'"'" Ќ  ] Performance:  $ FY1999ActualPerformancemettheFY1999Target.ForFY2000,29Stateshadsuchcapacity.ForFY2001,ActualPerformancemettheFY2001Target.Itisestimatedthat35StateshadTBIcorecapacity,comparedwithatargetof35.ForFY2002,theprogramhassetagoalof42Stateswithcorecapacity.FortytwoStates(includingtheDistrictofColumbia)havereceivedTBIplanninggrants.Theremaining9Statesbypassedplanninggrantfundingand#X*XXbXH\#bXHXXX* t)$#  +&% ri     ]Ҁmoveddirectlytoimplementation.Therefore,42iscurrentlythemaximumnumberofStatesdevelopingcorecapacityplans,andthetargetforFY03isretainedat42. DataIssues:  $ Dataaretobecollectedfromanannualsurveyofgrantees. @ _00 #X*XXbXH#XHXXX*   \   FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  2%  2.13ProgramTitle:HealthyStart%4XXH % 8 *`l dd bR@  bR@ bR@bb@"", SS , SS ,SSS ,SS +  !<< Z  !#XHX4%#&&%%XXH  PerformanceGoals 8<<#!  << 8  Targets 8<<#!  << 8  ActualPerformance 8<<<#!  << 8  Reference 8<<#!   <<< 8I.ELIMINATEBARRIERSTOCARE   Z   A.IncreaseUtilizationfor b  UnderServedPopulations #XHX%%&&#1.Reducethepercentageof B  enrolledwomenwhoreceivelateornoprenatalcare. )<<<< ) FY03:11.0%FY02:12.0%FY01:13.0% )<<F<< ) FY01:(7/02)FY00:15.3%FY99:11.1%FY98: 17.2% -<<<.~#<< -̀B206 NEW  ' FY00DATA /<< )<<< / III.ASSUREQUALITY * OFCAREB.AssureEffectivenessofCare  - 1.DecreasethepercentageoflowbirthweightbabiesborntoHealthyStartclients. )<<1<< ) FY03:11.2%FY02:11.3%FY01:11.4% Z8  )<<v9<< ) FY01:(7/02)FY00:10.78%FY99:11.58%FY98: 12.06% -<<<!C<< -#X*XXXH#X*XXX*Ԁ D ЀB206 #X*XXX*M #X*XXX*NEW VG FY00DATA /<<<>I<<< / TotalFunding:Healthy 2#J Start ($in000's) :% L  +<<<V&!M<<< + FY2003:$98,989 2#N FY2002:$98,989FY2001:$89,996FY2000:$89,982FY1999:$104,967FY1998:$95,526 1<<<<($S<<< 1ЀBx:page#budget̀HP:HealthyPeoplefocusarea+!N$U  <<<< +#X*XXX* #XHXXX* '  ,b'W  2.13.1ProgramDescription,ContextandSummaryofPerformance   #X*XXXH"#XHXXX* ProgramDescriptionandContext:  8 HealthyStart,establishedin1991andauthorizedundertheChildrensHealthActof2000,isdesignedtoreduceinfantmortalityanddisparitiesinperinatalhealthinhighriskcommunitiesbyimprovingthequalityofhealthcareforwomenandinfants.HealthyStarthelpscommunitiesidentify,planandimplementdirectoutreachwithindigenouscommunityworkers,casemanagementandhealtheducation.Theseprojectsaredesignedtofullyaddressthemedical,behavioraland_00psychosocial_00Ԁneedsofwomenandchildrenfromconceptionthroughthetwoyearsafterdelivery(the_00interconceptional_00Ԁperiod).Currently,thereare95communitiesoperatingHealthyStartprojects.#X*XXXH##XHXXX* x  TheU.S.infantmortalityratehasbeendroppingsteadilyoverthepastfewdecades,from12.6in1980to7.1in1999(Source:NationalVitalStatisticsReport,Vol49,No.3,June2001),butitremainsoneoftheworstintheindustrializedworld.AccordingtostatisticspublishedbyCDC,theU.S.rankedonly26thamongnationsin1996.Furthermore,substantial t disparitiesininfantmorbidityandmortalitybyethnicity,race,geographicareaandsocioeconomicstatuspersist.InfantdeathratesamongBlacks,Hispanics,andotherracial/ethnicminoritieswerewellabovethenationalaverageof7.2deathsper1,000livebirthsin19951997.Theblackinfantmortalityratewasmorethandoublethatofwhiteinfantsin1998(14.3per1,000vs.6.0per1,000)(NationalVitalStatisticsReports,Vol48,No.11,July24,2000).Theleadingcausesofinfantdeathin1999werecongenitalmalformationsanddisordersrelatedtoshortgestationandSIDS(Source:NationalVitalStatisticsReport,Vol49,No.3,June2001#X*XXXH'#XHXXX*).(Note:The1999datawerereportedusingnew_00ICD_00Ԅ10codeswhichareslightly  \ differentfromthe_00ICD_00Ԅ9codesusedinprioryears.)Thesefactorsaccountedforalmostonehalfofallinfantdeathsthatyear.Whileinfantmortalityhasslowlydeclinedinrecentyears,lowbirthweight,unfortunately,hascontinuedtoriseamongbothblacksandwhites.Thenationalratein1998was7.6percent.LowbirthweightamongBlackswasmorethandoubletherateforwhitesin1998.Theuseoftimely,highqualityprenatalcarecanhelptopreventlowbirthweightandinfantmortality,especiallybyidentifyingwomenwhoareatparticularlyhighriskandprovidingcounselingandassistancetoreducethoserisks.Overall,83.2percentofpregnantwomenreceivedprenatalcareinthefirsttrimesterin1999.Thisindicatorhasshownasteadyincreasesince1990forallpopulationgroups,butminoritywomenremainlesslikelythanwhitestoentercareearlyandtoreceiveadequatecare(88.4percentofwhites,vs.74.1percentofBlacksand74.4percentofHispanics)(NationalVitalStatisticsReport,Vol49,No.1,April17,2001).#X*XXXH|+#XHXXX*  p+&( DataIssues:#X*XXXH0#X\>XXX*   #X*X>XX\0#bXHXXX*DatafortheperformancegoalswillcomefromtheHealthyStartDataReporting  Requirements,developedincollaborationwithHealthyStartgranteestobeusefulforbothFederalandgranteepurposes.#X*XXbXHK1#XHXXX*Asnotedearlier,communitybasedgranteesdonotalwaysstartwiththecapacitytoprovide  , allthedatathatmightbedesired.TheHealthyStartprogramhasworkedwithgranteestohelpthemdevelopdatasystemsappropriatetotheirfunctionsandobjectives,andhaveadvisedthemonalternativesourcesandstrategiesfordata.Thisassistanceandadvicewillcontinue. 2.13.2  GoalbyGoalPresentationofPerformance     %  GoalI.A.1%p4:0 ReducethepercentageofenrolledwomenwhoreceivelateornoprenatalP  " " care.  l  Context:  T Earlyhighqualityprenatalcareiscriticaltoimprovingpregnancyoutcomes.Itcanhelptopreventlowbirthweightandinfantmortalitybyidentifyingwomenwhoareatparticularlyhighriskandprovidingcounselingandassistancetoreducethoserisks.Itcanalsohelpassurethatwomenwithcomplexproblemsandwomenwithchronicillnessorotherrisksareseenbyspecialists.Indicator:Thepercentageofenrolledwomenwhoreceivelateornoprenatalcare.#X*XXXHk2#XHXXX* Performance:   Asaresultofintensiveoutreacheffortsbygranteestogetpregnantwomenenrolledinprenatalcareearlierintheirpregnancies,andthentokeeptheminvolvedandreceivingcare,theFY1999performancewas11.1%#X*XXXHH7#XHXXX*.InFY2000,theresultof15.3%,becauseofaresultof ! achangeinprogramemphasistowardhardtoreach,veryhighriskwomen,#X*XXXH8#XHXXX* t" Theapparentincreaseinthepercentageofwomenwhoactuallyreceivedlateornoprenatalcarefrom1999to2000isduetotheshiftinprogramemphasisinearly2000.Areviewofprojectsbasedonlocalbirthanddeathrecordsrevealedthatpregnantwomenwhohadlateprenatalcare#X*XXXHc9#XHXXX*Ԁornoprenatalcarewereathighestriskforinfantmortalityandotheradverse p'"" outcomes.Projectsthereforefocusedspecialoutreachactivitiesinfiscalyear2000toenrollhardtoreach,highriskwomenlateinpregnancyorevenatdeliveryinordertoensurethattheywerebroughtintothecaresystemandlinkedtomedicalhomes. P+&& HealthyStartwillcontinuetofocusintensiveoutreacheffortsaimedathardtoreach,highriskwomen.Therefore,theFY2000resultof15.3%shouldbeconsideredanewprogrambaseline.Futureyearperformancetargetshavebeenadjustedupward,reflectingtheincreaseddifficultyofgettingalargerpercentageofveryhighriskwomenintocare. #X*XXXH:#XHXXX* ' %  GoalIII.B.1%(>0 DecreasethepercentageoflowbirthweightbabiesborntoHealthyStart  " " clients.    #X*XXXH=#bXHXXX* Context: HealthyStartisdesignedtoreduceadverseperinataloutcomes,e.g.lowbirthweightand l  infantmortality,byhelpingcommunitiesidentify,planandimplementadiverserangeofinterventionstosupportandimproveperinataldeliverysystemsinprojectcommunities.Lowbirthweightisassociatedwithanincreasedriskofinfantdeath.Thelowbirthweightratehas,unfortunately,continuedtoriseamongbothblacksandwhitesinrecentyears.Thenationalratein1999was7.6percent,unchangedfrom1998.Overall,lowbirthweightamongblackshasdeclinedsince1990,from13.3to13.1in1999,butitremainshigh.ItwasmorethandoubletherateforwhitesandHispanicsin1999.Indicator:Numberofdeliveries/birthsweighing15002499grams.#X*XXbXH?#XHXXX* Performance:  P ActualFY1999performancehasalreadyexceededtheoriginaltargetsetforFY01.ThetargetsforFY01andFY02havebeenadjustedaccordingly,totakeintoaccounttheprogressinperformancemadetodate.#X*XXXHjB#XHXXX*ThetargetforFY02is11.3%,andthetargetforFY03is D 11.2%.#X*XXXHC# 0   L    XHXXX*FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  2.14ProgramTitle:HospitalPreparedness (_00Bioterrorism_00)  8 *<dd SS  SS  SSS SSS `l"", dd , dd ,dd ,dd +  /X X /PerformanceGoals AX,!l"X ATargets AX,!l"X AActual l Performance AX,! "X AReference =(&l"  X = &&%%XXHIV.IMPROVEPUBLIC  X  HEALTHANDHEALTHCARESYSTEMSC.PromoteSystemsandInfrastructureDevelopment    1.Conductanationalneedsassessmentin59U.S.States,JurisdictionsandRegions.#&M'%%%&&{D#&&%%'%&M (Developmental) #XHX%%&& H# $X  $&&%%XXHFY03:N/A x  FY02:59States/Territories/Regions#XHX%%&&I# X  #X*XXXH0I#XHXXX*  | #X*XXXHlJ#XHXXX*  8#  #X*XXXHJ#XHXXX*B217 )x (" )&&%%XXH2.Conveneameetingof h) stakeholderstodiscusstheresultsoftheneedsassessment,andidentifyfundingpriorities. (Developmental) #XHX%%&&K# $ . $&&%%XXHFY03:N/A h/ FY02:1#XHX%%&&L#  p0   h1 B217  h2 &&%%XXHTotalFunding:Hospital <3 Preparedness  d4 ($in000's)#XHX%%&&AM# $l5 $&&%%XXHFY2003:$235,000 <6 FY2002:$135,000#XHX%%&&N# D7 #X*XXXH6K#XHXXX*  L8 &&%%XXHBx:page#budget <9 HP:HealthyPeopleGoal#XHX%%&&N#L;    2.14.1ProgramDescription,ContextandSummaryofPerformance <  TheHospitalPreparednessProgramforBiological,ChemicalandRadiologicalTerrorism,which  = isapartofthePresidentsHomelandSecurityinitiative,hasagoalofupgradingthepreparednessofstateshealthcaresystemstorespondtobiologicalandchemicalterroristevents.#X*XXXHN# X*XXX*Thisprogram x"? isincludedintheFY2002_00Bioterrorism_00ԀSupplementalAppropriation.Underthisprogram,_00HRSA_00Ԁwillprovide$135millioninFY2002fundsforupto59grantsforStates,TerritoriesandregionstoimprovethecapacityoftheNationshospitals,especiallytheiremergencydepartmentstorespondtobiological,chemicalandradiologicalterroristattacksandsituationsinvolvinglargescale_00casualities_00Ԁ(e.g.,hundreds).TheprogramwillalsoallowStateandregionalplanningamonglocalhospitals,emergencymedicalservices,communityhealthcenters,poisoncontrolcenters,andotherhealthcarefacilitiestoimprovetheirpreparednesstoworktogethertocombatterroristattack.#X*XX X*EQ#bXHXXX*TheawardswillbemadeavailabletoStatesthroughcooperativeagreementswithhealth )(%G departmentsinStatesandothereligibleentitiestodevelopStatebased_00bioterrorism_00ԀpreparednessplansfocusedonhospitalsandEMSsystems.#X*XXbXHT# X*XXX* +'I Ї#X*XX X*V#XHXXX*InthewakeoftheterroristattacksofSeptember11,2001,andthesubsequentanthraxepidemic,  attentionwasfocusedontheabilityofhospitalsandemergencymedicalservicessystemstorespondtobiologicalandchemicalterroristevents.ArecentsurveyofruralandurbanemergencydepartmentsinthemiddleAtlanticarea,reportedintheAnnalsofEmergencyMedicine,found t thatmosthospitalsareinadequatelypreparedforeitherbiologicalorchemicalweaponsincidents,andthattheproblemisparticularlysevereinruralareas.Only50%ofurbansiteshaddecontaminationstationsthatcouldaccommodate1015casualtiesatatime;noneoftheruralsiteshadsuchcapabilities.Although87%ofhospitalssurveyedcouldhandle1050noncontaminatedcasualtiesatonce,only10%couldmanage50100masscasualtypatients.Thestudyalsofoundthatthereisauniversalneedfortraininginhandlingcasualtiesofweaponsofmassdestruction.ItisproposedthatStateswillpulltogetherconsortiathatincludetheStateHospitalAssociationandrepresentativesofthemajortrauma/EMShospitalsandhealthfacilities.Thegrantswillbemadeintwophases.InPhase1,fundswillbeusedtoconductneedsassessmentsofStatepreparednesstorespondtoabiochemicalterroristincident,andtodevelopaplanofactioninresponsetotheidentifiedneeds.InPhase2,Stateswillbegiventheflexibilitytoprioritizetheirfundingbasedupontheirneedsassessmentandwillimplementthenecessarypreparednessplansinresponsetotheirprioritizedneeds.Projectswillbeapprovedfora2yearperiod.FY2003fundingwillcontinuetheimplementationoftheneedsassessmentsandplansdevelopedinPhaseI.Theintentisthatthehealthcaresystem,inparticularthehospitalsystem,willbecomemorepreparedtodealwithnonterroristeventsaswell,suchasoutbreaksofrarediseasesormassiveenvironmentalchemicalcontamination. ' ThedesiredgoalofthisprogramisforStatestohave:L 23456789Ihh23456789L 23o   23 _2I3  0 '   Aclearunderstandingoftherelativelevelofhospitalpreparedness;23 _4_݌4'"'" Ќ   23p   23`2I3  0 '   EarlywarningsystemsidentifiedtoalertStateofficialstounusualtrendsinEMSuseand  P morbidity/mortalitypatternsinhospitals;23`-`݌ '"'" Ќ   23q   23Ga2I3  0 '   Timely,systematicreportingandknowledgeofhospitalbed,staff,andotherresource "X capacities;23Gara݌ '"'" Ќ   23r   23hb2I3  0 '   TheabilitytoeffectivelycommunicatetoandamongEMSsystemsandhospitalsduring $`  normaloperationsandduringdisasters,highusageperiods(influenzaoutbreaks),orterroristevents;23hbb݌ '"'" Ќ   23s   23c2I3  0 '   AllStatesbecapableofcommunicatinghospitalpreparednesstoFederalhealthauthorities 'T"# inasystematic,timely,anduniformmanner.23cd݌ '"'" Ќ  L 23456789Ihh23456789LInFY2002andFY2003,itisexpectedthatfundswillbeawardedtoupto59states,territoriesorregions.  0,'( 2.14.2GoalbyGoalPresentationofPerformance   Additionalperformancemeasureswillbedevelopedforhospitalsastheprogramisfurtherdevelopedduringthefirstyear.ThesegoalswillfocusonmeasuresoftheabilitytocommunicateamongEMSsystemsandhospitals;theabilityofStatestocommunicatehospitalpreparednesstoFederalhealthauthoritiesinatimelymanner;andimprovedreportingonhospitalbedandresourcecapacities. #X*XXXHoV# X*XXX*GoalIV.C.1.:#X*XX X*h#XHXXX*Conductanationalneedsassessmentinall59jurisdictions.#X*XXXHPh# XHXXX*    Context:  X  Duringthefirstyearofthisprogram(FY2002),aneedsassessmentandactionplanwillbecompletedtodetermineStatepriorityneedstobeaddressedduringphaseIIandduringtheproposedsecondyearoffunding._00HRSA_00ԀwillworkwithStates,Territoriesandregionsunderthecooperativeagreements,incollaborationwithatechnicalassistancecontractor,toensurethattheneedsassessmentreflectsthecommonexperiencesoftheStates,andthatasubsequentplanisresponsivetothoseneeds.#X*XXXHh#XHXXX*  Indicator:Completionofareportsummarizingtheresultsoftheneedsassessment. #X*XXXH_k# X*XXX*Performance:  0 Areportwillbecompletedsummarizingtheresultsoftheneedsassessment.ThereportwillpresentStatebyStatedata,identifyinginfrastructure,personnel,training,andimplementationneeds.#X*XX X*l#XHXXX* $t  #X*XXXH:m# X*XXX*GoalIV.C.2.: #X*XX X*m#XHXXX*Ԁ Conveneameetingofstakeholderstodiscusstheresultsoftheneeds \ assessment,andidentifyfundingpriorities.#X*XXXHm# XHXXX* L  Context: #X*XXXHn#XHXXX* ! Preparednessfordisastersinvolvesarangeofstakeholders,includingfederal,stateandprivatehealthcareorganizations.Stakeholderswillbeconvenedtodiscusstheresultsoftheneedsassessment,andprioritizeneedsforfuturefunding.Indicator:Conductofanationalmeeting. Performance:  (8$# Thismeetingisexpectedtoresultinthedevelopmentofanationalactionplanforhospitalpreparedness.#X*XXXHo#   *@&% bXHXXX*FY2003PerformancePlan,FinalFY2002PlanandFY2001PerformanceReport   ]   2.15EmergencyMedicalServicesforChildren  8 * dd dd  dd  dd dd <)#)#, bR@, bR@,bR@,bb@+  7<<"  p C7d @ d  PerformanceGoals A<<,! C << CAd*` ` X* 80d  $` X$Targets 80 A<<,! C << CAd  *` ` X* 80d  $` X$ActualPerformance 80 A<<<,!  C"<< CAd$ ` X$ 80d  ! ` X!Reference 80 T<<?'  C   <<< CTd 80db&&%%XbXHIV.IMPROVEPUBLIC  0 HEALTHANDHEALTHCARESYSTEMS     C.PromoteSystemsand h  InfrastructureDevelopment  @  1.4ghO  5  6wO xs,(  7gr:x 80ӀIncreasethenumberof h  StatesthathaveimplementedStatewidepediatricprotocolsformedicaldirection.#bXHX%%b&&w# ;<<,! C<< C;d'` ' 80d$` X$b&&%%XbXHFY03:17 |  FY02:15(Statewide)FY01:15(Statewide)FY00:20(Statewide&partial)FY99:18(Statewide&partial)#bXHX%%b&&z# 80 ;<<,!$C<< C;d*` ` X* 80d$` X$b&&%%XbXHFY01:(2/02) T - FY00:12StatewideFY99:25(10Statewide,15partial)FY98:16(6Statewide,16partial)#bXHX%%b&&{# 80 ?<<<,!d5C<< C?d$ ` X$ 80d! ` X!b&&%%XbXHB 80213  ;  HP1#bXHX%%b&&H}# T<<?' =C  <<< CTd 80db&&%%XbXH2.Increasethenumberos `? Statesthatrequireall_00EMSC_00ԄrecommendedpediatricequipmentonAdvancedLifeSupport(ALS)ambulances.4gri O  5   C #bXHX%%b&&K~#6!O5s,(  7gr]c 80 ;<<,!DC<< C;d'` ' 80d*4 X*Ӏb&&%%XbXH `F FY03:25FY02:23FY01:23FY00:10FY99:7#bXHX%%b&&܀# 80 ;<<,!LC<< C;d-` 4 X- 80d$` X$b&&%%XbXHFY01:(2/02) 8P FY00:19FY99:18FY98:5#bXHX%%b&&;# S  80 ?<<<,!TC<< C?d$ ` X$ 80d! ` X!B 80213 #X*XXbXHDq#HP1 T<<<?'XC  <<< CTd 80d TotalFunding:  HZ EmergencyMedicalServicesforChildren  " \ ($in000's) 80 =<<<,!# ]C<<< C=d'` ' 80d$` X$FY2003:$18,993FY2002:$18,991FY2001:$18,985FY2000:$16,997FY1999:$14,995FY1998:$12,941 80 C<<<<0!% dC<<< CCd-` ` X- 80d'` X'Bx:page#budgetHP:HealthyPeoplegoal 80:0.!4gC   <<<< : 80  &!g 2.15.1ProgramDescription,ContextandSummaryofPerformance   ] ProgramDescriptionandContext:   Section1910ofthePublicHealthServiceActauthorizestheimplementationofaprogramofgrantstoStatesoraccreditedschoolsofmedicineinStatestodevelopandevaluateimprovedemergencyproceduresandprotocolsforchildren.Itcoverstheentirespectrumofemergencymedicalcare,includingeducationofemergencyprovidersaboutpediatriccare,primaryprevention,acuteclinicalcare,andrehabilitation,andisacriticalcomponentofthePresidentsinitiativetocombatterrorismand_00bioterrorism_00.The_00EMSC_00Ԁprogramisjointlyadministeredby_00MCHB_00ԀandtheNationalHighwaySafetyTrafficAdministration,U.S.DepartmentofTransportation.Itisbuiltupontheexistingemergencymedicalservicessystem,andisdesignedtocomplementotherfederal,stateandlocaleffortstoreducetheconsequencesofcriticalillnessandlifethreateninginjuriesamongchildren.TheEmergencyMedicalServicesforChildren(_00EMSC_00)demonstrationprogramistheonlyFederalprogramfocusingontheseissuesthataresocriticaltoimprovingthequalityofchildrensemergencycare.Thestandardemergencymedicalservices(EMS)systemwasdevelopedprimarilyforadultstoaddresscardiacarrest.Becausechildrensufferfromadifferentspectrumofdiseaseandinjuriesthanadults,emergencymedicalservicesforadultsdiffersignificantlyfromthosethatareneededbychildren.Childrenaresmaller,oftenrespondwithdifferentsymptomsthanadultsdisplayinsimilartraumaticcircumstances,andrequirespecializedequipmentandprovidertraining._00EMSC_00Ԁisspecializedcareforchildrenwhoexperienceaseriousinjuryoranacuteillness._00EMSC_00ԀisintegratedintothestandardEMSsystem,andenhancesitscapabilitytoaddressthespecialneedsofchildren.Eachyear,wellover31millionchildrenandadolescentsareseeninemergencydepartments.Fewerthanhalfofallhospitals(46%)withemergencydepartmentshaveallthenecessaryequipmentforthestabilizationofillandinjuredchildren.OnlyfiveStatescurrentlyrequirethatadvancedlifesupportambulancescarryalltherecommendedequipmentneededtostabilizeachild.Themostseriouslyillandinjuredchildrenmayrequirecareinpediatricspecialtycentersandaccesstorehabilitationservices.Yet,nomorethan11Stateshaveguidelinesfortheidentificationofpediatricacutecarefacilities,toensurethatchildrengettotherighthospitalinatimelymanner.Injuries,causedbymotorvehiclecollisions,bicyclecrashes,burning,submersion,andshootings,bothaccidentalandintentional,arealeadingcauseofdeathanddisabilityforchildrenandadolescents.However,mentalhealthemergenciesareasignificantandgrowingconcern.Forexample,suicide,dependingonthelocation,iseitherthesecondorthirdleadingcauseofdeathinadolescents.Yet,only24percentofhospitalsintheUnitedStateshavementalhealthservicesforchildrenandadolescents. h+&* The_00EMSC_00ԀprogramprovidestwotypesofgrantstoStatesandmedicalschools:Statesystemsgrants,andtargetedissuegrants.Statesystemsgrantsprovidefundsforprogramplanningandimplementationandtosupportstatewide_00EMSC_00.Mostplanninggrantshavebeencompleted.AfewStatesstillhaveongoingimplementationgrants.MostStatescurrentlyhavePartnershipgrants,whichfundactivitiesthatrepresentthenextlogicalstepstoimproverefineandinstitutionalize_00EMSC_00ԀinaState,basedonpreviouslydevelopedprogramplans.Targetedissuegrantsaredesignedtosupportspecificactivitiesaimedatimprovingknowledge,ortodevelopandevaluatemodelsorproducts,basedonanationalfiveyearplan.ThefiveyearplanisbasedonrecommendationsmadebytheInstituteofMedicine(_00IOM_00)inits1993report EmergencyMedicalServicesforChildren.ProgramfundshavebeenusedtoestablishandmaintaintheNational_00EMSC_00ԀResourceCenter,theNational_00EMSC_00ԀDataAnalysisResourceCenter(_00NEDARC_00),andtoinitiateamultiagencyresearchprogramtoimprovethequalityandquantityofresearchrelatedto_00EMSC_00,thegoalofwhichistoreducemorbidityandmortalityinchildrenthroughimprovedcaredelivery._00NEDARC_00Ԁfocusesondatacollectionandanalysis,researchdesign,qualityimprovement,communicationofdata,andgrantwriting.TheProgramalsoprovidesfundingforthe_00EMSC_00ԀNationalResourceCenter(_00EMSC_00ԀNRC),locatedinWashingtonDC.The_00EMSC_00ԀNRC,establishedin1991,workswithstatesinidentifyingtheresourcesneededtoorganizeandimplement_00EMSC_00Ԁactivitiesthroughoutthenation.Thisincludesprovidingguidanceinsecuringfunding,developinginjurypreventionplans,buildingcoalitions,shapingpublicpolicy,trainingprehospitalandhospitalcareproviders,producingeducationalresources,andeffectivelydistributingtheresourcesthroughoutthecountry.FundingincreasesinFY2001providedsupportforanestimatedthreeadditional_00EMSC_00ԀgrantsleadingtothedevelopmentofaNationalInjurySurveillanceSystemforChildren,ClinicalPracticeGuidelinesforChildren,andaninitiativetoenhancepediatricpatientsafetybydemonstratingtheeffectivenessofsystemstoreducemedicalerrorsinemergencytreatments.AdditionalfundingwillbemadeavailablethroughtheNational_00EMSC_00ԀDataAnalysisResourceCentertoprovideincreasedandenhancedtechnicalassistancetoStates.Finally,fundinghasbeenallocatedforthecreationofapediatricemergencydepartmentresearchnetwork(_00PEDARN_00)thatincludes4regionalnodesandnearly20affiliatedemergencydepartments;thisnetworkwillprovidetheinfrastructurefordatacollection,multiinstitutionalclinicalevaluationprogramsconcerningemergencycareofchildren. DataIssues:  &"% Performancemeasuresforthe_00EMSC_00Ԁprogramareprocessoriented,andaredesignedtoassessthedegreetowhichStatesareimplementingsomeofthecorerecommendationsofthe1993_00IOM_00Ԁreport,whichincludethedevelopmentofpediatricemergencyprotocols,andtheprovisionofpediatricemergencyequipmentonAdvancedLifeSupportambulances. h+&* The_00IOM_00Ԁreportrecognizedaneedformoreandbetterqualitydataonthevolume,nature,andhealthoutcomesofemergencycare,butacknowledgedthattherewouldbesignificantchallengestoobtainingthem.EMSsystemsdependonsuccessfulcoordinationofservicesfrommanyseparatecomponents,includingprehospitalcare,emergencydepartmentcare,inpatientcare,andrehabilitation.Linkingdataacrossthesedifferentsystemsinvolvesbothtechnicalchallenges,andaccessissues.Otherissuesincludealackofcommondefinitionsacrosssystems,alackofconsensusonneededdataelements,alackofvalidatedmeasuresofseverityandacuity,alackofvalidatedmeasuresofpatientoutcomes,andalackofconsensusonwhatoutcomestomeasureandwhentomeasurethem.Mortalityisthemostreadilyavailableandmostwidelyusedoutcome,butrelativelyfewchildrenneedingorreceivingemergencycaredie.Otheroutcomesincludethepresenceorabsenceofdiseases,impairments,functionallimitations,ordisabilitiesinterferingwithageappropriateactivities;physicalmobilityandfunctioning;socialandrolefunctioning;andemotionalandmentalwellbeing.Measuringthesereliablyinchildrenisachallenge._00MCHB_00Ԁcontinuestomakeprogressintheimplementationofthe_00IOM_00Ԁrecommendations,buttheabilitytolinkemergencymedicalcareforchildrentohealthoutcomeswilltaketime. 2.15.2GoalbyGoalPresentationofPerformance  H  GoalIV.C.1IncreasethenumberofStatesthathaveimplementedStatewidepediatric  p protocolsformedicaldirection.   \  Context:  8 HavingStatewidepediatricprotocolsformedicaldirectionwithinaStatewillincreasethestandardofcareforpediatricemergencypatients.Indicator:NumberofStateswithStatewidepediatricprotocolformedicaldirection. Performance:   TheFY1999baselineforStatewidesystemswas10.TheFY2000performancelevelis12.TheFY2000targetof20didnotdistinguishbetweenStatewideandpartialsystems,buttheperformancelevelofincreaseforFY2000Statewideisnotinconsistentwiththegoaltrends.ThetargetforFY03is17. GoalIV.C.2:IncreasethenumberofStatesthatrequireall_00EMSC_00-recommended  $\" pediatricequipmentonAdvancedLifeSupport(ALS)ambulances.  $H #  Context:  & "% Requiringall_00EMSC_00-recommendedpediatricequipmentonAdvancedLifeSupport(ALS)ambulanceswillincreasethequalityandappropriatenessofcareforpediatricemergencypatients.Indicator:NumberofStatesthatrequireallpediatricequipmentonALSambulances. Performance:  *%) FY00ActualperformanceexceededtheFY00Targetlevel.ThetargetforFY03is25.  l+&*  bXHXXX*  FY2003PerformancePlan,FinalFY2002PlanandFY2001PerformanceReport  ]  %  2.16PoisonControlCenters %N  *< d d bR@  bR@ bR@bb@)#)#, bR@, bR@,bR@,bb@+  7<<" ` C7d @ d  PerformanceGoals 80 A<<,!$C << CAd*` ` X* 80d  $` X$Targets 80 A<<,!$C << CAd  *` ` X* 80d  $` X$ActualPerformance 80 A<<<,!  C"<< CAd$ ` X$ 80d  ! ` X!Reference 80 T<<?'$ C   <<< CTd 80db&&%%XbXHIII.ASSUREQUALITYOF  p CARE   H  A.Promote   AppropriatenessofCare    1.Developandfieldtestuniformandevidencebasedguidelinesforthetreatmentofpoisoning.#bXHX%%b&&#4!graO  5  #X*XXbXH#bXHXXX*6O  78a"   \   ;<<,! C<< C;d'` 'd$` X$b&&%%XbXHFY03:10   FY02:5FY01:0" #  1        #bXHX%%b&&# ;<<,!0#C<< C;d*` ` X*d$` X$b&&%%XbXHFY02:(6/02)  * FY01:NAFY00:0#B #  2      l , FY99:0#bXHX%%b&&# 80 ?<<<,!D -C<< C?d$ ` X$ 80d! ` X!B215 80 O<<<:' 3C  <<< CO b&&%%XbXHC.PromoteSystemsand ,|4 InfrastructureDevelopment  T5 1.IncreasethepercentageofcertifiedPoisonControlCenters.#bXHX%%b&&S#4%8O  5  63OG$  7u =<<<,! 8C<<< C=b&&%%XbXHFY03:80% < FY02:77%FY01:75%#bXHX%%b&&# ?<<<<,!>C<<< C?b&&%%XbXHFY01:(9/02) D FY00:70%#bXHX%%b&&Ҿ# ?<<<<,!EC<<<< C?B215  ,|F  T<<<?'HGC  <<<< CTd 80d TotalFunding:Poison lI ControlCenters  XJ ($in000's) 80 =<<<,!DKC<<< C=d'` ' 80d$` X$FY2003:$21,211FY2002:$21,349FY2001:$20,127FY2000:$2,999FY1999:n/aFY1998:n/a 80 C<<<<0! RC<<< CCd-` ` X- 80d'` X'Bx:page#budgetHP:HealthyPeoplegoal 80:0.DVC   <<<< : 80  "W 2.16.1ProgramDescription,ContextandSummaryofPerformance    ProgramDescriptionandContext:   Eachyearmorethan2,000,000poisoningsarereportedtopoisoncontrolcentersthroughouttheUnitedStates.Morethan90percentofthesepoisoningshappeninthehome.Fiftythreepercentofpoisoningvictimsarechildrenyoungerthansixyearsofage.Yet,25percentofAmericanslackaccesstopoisoncontrolservices24hoursaday,7daysaweek.Poisoncontrolcentersareavaluablenationalresourcethatprovidelifesavingandcosteffectivepublichealthservices.TheyarealsoakeycomponentofthePresidentsinitiativetocombatterrorismand_00bioterrorism_00.Studieshaveshownthatforeverydollarspentonpoisoncontrolcenters,$7inmedicalcostsaresaved.Theaveragecostofapoisoningexposurecallis$32,whiletheaveragecostifotherspartsofthemedicalsystemareinvolvedis$932.Overthelast2decades,theinstabilityandlackoffundinghasresultedinasteadydeclineinthenumberofpoisoncontrolcentersintheUnitedStates.Overthelastfewyears,severalpoisoncontrolcentershavebeenforcedtoclosebecauseoffundingproblems.ThePoisonControlCenterEnhancementandAwarenessAct,Section6(P.L.106174,February2000)authorizedagrantprogramtostabilizethefundingstructureandincreaseaccessibilitytopoisoncontrolcenterstoincreasethenumberofUnitedStatesresidentswhohaveaccesstoacertifiedpoisoncontrolcenter,andtoreducetheinappropriateuseofemergencymedicalservicesandothermorecostlyhealthcareservices.Inadditiontothegrantprogram,thelawalsoauthorizestheestablishmentofanationalmediacampaigntoeducatethepublicandhealthcareprovidersaboutpoisonpreventionandtheavailabilityofpoisoncontrolresourcesinlocalcommunities,toestablishanationwidetollfreenumber,andtoconductadvertisingcampaignsconcerningthenationwidetollfreenumber.FY2001activitiesbuildonajointeffortwiththeCentersforDiseaseControlandPrevention(CDC)toassureuniversalaccesstoqualitypoisonservices.Anationalstakeholdersgroupwasconvenedtoexaminepoisoncontrolissuesandsuggestcosteffectivesolutionsandneededimprovements.Implementationoftherecommendationshasalreadybegun.Theserecommendations,whichalsoformedthebasisofthePoisonControlAwarenessActinclude:L 23456789Ihh23456789L 23t   ]232I3  0 '   Coordinationofall_00PCCs_00Ԁthroughasinglenationaltollfreenumber.Planningforthetoll $X" freenumberandanassociatednationaleducationcampaignhasbegunthroughajointCDC/_00MCHB_00ԀCooperativeAgreementwiththeAmericanAssociationofPoisonControlCenters._00PCCs_00Ԁcurrentlyhandleabout2millioncallsperyear.Thatnumberisexpectedtoincreaseaftertheimplementationofthenationaltollfreenumber.23݌ '"'" Ќ  ]L 23456789'Ihh23456789LL 234567897Ihh23456789L 23u   ]2327I3  0 '   Developmentandimplementationofuniformpatientmanagementguidelines.23.݌)$('"'" Ќ  ]L 23456789GIhh23456789LL 23456789WIhh23456789L 23v   ]232WI3  0 '   Developmentandrefinementofanonline,efficientdatacollectionprogram.23݌h+&*'"'" Ќ  L 23456789gIhh23456789L 23w   232gI3  0 '   Developmentandevaluationofstandardizedpubliceducationprogramsforpoison  prevention.23+݌ '"'" Ќ  L 23456789wIhh23456789L 23x   23h2wI3  0 '   Encouragementofsystemsdevelopment,efficiency,andcollaborativeactivitybetween t centers.23h݌ '"'" Ќ  ݀L 23456789Ihh23456789L 23y   232I3  0 '   Supportfornoncertifiedcentersornewlyestablishedcenterswhichcandemonstratethe 8  abilitytoobtaincertificationwithintwoyears.23݌ '"'" Ќ  C * $h23456789Cz 2.16.2GoalbyGoalPresentationofPerformance   8   % & GoalIII.A.1%&:Developandfieldtestuniformandevidencebasedguidelinesforthe   treatmentofpoisoning.     Context:    HavingevidencedbasedguidelinesavailableforuseatthePoisonControlCenterswillimproveuniformityandstandardcareforacutepoisoningrelatedincidents,therebyimprovingthequalityofcare. DataIssues:   p Mostdatawillbecollectedfromannualapplicationsandreportsfromgrantees. % ' GoalIII.A.2%':IncreasethepercentageofcertifiedPoisonControlCenters.     ' Context:   Increasingthepercentageofcertifiedcenterswillincreaseaccessto,andqualityof,servicesfortheU.S.population. Performance:  X  Approximately70%ofpoisoncontrolcenterswerecertifiedin2000.Thistranslatestoapproximately49centers(70%of70centers).Itisproposedtoincreasethatpercentageineachofthenextthreeyears. DataIssues:  $D # Annualreportsfromgrantees.#X*XXbXHO# X*XXX* &M'%X X* %0!$ #&M'%'% &M##X*X'%&M#  h+&* FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   lD 2.17ProgramTitle:AbstinenceEducationProgramTitleV and_00SPRANS_00 t %  CommunityBasedAbstinenceEducationProjects%L  d * dd bR@  bR@ bR@bb@< "",` bR@, bR@,'bR@,bb@+  7<<" <  C7d @ d  PerformanceGoals A<<,! C << CAd d  Targets A<<,!  C << CAd  d  Actual      Performance 80 A<<<,!  C"<< CAd 80d  Reference 80 T<<?' C   <<< CTd 80d I.ELIMINATE  L BARRIERSTOCARE   8   C.FocusonTarget $  Population    1.AchieveStatesettargetsforreducingtheproportionofadolescentswhohaveengagedinsexualintercourse. 80 ;<<,!HC<< C;d 80dFY03:50%FY02:50%FY01:50% 80 ;<<,!p#C<< C;d 80dFY01:(6/04)FY00:(6/03)FY99:(6/02)FY98:71.4%(15of21Statesreporting) 80 ?<<<,! p0C<< C?d 80dB 80 221  104 HP9 T<<?' \ 6C  <<< CTd 80d2.AchieveStatesettargetsforreducingtheincidenceofyouths15-19yearsoldwhohavecontractedselectedsexuallytransmitteddiseases. 80 ;<<,!X>C<< C;d 80dFY03:50%FY02:50%FY01:50% 80 ;<<,!DCC<< C;d 80dFY01:(6/04)FY00:(6/03)FY99:(6/02)FY98:44.8%(13of29Statesreporting) 80 ?<<<,!DLC<< C?d 80dB 80 221  104 bXHXXX*HP9 T<<?'PC  <<< CTd 80d3.AchieveStatesettargetsforreducingtherateofbirthstoteenagersaged15-17. 80 ;<<,!#hUC<< C;d 80dFY03:50%FY02:50%FY01:50% 80 ;<<,!#hZC<< C;d 80dFY01:(6/04)FY00:(6/03)FY99:(6/02)FY98:67.8%(19of28Statesreporting 80 ?<<<,!&"cC<< C?d 80dB 80 221  104 #X*XXbXH~#bXHXXX*HP9 O<<<:'"gC  <<< CO4.Thepercentageofgranteesinthecommunitybasedprogramabletoreportdataon4coremeasures. =<<<,!t+&lC<<< C=FY03:55%FY02:50% @<<</!(0$nC<<< C@FY01:NA ?<<<<,!(0$pC<<< C?B 219  104 O<<<:''#qC  <<<< CO5.Increasethenumberof grantapplicantsthatareFaithBasedOrganizationsand/orCommunityBasedOrganizations. =<<<,! C<<< C=FY03:_00TBD_00FY02:_00TBD_00Ԁ @<<</!,C<<< C@FY01: ?<<<<,!, C<<< C?B 219 HP:N/A T<<<?', C  <<<< CTd 80d TotalFunding:  L AbstinenceEducationProgram   $ ($in000's) 80 =<<<,!  C<<< C=d 80dFY2003:$50,000+73,044FY2002:$50,000+40,059FY2001:$50,000+20,056FY2000:$50,000FY1999:$50,000FY1998:$50,000 80 C<<<<0! C<<< CCd 80dBx:page#budgetHP:HealthyPeoplefocusarea &C0:0. 8C   <<<< : &C0 2.17.1ProgramDescription,ContextandSummaryofPerformance    #X*XXbXH#CX*XXX* ProgramDescriptionandContext:  X Section510ofTitleVoftheSocialSecurityAct,createdunderSection912ofthe1996WelfareReformlaw,establishedanewcategoricalprogramofblockgrantstoStatesforabstinenceeducation.ItspurposeistoenableStatestosupportabstinenceeducation,andattheoptionofeachState,whereappropriate,_00mentoring_00,counseling,andadultsupervisiontopromoteabstinencefromsexualactivity,withafocusonthosegroupswhicharemostlikelytobearchildrenoutofwedlock.Thelawprovidedforamandatoryannualappropriationof$50millionforeachfiscalyear(FY)1998through2002.$50millioniscontinuedinFY2003.GrantsareawardedtotheStatesbasedonastatutoryformuladeterminedbytheproportionthatthenumberoflowincomechildrenintheStatebearstothetotalnumberoflowincomechildrenforallStates.GrantapplicationsareacceptedonlyfromtheStatehealthagencyresponsiblefortheadministrationoftheTitleVMaternalandChildHealthServiceBlockGrant,withfundsdispersedatthediscretionoftheGovernorunlessotherwiseestablishedbyStatelaworjudicialprecedent.ThereisarequiredmatchofthreenonFederaldollarsforeveryfourFederaldollarsawarded.InadditiontotheprogramauthorizedunderSection510describedabove,_00MCHB_00Ԁalsoadministersaprogramofcommunitybasedabstinenceeducationgrants.ThisprogramwasinitiatedinFY2001with$20million.$40millionisappropriatedfortheprograminFY2002,and$73millionisrequestedforFY2003.Thepurposeoftheprogramistoprovidesupporttopublicandprivateentitiesforthedevelopmentandimplementationofabstinenceonlyeducationprogramsforadolescents,ages12through18,incommunitiesacrossthecountry.ProjectsmustclearlyandconsistentlyfocusontheSection510(b)(2)definitionofabstinenceeducationandagreenottoprovideaparticipatingadolescentanyothereducationregardingsexualconductinthesamesetting.Oneyearplanninggrantsandthreeyearimplementationgrantsarefundedundertheprogram.  ̀#X*XXCX*i#CX*XXX* <,'9 #X*XXCX*^#XHXXX*Abstinenceonlyeducationprogramsareawaytoeducateyoungpeopleandcreatean  environmentwithincommunitiesthatsupportteendecisionstopostponesexualactivity.In1999,49.9percentofhighschoolstudentsreportedeverhavinghadsexualintercourseand36.3percentreportedhavinghadsexualintercoursewithinthepreviousthreemonths(CDC,_00MMWR_00,June9,2000.)Therearesomeindicationsthatearlysexualintercoursebyadolescentscanhavenegativeeffectsonsocialandpsychologicaldevelopment.Researchshowsthatteenpregnancyislinkedtoalistofriskfactorssimilartothoseforotherproblembehaviorsofadolescence,suchasalcohol,druguse,violence,delinquency,andschooldropout.Teenparentingisassociatedwiththelackofhighschoolcompletionandtheinitiationofacycleofpovertyformothers.TheDepartmentofHealthandHumanServicesestablishedthereductionofteenpregnanciesasaprioritygoalinits1997strategicplan.Birthratesforteenagers1519yearsofagedeclinednationallybetween1991and1998forallagesandraces,andHispanicoriginpopulations.Thesteepestdeclineswererecordedforblackteenagers.Overall,theteenbirthratedeclinedby18percentfrom1991to1998,withallStatesreportingadeclineinthebirthrateofteens1519yearsofagebetween1991and1998(CDC,_00NCHS_00,NationalVitalStatisticsReports,April24,2000)   Despiterecentdeclines,teenpregnancyandoutofwedlocksexualactivityremainsignificantproblemsincommunitiesacrossthecountry.#X*XXXH#XHXXX*ԀU.S.teenpregnancyratesremainamongthe H highestintheindustrializedworld,with800,000900,000adolescentsaged19years 4 becomingpregnanteachyear(CDC,_00MMWR_00,July14,2000.)#X*XXXH#XHXXX*Despitedeclinesduringthe  p 1990's,thebirthratesforHispanicandblackteenscontinuetobehigherthanthosefornonHispanicwhiteandAsianorPacificIslandyouth.#X*XXXH#XHXXX* H  ProgramPerformance:    Questionsaboutteenagesexualbehavioraresensitive,andtheprogramisstillrelativelynew,sotherehasbeensomedifficultyinobtaininghighqualitydataintheseearlystagesoftheprogram.#X*XXXH#XHXXX*ԀSpecificissuesfortheSection510programarediscussedingreaterdetailinthe  DataIssuessectionbelow.Becauseoftheissuesinvolvedinobtainingdata,theprogramdoesnotyethavereliablebaselinedatatouseinsettingreasonableperformancetargetsforfutureyears.Accordingly,theFY03targetsarebeingretainedattheFY01and02levels,pendinganalysisoftheFY1999data.DataforFY1999(thesecondyearofoperation#X*XXXH #XHXXX*s),werereported D! inJuly2000,andareexpectedtobeprocessedandavailablebySummer,2002#X*XXXH2 #XHXXX*.Forthe 0"  communitybasedprogram,theabilitytoreportdataoncoreitemsisconsideredtobeacriticalmeasureofprogramperformance.#X*XXXH #CX*XXX* 2.17.2Goal-by-GoalPresentationofPerformance %0!$ %  GoalI.C.1%< :AchieveState-settargetsforreducingtheproportionofadolescentswho '#& haveengagedinsexualintercoursein50percentoftheparticipatingStates.#X*XXCX* #CX*XXX* (#' Context:  |*%) Half(49.9percent)ofallthehighschoolstudentsintheU.S.havehadsexualintercourse h+&* duringtheirlifetime.Nationwide,8.3percentofstudentshadinitiatedsexualintercoursebeforeage13years#X*XXCX*5#XHXXX*(CDC,_00MMWR_00,June9,2000.)#X*XXXH#CX*XXX*Ԁ#X*XXCX* #XHXXX*Sexualexperience,andparticularlytheage  atfirstintercourse,representcriticalindicatorsoftheriskofpregnancyandsexuallytransmitteddiseases.#X*XXXHN#CX*XXX*Abstinence-onlyeducationprogramsareawaytoeducateyoungpeople t andcreateanenvironmentwithincommunitiesthatsupportteendecisionstopostponesexualactivity. Indicator:ThepercentageofparticipatingStatesthatachieveState-settargets. $ t #X*XXCX*A#CX*XXX* Performance:   L  Ofthe21StatesreportingFY1998data,15,or71.4%,achievedtheirStatesettargets.#X*XXCX*#CX*XXX* %  GoalI.C.2%:AchieveState-setratesforreducingtheincidenceofyouths15-19yearsold   whohavecontractedselectedsexuallytransmitteddiseases(_00STDs_00).#X*XXCX*t#CX*XXX*Context:  p _00STDs_00Ԁarepreventablediseases.Theavailabilityandqualityofsexuallytransmitteddiseaseservicesareimportantfactorsinpreventingthespreadofdiseaseandcomplications.ApproximatelythreemillionteenagersintheU.S.contractan_00STD_00Ԁeachyear(_00DSTDP_00,CDC,1994.)Teensareathighbehavioralriskforacquiringmost_00STDs_00.Some_00STDs_00Ԁ(gonorrhea,syphilis,hepatitisB,andchancroid)aredecliningamongteensandotheragegroups.Chlamydiamaybegoingdowninareaswherethereisscreeningandtreatmentamongteens,butmaybestableorincreasingwheretheseservicesarenotavailable(CDC,SexuallyTransmittedDiseaseSurveillance,1998.)Primaryandsecondarypreventionapproachesareeffectivewaystoreduce_00STDs_00.Abstinence-onlyeducationprogramsareonewaytoeducateyoungpeopleregardingtherelationshipofsexualactivityand_00STDs_00.Indicator:ThepercentageofparticipatingStatesthatachieveState-settargets.#X*XXCX*#CX*XXX* Performance:  X  Ofthe52Statesandjurisdictionswithgrants,29wereabletoreportaggregateFY1998dataforthismeasure.Ofthese,13States,or44.8%,wereabletomeettheirStatesettargets.ThetargetforFY03is50%.#X*XXCX*#CX*XXX* %  GoalI.C.3:% ԀAchieveState-settargetsforreducingtherateofbirthstoteenagersaged $D # 15-17.#X*XXCX*#CX*XXX* %0!$  Context:  '#& #X*XXCX*#XHXXX*Adolescentpregnancyandchildbearinghavebeenassociatedwithadversehealthandsocial (#' consequencesforyoungwomenandtheirchildren(CDC,_00MMWR_00,July14,2000.)#X*XXXH?#CX*XXX*ԀTeen )$( parentingisassociatedwiththelackofhighschoolcompletionandinitiatingacycleofpovertyformothers.Overall,theteenbirthratedeclinedby18percentfrom1991to1998,withall h+&* _00Statesreportingadeclineinthebirthrateofteens1519yearsoldbetween1991and1998#X*XXCX*Z#XHXXX*(CDC,NCHS,NationalVitalStatisticsReports,March28,2000)#X*XXXH#CX*XXX*.  #X*XXCX*~#XHXXX*Indicator:ThepercentageofparticipatingStatesthatachieveState-settargets. t #X*XXXH#CX*XXX* Performance:  L  OverhalfoftheStateswereabletoreportFY1998dataforthismeasure.Ofthe28Statesreporting,19,or67.8%,wereabletomeettheirStatesettargets. %   GoalI.C.4:% n!Ԁ#X*XXCX* #bXHXXX*Thepercentageofgranteesinthecommunitybasedprogramabletoreport  8  dataon4coremeasures. #X*XXbXH!#CX*XXX* $   Context:    Thepurposeofthecommunitybasedabstinenceprogramistoprovidesupporttopublicandprivateentitiesforthedevelopmentandimplementationofabstinenceonlyeducationprogramsforadolescents,ages12through18,incommunitiesacrossthecountry.#X*XXCX*v"#CX*XXX*Thekey p assumptionsunderlyingtheprogramare:1)thatcompletionofanabstinenceonlyeducationprogramcansuccessfullyreducetheproportionofprogramparticipantswhoengageinsexualintercourse,2)reducetheproportionofprogramparticipantswhoengageinotherriskbehaviorssuchasalcohol,tobacco,anddruguse,and3)thatreductioninthesebehaviorswillresultinalowerrateofbirthstofemaleprogramparticipants.Indicator:Theproportionofgranteesabletoreportdataon:1)theproportionofprogramparticipantswhosuccessfullycompleteorremainenrolledinanabstinenceonlyeducationprogram;2)theproportionofprogramparticipantswhohaveengagedinsexualintercourse;3)theproportionofprogramparticipantswhoreportareductioninriskbehaviors,suchastobacco,alcoholanddruguse;and4)therateofbirthstofemaleprogramparticipants. Performance:  l PerformanceonthisnewmeasurewillbeassessedusingdatafromgranteesAnnualProgressReports.ThetargetforFY02is50%.ThetargetforFY03is55%.qp(#X*XXCX*##XHXXX* GoalI.C.5:IncreasethenumberofgrantapplicantsthatareFaithBasedOrganizations $X" and/orCommunityBasedOrganizations. '    Context: ThenumberofgrantapplicantstotheSPRANSAbstinenceEducationProgramthatareself '#& identifiedasaFaithBasedOrganization(FBO)and/oraCommunityBasedOrganization(CBO)wasselectedasthebestmeasuretoassessprogresstowardeliminatingbarriersforFBOs/CBOsinterestedinparticipatinginFederallyfundedhealthandhumanserviceprograms.ThisperformancemeasureisinconcertwiththeWhiteHouseInitiativeandHHS h+&* SecretarialInitiativetoensurefullparticipationbyqualifiedFBOs/CBOsinappropriateFederallyfundedprograms.HRSAsgrantprogramsannouncementsandgrantapplicationguidanceinviteallinterestedandqualifiedFBOs/CBOstoapplyforHRSAfundingopportunities.  t Performance: TheagencyproposestomeasureprogressandperformanceonthisperformancemeasureinFY 8  2003,onceabaselinehasbeenestablishedinFY2002.ImplementationoftheproposedsupplementtotheSF424applicationformforapplicantswillenableHRSAtocollectthedataneededtoestablishthebaselinenumberofthegrantapplicantsthatselfidentifyasFaithBasedOrganizationsand/orCommunityBased,andtosetaproposedtargetof10%overbaselineforFY2003. DataIssues: Dataforallperformancemeasuresisreportedintheannualformulagrantapplications.These   applications,dueinJulyofeachcalendaryearforthenextfiscalyear(FY),reportdatafortheprecedingFY.Dataforthesecondyearofoperation,FY1999,asreportedinJuly,2000,willbeprocessedandavailablebysummer,2002.TheStatesdonotallhavegooddataforsomemeasuresrelatedtoteenagesexualbehaviors,sotheremaybesomedifficultyinobtaininghighqualitydataintheearlystagesofthisprogram. Atthecurrenttime,theonlysourceofdataforStateestimatesofteenagesexualbehaviorsistheYouthRiskBehavioralSurvey(YRBS),whichisconductedeverytwoyearsbytheStatesandtheCentersforDiseaseControlandPrevention.In1999,41Statesand4Territoriesparticipatedinthesurvey.ItistheBureausunderstandingthatall50Stateshaveagreedtoparticipateinadministrationofthe2001survey.UndercurrentarrangementswiththeStates,whenschooldistrictsareselectedforparticipationintheYRBS,theyareallowedtoexcludequestionsthattheybelievearetoosensitive,sothatnotallincludethequestionsaboutsexualbehavior. 0EveryeffortwillbemadetoworkwiththeStatestoimprovethequalityoftheirdataasquicklyaspossible. Forexample,all53jurisdictionsthatparticipateintheSection510AbstinenceEducationGrantProgramarerequiredtoreportonfourperformancemeasures.DataforakeymeasuretheproportionofadolescentswhohaveengagedinsexualintercourseareonlyavailablefromtheYRBS#X*XXXH(#bXHXXX*,unlessaStatehasconducteditsownsurvey.Stateswhocannot $X" reportonthesemeasuresatthetimetheysubmittheirapplicationsforfederalfinancialsupportunderSection510arerequiredtoexplainhowtheywillclosethisdatagap.  %0!$  4|6 ThefollowingdataarerequiredfromAbstinenceEducationGrantees:L 23456789Ih$*L 23   2372I3  0 '   Anunduplicatedcountofmalesandfemalesservedbytheprogram,byagegroup:<10,10 )$( 14,1517,1819,and>24yearsofage,byraceandethnicity.2377݌ '"'" Ќ   23   2382I3  0 '   Totalencountersbyagegroup,race,andethnicity.238 9݌h+&*'"'" Ќ   23   2392I3  0 '   Statepopulationcountsforeachoftheaboveagegroups,bygender,raceandethnicity,for  eachyearfrom1993tothepresent.2399݌ '"'" Ќ   23   23;2I3  0 '   ThenumberandlocationofcommunitiesintheStatewithanAbstinenceOnlyEducation  Programfundedbythisproject. 623;1;݌ '"'" Ќ  MCHBiscommittedtoevaluatingthisprogram.InFY2001,HRSAandtheOfficeofthe L  AssistantSecretaryforPlanningandEvaluation(ASPE)enteredintoanintraagencyagreementthattransferred$500,000fromMCHBtoASPEtosupportcomprehensive $ t evaluationsofabstinenceeducation.#X*XXbXHk5#XHXXX*ԀFundingtransferswillcontinueforevaluationpurposes.#X*XXXH=#XHXXX*Ԁ  ` Upto3.5percentofthetotalFY2002appropriationwasearmarkedtosupportcomprehensiveevaluations,includinglongitudinalevaluationsofabstinenceeducation.#X*XXXHE>#  8   XHXXX*C!XXH@*@*_00Ԉ +'& Ї  HEALTHPROFESSIONS#XHX!C}?#  @  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   l@  ThemissionoftheBureauofHealthProfessions(_00BHPr_00)istocontributetoensuringaccesstoqualityhealthcareforallAmericansbysupportingeducationandtrainingprogramsthatimprovethediversity,distribution,andqualityofthehealthcareworkforce.Throughacollectionofprogramsandactivities,theBureaustrivestoimprovethehealthstatusofallAmericans,particularlythe_00underserved_00,byenhancingtheeducation,utilization,training,diversity,andqualityoftheNationshealthpersonnel.ThroughTitlesVIIandVIIIprogramsandthroughtheNationalHealthServiceCorps,theBureauprovidesbothpolicyleadershipandsupportforhealthprofessionsworkforceenhancementandeducationalinfrastructuredevelopment.Currentemphasisisonimprovingthegeographicdistributionanddiversityofthehealthprofessionsworkforce.TheBureauutilizesanoutcomebasedperformancesystemtomeasurewhetherprogramsupportismeetingitsnationalhealthworkforceobjectives,andtosignalwhereprogramcoursecorrectionisnecessary. '     [  '     [ Programsincludedinthissectioninclude:2.180 HealthProfessionsandNursingTrainingPrograms#X*XXXH^?# p " " 2.190 TheNationalHealthServiceCorps \ " " 2.200 NursingLoanRepaymentH " " 2.21 EducationalIncentivesforCurriculumDevelopmentandTraining 4 2.220 WorkforceInformationandAnalysis  " " 2.230 ChildrensHospitalsGraduateMedicalEducation  " " 2.240 HealthEducationandAssistanceLoans(HEAL)Program " " 2.250 NationalPractitionerDataBank, " " 0 ' 0 '"'"HealthcareIntegrityandProtectionDataBank  " " 2.260 _00Ricky_00ԀRayHemophiliaReliefFundProgram l! " "  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001Performance  Report    2.18ProgramTitle:HealthProfessionsandNursingEducationandTrainingPrograms t  *<dd` bR@` bR@ 'bR@'bb@"", dd , dd ,dd ,dd +  5 L  d5&M'%XX*PerformanceGoals M8' "d dMTargets M8' "d dMActual   Performance M8'  "d dMReference CX.,  "  d C I.ELIMINATE  D  BARRIERSTOCARE      A.IncreaseUtilizationfor    _00Underserved_00ԀPopulations  |  1.Increasethenumberofstudents/traineesinclinicaltrainingwithhealthcareservicedeliveryorganizationsserving_00underserved_00Ԁareas. $X $FY03:0FY02:41,520FY01:37,790(41,300)*FY00:33,580FY99:31,575   FY01:12/02FY00:43,285FY99:31,695FY98:26,347  d( B 137 NEW | , FY00DATA  ,| .  )X, 0" )2.Increasethenumberofgraduatesand/orprogramcompleterswhoenterpracticein_00underserved_00Ԁareas $X4X $FY03:1,532FY02:5,790FY01:5,565(5,387)*FY00:4,482(5,242)*FY99:4,391(4,660)*  X: FY01:12/03FY00:3,891FY99:5.759FY98:5,383&&%%'%&M  X@  #&M'%%%&&Q#&&%%'%&MB 137   A  #&M'%%%&&;R#&&%%'%&MNEW C FY00DATA )X0E" )3.Increasethenumberofgraduatesand/orprogramcompletersofhealthprofessionsprimarycareϐtracksandprogramsthatsupportprimarycare. $KX $FY03:4,243FY02:112,441FY01:103,983π(110,841)*FY00:68,232(95,225)*FY99:68,350(96,018)*   R FY01:12/03FY00:92,582FY99:89,769FY98:97,780   Y B 137 #&M'%%%&&R#&&%%'%&MNEW $t\ FY00DATA )X$^" ) II.ELIMINATEHEALTH !@_ DISPARITIES  "`  B.IncreaseUtilizationfor #a _00Underserved_00ԀPopulations  x$b 1.Increasethenumberofminority/disadvantagedgraduatesandprogramcompleters. $'(#fX $FY03:862FY02:14,287FY01:13,186(13,101)*FY00:11,587(11,739)*FY99:10,652(11,538)*  'P"m FY01:12/03FY00:19,950FY99:9,942FY98:9,793  '(#u ЀB 137 #&M'%%%&&T#&&%%'%&MNEW #x FY00DATA  P% z ̀ X ($~ 2.Increasethenumberofminority/disadvantagedϐenrollees. $ X $FY03:8,692FY02:22,906FY01:21,717(22,080)*FY00:21,286(21,344)*FY99:21,231(21,554)*     FY01:12/02FY00:16,845FY99:19,579FY98:20,972    B 137 NEW   FY00DATA     #&M'%%%&&W#&&%%'%&M X   3.Increasethenumberofϐ_00underrepresented_00Ԁminoritiesservingasfaculty. $X $FY03:0FY02:2,226FY01:1,954(2,043)*FY00:334(1,889)*FY99:326(1,797)*  \h  FY01:12/03FY00:1,494FY99:1,883FY98:1,700  4@ # B 137 NEW & FY00DATA  \h (  #&M'%%%&&Y#&&%%'%&M X   * TotalFunding:Health x + ProfessionsandNursingTrainingPrograms ($in000's) $ .X $FY2003:$108,502FY2002:$387,138FY2001:$359,364FY2000:$301,133FY1999:$301,177FY1998:$289,101  4 Bx:page#budgetHP:HealthyPeoplegoalP\ 6     '  *PleaseseedataissuesexplanationonPage132,ProgramDataIssues 6 #XHX%%&&K#2.18.1ProgramDescription,ContextandPerformance  |8   ht9  TitlesVIIandVIIIofthePublicHealthServiceActcreateprogramstosupporttheeducation T`: andtrainingofthehealthcareworkforce.Theprogramsconsistofcompetitivegrantsandcooperativeagreementstoorganizationsthattrainandeducatehealthcareprofessionals.Currenteffortsarefocusedonimprovingthegeographicdistributionanddiversityofthehealthcareworkforce.   >  The_00BHPr_00Ԁexercisespolicyleadershipandsupportforenhancingthehealthprofessions !@ Аworkforceandeducationalinfrastructure.Thisisaccomplishedthroughadministrationofapproximately40grantandcooperativeagreementprogramstoeducateandtrainphysicians,physicianassistants,nurses,dentists,alliedhealthprofessionalsandpublichealthpractitionersatapproximately1,700institutions._00BHPr_00Ԁpersonnelalsomaintainextensiveprofessionalrelationshipswithnumerousprofessionalorganizationsconcernedwithhealthcaresotheprogramsrespondquicklytoevolvingneeds.Mostgrantsandcooperativeagreementsareawardedonthebasisofpeerreviewedapplicationstoassurethehigheststandardsofprofessionalcompetenceandobjectivity.Toassuremaximumavailabilityofinformationtoourcustomers,theBureau/AgencymaintainsaWebsitethatprovidesinformationabouttheBureau/Agency,grantstobeawardedintheupcominggrantcycleandmaterialswithwhichtoapplyforagrant. , %K ЇWithin_00HRSA_00,the_00BHPr_00Ԁsupports_00HRSA_00sBorderHealthInitiativetocarryoutanoutreachprojectinfiveborderstatestotrainlocalresidentsascommunityhealthworkers,encouragehealthpromotion,andreachouttofamiliestoenrollchildrenintheChildHealthInsuranceProgram(CHIP).Inaddition,_00BHPr_00ԀhasdevelopedanOralHealthActivity(OH)thatsupports_00HRSA_00sOH.TheOHisdesignedtoincreaseaccessandimprovethequalityofdentalservicestodisadvantagedandspecialcarepopulations,suchaschildrenwithspecialneeds.Finally,_00BHPr_00ԀsponsorstheSecretarysAwardforInnovationsinHealthPromotionandDiseasePreventionincollaborationwiththeFederationofAssociationsoftheSchoolsoftheHealthProfessions(_00FASHP_00),theSecretarysPrimaryCarePolicyFellowshipincollaborationwithotherFederalagencies,andtherevitalizationofPrimaryCareWeekthrougheffortsofthe_00AHEC_00ԀProgram,FamilyMedicineprofessionalassociations,studentassociations(_00AMSA_00)andothercollaboratingpartners. ProgramPerformance:    Thegrantprogramsareprovensuccessesinfillinggapsleftbythehealthcaremarketplace. .   Currently,only10%ofallU.S.healthcaregraduatespracticeinmedically_00underserved_00communities.AsamplingofBureaufundedprogramsinFY1999showsthat43%ofAdvancedEducationNursing_00Traineeships_00Ԁgraduates,54%ofNursePractitioner/Midwifegraduates,and86%ofFamilyPracticeresidencygraduatespracticeintheseareas. Thegoalof H graduatinghealthcareprofessionalsfrom_00underrepresented_00Ԁracial/ethnicbackgroundsissimilarlywelladvancedbyTitleVIIandVIIIprograms.WhereastheaveragegraduatingcohortofhealthcareprofessionalschoolsintheU.S.iscomposedofapproximately10%_00underrepresented_00Ԁminorities,Bureaufundedprogramsareaccomplishingtheobjectiveofgraduatinglargeproportionsoftheseindividuals.Forexample,theproportionof_00underrepresented_00Ԁminoritiesgraduatingfrom_00BHPr_00ԀprogramsinFY2000include:FamilyMedicinegraduatetraining,31%;andGeneralInternalMedicineandGeneralPediatricGraduatetraining,69%. ProgramDataIssues:   ThegoalspresentedinSection2.18capturethesignificantoutputforBureaugoalsconcerningaccesstohealthcareandthediversity,distributionandqualityofthehealthcareworkforce \  whichcutacrossTitleVIIandVIIIprograms.Thegoalsprovideusefulinformationtoidentifyprogramstrengthsandareasthatneedtechnicalassistancetobettermeetprogramobjectives.Priorto1994,theBureaureliedondatacollectedfromgrantees,butlackedaunifiedapproachtothecollectionactivity.InJuly1994,_00BHPr_00Ԁbegandevelopingastructured,agencywidestrategicapproachtocollectingperformancedataonTitleVIIandVIIIhealthprofessionsandnursingtrainingandeducationprograms.Throughtheassistanceofoutsidecontractorsandapanelofexternaladvisors,theAgencysetgoalsanddesignedasystemtocaptureperformancedata.TheComprehensivePerformanceManagementSystem(_00CPMS_00)istheresultofthatmultiyeareffort.Ademonstrationprojectofthe_00CPMS_00Ԁin1998showedthatitwasbothfeasibleanddesirabletocapturethequalitativeandquantitativeinformationinamorestreamlinedmanner.Wealso l+&* _00learnedthatdesigningaformthatisbotheasytouseandsufficientlycomprehensivetocaptureinformationonapproximately40programspresentsuniquechallenges.ThefirstnationwidecollectionofCPMSperformancedatafromallgranteesfortheperiodJuly1,1997June30,1998wascompletedintheSpringof1999.ThedatabecameavailableinDecember1999.ThedataforJuly1,1998June30,1999(FY1999)becameavailableinSeptember2000.ImplementationofafullyautomatedversionoftheCPMSwasexpectedinOctober2001.However,wehaveexperiencedimplementationdifficultiesduringthisyearandthereforecannotprovideupdatestotheDiversityandDistributionCharts.Toreduceconfusion,wehaveeliminatedthesecharts.WhentheCPMSisfullyoperational,itwillincreaseresponseratesandfurtherreducetheincidenceoferrorbothfromgranteesanddatatranscriptionandmakethedatathatmuchmoreaccurateandthecollectionmoreefficientovertime.Pleasenote,targetsfornursingprogramshavenotbeenadjustedforbudgetoutyearsbecauseofafundingmethodologyrequirementandholdharmlesslanguageintheexistingTitleVIIIlegislation.NowthattheBureauiswellunderwayindevelopingstandarddatacollectiontools,webelieveitisimportanttolineupourbudgetwithGPRApresentations.Therefore,wehaveadjustedourGPRAchartstobeconsistentwiththeFY03budgetpresentation.Todothis,wehaveworkedourwaybackfromcurrentFY03budgetestimatestoFY98GPRAperformance.Thiseffortresultsinamovementofactualperformanceformanyprogramsbackoneyear.DuringFY2002,theBureauwillbereviewingoureffortsindatacollection,budgetanalyses,andperformancemeasurementtofurtherrefineandmakeGPRAandbudgetpresentationsmoreconsistent.#X*XXXH\#XHXXX*ԀHowever,untilthiseffortiscompleted,therewillcontinuetobesome H discrepancybetweenGPRAandbudgetpresentations.AnotherongoingchallengeforBHPrisbudgetfluctuation.Wewillcontinuetoimproveoureffortstomanagethischallenge.#X*XXXH{#XHXXX*#X*XXXHG}#XHXXX* 2.18.2GoalbyGoalPresentationofPerformance  #X*XXXH}# XHXXX* K GoalI.A.1:IncreasetheNumberofStudents/TraineesinClinicalTrainingwithHealth  CareServiceDeliveryOrganizationsServingUnderservedAreas. Context:  D! Onemajorreasonwhyapproximately40millionAmericansdonothaveaccesstohealthcareisthatphysicians,dentists,nursesandotherhealthprofessionalsarenotdistributedevenlythroughoutthepopulation.Theunevendistributionisparticularlyproblematicinruralandinnercityareas.ThehealthcarestudentsfundedthroughTitleVIIandVIIIprogramsprovidebasichealthcareservicestounderservedpopulationsaspartoftheirtraining.Thenumberofstudent/traineesinclinicaltrainingwithhealthcareservicedeliveryorganizationsservingunderservedpopulationsprovideanindicatoroftheextenttowhichhealtheducationprogramshelpmeettheneedsoftheunderserved. 4Ӏ  +L'* Performance:     r   N   TargetsActuals*<dd dd  dd  dd dd <F"F",ZZ@,ZZ@,ZZ@,ZZ@,ZZ@,ZZ@,ZZ@+  ' = C' '=C C'FY03 '=C3 C'FY02 '=C3 C'FY01 '=C3 C'FY00 '=C3 C'FY00 ' Y C3 C'FY99 :0= C3 C:RuralInterdisciplinary ;1 1 C # C;0 ]S&E C3 #  @1520C@]1,520 ka4EC3 @1520 @ P@1300CP@k1,300 ka4EC3 P@1300 P@ P@1300CP@k1,300 I?4EC3 P@1300 P@ CI1/3,452 I? 1C3 P@1300CP@I1,300 \R:EC3 P@1300 P@ C\HETC ;1 C # C;0 ]S& C3 #  @@8000C@@]8,000 j`4 C3 @@8000 @@ ~@490C~@j490 i_3 C3 ~@490 ~@ q@280Cq@i280 H>3 C3 q@280 q@ CH2/8,308 H> C3 x@395Cx@H395 [Q9 C3 x@395 x@ C[AHEC ;1 C # C;0 ^T& C3 #  @@32000C@@^32,000 mc5 C3 @@32000 @@ @36000C@m36,000 mc5 C3 @36000 @ @@32000C@@m32,000 J@5  C3 @@32000 @@ CJ3/31,525 J@ "C3 L@30000CL@J30,000 ]S; #C3 L@30000 L@ C] Total ;1} $C # C;0 ^T&} %C3 #  F@41520CF@^41,520 mc5} &C3 F@41520 F@ s@37790Cs@m37,790 mc5} 'C3 s@37790 s@ e@33580Ce@m33,580 mc5} (C3 e@33580 e@ "@43285C"@m43,285 mc5} )C3 "@43285 "@ @31695C@m31,695 KA?} *C3 @31695  @ K1/RuralInterdisciplinaryactualperformancereflectsbettergranteereporting2/HETCactualperformancerepresentsimplementationofBHPrsCPMSUPRreportingsystem3/AHECactualperformancewasgeneratedfromAHECbranchelectronicfiles.TheAHECprogramdatahavebeenroutinelycompiledthroughhardcopyrecordsontoexcelfiles.ChangesinFY02andFY03targetsforprogramsreflectsactualleveloffundingforFY02.ProjectedFY03fundingthatissubstantiallybelowFY02levelswillresultinacommensuratedeclineinthenumberofprogramgraduateswhoenterpracticeinunderservedareas.#X*XXXH~# X*XXX*  4  #X*XX X*[#XHXXX*AreaHealthEducationCenters(AHECs)areexceptionallyproductiveintermsoftraininghealthprofessionalsinunderservedareas.InFY98,AHECsprovidedabout25,000healthprofessionsstudentsatrainingexperienceinunderservedareasand30,000inFY99,a17%increase.TheAHECprogramhasmodestlyincreasedtheleveloftrainingaccessintoFY00.AHECunderservedtrainingsitesincludedCommunityHealthandMigrantHealthCenters.Ofthe144U.S.medicalschools,112participateintheAHECprogram.HealthEducationTrainingCenters(HETCs),aresimilartoAHECsbutfocusontraininghealthprofessionstudentsinunderservedHispanicpopulationareasalongtheU.S.MexicoborderandinFloridaaswellasspecialremotepopulationsinKentucky,SouthCarolina,GeorgiaandArkansas.#X*XXXH#XHXXX* GoalI.A.2:IncreasetheNumberofGraduatesand/orProgramCompletersWhoEnter M&!A PracticeinUnderservedAreas Context:  q)$D Thereareseveralcommonstrategiesforencouraginggraduatestoenterpracticeinmedicallyϐunderservedcommunities(MUC).Amongthemare:providingdidactictrainingtoprepare ~+&F studentsforpracticeinMUCs,interactionwithfacultyrolemodelswhoserveinMUCsandplacementservicesforpracticinginsuchareas.Studieshaveshownthathealthcarepractitionershaveahigherlikelihoodoflocatinginunderservedareasiftheyspendpartoftheirtrainingprovidingforthehealthneedsoftheunderserved.Regardlessofthestrategyselected,oneclearindicatorofsuccessforTitlesVIIandVIIIprogramsisthe numberof ` graduatesand/orprogramcompleterswhoenterpracticeinunderservedareas. Performance: #X*XXXH(#XHXXX*    r  0 N 0N "N "TargetsActuals "" * < ddZZ@ZZ@ZZ@ZZ@ZZ@ZZ@ZZ@<F"F",A ZZ@,ZZ@,9ZZ@,9ZZ@,9ZZ@,9ZZ@,ZZ@+  '    C' '  C C'FY03 '  C3 C'FY02 '  C3 C'FY01 '  C3 C'FY00 '  C3 C'FY00 ' C" C'FY99 :0  C" C:AlliedHealthSpecialProjects ;1 C # C;0 ]S& C3 #  @1150C@]1,150 I?4 C3 @1150 @ CI1,066 I? C3 x@1007Cx@I1,007 ka4 C3 x@1007 x@ @1127C@k1,127 j`4 C3 @1127 @ Ќ@922CЌ@j922 [Q9 C3 Ќ@922 Ќ@ C[AdvancedGeneralandPediatricDentistry ;1xC # C;0 \R& C3 #  c@156Cc@\156 i_3 C3 c@156 c@ \@115C\@i115 h^3 C3 \@115 \@  W@92CW@h92 g]2 !C3  W@92 W@  @W@93C@W@g93 g]2 "C3  @W@93 @W@  @U@85C@U@g85 ZP8 #C3  @U@85 @U@ CZHealthAdministration ;1d$C # C;0 \R&d%C3 #  @632C@\632 i_3d&C3 @632 @ @693C@i693 i_3d'C3 @693 @ @630C@i630 i_3d(C3 @630 @ @630C@i630 i_3d)C3 @630 @ @630C@i630 VL9d*C3 @630 @ CVDentalPublicHealth ;1P+C # C;0 ZP&P,C3 #    @8C @ZЀ8 e[1P-C3   @8  @  @4C@e4 e[1P.C3  @4 @  @4C@eЀ4 e[1P/C3  @4 @  @5C@e5 e[1P0C3  @5 @  @4C@e4 TJ7P1C3  @4 @ CTRuralInterdisciplinary ;1<2C # C;0 \R&<3C3 #  @760C@\760 i_3<4C3 @760 @ P@650CP@i650 i_3<5C3 P@650 P@ P@650CP@i650 H>3<6C3 P@650 P@ CH1/111 H>(x8C3 @736C@HЀ736 VL9<9C3 @736 @ CVPublicHealthTrainingCenter(ShortTerm) ;1P;C # C;0 \R&d<C3 #  y@400Cy@\400 i_3d=C3 y@400 y@ i@200Ci@iЀ200 H>3d>C3 i@200 i@ CHЄ 'd?C3 C'2/0 'PAC3 C'ЀN.A. 5+dBC3 C5PreventiveMedicine ;1<CC # C;0 [Q&<DC3 #   1@17C1@[17 g]2<EC3  1@17 1@  (@12C(@g12 g]2<FC3  (@12 (@  &@11C&@gЀ11 g]2<GC3  &@11 &@  >@30C>@g30 g]2<HC3  >@30 >@  (@12C(@g12 ZP8<IC3  (@12 (@ CZFamilyMedicine/GraduateTraining ;1DKC # C;0 \R&(LC3 #  }@474C}@\474 i_3(MC3 }@474 }@ 0{@435C0{@i435 i_3(NC3 0{@435 0{@ r@303Cr@i303 H>3(OC3 r@303 r@ CH3/408 H>QC3 y@410Cy@HЀ410 [Q9DSC3 y@410 y@ C[PhysicianAssistantTraining ;1UC # C;0 \R&0VC3 #  }@479C}@\479 i_30WC3 }@479 }@ X@555CX@i555 i_30XC3 X@555 X@ `y@406C`y@i406 H>30YC3 `y@406 `y@ CH4/460 H>[C3 @544C@HЀ544 [Q9L]C3 @544 @ C[AdvancedNurseEducation H>8^C e@175Ce@H175 i_38_C3 e@175 e@ e@175Ce@i175 i_38`C3 e@175 e@ e@175Ce@i175 i_38aC3 e@175 e@ a@140Ca@i140 h^38bC3 a@140 a@  S@79CS@h79 g]28cC3  S@79 S@  @S@77C@S@g77 ZP88dC3  @S@77 @S@ CZNursePractitioner/Midwife H>$eC n@245Cn@H245 i_3$fC3 n@245 n@ n@245Cn@i245 i_3$gC3 n@245 n@ n@245Cn@i245 H>3$hC3 n@245 n@ CH230Rev231 H>!,kC3 o@255Co@H255 i_3 "\nC3 o@255 o@ }@475C}@iЀ475 [Q9$oC3 }@475 }@ C[AdvancedEducationNursingTraineeship H>#4qC @920C@H920 i_3"HrC3 @920 @ @920C@i920 i_3"HsC3 @920 @ @920C@i920 i_3"HtC3 @920 @ @880C@i880 H>3"HuC3 @880 @ CH5/1,280 I?#4wC3 @1505C@IЀ1,505 \R:"HxC3 @1505 @ C\GeneralInternalMed/GeneralPediatrics/Graduatetraining ;1&!{C # C;0 \R&$ |C3 #  @`@130C@`@\130 i_3$ }C3 @`@130 @`@ pr@295Cpr@i295 i_3$ ~C3 pr@295 pr@ Z@107CZ@i107 i_3$ C3 Z@107 Z@ @]@117C@]@i117 i_3$ C3 @]@117 @]@ `q@278C`q@i278 VL9$ C3 `q@278 `q@ CVPodiatry ;1'"C # C;0 ZP&'"C3 #   @5C@Z5 e[1'"C3  @5 @  @7C@e7 e[1'"C3  @7 @  @7C@e7 e[1'"C3  @7 @  @5C@e5 f\1'"C3  @5 @  1@17C1@f17 UK8'"C3  1@17 1@ CUNurseAnesthetistTraineeship NDl)$C e@175CPe@N175 uk9(#C3P e@175 e@ e@175CPe@u175 oe9(#C3P e@175 e@ e@175Ce@o175 H>3(#C3 e@175 e@ CH0  Rev175 '*%C C'6/365 H>l)$C3 r@297Cr@HЀ297 VL9(#C3 r@297 r@ CVNurseAnesthetistEducation Program MCC  1@17CP1@M17 si8C3P  1@17 1@  1@17CP1@s17 mc8C3P  1@17 1@  1@17C1@m17 G=2C3  1@17 1@ CG15Rev17 G=C3  ,@14C,@G14 g]2 C3  ,@14 ,@  1@17C1@g17 ZP8 C3  1@17 1@ CZ TOTAL    OE C @1532CP@O1,532 wm:C3P @1532 @ o@5743CPo@w5,743 qg:C3P o@5743 o@ @5565C@q5,565 I?4C3 @5565 @ CI4,482Rev4,660 I? HC3 s@4979Cs@I4,979 ka4C3 s@4979 s@ y@6009Cy@k6,009 J@>C3 y@6009  y@ JH.` hp x (#` XH1/Individualsinthisprogramcomefromamultitudeofdisciplinesservingarotationinruralareas.Becausetheirparticipationinthisprogramoccursatvarioustimesduringtheirprofessionaltrainingtheyoftengraduateyearsapart,makingitdifficulttotrackthem.FY98andFY99actualdatareliesheavilyonimputationfromonlyafewprograms.FurtheranalysisofdatawillbeundertakentodeterminethelikelihoodoftheBureautoeverbeabletocollectreliablelongitudinaldata.2/Thisisanewprogramanddataisnotavailable atthistime.TheFY01performancetarget  istheresultofgoalclarificationastheprogramdevelops.    #X*XXXH$#XHXXX*3/ FamilyMedicine/GraduateTrainingwasgreaterthanFY00performancereflectsincreased   emphasisonpracticeinunderservedareasinthegrantapplicationmaterialsform.4/PhysicianAssistantTrainingprogramseachyearfluctuateintheclasssizewhichaffectsthenumberofgraduates,includingthosepracticinginMUCs.ActualperformanceinFY99wassignificantlyhigherthanexpectedandactualFY00performanceismoreinlinewithexpectedperformance. #X*XXXH#XHXXX*  % #X*XXXH#XHXXX* 5/AdvancedEducationNursingTraineeshipchangetonowincludefulltimeandparttime & Ѐstudents.#X*XXXHQ#XHXXX*6/NurseAnesthetistTraineeshipprogramhadaslightlyhighernumberofgraduatesandmore ( ofthemgoingtounderservedareas.FY00actualperformancerepresentsapartialpresentation.Dataarenotavailableforallprogramsduetovaryinggrantawardcycles.ChangesinFY02andFY03targetsforprogramsreflectsactualleveloffundingforFY02.#X*XXXH# XHXXX*ProjectedFY03fundingthatissubstantiallybelowFY02levelswillresultina " . commensuratedeclineinthenumberofprogramgraduateswhoenterpracticeinunderservedareas.#X*XXXH# X*XXX*  $0 GoalI.A.3:IncreasetheNumberofGraduatesand/orProgramCompletersofHealthProfessionsTrainingProgramsthatProvideandSupportPrimaryCareContext:  *T%5 TitleVIIandVIIIeducationandtrainingprogramsaredesignedtoimprovethegeographicdistributionanddiversityofthehealthprofessionsandnursing.The numberofgraduates ,a'7 and/orprogramcompletersprovidesabasisforevaluatingtheeffectivenessoftheseprogramsinimprovingdistributionanddiversity.Performancetargetswerealsochangedtoreflectchangesinfundingforspecificprogramlines. Performance:       N     Targets   ^   Actuals  , * ddA ZZ@A ZZ@9ZZ@99ZZ@99ZZ@99ZZ@9ZZ@ < F"F",4ZZ@,9ZZ@,ZZ@,ZZ@,ZZ@,ZZ@,9ZZ@+  ,"  H C, ' HC C'FY03 ' HC3 C'FY02 ' H C3 C'FY01 ' H C3 C'FY00 ' H C3 C'FY00 ' d C C'  ӀFY99 ?5 PC  C? LongTerm  <  Training 8#( C CP8 M8' < C3P CPM M8' < C3P CPM M8' < C3P CPM G2' < C3P CG A,! < C3 CA I?, < C3   CIFamilyMedicineFacultyDevelopment A7 C # CPA0 h^, C3P #  \@114CP\@h114 uk9 C3P \@114 \@  d@161CP d@u161 tj9 C3P  d@161  d@  J@53CPJ@t53 MC8 C3P  J@53 J@ CM1/102 H>0 C3 c@152Cc@H152 VL9 !C3 c@152 c@ CVFamilyMedicineGrad.Training A7#C # CPA0 h^, $C3P #  @@904CP@@h904 uk9 %C3P @@904 @@ @867CP@u867 uk9 &C3P @867 @ @759CP@u759 oe9 'C3P @759 @ `@812C`@o812 i_3 (C3 `@812 `@ @818C@i818 VL9 )C3 @818 @ CVGIM/GPGrad.Training A7+C # CPA0 h^,,C3P #  P|@453CPP|@h453 uk9-C3P P|@453 P|@ t@330CPt@u330 uk9.C3P t@330 t@ y@414CPy@u414 oe9/C3P y@414 y@ `y@406C`y@o406 i_30C3 `y@406 `y@ ps@311Cps@i311 VL91C3 ps@311 ps@ CVGIM/GPFacultyDev. A7h3C # CPA0 g],|4C3P #   @W@93CP@W@g93 si8|5C3P  @W@93 @W@  J@53CPJ@s53 tj8|6C3P  J@53 J@ @Y@101CP@Y@t101 ND9|7C3P @Y@101 @Y@ CN2/83 G=9C3  I@50CI@G50 ZP8|:C3  I@50 I@ CZPhysicianAssistantTraining A7p<C # CPA0 i_,=C3P #  $@1289CP$@i1,289 wm:>C3P $@1289 $@ ܗ@1527CPܗ@w1,527 wm:?C3P ܗ@1527 ܗ@ d@1561CPd@w1,561 OE:@C3P d@1561 d@ CO3/1,237 I?CC3 d@1497Cd@I1,497 \R:DC3 d@1497 d@ C\AlliedHealthSpec.Pro. A7dFC # CPA0 i_,xGC3P #  N@2215CPN@i2,215 wm:xHC3P N@2215 N@ @2050CP@w2,050 wm:xIC3P @2050 @ x@2014CPx@w2,014 qg:xJC3P x@2014 x@ Н@1908CН@q1,908 ka4xKC3 Н@1908 Н@ @2050C@k2,050 \R:xLC3 @2050 @ C\InterdisciplinaryRuralHealth A7<NC # CPA0 i_,POC3P #  @1520CP@i1,520 wm:PPC3P @1520 @ P@1300CPP@w1,300 wm:PQC3P P@1300 P@ P@1300CPP@w1,300 qg:PRC3P P@1300 P@ V@3115CV@q3,115 ka4PSC3 V@3115 V@ <@1935C<@k1,935 \R:PTC3 <@1935 <@ C\AdvancedGeneral&PediatricDentistry A7dVC # CPA0 h^,(xWC3P #  v@352CPv@h352 uk9(xXC3P v@352 v@ t@332CPt@u332 TJ9(xYC3P t@332 t@ CPT282Rev338 -#0 \C3P C-4/210π H>0 _C3 n@244Cn@H244 VL9(x`C3 n@244 n@ CVPublicHealthTraineeships A7"XbC # CPA0 h^,!lcC3P #  @540CP@h540 uk9!ldC3P @540 @  @516CP @u516 uk9!leC3P  @516  @  @516CP @uЀ516 oe9!lfC3P  @516  @  @498C @o498 i_3!lgC3  @498  @  @516C @i516 VL9!lhC3  @516  @ CVPreventiveMedicine A7"DiC # CPA0 g],"DjC3P #   A@35CPA@g35 si8"DkC3P  A@35 A@  @@33CP@@s33 si8"DlC3P  @@33 @@  ?@31CP?@s31 mc8"DmC3P  ?@31 ?@  >@30C>@m30 g]2"DnC3  >@30 >@  ?@31C?@g31 UK8"DoC3  ?@31 ?@ CUDentalPublicHealth A7#0pC # CPA0 g],#0qC3P #   3@19CP3@g19 si8#0rC3P  3@19 3@  .@15CP.@s15 si8#0sC3P  .@15 .@  .@15CP.@s15 lb8#0tC3P  .@15 .@  "@9C"@l9 e[1#0uC3  "@9 "@   @8C @e8 YO7#0vC3   @8  @ CYHealthAdministration A7%!xC # CPA0 h^,$ yC3P #   |@450CP |@h450 uk9$ zC3P  |@450  |@ {@440CP{@u440 uk9$ {C3P {@440 {@ y@400CPy@u400 oe9$ |C3P y@400 y@ P{@437CP{@o437 i_3$ }C3 P{@437 P{@ y@400Cy@i400 [Q9$ ~C3 y@400 y@ C[Podiatry P A7&!C # CPA0 g],&!C3P #   Q@68CPQ@g68 si8&!C3P  Q@68 Q@  4@20CP4@s20 si8&!C3P  4@20 4@  4@20CP4@s20 MC8&!C3P  4@20 4@ CM5/70 G='#C3  G@47CG@G47 ZP8&!C3  G@47 G@ CZAdvancedNurseEd. ND(#C @@500CP@@N500 uk9(#C3P @@500 @@ @@500CP@@u500 uk9(#C3P @@500 @@ @@500CP@@u500 uk9(#C3P @@500 @@ y@400CPy@u400 oe9(#C3P y@400 y@ r@299Cr@o299 i_3(#C3 r@299 r@ t@335Ct@i335 [Q9(#C3 t@335 t@ C[AdvancedEducationNursingTraineeships OE*%C @2300CP@O2,300 wm:)$C3P @2300 @ @2300CP@w2,300 wm:)$C3P @2300 @ @2300CP@w2,300 wm:)$C3P @2300 @ 0@2200CP0@w2,200 OE:)$C3P 0@2200 0@ CO6/3,047 I?*%C3 X@3500CX@I3,500 \R:)$C3 X@3500 X@ C\NursePract./Midwife NDp+&C @700CP@N700 uk9p+&C3P @700 @ @700CP@u700 uk9p+&C3P @700 @ @700CP@u700 uk9p+&C3P @700 @ @660CP@u660 oe9p+&C3P @660 @ Њ@858CЊ@o858 i_3p+&C3 Њ@858 Њ@ @881C@i881 [Q9p+&C3 @881 @ C[ScholarshipsforDisadvantagedStudents(SDS) OET C @1199CP@O1,199 wm:| C3P @1199 @ @3033CP@w3,033 wm:| C3P @3033 @ @3033CP@w3,033 wm:| C3P @3033 @ ^@3119CP^@w3,119 OE:| C3P ^@3119 ^@ CO7/π2,614 I?h C3 ^@3119C^@I3,119 WM:| C3 ^@3119 ^@ CW TotalLongTerm OE@  C @4744CP@O4,744 xn:@  C3P @4744 @ |@14585CP|@x14,585 yo;@  C3P |@14585 |@ @14177CP@y14,177 VL;@ C3P @14177 @ CPV13,845 @  Rev13,901 PFHC3P @15735C@P15,735 mc5@ C3 @15735 @  @15894C @m15,894 XN;, C3  @15894  @ CXShortTerm 4 Training 2<<<< C C2 A<<<<,!4C3<<<< CA A<<<<,!4C3<<<< CA A<<<<,!4C3<<<< CA A<<<<,!4C3<<<< CA A<<<<,!4C3<<<< CA I?'4C3 <<<< CIAHEC A7 C # CPA0 j`, C3P #  @@32000CP@@j32,000 yo; C3P @@32000 @@ @36000CP@y36,000 yo;  C3P @36000 @ @@32000CP@@y32,000 si; !C3P @@32000 @@ @@31525C@@s31,525 mc5 "C3 @@31525 @@ L@30000CL@m30,000 XN;|$C3 L@30000 L@ CXAHECHeathCareers912 A7T &C # CPA0 j`,h 'C3P #  j@25000CPj@j25,000 yo;h (C3P j@25000 j@ L@30000CPL@y30,000 VL;h )C3P L@30000 L@ CPV25,000REV25,600 -# -C3P C-9/26,156 I?@ 0C3 |@5500C|@I5,500 WM:h 1C3 |@5500 |@ CWFamilyMedicine/FacultyπDevelopment(Short) A7P4C # CPA0 h^,x 5C3P #  Ѝ@954CPЍ@h954 uk9x 6C3P Ѝ@954 Ѝ@ 8@903CP8@u903 vl9x 7C3P 8@903 8@ ȟ@2034CPȟ@v2,034 OE:x 8C3P ȟ@2034 ȟ@ CO1/857 H>:C3 @852C@H852 VL9x ;C3 @852 @ CVGIM/GPFacultyπDevelopment(Short) A7>C # CPA0 h^,<?C3P #  e@173CPe@h173 uk9<@C3P e@173 e@ j@213CPj@u213 tj9<AC3P j@213 j@  @R@73CP@R@t73 MC8<BC3P  @R@73 @R@ CM2/155 H>XDC3  i@201C i@H201 [Q9<EC3  i@201  i@ C[GeriatricPrograms A7|FC # CPA0 j`,|GC3P #  @36080CP@j36,080 yo;|HC3P @36080 @ |@22000CP|@y22,000 yo;|IC3P |@22000 |@ @20000CP@y20,000 si;|JC3P @20000 @ `b@37651C`b@s37,651 mc5|KC3 `b@37651 `b@ @20000C@m20,000 XN;hMC3 @20000 @ CXHETC A7TNC # CPA0 i_,TOC3P #  @2300CP@i2,300 vl:TPC3P @2300 @ y@400CPy@v400 TJ9TQC3P y@400 y@ CPT280Rev410 -#\ TC3P C-10/2,397 H>@VC3 x@395Cx@H395 VL9TWC3 x@395 x@ CVPublicHealthTrainingCenter A74"YC # CPA0 i_,H!ZC3P #  @@1000CP@@i1,000 vl:H![C3P @@1000 @@ i@200CPi@v200 TJ9H!\C3P i@200 i@ CPTЄ -#H!]C3P C-11/0 ;14"_C3 # C;Ѐ0 I?,H!`C3 #  CI TotalShortTerm A7 #aC # CPA0 j`, #bC3P #  0@97507CP0@j97,507 yo; #cC3P 0@97507 0@ @89806CP@y89,806 VL; #dC3P @89806 @ CPV54,387  #e Rev80,117 PF(%gC3P P@98741CP@P98,741 mc5 #hC3 P@98741 P@ @56948C@m56,948 XN; $jC3 @56948 @ CX TOTAL  &k  OE0'lC @4744CP@O4,744 yo:&mC3P @4744 @ ]@112092CP]@y112,092 {q<&nC3P ]@112092 ]@ b@103983CPb@{103,983 WM<&oC3P b@103983 b@ CPW8/68,232Rev94,018 QG)sC3P @114476C@Q114,476 nd6'uC3 @114476 @ @72842C@n72,842KA?'wC3 @72842  @ K #X*XX X*#XHXXX*Ԁ )x w 1/FamilyMedicine/LongandShortTermFacultyDevelopmentactualperformancereflectstheincreasingneedforcommunitybasedfacultyandpreceptorsformedicalstudentsand +"y residents.Thisneedledtosettingtargets,startinginFY98forFY00,thatenhancedprogrammaticfocusontrainingcommunityfacultyinShortTermprograms.ThustheFY00targetsforShortTermFacultyDevelopmentweresethighandtheLongTermtrainingtargetssetlow.TheFY00programperformancereflectsapartialshifttowardscommunitybasedfacultywithmoreShortTermtraineesthaninFY99,butmanyfewerLongTermtrainees.2/GIM/GPLongandShortTermFacultyDevelopmentseekstohavefullytrainedinternalmedicineandgeneralpediatricsacademicfacultywithresearchpreparation.Anincreasedprogrammaticemphasisonthisledtomorefacultycompletingfellowships,althoughnotaslargeanumberastargeted,andcorrespondingly,fewerShortTermfellowshipgraduatescomparedwithFY99performance,althoughmorethantargeted.3/PhysicianAssistantTrainingprogramshaveafluctuatingclasssizeeachyearwhichaffectsactualperformance.Manynewerprogramswerefunded,andnewprogramstendtohavesmallerclasssizesandrequiremorestartupsupport.4/AdvancedGeneralandPediatricDentistryprogramperformanceinFY00waslessthanFY99.TheFY00targetreflectstheincreasingtrendforadvancedtrainedgeneraldentiststocontinuespecialtydentaltrainingandnottoenterprimarycarepracticeimmediatelyuponcompletionoftheirtraining.5/Podiatryprogramsactualperformancereflectstheincreasedemphasisonpracticeinprimarycareandincreasednumberoffundedprograms.6/AdvancedEducationNursingTraineeshipchangetonowincludefulltimeandparttimestudents.#X*XXXH=+#XHXXX*7/ScholarshipsforDisadvantagedStudents(SDS)program,projectedFY03fundingthatis ,| belowFY02levelswillresultinacommensuratedeclineinthenumberofgraduatesthatprovideandsupportprimarycare,comparedwithFY02.FY00ActualswerelessthantheFY00goalbecausetheaveragescholarshipawardincreased,resultinginadecreaseinthetotalnumberofstudentsfunded.#X*XXXH2#XHXXX* , 8/FY00actualperformancerepresentsapartialpresentation.Datanotavailableforallprogramsduetovaryinggrantawardcycles.9/AHECactualperformancewasgeneratedfromAHECbranchelectronicfiles.TheAHECprogramdatahavebeenroutinelycompiledthroughhardcopyrecordsontoexcelfiles.#X*XXXH4#XHXXX*10/#X*XXXH86#XHXXX*ԀHETCactualperformancerepresentsimplementationofBHPrsCPMSUPRreporting "X system.11/PublicHealthTrainingCenterprogramestablishedinFY00;datanotavailableatthistime.#X*XXXH~6#XHXXX* $L ! #X*XXXH7#XHXXX*ChangesinFY02andFY03targetsforprogramsreflectsactualleveloffundingforFY2002.#X*XXXH7# XHXXX*ProjectedFY03fundingthatissubstantiallybelowFY02levelswillresultina  (p#$ commensuratedeclineinthenumberofprogramgraduateswhoenterpracticeinunderservedareas.#X*XXXH8# X*XXX*  )H%&  #X*XX X*9#XHXXX*#X*XXXH9#XHXXX* KGoalIIB.1:IncreasetheNumberofMinority/DisadvantagedGraduatesandProgram 0,'( Completers   ?+ ` hp x (#X? Context:  8 Studieshaveshownthatmembersofminoritiesanddisadvantagedgroupsaremorelikelytosetuppracticeswhichaddresstheneedsoftheunderserved.Thenumberofminority/disadvantagedgraduatesandprogramcompletersprovidesanimportantindicatorofthesuccessofTitleVIIandVIIIprogramsinassuringprogresstowardadiversehealthcareworkforcetomeettheneedsofadiversepopulation. 84 Performance: #X*XXXH7:#XHXXX*    [   0  Targets    Actuals A  " " *<dd4ZZ@49ZZ@9ZZ@ZZ@ZZ@ZZ@9ZZ@9 "", ZZ@,ZZ@,9ZZ@,9ZZ@,9ZZ@,ZZ@,ZZ@+  ' f  C' 'f C C'FY03 '6 C3 C'FY02 'f C3 C'FY01 'f C3 C'FY00 'f C3 C'FY00 '6 C3 C'ЀFY99$ X` X$ :0R C3 C:ScholarshipsforDisadvantagedStudents OE^ C @1382CP@O1,382 wm:"r C3P @1382 @ R@3369CPR@w3,369 wm:"r C3P R@3369 R@ R@3369CPR@w3,369 wm:"r C3P R@3369 R@ "@3473CP"@w3,473 UK:"r C3P "@3473 "@ CPU1/2,920 UK^ C3P "@3473CP"@U3,473 bX@"r C3P "@3473 "@ CbGIM/GPGrad.Training A7JC # CPA0 h^,JC3P #  b@148CPb@h148 uk9J C3P b@148 b@ e@173CPe@u173#X*XXXH8=#XHXXX* uk9J!C3P e@173 e@ ^@123CP^@u123 TJ9J"C3P ^@123 ^@ CPT2/131 TJ6$C3P `d@163CP`d@T163 aW?J%C3P `d@163 `d@ CaGIM/GPFac.Developmentπ A7'C # CPA0 g],"(C3P #   E@43CPE@g43 si8")C3P  E@43 E@  M@59CPM@s59 si8"*C3P  M@59 M@  6@22CP6@sЀ22 SI8"+C3P  6@22 6@ CPS3/39 SI",C3P  L@56CPL@S56 `V>"-C3P  L@56 L@ C`AdvancedGeneralDentistry/Ped.Dental A7/C # CPA0 h^,0C3P #  @c@154CP@c@h154 uk91C3P @c@154 @c@ a@143CPa@u143 tj92C3P a@143 a@  Q@70CPQ@t70 SI83C3P  Q@70 Q@ CPS4/124 TJ5C3P @Z@105CP@Z@T105 aW?6C3P @Z@105 @Z@ CaHealthCareersOpportunityπProgram(HCOP)̀PostSecondarỳK12 -#:C C-0 3)2>C3 C35,9292,562 3)2BC3 C35,3802,325 3)2FC3 C34,6871,614 3)RKC3 C35/4,7112,019 3)>QC3 C34,2331,676 @6RVC3 C@Fam.Med./GraduateTraining A7XC # CPA0 h^,*YC3P #  t@335CPt@h335 uk9*ZC3P t@335 t@ p@265CPp@u265 uk9*[C3P p@265 p@ a@136CPa@u136 TJ9*\C3P a@136 a@ CPT6/289 TJ 6_C3P @o@250CP@o@T250 aW?*`C3P @o@250 @o@ CaFam.Med./Fac.Dev.Trainee A7"bC # CPA0 h^,!"cC3P #  Pu@341CPPu@h341 uk9!"dC3P Pu@341 Pu@ b@148CPb@u148 uk9!"eC3P b@148 b@ j@208CPj@u208 TJ9!"fC3P j@208 j@ CPT7/306 TJ"hC3P a@140CPa@T140 aW?!"iC3P a@140 a@ CaPodiatry A7#jC # CPA0 [Q,#kC3P #  # CP[0 f\,#lC3P #   @6CP@f6 qg7#mC3P  @6 @  @6CP@q6 RH7#nC3P  @6 @ CPR8/0 SI$pC3P  $@10CP$@S10 [Q>#qC3P  $@10 $@ C[PhysicianAssistant A7% rC # CPA0 h^,% sC3P #   j@209CP j@h209 uk9% tC3P  j@209  j@ x@527CPx@u527 uk9% uC3P x@527 x@ @562CP@u562 TJ9% vC3P @562 @ CPT9/170 TJn&!xC3P (@517CP(@T517 \R?% yC3P (@517 (@ C\AlliedHealth A7Z'"zC # CPA0 h^,Z'"{C3P #  {@442CP{@h442 uk9Z'"|C3P {@442 {@ y@410CPy@u410 uk9Z'"}C3P y@410 y@ v@363CPv@u363 uk9Z'"~C3P v@363 v@ pu@343CPpu@u343 uk9Z'"C3P pu@343 pu@ w@369CPw@u369 \R?Z'"C3P w@369 w@ C\PublicHealthTraineeships A7F(#C # CPA0 h^,F(#C3P #  @p@260CP@p@h260 uk9F(#C3P @p@260 @p@ m@236CPm@u236 uk9F(#C3P m@236 m@ m@236CPm@u236 uk9F(#C3P m@236 m@ @k@218CP@k@u218 uk9F(#C3P @k@218 @k@ m@236CPm@u236 \R?F(#C3P m@236 m@ C\PreventiveMedicine A72)$C # CPA0 g],2)$C3P #   .@15CP.@g15 si82)$C3P  .@15 .@  (@12CP(@s12 si82)$C3P  (@12 (@  &@11CP&@s11 si82)$C3P  &@11 &@  4@20CP4@s20 si82)$C3P  4@20 4@  4@20CP4@s20 [Q>2)$C3P  4@20 4@ C[DentalPublicHealth A7*n%C # CPA0 f\,*n%C3P #   @5CP@f5 qg7*n%C3P  @5 @  @6CP@q6 qg7*n%C3P  @6 @  @6CP@q6 qg7*n%C3P  @6 @  @3CP@q3 qg7*n%C3P  @3 @  @4CP@q4 ZP=*n%C3P  @4 @ CZPublicHealthTrainingCenter A7+F'C # CPA0 h^, +Z&C3P #  @o@250CP@o@h250 tj9 +Z&C3P @o@250 @o@  I@50CPI@t50 SI8 +Z&C3P  I@50 I@ CPSЄ G= +Z&C3P # CPG0 G=, +Z&C3P #  CPGЄ ;1 +Z&C3P C;HealthAdminTraineeships A7C # CPA 0 g],C3P #   Q@70CPQ@g70 si8C3P  Q@70 Q@  @S@77CP@S@s77 si8C3P  @S@77 @S@  Q@70CPQ@sЀ70 si8C3P  Q@70 Q@  Q@70CPQ@s70 si8C3P  Q@70 Q@  Q@70CPQ@s70 [Q>C3P  Q@70 Q@ C[ -#C CP- 3) C3P CP3 3) C3P CP3 3) C3P CP3 3) C3P CP3 3) C3P CP3 ;1C3P C; TOTAL   OEC @1382CP@O1,382 xn:C3P @1382 @ @14132CP@x14,132 yo;C3P @14132 @ @13186CP@y13,186 yo;C3P @13186 @ @11587CP@y11,587 yo;C3P @11587 @ 1@11363CP1@y11,363 yo;C3P 1@11363 1@ @11642CP@y11,642 QGEC3P @11642  @ Q#X*XXXHE#XHXXX*1/FY00ActualswerelessthantheFY00goalbecausetheaveragescholarshipawardincreased,resultinginadecreaseinthetotalnumberofstudentsfunded.#X*XXXHo#XHXXX*2/GIM/GPGraduateTraininggranteesdecreasedinFY00,therefore,thenumberof   minority/disadvantagedgraduatesalsodecreasedwhencomparedwithFY99performanceandtheFY00target.Nevertheless,theprogramexceededitsFY00target.3/GIM/GPFacultyDevelopmentgranteesdecreasedinFY00.Therefore,thenumberofminority/disadvantagedtraineesalsodecreasedwhencomparedwithFY99performanceandtheFY00target.Nevertheless,theprogramexceededtheFY00target.4/AdvancedGeneralDentistry/PediatricDentistryexceededFY99performanceandFY00targetsforthenumberofminority/disadvantagedgraduatesasaresultofaprogrammaticfocusontherecruitmentofminoritiesandanincreaseinthenumberofgrantsawarded.#X*XXXHp#XHXXX*5/HCOPprogramperformanceinFY00increasedduetothegranteesexpandingparticipation % tomorestudents.6/FamilyMedicine/GraduateTrainingperformanceexceededtheFY99actualperformanceandFY00targetduetoincreasedapplicationmaterialemphasisonminority/disadvantagedrecruitment.7/FamilyMedicine/FacultyDevelopmentperformancegreatlyexceededFY99performanceandtheFY00targetduetoincreasedinterestintrainingfromcommunitypreceptorsinunderservedcommunities,manyofwhomareminoritiesordisadvantagedthemselves.8/Podiatryprogramisverysmallandthereforethedifferenceisnotsignificant.Thefieldofpodiatryhashaddifficultrecruitingunderrepresentedminorities.Enrollmentnumberssuggestthatthefuturegraduationandprogramcompleterrateswillbehigher.9/PhysicianAssistantprogramperformancewasoverestimatedlastyear.Theestimateshavebeenbasedonasmallnumberofprogramreportingthisdata,whichhadnotbeenreliablycollectedbyprogramsinthepast.ThusFY00targetshavebeensetatlevelswhicharetoohighbasedontheeligibleapplicantpool.WehaveadjustedFY02targetstoreflectthisinformation.FY00actualperformancerepresentsapartialpresentation.Datanotavailableforallprogramsduetovaryinggrantawardcycles.#X*XXXHs#XHXXX* X% 6 Ѐ#X*XXXHsy#XHXXX*ChangesinFY02andFY03targetsforprogramsreflectsactualleveloffundingforFY2002. '"8 #X*XXXHy# XHXXX*ProjectedFY03fundingthatissubstantiallybelowFY02levelswillresultinacommensurate (#9 declineinthenumberofprogramgraduateswhoenterpracticeinunderservedareas.#X*XXXHz#X*XXX*  p)$:  #X*XXX*{#XHXXX*#X*XXXH{#E.` hp x (#XEXHXXX* GoalII.B.2:IncreasetheNumberofMinority/DisadvantagedEnrollees  +'<  Context:    Thegoalofadiversehealthcareworkforceisdependent,inpart,onthenumberofyoungminority/disadvantagedstudentswhoaremotivatedinelementaryschoolandhighschooltosucceedintheacademicallychallengingworkrequiredforadmissiontohealthcareeducation.BHPrhasinitiatedseveraloutreachinitiativestoencouragesuchstudentsinelementaryandhighschoolandhelpthemtoseehealthprofessionsasarealisticcareerchoice.Thenumberofϐminority/disadvantagedenrolleesisanindicationofsuccessinassuringaprerequisitetoadiverseworkforceminority/disadvantagedstudentschoosingitasacareer. Performance:  S     [   Targets  Actuals -  *<dd ZZ@ ZZ@9ZZ@99ZZ@99ZZ@9ZZ@ZZ@<"", ZZ@,9ZZ@,9ZZ@,9ZZ@,ZZ@,gZZ@,9ZZ@+  ' M  C' 'M C C'FY03 'M C3 C'FY02 'M C3 C'FY01 'M C3 C'FY00 'M C3 C'FY00 'm C3 C'  ӀFY99   :0m C# C:.  ScholarshipsforϐDisadvantagedStudents -#1C C-5,529 3) YC3 C313,477 PF YC3 R@13477CR@P13,477 mc5 YC3 R@13477 R@ "@13892C"@m13,892 J@5 YC3 "@13892 "@ CJ1/11,679 J@EC3 "@13892C"@J13,892 ]S; YC3 "@13892 "@ C]NursePractitioner/Midwife H> C h@525Ch@H525 i_3!C3 h@525 h@ h@525Ch@i525 i_3"C3 h@525 h@ h@525Ch@i525 i_3#C3 h@525 h@ @@500C@@i500 i_3$C3 @@500 @@ @536C@i536 i_3%C3 @536 @ `z@422C`z@i422 [Q9&C3 `z@422 `z@ C[AdvancedEducationNursingTraineeships I?(C 0@1740C0@I1,740 ka4 )C3 0@1740 0@ 0@1740C0@k1,740 ka4 *C3 0@1740 0@ 0@1740C0@k1,740 ka4 +C3 0@1740 0@ ,@1675C,@k1,675 I?4 ,C3 ,@1675 ,@ CI2/2,067 I?.C3 4@1869C4@I1,869 \R: /C3 4@1869 4@ C\NursingWorkforceDiversity I?}1C @2400C@I2,400 ka42C3 @2400 @ @2400C@k2,400 ka43C3 @2400 @  @1800C @k1,800 ka44C3  @1800  @ p@1500Cp@k1,500 ka45C3 p@1500 p@ @1769C@k1,769 ka46C3 @1769 @ P@1620CP@k1,620 \R:7C3 P@1620 P@ C\Podiatry ;1i8C # C;0 [Q&i9C3 #   2@18C2@[18 f\2i:C3  2@18 2@  @6C@f6 e[1i;C3  @6 @  @6C@eЀ6 F<1i<C3  @6 @ CF3/19 F<i=C3   @8C @F8 YO7i>C3   @8  @ CYFamilyMedicineGraduateTraining ;1A@C # C;0 \R&UAC3 #  {@440C{@\440 i_3UBC3 {@440 {@ @506C@i506 i_3UCC3 @506 @ z@416Cz@i416 H>3UDC3 z@416 z@ CH4/395 H>UEC3 }@477C}@H477 [Q9UFC3 }@477 }@ C[FamilyMedicineFacultyDevelopment ;1iHC # C;0 [Q&-}IC3 #   X@96CX@[96 h^2-}JC3  X@96 X@ b@148Cb@h148 H>3-}KC3 b@148 b@ CH208Rev213 '9NC3 C'5/86 G=MPC3  H@48CH@G48 ZP8-}QC3  H@48 H@ CZGIM/GPGraduateTraining. ;1!aSC # C;0 \R&% uTC3 #  t@320Ct@\320 i_3% uUC3 t@320 t@ 0v@355C0v@i355 i_3% uVC3 0v@355 0v@ w@381Cw@i381 H>3% uWC3 w@381 w@ CHЀ6/287 H>E!YC3 t@335Ct@H335 VL9% uZC3 t@335 t@ CVGIM/GPFacultyDevelopment ;1#m\C # C;0 \R&1"]C3 #  _@126C_@\126 h^31"^C3 _@126 _@  M@59CM@h59 g]21"_C3  M@59 M@  6@22C6@g22 G=21"`C3  6@22 6@ CG7/113 G=Q#bC3  C@38CC@G38 ZP81"cC3  C@38 C@ CZPhysicianAssistantTraining ;1)%y eC # C;0 \R&=$fC3 #  h@909Ch@\909 j`3=$gC3 h@909 h@ @1072C@j1072 ka4=$hC3 @1072 @ H@1170CH@k1,170 I?4=$iC3 H@1170 H@ CI8/872 I?]% kC3 l@1051Cl@I1,051 WM:=$lC3 l@1051 l@ CWHCOP(Matriculate) ;1I&!mC # C;0 ]S&I&!nC3 #  Đ@1073CĐ@]1,073 j`4i'"pC3 Đ@1073 Đ@ p@974Cp@j974 H>3i'"rC3 p@974 p@ CH936Rev804 'U(#uC3 C'9/1,413 I?5'"wC3 ̓@1267C̓@I1,267 WM:I&!xC3 ̓@1267 ̓@ CWHETC ;1A)$yC # C;0 \R&A)$zC3 #  t@335Ct@\335 i_3A)${C3 t@335 t@ t@335Ct@i335 H>3A)$|C3 t@335 t@ CH280Rev0 'a*%~C3 C'10/π342 H>-*}%C3 0q@275C0q@H275 [Q9A)$C3 0q@275 0q@ C[NurseAnesthetistTraineeship H>C u@350Cu@H350 i_3C3 u@350 u@ u@350Cu@i350 i_3C3 u@350 u@ u@350Cu@i350 H>3C3 u@350 u@ CH0 Rev350 H> C3 x@398Cx@H398 i_3 C3 x@398 x@ X@715CX@i715 [Q9 C3 X@715 X@ C[AdvancedNurseEducation H> C Pt@325CPt@H325 i_3 C3 Pt@325 Pt@ Pt@325CPt@i325 i_3 C3 Pt@325 Pt@ Pt@325CPt@i325 i_3C3 Pt@325 Pt@ r@300Cr@i300 i_3C3 r@300 r@ j@213Cj@i213 i_3C3 j@213 j@ r@300Cr@i300 VL9C3 r@300 r@ CVNurseAnesthetistEducationProgram G= C  F@45CF@G45 g]2C3  F@45 F@  F@45CF@g45 g]2C3  F@45 F@  F@45CF@g45 G=2C3  F@45 F@ CG35Rev45 G= C3  <@28C<@G28 g]2C3  <@28 <@  G@47CG@g47 ZP8C3  G@47 G@ CZ TOTAL    -# C C-10,914 3) C3 C322,179 PF C3 @5@21717C@5@P21,717 J@5 C3 @5@21717 @5@ CJ21,321Rev21,274 J@ "C3 @@20217C@@J20,217 mc5 #C3 @@20217 @@ @22364C@m22,364 KA? $C3 @22364  @ KB.` hp x (#XB #X*XXXHw|#XHXXX*1/SDSrevisionsbasedonincreaseinFY02appropriations.FY00ActualswerelessthantheFY00goalbecausetheaveragescholarshipawardincreased,resultinginadecreaseinthetotalnumberofstudentsfunded.#X*XXXHɬ#XHXXX*2/AdvancedEducationNursingTraineeshipprogramnowincludesfulltimeandparttime  ( students.   )  #X*XXXH#XHXXX*3/Podiatryprogramperformancehasincreasedduetoincreasedemphasisonminority  * recruitmentinthegrantapplicationmaterials.4/FamilyMedicineGraduateTrainingmodestdecreasecomparedwithFY99performanceandtheFY00targetreflectsnationaltrendsandincreasingcompetitionamongprofessionforqualifiedminoritystudents.5/FamilyMedicineFacultyDevelopmentperformancerepresentsasignificantincreaseoverFY99performanceduetoincreasedemphasisonminorityrecruitmentintheapplicationmaterialsandthenationalfocusondevelopingminorityfaculty.PipelinelimitationsmeanttheprogramdidnotmeettheFY00target.6/GIM/GPGraduateTrainingperformanceshowsamodestdecreasefromFY99performanceandtheFY00targetreflectsnationaltrendsandincreasingcompetitionamongprofessionsforqualifiedminoritystudents.7/GIM/GPFacultyDevelopmentfarexceededFY00targets.ThisincreaseinperformancecomparedwithFY99performanceandtheFY00targetisduetoincreasedemphasisonminorityrecruitmentintheapplicationmaterialsandthenationalfocusondevelopingminorityfaculty.8/PhysicianAssistantTrainingprogramperformancerepresentsadecreasefromFY99performanceandtheFY00targetwhichreflectsthefundingoffewerPhysicianAssistantstudentsinnewerprograms.9/HCOPprogramperformanceinFY00increasedduetothegranteesexpandingparticipationtomorestudents.10/HETCactualperformancerepresentsimplementationofBHPrsCPMSUPRreportingsystem.FY00actualperformancerepresentsapartialpresentation.Datanotavailableforallprogramsduetovaryinggrantawardcycles.#X*XXXH#XHXXX* |+&B Ї#X*XXXH#XHXXX* ChangesinFY02andFY03targetsforprogramsreflectsactualleveloffundingforFY2002.  #X*XXXH# XHXXX*ProjectedFY03fundingthatissubstantiallybelowFY02levelswillresultinacommensurate  declineinthenumberofprogramenrolleeswhoenterpracticeinunderservedareas.#X*XXXH¶#X*XXX*   #X*XXX*˷#XHXXX*GoalII.B.3:IncreasetheNumberofUnderrepresentedMinoritiesServingasFacultyContext:   X Thereismountingawarenessthattheeffectivenessofthehealthcareworkforceisdependentonitssensitivitytotheculturaldifferenceswhichaffecthealthcare.Thecompositionofthehealthcareworkforceshouldreflect,ingeneral,thecharacteristicsofthegeneralpopulation.Facultymemberswhoarefromunderrepresentedminoritieshaveuniqueinsightsintotheculturalcomponentofhealthcareandproviderolemodelsforfuturehealthcareworkersfromunderrepresentedminoritygroups.Thenumberofunderrepresentedminoritiesserving as   facultyprovidesanindicatorthatisusefulinmonitoringseveralissues. Performance:     [      c  I  S     [     Targets     k Actuals !  n *<dd ZZ@ 9ZZ@99ZZ@99ZZ@9ZZ@gZZ@g9ZZ@9<"", dd#,dd#,dd#,dd#,9dd#,9dd#,dd#+   >    FY03 '" 'FY02 '" 'FY01 '" 'FY00 '" 'FY00 '" 'FY99 '" 'LoanRepaymentsandFellowshipsFacultyPositions ;1j # ;0 [Q&B3 #   C@38C@[38 g]2B3  C@38 C@  A@35A@g35 g]2B3  A@35 A@  A@34A@g34 G=2B 3  A@34 A@ G1/28 G=.~"3  F@44F@G44 >42B#3  F@44 F@ >  FamilyMedicineFacultyDevelopmentTrainees ;1% # ;0 \R&&3 #  @_@125@_@\125 i_3'2 @_@125 @_@ b@148b@i148 i_3(3 b@148 b@ j@208j@i208 H>3)3 j@208 j@ H2/112 G=+3  V@91V@G91 G=2,3  V@91 V@ GGIM/GPFacultyDevelopment. ;1B. # ;0 \R&V/3 #  `d@163`d@\163 h^3V03 `d@163 `d@  M@59M@h59 g]2V13  M@59 M@  6@226@g22 G=2V23  6@22 6@ G3/146 G=B43  @@32@@G32 G=2V53  @@32 @@ GCentersofExcellenceURMFaculty ;1^"7 # ;0 ]S&r!83 #  @1900@]1,900 ka4r!93 @1900 @ Ԛ@1717Ԛ@k1,717 I?4r!:3 Ԛ@1717 Ԛ@ I70Rev1,647 @6~#=3 @1465@@1,465 YO+r!> @1465 @ @1597@YЀ1,597 @6+~#A @1597 @ @ TOTAL ;1$N B # ;0 ]S&$N C3 #  d@2226d@]2,226 ka4$N D3 d@2226 d@ @1954@k1,954 I?4$N E3 @1954 @ I334 $N F Rev1,911 I? 'Z"H3 \@1751\@I1,751 ka4$N I3 \@1751 \@ @1764@k  1,764 $N J jD:8&n!K3 @1764  @ DB.` hp x (#XB1/LoanRepaymentsandFellowshipsFacultyPositionsprogramperformanceforFY00waslessthantheFY00Targetsbecausetheaverageloanrepaymentawardincreased,resultinginadecreaseinthetotalnumberoffacultyfunded.#X*XXXH%#XHXXX*2/FamilyMedicineFacultyDevelopmentTraineesprogramperformanceincreasedoverFY >,'O 00duetoprogramfocusonthedevelopmentofminorityfaculty,butpipelinelimitationspreventedtheprogramfromachievingitsFY00target.3/GIM/GPFacultyDevelopmentincreasedoverFY99andfarexceededtheFY00targetduetotheprogramfocusonthedevelopmentofminorityfaculty.Thecollectionofdatahasbeenfurtherdefinedtoincludeonlythosefacultyengagedinaformaldevelopmentprogram.FY00actualperformancerepresentsapartialpresentation.Datanotavailableforallprogramsduetovaryinggrantawardcycles.#X*XXXH2#XHXXX*   ChangesinFY02andFY03targetsforprogramsreflectsactualleveloffundingforFY2002.#X*XXXH# XHXXX*ProjectedFY03fundingthatissubstantiallybelowFY02levelswillresultinacommensurate    declineinthenumberofprogramfaculty.#X*XXXH#X*XXX*     #X*XXX*#XHXXX*_00#X*XXXH#  H   XHXXX*  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  2.19ProgramTitle:TheNationalHealthServiceCorps     @  *dd dd# dd#dd#dd#9dd#99dd#9dd#<"",` kk, kk,kk,kk+  A<<<<V, 0  dAd  d 408 PerformanceGoals U<<<<V@+  <<<<Vd dU 40d  d 40Targets U<<<<V@+  <<<<Vd dU 40d  dActual 40Performance U<<<<V@+   <<<<Vd dU  Reference#X*XXXHe# XHXXX* h<<<<VS6>     <<<<Vd d h 40 I.ELIMINATE    BARRIERSTOCARE#X*XXXHR#XHXXX*   A.IncreaseAccess  n   Points  Z   401.IncreasethefieldstrengthoftheNationalHealthServiceCorpsthroughscholarshipsandloanrepaymentagreements. @<<<<-"2<<<<Vd  @ 40 򀀀   ЀField#X*XXXHF#XHXXX*    FY03: 3,1 56 48  n  FY02: 2,624 򀀀  Z  FY01:2,380FY00:2,697 40FY99:2,526 6<<<<#"r <<<< 6 40 󀀀    Field#X*XXXH#XHXXX*    FY01: 2,380 J " FY00:2,376FY99:2,526 40FY98:2,439 6<<<<#^ %<<<< 6 40d  dB 131  64   " )  40 NEW  * FY01DATA ^<<<<VI'F ,   <<<< d ^ 40dd2.Increasethepercentof_00NHSC_00Ԁcliniciansretainedinservicetothe_00underserved_00. 40 @<<<<-"N2<<<<Vd  @ 40dFY03:77%FY02:76%dFY01:75%FY00:74% 40FY99:72% 6<<<<#R9<<<< 6 40ddFY01:(4/02)FY00:75.0%FY99:70.1% 40FY98:70.9% 6<<<<#b@<<<< 6 40d  d 40B 131  64 #X*XXXH# X*XXX* c<<<<VN,rE    <<<< d c 40d dTotalFunding: N#X*XX X*# X*XXX*ational G HealthServiceCorps ($in000's) #X*XX X*# X*XXX* I dZd @<<<<-"J<<<<Vd  @dd 40FY2003: $191,514 L FY2002: $147,469 :M FY2001:$127,249FY2000:$113,783FY1999:$112,374FY1998:$112,444#X*XX X*&# X*XXX* 1<<<<Z Q<<<< 1 40ddBx:page#budgetHP:HealthyPeople2000chapter#X*XX X*#  T   d  d 40?53Y     <<<< ? 2.19.1ProgramDescription,ContextAndSummaryofPerformance p"Z  TheNationalHealthServiceCorps(_00NHSC_00)programassistsHealthProfessionalShortage #[ AreasineveryState,Territory,andpossessionoftheUnitedStatestomeettheirprimary,oralandmentalhealthservicesneeds.Overits29yearhistory,the_00NHSC_00Ԁhasofferedrecruitmentincentives,suchasscholarshipsandloanrepaymentsupporttomorethan22,000healthprofessionalscommittedtotheidealofservicetothe_00underserved_00.The_00NHSC_00Ԁprovidersareinawidevarietyofsitesthatserve_00underserved_00Ԁpopulations.Theyincludefederallyfundedcommunityhealthcenters,hospitalbasedpractices,healthdepartments,ruralhealthclinics,andprivatepractices.Allofthesesitesprovidecareto  L+&c  patientsregardlessoftheirabilitytopay.Accesstoprimarycareservicescontinuestobeaproblemfor_00underserved_00Ԁpopulationsforavarietyofreasons:L 23456789Hhh23456789L 23   23)2H3  0 S   Adisproportionatenumberofhealthprofessionalscontinuetopursuenonprimarycare  training.23)T݌ S"S" Ќ   23   23H2H3  0 S   Geographic_00maldistribution_00Ԁofallhealthprofessionalsremainsamajorproblem.23Hs݌S"S" Ќ   23   23k2H3  0 S   Anagingprimarycareworkforceinmany_00underserved_00Ԁareasmovestowardretirement  , withoutreplacementashealthprofessionalsconcentrateinalreadywellservedcommunities.23k݌ S"S" Ќ   23   232H3  0 S   Thenationalhealthcareworkforceforthemostpartdoesnotreflecttheracialand   ethnicdiversityofthepopulationincommunitieswherethelackofaccesstoservicesandincreasedhealthdisparitiesexist.23$݌ S"S" Ќ   X*XXX*Specificperformanceindicatorsinaccessincludethefieldstrengthofthe_00NHSC_00,which 0  providesaculturallycompetentworkforceforHealthCentersandsiteswhichotherwisefinditdifficulttorecruitclinicians,andcontinuedassuranceofpreventiveandprimarycareservicestolowincome,minority,anduninsuredindividuals.#X*XX X*#  X*XXX*DiscussionofDataSources: ,  Severalyearsago,_00BPHC_00ԀinitiatedtheUniformDataSystem(_00UDS_00).Thissystemwas H developedandimplementedtocollectaggregateadministrative,demographic,financial,andutilizationdataannuallyfromeachorganizationreceivingsupport.Itisvalidatedthrougheditchecksandonsitereviewsconductedduringeachorganizationsprojectperiod.Itisusedtosupplyinformationfortheaccessperformancegoals.#X*XX X*[# X*XXX*Mandatoryelectronictransmissionand  unificationaccomplished,itisanticipatedthatCY2000_00UDS_00Ԁdatawillincreaseovernextseveralyears.   The_00NHSC_00Ԁ isinthesecondyearofcollecting_00UDS_00Ԁdatafromnon_00HRSA_00Ԁgrantsites.This  year,58%ofnearly800non_00HRSA_00Ԁgrantsitesreporteddemographic,utilization,administrative,andfinancialdata.CombiningHealthCenterandnon_00HRSA_00Ԁgrantsite_00UDS_00    dataprovidesthefollowingestimatesof_00NHSC_00Ԁusers,theirrace/ethnicity,income,andinsurancestatus:3.7Musers,ofwhom46%wereracial/ethnicminorities,and59%wereMedicaidorselfpay(_00underinsured_00/uninsured).The_00NHSC_00ԀanticipatesthatthreeyearsaccumulationofdatawillenabletheprogramtoestablishabaselineagainstwhichtomeasureFY2003PerformanceGoalstargeting_00underserved_00Ԁusers. #X*XX X*#  X*XXX* ,%| ! #X*XX X*# 2..19.2GoalbyGoalPresentationofPerformance d'"# GoalIA.1:IncreasethefieldstrengthoftheNationalHealthServicesCorpsthroughscholarshipsandloanrepaymentagreements.  +&'  Context:   The_00NHSC_00Ԁcliniciansprovide accesstocarefor_00underserved_00Ԁpeople.About46%of_00NHSC_00  clinicianspracticein_00HRSA_00Ԁgrantsupportedhealthcenters,and 54% arelocatedinnon_00HRSA_00  grantsupportedpracticesin_00underserved_00Ԁareas._00NHSC_00Ԁclinicianscurrentlymeetonly10%oftheneedforprimarycare,oral,andmentalandbehavioralhealthcliniciansin_00HPSAs_00.Indicators:Totalsizeof_00NHSC_00Ԁfieldstrengthandinfutureyearsthe totalnumberofusers.    Performance:   T InFY2000,_00NHSC_00Ԁfieldstrengthwas2,376,12%lowerthantheestimate.ThistargetfailedtoaccountfortheincreaseinthenumberofLoanRepaymentcontractamendments(whichreducedtheamountoffundingavailablefornewcontracts),andtheincreasedindebtednessofprogramapplicants(whichraisedthecostofnewcontracts,thusreducingthetotalnumberofnewcontractsawarded).Accountingforthesevariablesandincreasedfunding,fieldstrengthisincreasedto2,380inFY2001andisprojectedat2,624inFY2002.ForFY2003(anticipatingprogramchangesbasedoncurrentdraftlegislation),thefieldstrengthtargetof X*XXX*3,1 56  48 reflects  anadditionof432 loan_00repayers_00,144ofwhichwouldbefrommentalandbehavioralhealth  disciplines.*dd` kk` kk kkkk"",kk,Gkk,Gkk,Gkk,Gkk,Gkk,>kk+  5<<<<"  5dd 6<<<<#b<<<< 6 40dd 40FY1998Actual ?<<<<,!:"<<<< ? 40dd 40FY1999Actual ?<<<<,! Z"<<<< ? 40ddFY2000 40ӀActual ?<<<<,! Z!"<<<< ? 40ddFY2001 40 ?<<<<,! Z%"<<<< ? 40ddFY2002 40 ?<<<<,!n("<<<< ?FY2003 W<<<<D,&+"   <<<< W 40dd 40Scholarship_00Obligers_00 6<<<<#.<<<< 6 40dd 40533 `<<<<M!03<<<< @@648@@` 40dd 40648 <<<<nB23 @@648 @@<<<< @@776@@ 40dd 40776 <<<<nB43 @@776 @@<<<< P@906P@ 40dd 40906 <<<<oB63 P@906 P@<<<< D@1041D@ 40dd 401,041 <<<<pC83 D@1041 D@<<<< t@1117t@1,117 y<<<<fNB93 t@1117   t@<<<< y 40dd 40FederalLoan_00Repayers_00 6<<<<#:<<<<< 6 40dd 401,306 a<<<<N!N>3<<<< @1282@a 40dd 401,282 <<<<pCN@3 @1282 @<<<< @1093@ 40dd 401,093 <<<<oCNB3 @1093 @<<<< h@973h@ 40dd 40973 <<<<oBND3 h@973 h@<<<< ؐ@1078ؐ@ 򀀀 E  1,078 <<<<pCF3 ؐ@1078 ؐ@<<<< @1518@  <<<<pCF3 ؐ@1078 ؐ@<<<< @1510@ _00 1,51 8  0 _00 y<<<<fNH3 @1518   @<<<< y 40dd 40Feds V<<<<CV J<<<<  Q@70Q@V 40dd 4070 <<<<lAV L3  Q@70 Q@<<<<  N@60N@ 40dd 4060 <<<<lAV N3  N@60 N@<<<<  E@43E@ 40dd 4043 <<<<lAV P3  E@43 E@<<<<  E@43E@ 40dd 4043 <<<<lAV R3  E@43 E@<<<<  E@43E@ 40dd 40Ӏ43 <<<<lAV T3  E@43 E@<<<<  E@42E@42 w<<<<dLBU3  E@42   E@<<<< w 40dd 40StateLoan_00Repayers_00 6<<<<#!W<<<< 6 40dd 40508 `<<<<M!!Y3<<<< 0@5180@` 40dd 40518 <<<<nB![3 0@518 0@<<<< {@446{@ 40dd 40446 <<<<nB!]3 {@446 {@<<<< {@440{@ 40dd 40440 <<<<nB!_3 {@440 {@<<<< {@444{@ 40dd 40Ӏ444 <<<<nB!a3 {@444 {@<<<< |@463|@ 463 x<<<<eM^!b3 |@463   |@<<<< xCommunityScholars 6<<<<##d<<<< 6 40dd 4022 _<<<<L!.#~f3<<<<  2@182@_ 40dd 4018 <<<<lA.#~h3  2@18 2@<<<<  2@182@ 40dd 4018 <<<<lA.#~j3  2@18 2@<<<<  2@182@ 40dd 4018 <<<<lA.#~l3  2@18 2@<<<<  2@182@ 40dd 40Ӏ18 <<<<lA.#~n3  2@18 2@<<<<  0@160@16 w<<<<dL"o3  0@16   0@<<<< w 40dd 40TotalFieldStrength 6<<<<#"%r q<<<< 6 40dd 402,439 a<<<<N!"%r s3<<<< @2526@a 40dd 402,526 <<<<pC"%r u3 @2526 @<<<< @2376@ 40dd 402,376 <<<<pC"%r w3 @2376 @<<<< @2380@ 40dd 402,380 <<<<pC"%r y3 @2380 @<<<< @2624@ 2,624 <<<<pC%*!{3 @2624 @<<<< @3156@  <<<<pC%*!{3 @2624 @<<<< @3148@ _00 3,1 56  48 _00^TR%*!}3 @3156    @<<<< ^ 40#X*XX X*x # X*XXX*Accordingtorecent_00NHSC_00Ԁdata,approximately46%of_00NHSC_00Ԁcliniciansservein_00HRSA_00Ԁgrantsupportedsites.Thispercentagerosefrom40%inFY1999.ExpansionofHealthCenterpatientswilllikelyplaceadditionalrelianceon_00NHSC_00Ԁproviders.Overall,_00NHSC_00Ԁfieldstrengthisprojectedtoserve nearly4.8million_00underserved_00Ԁpeople inFY2003.  *% #X*XX X*& # X*XXX* t+& Ї GoalI.A.2:Increasethepercentof_00NHSC_00Ԁcliniciansretainedinservicetothe  _00underserved_00.Context:  t Retentionof_00NHSC_00Ԁclinicianspreservesaccesstocareforthe_00underserved_00Ԁbeyondtheperiodofservicecommitment.Indicator:Percentof_00NHSC_00Ԁclinicianswhoremaininservicetothe_00underserved_00Ԁimmediatelyfollowingcompletionoftheirservicecommitment._00NHSC_00ԀwillprovidethesefiguresintheAnnualRetentionReports. Performance:  $  Accordingtothe_00NHSC_00Ԁ 2000 AnnualRetentionReport, 75%of_00NHSC_00Ԁcliniciansreport   remaininginservicetothe_00underserved_00Ԁataninterviewconductedaftercompletionofservicecommitment;a1%increasefromthetarget.Retention hasgrown steadilyfrommid50%range   inFY1995.An_00NHSC_00Ԁprogramevaluationstudy EvaluationoftheEffectivenessofthe   NationalHealthServiceCorps,(May31,2000) indicatesthatmorethanhalfof_00NHSC_00 x clinicianswhocompletedtheirservicecommitmentsbetween1983and1997arecurrentlyinservicetothe_00underserved_00.Theprogramplanstomeasureretentionatoneyearafterserviceobligationandfollowcohortsofcliniciansovertheirworkinglivestoassessretentionatlongerintervals.#X*XX X*( #  T К XHXXX*  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   0  2.20ProgramTitle:NursingEducationLoanRepaymentProgram   #X*XXXH/ #XHXXX**<ddkkGkkGGkkGGkkGGkkGGkkG>kk>"", dd , dd ,dd ,dd +  /X ` /PerformanceGoals AX,!"X ATargets AX,!"X AActual  Performance AX,! "X AReference =(& "  X = I.ELIMINATE 0   BARRIERSTOCAREB.IncreaseAccessPoints   X  1.Awardnursingloanrepaymentcontracts. $0  $FY03:675contractsFY02:560FY01:200FY00:200FY99:200    FY01:400FY00:195contractsFY99:202FY98:170    B 188   1    88   62 ) X " ) TotalFunding:Nursing $t! LoanRepaymentProgram ($in000's) $8$ $FY2003:$15,000FY2002:$10,239FY2001:#X*XXXH%1 #XHXXX*$7,279 L' FY2000:$2,279FY1999:$2,278FY1998:$2,199  * ЀBx:page#budget̀Px:page#performanceplaǹHP:HealthyPeoplegoalL-    2.20.1#X*XXXH6 #ProgramDescription,ContextandSummaryofPerformance .   ProgramDescriptionandContext:  0 TheNursingEducationLoanRepaymentProgram(_00NELRP_00)focusesonprovidingserviceobligatedregisterednursesfornotlessthantwoyearstoanIndianHealthServiceCenter,aNativeHawaiianHealthCenter,apublichospital,aFederallyQualifiedHealthCenter(_00FQHC_00),aruralhealthclinic,oraHealthCenterdeterminedbytheSecretarytohaveacriticalshortageofnurses.AchievingandmaintainingadequatelevelsofnursingstaffinshortageareasisthecentralpurposeoftheNursingEducationLoanRepaymentProgram.Theprogramassistsregisterednursesbyrepayingupto85percentoftheirqualifiededucationalloansinreturnfortheircommitmenttobeemployed(orremain)atthesehealthfacilitiesforthreeyears.Thisprogramisincontrasttothe_00NHSC_00Ԁloanrepaymentandscholarshipprogramswhichprovideobligatednursepractitioners,nursemidwives,psychiatricnursespecialistsandphysicianassistantsaswellasphysicianstoentitieslocatedinhealthprofessionalshortageareas.TherecontinuestobeaseriousshortageofnursesathealthfacilitiesincertainareasoftheUnitedStates.Thedemandhasintensifiedfornursespreparedinprogramsthatemphasize  8,'B  leadership,patienteducation,casemanagement,andcareacrossavarietyofdeliverysettings.AccordingtotheAmericanAssociationofCollegesofNursing(_00AACN_00),thecountrysagingpopulationisstrainingcurrentnursingresourcesandshortagesareprojectedtoworseninthecoming5to15years.NationalandStatestudiesincludingtheBureausNationalsamplesurveyofregisterednurses,demonstratetheagingnursingworkforcewillresultinsignificantreductionsinthesupplyofregisterednursesinthefirstdecadeofthiscentury. 2.20.2GoalbyGoalPresentationofPerformance   `  GoalI.B.1.Awardnursingloanrepaymentcontracts. Context:    Indicator:NumberofLoanrepaymentcontractsmade. Performance:    InFY1999,202loanrepaymentcontractswerenegotiated.InFY2000,195loanrepaymentcontractswerenegotiated.In2001,anadditional$5millionwastransferredintotheprogramand400loanrepaymentcontractsand35amendmentswerenegotiated.  8  XHXXX*FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001Performance  Report  2.21ProgramTitle:EducationalIncentivesforCurriculumDevelopmentandTraining  t *n<odd dd  dd  dd dd <"", dd , dd ,dd ,dd +  /X L  /PerformanceGoals AX,! "X ATargets AX,! "X AActual   Performance AX,!  "X AReference =(&  "  X = &&%%XXHIV.IMPROVEPUBLIC  l  HEALTHANDHEALTHCARESYSTEMSC.PromoteSystemsandInfrastructureDevelopment  |  1.Implementationofthe_00HRSA_00ԀHealthProfessional_00Bioterrorism_00ԀPreparednesstrainingtohealthprofessionalsintraining,including_00NHSC_00Ԁmembers.#XHX%%&&E #   (NewMeasure)  d #X*XXXHB #XHXXX* $P $&&%%XXHFY03:65,500trainees   FY02:N/A#XHX%%&& H #   #X*XXXHG #XHXXX*  h  &&%%XXHFY02:N/A#XHX%%&&H #  & #X*XXXHH #XHXXX*  h(  B174 #X*XXXHwI #XHXXX* ) -" )&&%%XXH2.Healthprofessional  . schoolswillincorporate_00HRSA_00ԀHealthProfessional_00Bioterrorism_00ԀPreparednesstrainingintotheircurriculum.#XHX%%&&8J # 02  (Developmental) $X3 $&&%%XXHFY03:_00TBD_00  4 FY02:N/A#XHX%%&&K #  5    6  B174   7 &&%%XXHTotalFunding:Educational 8 Incentives  `9 ($in000's)#XHX%%&&L # $8: $&&%%XXHFY2003:$60,000 ; FY2002:N/A#XHX%%&&HM # `< #X*XXXHI #XHXXX*  8= &&%%XXHBx:page#budget > HP:HealthyPeopleGoal#XHX%%&&+N # `? 8@   #X*XXXHM #XHXXX* #X*XXXHO #XHXXX*2.21.1ProgramDescription,ContextandSummaryofPerformance ,"|B  Healthcareprofessionalsprovideapivotallinktotheircommunities.Theyarevehiclesforthe $TD disseminationofaccurate,responsible,trustworthy,timelyinformationtothepublicatlarge.Thisisacrucialcomponentoftheemergencyresponseforpreservingpublicorderandcooperationinpublichealthmeasurestocontaindiseaseoutbreakswhileusingresourceseffectivelyandefficiently.Accordingly,itisofutmostnecessitytoensurethattheUnitedStateshasaworkforceofpublichealthandhealthcareprofessionalsthatareequippedwithskills,knowledgeandnetworkstoaddress_00bioterrorist_00Ԁattacks.TheHealthResourcesandServicesAdministrationwillprovide$60,000,000inFY2003for d+&L _00thedevelopmentoftheEducationalIncentivesforCurriculumDevelopmentandTrainingProgram.Thegoalsofthisprogramwillbe1)thedevelopmentofaninterdisciplinaryworkforceofhealthcarepersonneltrainedtoprepareforandrespondtoabioterroristattack,and2)theintegrationofhealthcareprofessionalsintothepublichealthnetwork.Thisprogramwillensurethathealthprofessionals,bothcurrentlyactiveandthosewhowillbeeducatedinthefuture,areabletoidentifytheindicationsofabioterroristeventintheirpatients,tohavetheknowledgeofhowbesttorespondforthewellbeingofthatpatient,andtohavetheknowledgeofhowtoinformthepublichealthsystematthelocal,stateandnationallevel.#X*XXXHJO #XHXXX*  L  Effective,responsestopublichealthemergenciesrequireclosecollaborationbetweenprimarycarepractitioners,thepublichealthinfrastructure,medicalspecialists,alltypesofhealthprofessionalsinvolvedinpatientcare,andallparticipantsintheemergencyresponse.Toachievesuchacollaborativeenvironment,itwillbenecessarytodevelopnewmodelsofundergraduate,graduate,andcontinuingeducationforhealthprofessionalsthatbroadenpublichealthknowledgeandensurethatessentialinterdisciplinarycollaborativeresponsestoemergencieswilloccur.Therequestwillallowforthedevelopmentofaninterdisciplinaryworkforceofhealthcarepersonneltoprepareforandrespondtoabioterroristattackaswellastoaddressthecrucialneedforintegrationofhealthcareprofessionalsintothepublichealthnetwork.̀ 2.21.2GoalbyGoalPresentationofPerformance  H  GoalIV.C.1.:ImplementationoftheHRSAHealthProfessionalBioterrorism   Preparednesstrainingtohealthprofessionalsintraining,includingNationalHealthServiceCorp(NHSC)members. Context:   TraineeswouldincludehealthprofessionalsandmembersoftheNationalHealthServiceCorps l (NHSC)whoserveinunderservedcommunities,includingtheinnercityareasofournationsmetropolitancenters.Indicator:NumberofNHSCmembersthatreceiveHRSAHealthProfessionalBioterrorismPreparednesstraining. GoalIV.C.2.: HealthprofessionalschoolswillincorporateHRSAHealthProfessional &"% BioterrorismPreparednesstrainingintotheircurriculum.  ' #&  Context:  )$( ThetypicalenvironmentfortheeducationofhealthcareprofessionalswithintheUnitedStatesisbroaderthantraininginpublichealth.Undergraduate,graduate,andcontinuingeducationof l+&* ourhealthprofessionalshasbeencompartmentalizedbydiscipline.Anessentialcomponentforacoordinatedresponsetobioterrorismconsistsofactivecollaborationbetweenthepublicandprivatehealthsystemsaswellaswithinthevariousdisciplinesofthehealthcaresystem.#X*XXXHU #XHXXX*Indicator:NumberofhealthprofessionschoolsthathaveincorporatedHRSAHealth ` ProfessionalBioterrorismPreparednesstrainingintotheircurriculum. Performance:  $ t FY2003willbethefirstyearofawardunderthisprogram,therefore,specificperformancemeasuresthatwouldassesstheprogressofthisprogramwillcontinuetobedeveloped.#X*XXXH_ #Ԁ XHXXX*  P      _00   <  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   +a    2.22ProgramTitle:HealthProfessionsWorkforceInformationandAnalysis   *<dd dd  dd  dd dd n<o"", dd ,dd ,Sdd ,dd +  /X ` /PerformanceGoals AX,!"X ATargets AX,!"X AActual  Performance AX,! "X AReference =(& "  X = IV.IMPROVEPUBLIC 0   HEALTHANDHEALTHCARESYSTEMSA.ImproveInformationDevelopmentandDissemination    1.Increasethenumberofstatesthatarebeingprovidedtechnicalassistanceintheuseofworkforcerequirements,supplymodelsandotherworkforcetoolsandanalyses. $,| $FY03:10StatesFY02:9FY01:8FY00:5FY99:5  T# FY02:11/02FY01:8FY00:5FY99:5FY98:4states  T/ B 165  45 5 g  #X*XXXH` # XHXXX* 򀀀NEW  6 ЀFY01̀DATA ) 8 )2.Annuallyproduceresultsofdatacollectionandanalysisactivitiesconductedtoinformthemarketregardingissuesrelevanttohealthprofessionsandnursingworkforce. $ p@ $FY03:12ReportsFY02:11FY01:10FY00:7FY99:5  \E FY02:11/02FY01:10FY00:7FY99:5FY98:2reports  HK B 165  45 #X*XXXHTg #X*XXX*NEW N ЀFY01DATA #X*XXX*i #XHXXX* )\P" ) TotalFunding:  Q WorkforceInformationandAnalysis  x"S ($in000's) $d#T $FY2003:$1000FY2002:$824FY2001:$824FY2000:$714FY1999:$714FY1998:$686  <% Z Bx:page#budgetHP:HealthyPeoplegoal!\    2.22.1ProgramDescription,ContextandSummaryofPerformance  D'"]  ProgramDescriptionandContext:  0(#^ About15centsofeverydollarspentintheU.S.isonhealthcareandoneoutofevery12jobs(andgrowing)isinthehealthcareindustry.Inspiteofthemagnitudeofexpendituresandemploymentinthehealthcareindustry,exceptingphysicians,relativelylittleisknownofthehealthcareworkforce.Forexample,whilepublichealthisoneofthemostfundamental +4'b Federal,stateandlocalgovernmentfunctions!responsibleforaddressinghealthcareissuesthataccountfor50percentofallpreventabledeaths!#X*XXXHi #XHXXX*thereisnodataavailableonthepublichealth  workforce.Intheabsenceofdataonthepublichealthworkforce,itisimpossibletoassesspublichealthworkforceneedsversussupply,distribution,andtrainingneeds.TheinvestmentinworkforceinformationandanalysiswillresultinmoreefficientallocationofresourcesandgreatlyreducetheFederal,State,andprivateexpendituresinhealthcare.Forexample,betterinformationontheimpactofhealthprofessionaltrainingonpracticein_00underserved_00ԀareaswillresultinbetterdistributionofhealthcareprovidersandlowerFederalsubsidiesinhealthprofessionalseducation.Inrecentyears,healthpolicymakersandgroupsofexpertshaveadvocatedforastrongFederalgovernmentroleindevelopinginformationandconductinganalysesonhealthworkforcesupply,requirements,anddistribution.TwosuchreportsincludefindingsfromtheInstituteofMedicine(_00IOM_00):PrimaryCare:AmericasHealthinaNewEra,March1996andTheNations   PhysicianWorkforce:OptionsforBalancingSupplyandRequirements,February1996.Many   stateandlocalgovernmentshavealsovoicedthisneedthroughnumerousrequestsforassistanceinanalyzingtheirhealthworkforcesupplyandrequirements.TheHealthProfessionsWorkforceInformationandAnalysisprogram(_00BHPr_00sNationalCenterforHealthWorkforceAnalysis)playsacriticalroleinensuringhealthcareaccessfortheNation.Thegoalsoftheprogramareto:(1)providehealthworkforceinformationandanalysestonational,State,andlocalpolicymakersandresearchersonabroadrangeofissuessuchasgraduatemedicaleducation,Medicaid/_00SCHIP_00,andhealthcareworkforceplanningand(2)conductFederalStatecollaborativeeffortsdirectedatassessingtheadequacyofthecurrentandfuturelocalhealthcareworkforceanddevelopstrategiesforimprovingthediversityanddistributionoftheirrespectiveworkforces.AnetworkofFederal/RegionalCentersforHealthWorkforceStudiesisbeingdevelopedtoforecastlocalhealthworkforcesupplyandrequirements.Thefollowinghighpriorityactivitieswillbeconductedwiththeproposedfunding:L 23456789[hh23456789LӄContinuedsupportofoneRegionalCenter(orCenterofExcellence).WorkingwiththeappropriateStateofficials,theRegionalCenterdevelopsmethodologiesto:studylocaltrendsinthesupplyanddistributionofphysicians,dentists,nurses,alliedhealthandpublichealthprofessionals;identifyareashavinglocalizedshortagesoftheseprofessionals;identifythecausesoftheseshortages;anddevelopstrategiesforaddressingtheproblems.L 23456789[hh23456789LӄPublishupdatedStateHealthWorkforceProfiles.Eachreportcontainsstatespecificinformationon30healthprofessionsemployment,thestateinfrastructure,andpopulationdemographicsandhealthstatus.̄PublishareportonthestatusofhealthpersonnelintheUnitedStates.For30healthprofessions,thereportwillinclude15yearNationalsupplyanddemandprojectionsandidentificationandanalysisoftheassociatedworkforceissuesforeachdiscipline. h+&* _00Theprimarypartnersandcustomersare:1)HRSA,includingtheBureauofHealthProfessions(BHPr);2)NationalpolicymakersandadvisorycouncilssuchastheCongress,CouncilonGraduateMedicalEducation,NationalAdvisoryCouncilonNurseEducationandPractice,NationalGovernorsAssociation,NationalConferenceofStateLegislatures;3)StatepolicymakersandadvisorssuchasStateHealthDepartmentsandPrimaryCareOfficesandAssociations;and,4)thehealthpolicyresearchcommunitysuchasPEWHealthProfessionsCommission,RobertWoodJohnsonFoundation,andacademicresearchcenters.  8   ProgramPerformance:   d TheRegionalCenterforHealthWorkforceStudiesisveryproductiveandconductsverytopicalstudiesthathavewiderangingimplications.Forexample,onesuchstudyexaminedtheimpactofantiaffirmativeactionlegislationonminorityenrollmentinmedicalschoolsintheStateofCalifornia.ThestudyhasimplicationsforotherStateswhereantiaffirmativeactionlegislationhasbeenpassedorconsideredand,morebroadly,implicationsforthediversityofthehealthworkforceinthecountry.Thenumberofthesepolicyrelevantstudiesisanticipatedtoincrease5foldfrom1998to2002.    2.22.2GoalbyGoalPresentationofPerformance  d  GoalIV.A.1:IncreasetheNumberofStatesBeingProvidedTechnicalAssistanceintheUseofWorkforceRequirements,SupplyModelsandOtherWorkforceToolsandAnalyses.  d  Context: @ Ѐ Thegoaltargetsandactualperformancewererevisedtoreflectthelevelofappropriated , funding.#X*XXXH^n #XHXXX*ԀHealthworkforcerequirementmodels,tools,andanalysisareneededbyStatesfor  planninghealthprofessionalseducation,toassessaccessissues,andinplanningtomeetfuturehealthcareneeds. Performance : | Thebaselinereflectscurrentperformanceandthetargetsarebasedonprogramplanningestimates.Thenumberofstatesthathavebeenprovidedtechnicalassistanceindicatesthebreadthofuseoftheworkforcetoolsdevelopedunderthisprogram.InFY01,theBureausNationalCenterforHealthWorkforceAnalysisprogramprovidedtechnicalassistanceto8Statesontheuseofhealthworkforcedataandanalysis. InFY03thenumberofState $l" receivingtechnicalassistanceisprojectedtogrowto10duetoananticipatedincreaseinfundingandareallocationofresourcesawayfromotheractivities.  %H!$  +&* GoalIV.A.2:Annuallyproduceresultsofdatacollectionandanalysisactivitiesconductedtoinformthemarketregardingissuesrelevanttohealthprofessionsandnursingworkforce.    Context:  ` WorkforceanalysisisneededtoplanandimplementtheBureaushealthprofessionstrainingprograms.ItisalsoneededbyotherHRSAprograms,CMS,theCouncilonGraduateMedicalEducation,FederalandStateandlocalpolicymakers,healthpolicyresearchorganizations,andprofessionalassociations.   ` GoalPerformance:   8  Thenumberofhealthworkforceanalysesconductedisanindicatorofthenumberofworkforceissuesanalyzedandameasurementoftheapplied,relevantnatureoftheprogram.Inadditiontodevelopingtools,theNationalCenterforHealthWorkforceAnalysisalsoconductsresearchontopicalorcurrentworkforceissuesandcompilesdataanddescriptivereportsonthehealthprofessions.Theseimportantproductsareusedbyawiderangeofhealthcareplanners,policyanalysts,students,andresearchers.Thegoaltargetsandactualperformancewererevisedtoreflectthelevelofappropriatedfunding.InFY01importantstudiesthatwerecompletedincludebutarenotlimitedto:51StateHealthWorkforceProfiles,oneforeachstate;aCongressionallymandatedstudyontheshortageofpharmacists;anenumerationofthepublichealthworkforce,thefirstin20years;apublicationongraduatemedicaleducationandpublicpolicy;areportonwomenandminoritiesinthehealtheducationpipeline,andacompaniondocumenttotheHealthyPeople2010Report#X*XXXHG #.InFY03,thenumberofreportsisexpectedto L beatleast12._00  $   X*XXX*    FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport     2.23ProgramTitle:ChildrensHospitalGraduateMedicalEducationPaymentProgram    *<dd dd dd Sdd Sdd <""," dd ,dd ,dd ,dd +  /X ` /PerformanceGoals AX,!"X ATargets AX,!"X AActual  Performance AX,! "X AReference =(& "  X = I.EliminateBarrierstoCare 0   A.IncreaseUtilizationfor_00Underserved_00ԀPopulations   X  1. Maintainthenumberof  D  _00FTE_00Ԁresidentsparticipatinginandrotatingintoanapprovedresidencyprogramsponsoredbytheprogrameligiblechildrensteachinghospitalsandotherinstitutions(OnsiteTraining)   $h $FY03:4,549residentsFY02:4,549residentsFY01:4,263residents   ! FY02:(5/02)FY01:1.Numberof_00FTE_00ԀresidentssponsoredbytheCH:3,0312.Numberof_00FTE_00Ԁresidentssponsoredbyotherinstitutions:1,5184549TotalFY00:4,263residents  ,3 B 271  154 NEW  D 7 FY01DATA   9  ) ;" )2. Maintainthenumberof_00FTE_00 d residentsparticipatinginanapprovedresidencyprogramsponsoredbytheprogrameligiblechildrensteachinghospitalswhorotatetoothersites.(OffsiteTraining) (Revised)    2.Maintainthenumberof_00FTE_00residentsparticipatinginanapprovedresidencyprogramsponsoredbytheprogrameligiblechildrensteachinghospitalswhorotatetoothersites#X*XX X*Q # X*XXX*.(OnsiteTraining) T8  (Previous)  @$   #X*XX X*# # X*XXX* $ $FY03:300FY02:300FY01:271(RevisedDefinition)FY01:3,043residents    FY02:(5/02)FY01:271residentsFY00:3,043residents  t , B 271  154 ̀#X*XX X*Ę # X*XXX* NEW X </ ЀFY01̀DATA )4 1" )3. Monitortheproportionof |2 hospitalsgrossrevenuefrompatientcareattributedtopublicinsurance(Medicaid,Medicare,_00SCHIP_00),anduninsuredpatients. (Developmental) #X*XX X* # X*XXX* 47 #X*XX X* # X*XXX* $ 9 $FY03:Inpatient:49%Outpatient:40%FY02:Inpatient:48.25%Outpatient:40.89%#X*XX X* # X*XXX*   @ FY02:(5/02)FY01:Inpatient:48.25%Outpatient:40.89%FY00:NA#X*XX X* # X*XXX*   I #X*XX X*R # X*XXX*B 271 154  |J  NEW pTL FY01DATA  )H,N" ) IVIMPROVEPUBLIC d HEALTHANDHEALTHCARESYSTEMSA.ImproveInformationDevelopmentandDissemination    1. Monitorpercentageof   hospitalsfundedbytheprogramwithnegativetotalmargins. (Developmental) #X*XX X* # X*XXX*     $t  $FY03:21.4%FY02:21.4%̀   FY02:(5/02)FY01: 26%   FY00:21.4%   B! 271! ! 154! NEW 0 $ FY01DATA ) &" )2. Monitorhospitalallowable  ' operatingexpenses. (Developmental) $) $FY03:$7,377,551,372FY02:$7,377,551,372  / FY02:(50/02)FY01:$7,377,551,372FY00:NA  5 #X*XX X* # X*XXX*B" 271" " 154"   6  NEW 8 FY01DATA ):" ) TotalFunding:Childrens ,; HospitalGraduateMedicalEducation ($in000's) $> $FY2003:$200,420FY2002:$285,344FY2001:$235,334FY2000:$39,992FY1999:$0  C Bx:page#budgetHP:HealthyPeoplegoalE    2.23.1:ProgramDescription,ContextandSummaryofPerformance  G  ForFY03,theDepartmentisproposingabudgetfor$200millionforChildrens_00GME_00PaymentProgram.UnderthecurrentMedicareGraduateMedicalEducation(_00GME_00)PaymentProgram,freestandingchildrensteachinghospitalsthatprovidetrainingtomedicalresidents,fellows,andotherhealthprofessionals,receiverelativelylittlefundingfor_00GME_00Ԁcomparedtofundingreceivedbyotherteachinghospitals.Asmanagedcareorganizationsbecomeincreasinglyunwillingtopayfor_00GME_00,thelowerlevelofMedicaresupportputsaburdenonchildrensteachinghospitalsincompetingforprivateandMedicaidmanagedcarecontracts.TheChildrensHospitalsGraduateMedicalEducation(_00CHGME_00)PaymentProgramincreasesthe#  +$S # $ $ levelofFederalsupportfor_00GME_00Ԁtofreestandingchildrenshospitalsinordertoassistinsustaininggraduatemedicaleducationforphysiciansreceivingtheirresidencytraininginchildrenshospitals.The_00CHGME_00ԀPaymentProgramprovidespaymentsforbothdirectandindirectmedicaleducationtosupportthetrainingofresidentphysicians,asdoesMedicare.Paymentsfordirectmedicaleducation(_00DME_00)aretooffsetdirectexpensesassociatedwithoperatingapprovedgraduatemedicaleducationtrainingprograms.Paymentsforindirectmedicaleducation(_00IME_00)aretooffsetindirectexpensesassociatedwiththehighercostsofcareinteachinghospitalsresultingfromfactorssuchasseverelyillpatients.The_00CHGME_00ԀPaymentProgrampolicieshaveandwillcontinuetobecoordinatedwithCMStoemulatethesameprinciples.Inaddition,theprogramwillcontinuetoworkcloselywithpotentiallyeligiblechildrensteachinghospitalstoadministertheprogramefficiently,andassistthemasnecessaryforasuccessfulandasmoothimplementationoftheprogram. ProgramPerformance:  p The_00CHGME_00ԀPaymentProgramwasimplementedforthefirsttimeinfiscalyear2000.DevelopmentalperformancemeasureswerepublishedintheJune19,2000FederalRegister.Afterreceivingpubliccommentsregardingtheproposedperformancemeasures,the_00CHGME_00PaymentProgramdevelopedrevisedperformancemeasureswhichwerepublishedinafinalFederalRegisternoticeonJuly20,2001andwhichareincludedinthisreport.Guidancewasprovidedtoapplicantsconcerningtheperformancemeasuresforthe_00CHGME_00ԀPaymentProgramthroughtheFY2000andFY2001applicationprocesses. ProgramDataIssues:    #X*XX X*U # X*XXX*InFebruary2001,OMBapprovalwasreceivedforthecollectionofdatainsupportofFY2001  performancemeasures.PerformancedataforFY2000wascollectedinthelatesummerofFY2001aspartoftheFY2001applicationprocess;performancedataforFY2001willbecollectedinthespringofFY2002.Ascanbeexpected,therewillbeaoneyearlagformeasuringtheimpactoftheprogramfundingforFY2000andFY2001.TheimpactoftheFY2001dollarswillbeavailablewhentheperformancemeasuresarereportedforFY2002inthespringofFY2002.Asthegoalofthe_00CHGME_00ԀPaymentProgramistoprovidefundingfor_00GME_00Ԁtrainingtochildrenshospitals,theperformancemeasuresthathavebeenproposedforthe_00CHGME_00PaymentProgramaredesignedtomonitorkeycharacteristicsofchildrenshospitalsandtheirroles,suchasthesizeoftheirtrainingprograms,theirfinancialstatus,andtheirabilitytoprovidecareto_00underserved_00Ԁpopulations.ThetargetsfortheseperformancemeasureswillbebasedonmaintainingtheactualperformanceinthebaselineyearsoastostrikeabalancebetweenassuringthattherewillbeafuturephysicianworkforcetocareforourchildrenandanefficientuseoftheFederalfunds. h+&*  2.23.2GoalbyGoalPresentationofPerformance    0 S  GoalI.A.1.Maintainthenumberof_00FTE_00Ԁresidentsparticipatinginandrotatingintoan S"S" approvedresidencyprogramsponsoredbytheprogrameligiblechildrensteachinghospitalsandotherinstitutions.(OnsiteTraining)#X*XX X*M # X*XXX*#X*XX X* # X*XXX* ` GoalI.A.2.Maintainthenumberof_00FTE_00Ԁresidentsparticipatinginanapprovedresidencyprogramsponsoredbytheprogrameligiblechildrensteachinghospitalswhorotatetoothersites#X*XX X* # X*XXX*.#X*XX X* # X*XXX*Ԁ(OffSiteTraining)(Revised)  ` GoalI.A.2.Maintainthenumberof_00FTE_00Ԁresidentsparticipatinginanapprovedresidencyprogramsponsoredbytheprogrameligiblechildrensteachinghospitalswhorotatetoothersites#X*XX X*` # X*XXX*.(OnsiteTraining)(Previous)    #X*XX X* # X*XXX* Context:    Thehealthcareworkforceenvironmentrequiresthatsufficientnumbersofphysiciansbeappropriatelyandadequatelytrainedtocareforpediatricpopulations.Asfreestandingchildrenshospitalsexperiencefinancialpressurescommontotheacademichealthcentercommunity,theremaybeincreasedinterestinreducingoreliminatingtrainingprogramssincethesetrainingprogramsarenotprofitgeneratingcostcenters.Thesehospitalsandtheirtrainingprogramsprovidesignificantservicestothelocal,regionalandnationalcommunities.TheseservicesincludecaringfortheMedicaidpopulation,childrenthatareon_00SCHIP_00,andtheuninsured.Areductioninmedicalresidencytrainingprogramswouldimpacttheprovisionofthoseservices,aswellastheproductionofonequarteroftheNationspediatriciansandthemajorityofpediatric_00subspecialists_00.Theseperformancegoalsprovideanaccurateaccountingofthenumberof_00FTE_00Ԁresidentsreceivingtraininginandbeingsponsoredbythechildrenshospitalsthatareparticipatinginthe_00CHGME_00ԀPaymentProgram.Achildrenshospitalmaynothaveitsownresidencyprogrambutmayprovidecriticalservicestoalocal,stateorregionalcommunityand,assuch,providevaluableteachingexperienceformedicalresidents.Hence,itispivotalthatwecapturethenumberofresidentsrotatingthroughthehospitalfortraining.Thenumberofresidentssponsoredbyachildrenshospitalisanindicatoroftherobustnessofthehospitalstrainingprogramanditsabilitytomaintainandpotentiallyexpandtrainingprogramsingeneralpediatricsandpediatricsubspecialties.#X*XX X*> # X*XXX*  $\"  Performance:  %4!$ Althoughthesemeasuresarestillconsideredtobedevelopmental,baselinedataareavailableforFY2000andsubsequentdataisavailableforFY2001.Becausetheoverallprogramgoalisforthenumberofresidentsbeingtrainedandbeingsponsoredbychildrenshospitalsparticipatinginthe_00CHGME_00ԀPaymentProgramtobemaintained(i.e.,nottodecrease),thetargetsforfutureyearsarebasedontheactualperformancedatafromthebaseline.InFY2001,thoughthirtyfewerresidentsrotatedoffsitefromtheirsponsoringhospital,thetotal p+&* _00numberofresidentstrainedbyCHGMEsponsoredprogramsincreasedto4,549from4,263.ThisincreasemaybeduetobetteraccountingofFTEresidentsforthepurposeofCHGMEpayments.#X*XX X* # X*XXX*L 023456789Gxh23456789LThedefinitionforthesecondperformancemeasurehasbeen developmentalwasrefinedin ` Juneof2001tocaptureonlyresidentstraining offsite.Thetargetnumberofrotatorsof3,043residentswasrevisedtoreflectthechangeinthedefinitionoftheperformancemeasure.Thetargetnumberofrotatorsshouldbesetat300residents. DataIssues: Thenumbersofresidentsinagivenhospitalstrainingprogramiscurrentlycollectedbythe  8  CMSforthosefreestandingchildrenshospitalsthatopttorequestreimbursementfromMedicare.NotallfreestandingchildrenshospitalthatareeligibleforparticipationintheCHGMEPaymentProgramhavesubmittedsuchinformationtoCMS.Generally,eachhospitalcanreadilyaccountforthetotalnumberofresidentsinitsaccreditedprograms.However,accountingforresidentsrotatingthroughafreestandingchildrenshospitalforaportionoftheirtrainingismorecomplicated.Afewchildrenhospitalshavebeguntoquantifythenumberofresidentsrotatingtotheirhospitalfromothertrainingprograms.ChildrenshospitalshavereportedthesenumbersforFY2001andwillbeabletodothesameforFY2002.  H 0 S   S"S" GoalI.A.3.MonitortheProportionofHospitalsGrossRevenuefromPatientCareAttributedtoPublicInsurance(Medicaid,Medicare,SCHIP),anduninsuredPatients.(Developmental)#X*XX X*N # X*XXX* 4 #X*XX X* # X*XXX*Context:   ChildrenshospitalshavehistoricallyprovidedasignificantamountofcaretothetraditionallyunderservedpopulationssuchasthoseenrolledintheMedicaidorSCHIPprograms,andthosewhoareuninsured.GiventheincreasingfinancialpressuresonchildrenshospitalsthatprovideGMEtrainingpresentedbyachanginghealthcaredeliveryandfinancingsystem,itisimportanttomonitortheabilityofthesehospitalstocontinuetoprovidecaretotheunderserved.ThismonitoringprocessisespeciallyimportantgivenHRSAscommitmenttoprovidehealthcareservicestoallAmericans. S Performance:  $T" OMBapproveddatacollectionforthismeasure.BaselinedataisavailableforFY2001,andthebeginningoftrenddatawillbeavailableinFY2002.InFY2001,childrenshospitalsreportedthat48.25percentoftheproportionofthehospitalsgrossrevenueforinpatientcarecanbeattributedtopublicinsurance(Medicare,Medicaid,andSCHIP)anduninsuredpatients.Acomparablepercentage,40.89percent,ofthehospitalsgrossrevenuefromtheoutpatientcareisattributedtopublicinsuranceandtheuninsured. DataIssues: #X*XX X*, # X*XXX* d+&* UtilizingthepercentageofhospitalsgrossrevenuefrompatientcareattributedtothosereceivingMedicaidorSCHIPcoverageandthosewhoareuninsuredwasdeterminedafterreceivingfeedbackfromthehospitalscompletingtheFY2000applications.Whileitisfeasibleforhospitalstoprovidethisinformationrelatedtotheirgrossrevenue,itisextremelydifficultforthemtoprovidepercentagesofpatientsservedbythehospitalforeachofthevariousinsurancepaymentcategories.#X*XX X*J # L   GoalIV.A.1 MonitorPercentageofHospitalsFundedbytheProgramwithNegative $ t TotalMargins(Developmental)  d Goal X*XXX*IV.A.2MonitorHospitalsAllowableOperatingExpenses(Developmental)#X*XX X*Y # X*XXX*  <  #X*XX X* # X*XXX*Context:    In2001,26percentofChildrenshospitalshadnegativeoperatingmargins.Compoundingthishavebeenthemajorchangesinthehealthcaresystem.Factorssuchastheexpansionofmanagedcare,andtheincreasedefforttoconstrainhealthcarecostsmayputhealthfacilitiesthattrainphysiciansatacompetitivedisadvantageinthenewmarketplacebecauseteachinghospitalshavehigherpatientcarecosts.Inthecompetitivemarketplace,payersofhealthcareserviceshavefew,ifany,incentivestopayhighercoststositesthattrainhealthprofessionals.Inadditiontothesemarketforceswhichimpactthecostofprovidingservices,thereisanincreasingtrendinthehealthcaredeliverysystemtowardtheprovisionofoutpatientservices.Thistrendtowardoutpatientcarewillpotentiallyalsoimpactthehospitalsfinancialstatus.Theseperformancemeasures,reflectingthechildrenshospitalsfinancialstatusintermsofbothtotalandoperatingcosts,willallowtheChildrensHospitalGMEPaymentProgramtomonitorthefinancialstatusofchildrenshospitalsparticipatingintheprogramandtogainabetterunderstandingoftherelationshipbetweentotalmarginsandoperatingcosts.Inthisway,wecanbetterunderstandtheimpactoftrendsinhealthcaredeliveryandtrainingprogramsonthehospitalsfinancialstatus. Performance : `  FY2000baselinedatareflectsthe21.4percentageofhospitalswithnegativetotalmargins.FY2001dataindicateamoderateincreaseinthenumberofinstitutionswithnegativetotalmargins(26vs.21percent).Thisincreaseisnotsubstantial. DataIssues:  %P # Mostchildrenshospitalscollectsuchinformationfortheirownpurposes.Somemaybereluctanttosharedetailedfinancialinformationforvariousreasonsincludingprivacy,butdeterminingtotalmarginsinclusiveofallcostsandsourcesofrevenueswouldhelpdeterminewhichinstitutionsareatmostfinancialrisks.BaselinedataforallowableoperatingexpenseswereobtainedinFY2001.TrenddataandappropriateinferencewillbeavailableinFY_002002.  )$( К#X*XX X*H #   XHXXX*FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  T 2.24ProgramTitle:HealthEducationAssistanceLoans(HEAL) *<!dd" dd " dd dd dd <"", dd ,dd ,dd ,dd +  /X ` /PerformanceGoals AX,!"X ATargets AX,!"X AActual  Performance AX,! "X AReference =(& "  X = IV.IMPROVEPUBLIC 0   HEALTHANDHEALTHCARESYSTEMS   D   B.PromoteEducation 0  andTrainingofthePublicHealthandHealthCareWorkforce    1.Conductanorderlyphaseoutoftheoutstandingloanportfolio,resultinginareductionintheFederalLiabilityassociatedwiththeHEALprogram. $T $FY03:$3,200,000,000 FY02:$3,300,000,000    FY01:$3,400,000,000   FY00:$3,600,000,000FY99:$3,700,000,000FY98:$3,800,000,000  |# FY01:$3,672,000,000 FY00:$3,516,817,133  + FY99:$3,700,000,000FY98:$3,800,000,000  |- B% 309% % 162% NEW 0 2 FY01DATA   4  )|7" )2.ReducetheamountofHEALclaimstobepaidfromtheliquidatingaccount.(Amountpaid)decreasingtheFederalliabilityassociatedwiththeHEALprogram. $ H? $, FY03:$29,000,000  pA  FY02:$30,000,000 \B FY01:$30,000,000FY00:$35,000,000FY99:$38,000,000FY98:$50,000,000   \F  FY01:$14,484,641 FY00:$27,774,603 4K FY99:$27,087,241FY98:$38,295,256   \M B& 309& & 162&  N NEWFY01DATA ) pS" )TotalFunding:HEAL($in000's) $d#U $FY03:$10,914FY02:$13,791FY01:$13,672FY00:$18,687FY99:$21,679FY98:$34,261  'd"[   x"\ "x"]"  "  +0'a 2.24.1ProgramDescription,ContextandSummaryofPerformance  ProgramDescriptionandContext:   L 23456789"xx023456789LTheHEALprogramwascreatedtoprovidelastdollarfinancialsupporttostudentsofdiverse_00socio_00Ԅeconomicbackgroundsattendingschoolsofallopathicmedicine,osteopathicmedicine,dentistry,veterinarymedicine,optometry,podiatry,pharmacy,publichealth,healthadministration,clinicalpsychology,andchiropractic.Sincetheprogramsinception,$4billionhashelped156,000studentspayfortheirhealthprofessionseducation.AuthoritytomakenewHEALloansexpiredinFY1999.TheHEALprogramcontinuestohaveanoutstandingportfolioof$3.2billionwhichwillrequiremanagementandforatleastthenext25years,whenthelastloanisfullyrepaid.TheHEALprogramactivitiesfocusonportfoliomanagement,initiativestohelpborrowersmanagetheirindebtednessandremaininpractice,partneringwithlendersandholderstoassurethatHEALclaimspaymentscontinuetodecline,anddefaultreduction.TheseeffortsaredesignedtoreducethetotalFederalliabilityassociatedwiththeHEALprogram.AnexampleofanongoinginitiativeisHEALRefinancing,whichprovidesborrowerswithsignificantsavingsinloanpaymentsandreducesthetotalFederalliabilityandtheactualdefaultpaymentsmadebytheFederalGovernment.Inaddition,aspartofitseffortstoinducerepaymentfromdefaultersanddeterotherborrowersfromdefaulting,theHEALprogrammaintainsanInternetlistingofHEALdefaulterswhoareexcludedfromtheMedicareprogram.TheHEALportfolioisalsobeinganalyzedtodetermineotherinnovativeapproachesforpreventingdefaultsandrehabilitatingdefaultedborrowers. ProgramPerformance:    #X*XXXHf #XHXXX*ActualperformanceforFY01demonstratesadecreasefromthetargetduetorefinancingof  loansandadecreaseinrequestsforclaimsfromtheliquidatingaccount.TheHEALprogramremainscommittedtopropermanagementandoversightofthe$3. 2billionoutstandingloan  portfolio.Thisincludesprovidingthe 83,864HEALborrowerswhohavenotyetfullyrepaid l theirloanswithappropriateassistancetofacilitatetherepaymentoftheirloans,workingwithlendersandloanholderstominimizedefaults,andaggressivelypursuingHEALdefaulters.  D! #X*XXXH #XHXXX* 2.24.2GoalbyGoalPresentationofPerformance  $X"  GoalIV.B.1:ConductanOrderlyPhaseoutoftheLoanInsuranceAuthority  %0!$  Context : '#& AlthoughtheauthoritytomakenewHEALloansexpiredinFY1999,theoutstandingloanportfolioofmorethan$3.2billionwillrequiremanagementandoversightforatleastthenext25years,until2031,whenthelastloanisfullyrepaid.OngoingemphasisisplacedonreducingtheFederalliabilityoftheHEALprogram. l+&*  Performance:   Theperformancegoalsmeasurethegradualdecreaseoftheoutstandingloanportfolio.ThebaselinelevelrepresentsoriginalloanamountsplusaccruedinterestfortheHEALoutstandingloanportfolio.TargetestimatesreflecttheimpactofrepaymentsandHEALdefaultreductionactivitiesontheoutstandingloanportfolio.  `  GoalIV.B.2ReducetheamountofHEALclaimstobepaidfromtheliquidatingaccount.  $ t  Context:   L  #X*XXXH # , 0  HEALprograminitiativesincludeastrongemphasisoninnovativeactivities,includingloan  8  refinancing,designedtoreducetheamountofHEALclaimspaidfromtheliquidatingaccount.ThiswillminimizetheFederalliabilityassociatedwiththeHEALprogram. ""  Performance:    ThebaselineandtargetswereestablishedusingtheHEALclaimsprojectionmodelthathasbeendevelopedbyHEALprogramofficials.ThismodelconsidersnumerousvariablesthataffectHEALclaimspaymentamounts,basedonhistoricalHEALtrends.TheFY2001ActualPerformanceforHEALclaimspaidwassignificantlylowerthantheFY2001Targetduetotheeffectivenessofdefaultreductioninitiativesandtightmanagementcontrol.  4   XHXXX*FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport #X*XXXH #XHXXX*    2.25ProgramTitle:NationalPractitionerDataBank(_00NPDB_00)andHealthcareIntegrityandProtection_00Databank_00Ԁ(_00HIPDB_00) *V<Wdd dd dd dd dd <!"", , , , +  /X L  /PerformanceGoals AX,! "X ATargets AX,! "X AActualPerformance AX,! "X AReference F1&  "  X F III.ASSURE 0   QUALITYOFCAREB.AssureEffectivenessofCare  0  1.Increasetheuseofthe_00NPDB_00Ԁand_00HIPDB_00fordecisionmakingbyqueries. 6,!  6_00NPDB_00 0  FY03:3,900,000q  l Ѐ47,385d  X FY02:3,320,000q  D  Ѐ39,750dFY01:3,250,000q*Revised38,000d*FY01:4,300,000q̀14,350dFY00:4,000,000q̀13,350dFY99:3,200,000q̀10,400d_00HIPDB_00 T" FY03:1,020,000q̀1,020dFY02:1,000,000q̀1,000dFY01:1,000,000q*Revised1,000d*FY01:1,800,000q̀1,800dFY00:700,000q̀700dq=Queries.Selfqueriesareexcluded. %P / d=Decisionsaffectedπbyresponses._00HIPDB_00estimatesareadjustedforquerieswhichalsomatched_00NPDB_00Ԁreports. ')$4 '_00NPDB_00 0 5 FY01:3,273,012q̀38,900dFY00:3,258,918q̀11,050dFY99:3,235,621q̀10,800dFY98:3,164,119q̀10,000d_00HIPDB_00 TD FY01:1,088,238q̀1,100dFY00:674,906q̀675d*q=Queries.Selfqueriesareexcluded.*d=Decisionsaffectedbyresponses._00HIPDB_00estimatesareadjustedforquerieswhichalsomatched_00NPDB_00reports. '($U 'B' 190' ' 70' NEW  XX FY01DATA  0 Z  " ]"  "e  +&^ *#<$dd     V<W!#!#, , , ,e +  !  ! 2.Increasethenumberofdatabasesthe_00NPDB_00Ԁand_00HIPDB_00Ԁuseasinformationsourcestoimprovethequalityofinformationinthe_00NPDB_00Ԁand_00HIPDB_00. -#  -FY03:4databasesFY02:4databasesFY01:4databasesFY00:3databasesFY99:2databases   FY01:4FY00:3FY99:2FY98:1    ЀB( 190( ( 70(  d  NEW < FY01DATA   TotalFunding:  l NationalPractitionerDataBank and  D  HealthcareIntegrityandProtectionDataBank    *_00appr_00Ԁ=_00CMAS_00Accountappropriatedfunds.*_00uf_00Ԁ=userfees#X*XXXH^ #XHXXX* -#X& -FY03:$19,500,000_00NPDB_00Ԁ_00uf_00*$5,600,000_00HIPDB_00_00uf_00*FY02:$16,600,000_00NPDB_00Ԁ_00uf_00*$5,100,000_00HIPDB_00Ԁ_00uf_00*FY01:$14,886,000_00NPDB_00Ԁ_00uf_00*$4,373,000_00HIPDB_00Ԁ_00uf_00*FY00:$13,501,354_00NPDB_00Ԁ_00uf_00*$2,789,600_00HIPDB_00Ԁ_00uf_00*$916,000_00HIPDB_00_00appr_00.*#X*XXXH #XHXXX* :  d = #X*XXXH #XHXXX*  TH   lI   2.25.1ProgramDescription,ContextandSummaryofPerformance#X*XXXH #XHXXX* l"J ProgramDescriptionandContext: PriortoestablishmentoftheNationalPractitionerDataBank(_00NPDB_00)ahealthcarepractitioner 0% M couldeasilyescapethescrutinyofmedicaloversightorganizationssimplybymovingtoanotherstate.The_00NPDB_00Ԁprovidesanationaldatarepositorywhichcanbeaccessedbylicensing,privileging,andcredentialingauthoritiespriortogranting_00licensure_00Ԁorextendingclinicalprivileges.The_00NPDB_00Ԁtracksallsignificantadverseprofessionalactionsagainstphysiciansanddentistsaswellasmalpracticesettlementsandjudgmentsagainstalllicensedhealthcareprofessionals. +&T _00HRSAdevelopedandisoperatingtheHealthcareIntegrityandProtectionDataBank(HIPDB)fortheDHHSOIGandtheDepartmentofJusticetoimplementarequirementoftheHealthcareInsurancePortabilityandAccountabilityActof1996.TheHIPDBisoperatedinconjunctionwiththeNPDB.ItaugmentsinformationavailableintheNPDBandwillassisttheNPDBinimplementingreportingoflicensureandclinicalprivileginginformationforpractitionersotherthanphysiciansanddentistswhen Section5regulationsareadopted.TheHIPDBopenedforreportingonNovember22,1999andforqueriesonMarch6,2000.Medicalmalpracticeinsurancecompanies,Statelicensingboards,healthcareentitiessuchashospitals,HMOs,grouppracticesandprofessionalsocietiesarerequiredtoreportinformationtotheNPDBonpaidmedicalmalpracticejudgmentsandsettlements,sanctions,certainprofessionalreviewactions,andadversemembershipactionsinvolvinglicensedpractitioners.TheNPDBalsoreceivesreportsofpractitionerexclusionsfromtheMedicareandMedicaidprogram.HospitalsarerequiredtoquerytheNPDBandcurrentlyareresponsibleforabout1/3ofallqueriestotheNPDB.Statelicensureagencies,andhealthcareentitiesandprofessionalsocietieswhichmeetcertainrequirementsarepermittedtoquerytheNPDB.Thesevoluntaryqueriessubmitabout2/3ofallqueriestotheNPDB.TheNPDBisfundedthroughuserfees($5.00perquery,asofOct1,2001,previously$4.00perquery).Healthplansandfederalandstateprogramsandofficials(includinglicensingagencies,certificationagencies,criminalprosecutors,governmentattorneysparticipatingincivilcases,andagenciestakingprogramexclusionactions)arerequiredtoreporttotheHIPDBallfinaladverseactions(suchasrevocations,suspensions,exclusions,criminalconvictionsandciviljudgments)againsthealthcareproviders,suppliers,andpractitioners.FederalandStateagenciesandhealthplansarepermittedtoquerytheHIPDB.AlthoughappropriatedfundswereusedtodeveloptheHIPDBandpartiallyfunditsstartupperiodoperations,beginninginFY02itisexpectedtobefullyfundedthroughuserfees($5.00perquery,asofOct1,2001,previously$4.00perquery)#X*XXXH #XHXXX*Ԁratherthanappropriatedfunds.  Asnotedabove,theservicesprovidedbytheNPDBwereaugmentedbytheopeningoftheHIPDBduringFY00.TheNPDBandHIPDBprogramsareoperatedsothatentitiesrequiredtoreporttobothdatabanksneedonlyfileonereportandquerieseligibletoobtaininformationfrombothdatabanksneedonlyqueryonce.InadditiontoinformationrequiredtobereportedbylawtotheNPDB,theDepartmenthasagreementsforvoluntaryreportingtoandqueryingoftheNPDBbytheDepartmentofDefense,theDepartmentofVeteransAffairs,andtheDepartmentofJustice,DrugEnforcementAdministration.MedicareandMedicaidexclusionsalsoarereportedbyCMSandtheOIGtotheNPDB. ProgramPerformance:  '#& AsofSeptember30,2001,theNPDBcontained285,232reportson175,479practitioners.Approximately73percentofthesereportsconcernedmalpracticepayments;approximately14percentconcernedlicensureactions.Slightlymorethan9percentwereMedicare/Medicaidexclusions.Mostoftheremainderwereclinicalprivilegesactions.Approximately69percent h+&* ofthepractitionerswithreportswereaboutphysiciansand14percentaboutdentists.Othertypesofpractitioners,e.g.,nurses,chiropractors)whoarenormallyreportedonlyformalpracticepaymentsandforexclusionsrepresenttheremaining17percent.Although69percentofpractitionerswithreportsintheNPDBhaveonlyonereport,theNPDBhasanaverageof1.63reportsforeachpractitionerwithreports.DuringFY01,theNPDBprocessed3,273,012queriesfrom10,112registeredentities.Queryingentitiesreceived432,248responsesfromtheNPDBwhichcontainedreportsonthequeriedpractitioners.Thisisamatchrateof13.2percent.Queriesalsoreceived2,840,764responseswhichconfirmedthatthenamedpractitionerhadnomalpracticepayments,adverseactions,orexclusionssinceSeptember1,1990.DuringFY01theNPDBalsorespondedto35,764selfqueriesfrompractitioners.Oftheseresponses,3,187containedreports;theremainderconfirmedthatthepractitionerhadnoreportsonfileintheNPDB.AsoftheendofSeptember2001,theHIPDBcontained98,545reports.Ofthese,98percentconcernedindividualpractitioners,and2percentconcernedorganizations.DuringFY01,theHIPDBrespondedto1,088,238queries.Oftheseresponses138,851containedreports.Thisconstitutesamatchrateof12.8percent.Theremainingresponsesconfirmedthatthepractitioner,providerorsupplierhadnoreportsonfileintheHIPDB.The3,273,012FY01entityqueriestotheNPDBandthe1,088,238FY01entityqueriestotheHIPDBalongwithchargesforselfqueriesbypractitionersresultedintotalrevenuestotheNPDBinFY01of$14.9millionandtotheHIPDBof$4.37million.Theserevenuespaidallprogramcosts.Therearenoappropriatedfundsfortheseprograms. ProgramDataIssues:    TheNPDBhasconductedusersurveystoobtaindataconcerningusersatisfactionandtheusefulnessoftheprogram.AseriesofsuchsurveyshavebeenconductedbyacontractorandtheOIGinpreviousyears.DuringFY01,theUniversityofIllinoisatChicagoandNorthwesternUniversitycompletedasurveyonprogramusefulnessandusersatisfaction.SurveyrespondentsratedtheNPDBonhoweasyitistoreporttoandobtaininformationfromtheNPDB,thecompletenessandaccuracyoftheinformationprovided,howsignificantNPDBinformationisfortheirdecisionmakingprocess,andotherfactors.Resultsareverypositive.EightypercentofusersratedqueryingtheNPDBas veryuseful.WhenqueriersreceivedresponsesconcerningpractitionerswhohadbeenreportedtotheNPDB,88%foundtheinformationuseful.In9%ofthecasesinwhichreportinformationwasreceivedthelicensingandcredentialingdecisionwasdifferentthanitwouldhavebeeniftheyhadnotqueriedtheNPDB.TheusefulnessoftheNPDBprogramcanalsobeinferredfromthefactthatentitieswhicharenotlegallyrequiredtoquerypaidmorethan$13,000,000eachyeartosubmitover3,200,000queriestotheNPDB.Entitiesmadeover1,000,000voluntaryqueriestotheHIPDBatacostof$4.00eachduringFY01.TheseentitieswouldnotqueryiftheydidnotbelievetheNPDBandHIPDBprovidethemwithimportantinformation. h+&*  2.25.2GoalbyGoalPresentationofPerformance    GoalIII.B.1.IncreasetheuseoftheNPDBandHIPDBfordecisionmakingbyqueries.  Context:  ` NPDBqueryresponseinformationisusedbylicensingboards,hospitalsandotherhealthcareentities,andprofessionalsocietiesforlicensing,privileges,andmembershipdecisions.NPDBresponseswhichincludematchedmalpracticepayment,adverseaction,orexclusionreportinformationhavebeendemonstratedtoaffectentitydecisionsabout9%ofthetime.AccordingtoOIGandconsultantstudies,matchedresponsescontainingNPDBreportsalsoarevaluabletoqueryingentitieswhentheyconfirminformationtheentitieshavereceivedfromothersources.NPDB nomatchresponsesarelikewisevaluableaccordingtosurveyresultsbecausetheseresponsesconfirmthatapractitionerhashada cleanrecordsinceSeptember1,1990.These nomatchresponseswillbecomeevenmorevaluableasthenumberofyearsofreportingtotheNPDBincreases.TheNPDBservesasacentralreliablesourceof(mostly)adverseinformationconcerningpractitioners.Practitionersmayfailtoincludethisadverseinformationintheirlicensure,privileges,ormembershipapplicationsiftheythinkthattheiromissionswillnotbediscovered.Indeed,theproclivityofpractitionerswithlessthanperfectrecordstoomitdamaginginformationonapplicationswasamajorreasonforadoptionoftheHealthCareQualityImprovementActof1986,whichledtotheestablishmentoftheNPDB.TheexistenceoftheNPDBmakesitdifficult,ifnotimpossible,forpractitionerstosuccessfullyhidedamaginginformationfromNPDBqueries.BecauseoftheexistenceoftheNPDB,practitionersnowaremorelikelytodisclosedamaginginformationintheirapplications,presumablybecausetheybelieveitwouldbeseenasevenmoredamagingifitappearsthattheywereattemptingtohidetheinformation.EligibleentitiesbeganqueryingtheHIPDBonMarch6,2000.WeexpectedasubstantialnumbersofqueriestotheHIPDBbecauseitcontainsseveraltypesofdatanotfoundintheNPDB(suchaslicensureactionsonpractitionersotherthanphysiciansanddentistsandcriminalconvictionsandciviljudgments)andbecauseitcontainsinformationonprovidersandsuppliersaswellaspractitioners.Theaccuracyofthisexpectationhasbeenconfirmedbythefactthatthereweremorethan1,000,000queriesvoluntarilysubmittedtotheHIPDBduringFY01.#X*XXXH2 #XHXXX* Performance:  $H # DatafromourentityuserfileindicatethattheNPDBprovidedresponsesfor3,273,012queriesfromentitiesduringFY01.Thisislessthanonepercentgreaterthanourestimate.DuringFY01,NPDBqueriersreceived432,248matchedresponsescontainingreportinformation.BasedonausersurveyconductedbytheUniversityofIllinoisatChicago,anestimated38,900licensure,credentialing,ormembershipdecisionswereaffectedbythesematchresponsesduringFY01.ApplyingthesameusersurveyresultstoHIPDBitaffected l+&* 1,100decisionsinFY01.UsingthesurveyinformationcombinedwithcurrentqueryingandresponsedataisthemostreliableavailablemethodtoestimatetheimpactoftheNPDBondecisionmaking.TheNPDBalsoprovidedconfirminginformation,whichsurveyresponsesindicatearealsogenerallyviewedasusefulbyqueriesanestimated393,000timesduringFY01.Inaddition,theNPDBconfirmedthatpractitionerhadacleanrecord2,840,764timesduringFY01.Theusersurveyalsoindicatesthatthisinformationisgenerallyconsideredimportantbyusers.WeexpectthatasthenumberofNPDBqueriescontinuestoslowlyincreaseandthematchratealsocontinuestoincrease,thenumberofdecisionsdirectlyaffectedbyNPDBinformationwillalsocontinuetoincreaseasshowninthetableabove.Italsoshouldbenotedthat,paradoxically,theextenttowhichdecisionsarechangedbecauseofnewinformationreceivedfromtheNPDBmaydecreaseasagreaterproportionofpractitionerssubmitcompleteandfullyaccurateapplicationswhichdonotomitanynegativeinformation.ThiswouldnotindicatethattheNPDBisbecominglesseffective,butratherthatitsimportanceasadeterrentisincreasing.TheOIGfoundthatin1992(twoyearsaftertheNPDBopened)40%ofpractitionersapplicationstohospitalsomittedsomeinformationcontainedinNPDBreports.AlaterOIGstudyfoundthatby1994(fouryearsaftertheNPDBopened)only28%ofapplicationswereincomplete.ThesurveyconductedbytheUniversityofIllinoisatChicagoandNorthwesternUniversitywhichwascompletedin2001foundthat21%ofreportsreceivedbyqueriersincludednewinformationnotprovidedinpractitionerapplications.Nodataareavailabletodeterminehowmanypatientsweresavedfromsubstandardcareorimproperpractitionerbehaviorasaresultofthesedecisionsanditisunlikelythatreliabledataofthistypecouldbedeveloped. ProjectionsforFY02andFY03reflectactualFY00andFY01  performanceandthefactthatimplementationof Section5isnownotexpecteduntilFY03.Inadditionestimatesofdecisionsaffectedreflectnewsurveyresults.#X*XXXH-< #XHXXX*  l DataIssues:  D! IncreasedqueryingimpliesincreaseduseofNPDBandHIPDBinformationfordecisionmaking.Wecurrentlymeasureoursuccessinreachingthegoalintermsofthenumberofqueriessubmitted,whichiseasilymeasurable,andintermsofdecisionsaffected,whichisnoteasilymeasurable.Dataondecisionsaffected,i.e.,howNPDBandHIPDBdataisactuallyused,canbeobtainedonlyfromsurveysofNPDBandHIPDBusers.WebasedourcountsofdecisionsaffectedonprevioussurveyresultsandcurrentinformationfromtheNPDBcontractoronthenumberofqueriesandmatchedresponses.SurveystoobtaininformationonusersatisfactionandhowNPDBqueryresponsesareusedareexpensiveandarenotconductedeveryyear.Surveydataaresubjecttosamplinganddatacollectionerrors.Wehavenoreasontobelieve,however,thatthereareanysignificanterrorsinthenewlyavailablesurveydata. l+&* NPDBquerydataforFY03isestimatedtakingintoaccountpossiblechangesresultingfromimplementationoftheHIPDBand Section5.If Section5isnotimplemented,thisestimatewillbeexcessive.ThenumberofqueriesshownforFY01istheactualnumberofqueriesprocessedbytheNPDB. Decisionsaffectedbyresponsesisanestimatebasedonsurveydataandtheactualnumberofquerieswhichresultedinmatchresponsesduringtheyear.HIPDBqueryanddecisionsaffecteddataarebasedonourHIPDBbusinessplanandbudgetestimatesandregistrationsforqueryingtheHIPDB.TheTargetnumberofdecisionsaffectedbyHIPDBreportsinFY00wasbasedonanassumedinitial2percentmatchrateandanassumptionthat5percentofHIPDBmatcheswillprovidenewinformationwhichaffectsdecisionmaking.InfacttheHIPDBmatchrateinFY00was12.1percent.However,manyofthesematchesinvolvedquerieswhichwerealsomadetotheNPDB,soitisdifficulttoattributeaffecteddecisionstothesematches.UntildataisavailabletoassesstheimpactofHIPDBqueryingondecisions,wearemakingaveryconservativeassumptionthat0.1percentofHIPDBqueriesresultsininformationleadinganentitytochangeadecision.Thisislessthan1/8theratethatNPDBquerieshavebeenfoundtoaffectdecisions.DataonthefrequencywithwhichpractitionerswithholdinformationonapplicationsthatisdisclosedbytheNPDBcanbeobtainedonlythroughsurveysofNPDBusers.Suchsurveysareexpensiveandarenotconductedeveryyear.Likeallsurveydata,thistypeofinformationissubjecttosamplinganddatacollectionerrors. GoalIII.B.2:IncreasethenumberofdatabaseswhichareusedbytheNPDBasinformationsourcestoimprovethequalityofinformationintheNPDB.  4  Context:   TheNPDBsinformationcanbeimprovedbyobtaininginformationwhenneeded(suchastoconfirmlicensenumbers,addresses,etc.)fromothersources.Thisinformationisusedtohelpresolve partialmatches,thosesituationsinwhichtheNPDBcannotinitiallydeterminewithreasonablecertaintythatthepractitioneraboutwhominformationisbeingsoughtisthesamepractitioneronwhominformationhasbeenreportedtotheNPDB.Suchproblemsarisewhenqueriesdonothavecompleteinformation.Theseproblemsalsomayarisewhenpractitionershavethesameorsimilarnames. Performance:  $`" TheNPDBcurrentlyconfirmspractitioneridentificationandcharacteristicsinformationusingtheAMAdatabasewhennecessary.TheNPDBalsoobtainsinformationfromStatelicensureboardsasnecessarytoidentifypractitioners.AspractitionerinformationbecomesincreasinglyavailableontheInternet,theNPDBplanstoincreaseuseofthesesources,notonlyforphysiciansbutalsoforothertypesofpractitioners.TheNPDBalsonowcoordinateswiththeHIPDBforneededpractitioneridentificationinformation.#X*XXXHkG #XHXXX*  S  p+&* DataIssues:GeneralDescriptionsofthePerformanceDataSourceandSystem   PerformancedatausedtoassesstheperformanceoftheNationalPractitionerDataBankandHealthcareIntegrityandProtectionDataBankarebasedonroutinelyproducedmonthlyandweeklyoperationssummaryreportsprovidedtotheDivisionofPractitionerDataBanksbytheDataBankcontractor.Inaddition,theDivisionofPractitionerDataBanksreceivesfourcomputerdatasetseachyearfromthecontractor.ThesedatasetsprovideinformationonthereportingandqueryingactivitiesbyeachentityregisteredwiththeDataBanksaswellasinformationconcerningthenumberofmatchedresponseseachentityreceivesinresponsetoitsqueries.Thisinformationisused,amongotherpurposes,toconfirmthesummaryinformationpresentedinthemonthlyandweeklysummaryreports.Inaddition,sinceafeeischargedforeachquery,querycountsareconfirmedbytheamountofrevenuepaidbyqueries. QualityofPerformanceData    OvertheyearsthedataonqueryingandmatchingusedtoassessperformanceoftheDataBankhasbeenfoundtobehighlyaccurateandreliable.Theroutinereportsanddatasetsareproducedbycomputerwithminimalhumanintervention.Furthermore,thedatasetsaretestedforaccuracyandcompletenessbyaseriesofcomputertestsperformedbytheDivisionofPractitionerDataBankseachtimeadatasetisreceived. PerformanceInformationonDataSources   \ InformationonthenumberofdecisionsaffectedbyDataBankresponsesareestimatesbasedonactualcountsofmatchedqueryresponses(asdiscussedabove)andestimatesoftheproportionofmatchedqueryresponseswhichaffectdecisionmakingbyhospitalsandmanagedcareorganizations.TheestimatesoftheproportionofdecisionsaffectedpriortoFY01arebasedonfourindividualsurveysconductedbytheDHHSOfficeofInspectorGeneralattherequestoftheDivisionofPractitionerDataBanks.Theresultsofeachofthesesurveyswereconsistentwiththeresultsoftheothersurveys.EstimatesoftheproportionofdecisionsaffectedforFY01andlateryearsarebasedonresultsofasurveycompletedduringFY01bytheUniversityofIllinoisandNorthwesternUniversity. DataLimitations  0"  Webelievethatnocaveatsarerequiredconcerningcountsofqueriesandmatchedresponses.Therearealsonospeciallimitationsconcerningestimatesofthenumbersofdecisionsaffectedbymatchedresponsesbeyondgeneralcautionswhichapplytotheresultsofeventhebestdesignedsurvey.#X*XXXHW #XHXXX* %0!$ _00#X*XXXHmb #XHXXX*  &"%  #X*XXXHb #XHXXX*@FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport    2.26ProgramTitle:_00Ricky_00ԀRayHemophiliaReliefFundProgram(_00RRHRP_00) %4XXH  *%<&dd    e e#<$!#!#, dd ,Sdd ,4dd ,dd +  /X  /#XHX4%]d #&&%%XXHPerformanceGoals AX,!N"X ATargets AX,!N"X AActual N Performance AX,! &"X AReference =(&N "  X = III.ASSUREQUALITYOF B   CARE   j   C.Improve  B  Customer/PatientSatisfaction #XHX%%&&e #&&%%XXH   1.IssueNoticeofIntentCaseNumberlettertoeachindividualthatfilesaNoticeofIntenttoFileaPetitionwith#XHX%%&& h #&&%%XXH_00RRHRP_00.#XHX%%&&h #&&%%XXH (Measuretobe * Deleted) $ $FY02:NAFY01:NAFY00:100%FY99:65%  R  FY01:NAFY00:100%FY99:70%  R & 6 6   4 / / 4 6 5 5 6 5 4 4 5 6 3 3 6 6 6 8 B2938 6 6 7 2 2 7 6 3 3 . . 6 6 6 8 6 6 8 6 6 8 6 6 8 7 7 #XHX%%&&Ci #Uj &&%%XXH )*z ." )2.CompletethedeterminationwhetherapetitionmeetstherequirementsoftheActwithin120daysafterapetitionisfiledwith#XHX%%&&k #&&%%XXHԀ_00RRHRP_00.#XHX%%&&l #&&%%XXH $3 $FY03:100%FY02:100%FY01:100%FY00:100%FY99:NA#XHX%%&&l #&&%%XXH  8 FY01:95%FY00:100%FY99:NA#XHX%%&&m #&&%%XXH  = B9 2939   PNEW "@ FY01DATA Psn #XHX%%&&n #&&%%XXH#&M'%%%&&1c #&&%%'%&M )B )gn   3.SubjecttoavailabilityofsufficientamountsintheFund#XHX%%&&n #&&%%XXH,processpaymentof90 E percentofpetitionerpaymentawardswithin30calendardaysafterreceiptofanapprovedpetitionerspaymentinformation.#XHX%%&&o #&&%%XXH $&J $yo   FY03:90%FY02:90%FY01:90%FY00:90%FY99:NA#XHX%%&&p #&&%%XXH  NO q   FY01:100%PFY00:90%FY99:NA#XHX%%&&q #&&%%XXH  NT q < <   < < B= 293= ; : 293: ; = ; ; = ; ; = ; ; = ; ; = ; ; = ; ; NEW W FY01DATA )NY )r    TotalFunding:_00Ricky_00ԀRay B!Z HemophiliaReliefFundActof1998  "B\ ($in000's) $#] $s   FY2003:$0FY2002:$0FY2001:$580,000FY2000:$75,000FY1999:$0it Ӏ "z% c  "ЀBx:page#budget̀HP:HealthyPeoplegoal"je   #XHX%%&&5r # Pq 2.26.1ProgramDescription,ContextandSummaryofPerformance  n'"f  ProgramDescriptionandContext:  F)$h The_00Ricky_00ԀRayHemophiliaReliefFundActof1998(the Act)wassignedonNovember12,1998toprovidefor compassionatepaymentsof$100,000bytheSecretarytocertainindividualswithbloodclottingdisorders,suchashemophilia,whoweretreatedwith  ,Z'k _00antihemophilicfactorbetweenJuly1,1982andDecember31,1987,andwhocontractedHIV.SpouseswhocontractedHIVfromtheseindividualsandchildrenwhoacquiredHIVperinatallyfromtheirmothersmayalsobeeligibleforpayments.Specifiedsurvivorsofthesecategoriesofindividualsmayalsoreceivepayments.Section101oftheActestablishesintheTreasuryoftheUnitedStatesatrustfundknownastheRickyRayHemophiliaReliefFund.TheActauthorizesappropriationstotheFundof$750million.TheFY2000Labor/HHS/Educationappropriationprovided$75millionintheDepartmentsPublicHealthandSocialServicesEmergencyFundtosupporttheActandprovidedfurtherthatupto$10millionoftheamountmaybeavailableforadministrativeexpenses.TheRickyRayHemophiliaReliefFundProgramheldFY2000administrativecoststo50%ofthe$10,000,000authorizedundertheappropriation,whichresultedin$5millionrevertingtotheRickRayTrustFundforpaymentstoapprovedpetitioners.OnDecember21,2000,PresidentClintonsignedanomnibusappropriationsbillthatincluded$580millioninadditionalfundingfortheRickyRayHemophiliaReliefFund.TheFY2001appropriationincluded$10,000,000innoyearfundsforadministrativeexpenses.ThecombinedtotalsoftheFiscalYear2000and2001appropriations!#X*XXXH!o #XHXXX*Ԁ$655millioninnoyear   fundsprovidessufficientfundingtomakecompassionatepaymentsonalleligiblepetitionsreceivedtodate,andontheadditionalpetitionsthattheprogramanticipatesreceivingbyNovember13,2001,thepetitionfilingpostmarkdeadline.OurintentionistocontinuethepaymentprocessuntilalleligiblepetitionshavebeenpaidbeforetheFundexpiresinFY2004,asrequiredundercurrentstatute.HRSAissuedregulationstoimplementtheActandtodeterminethepoliciesandproceduresforsubmittingafullpetitionandforprioritizingpayments,asrequired.TheinterimfinalregulationswerepublishedintheFederalRegisteronMay31,2000.On July31#X*XXXH| #XHXXX*Ԁ2000,the 4 effectivedateoftheregulations,individualsbegansubmittingpetitionsforcompassionatepaymentsfromtheFund.AsofSeptember30 ,#X*XXXH #XHXXX*Ԁ2001,HRSAhadreceivedmorethan6,000 #X*XXXHڀ #XHXXX*   petitions,ofwhichabout4,350werepostmarked#X*XXXHJ #XHXXX*ԀJuly31,2000.HRSA,inconjunctionwitha  contractor,willrevieweachpetitionandsupportingmedicalandlegaldocumentationandmakedeterminationsregardingthepetitionsforcompassionatepayment.HRSAbeganmakingcompassionatepaymentstoapprovedpetitionersonAugust25,2000,fiveweeksaheadofthetargetedstartdate.TheprogramwillacceptpetitionssubmittedwithpostmarksnolaterthanNovember13,2001.AsofSeptember30 ,2001,5,615 petitionswereprocessed,resultinginover6,780 payments #l! totalingabout$536 million(Becausethenumberofsurvivingchildrenorsurvivingparentsmay $X" belargerthanthesingleindividualwithHIVonwhosebehalftheysubmittedapetition,thenumberofpaymentsexceedsthenumberofpetitions).HRSAhas substantiallyprocessedall %0!$ petitionsreceived.  &"%  TheprogramisadministeredinclosecoordinationwithHRSAsOfficeofGeneralCounseland (#' officialswithinHRSAsBureauofHealthProfessions.Theprogramhasalsoconsultedwithnationalhemophiliaadvocacygroupswithregardtotheprogramspoliciesandprocedures. h+&*  OnMarch24,1999,theSecretaryestablishedasafirstprocedureundertheActtheopportunity  forindividualstofileNoticesofIntenttoFilePetitions.TheRickyRayProgramOfficereceivedmorethan6,400NoticesofIntenttoFileaPetition.TheRickyRayProgramOfficerespondedtoeachNoticeofIntentwithanacknowledgmentletterreflectingacasenumberassignedtothefiling.TheNoticeofIntentwasthemethodforpreservingtherightsofindividualsundertheActincasefundswerenotappropriatedinsufficienttimetoallowforareasonableprocessforfilingpetitionswithinthestatutorydeadline.Nowthatfundshavebeenappropriated,theRickyRayProgramOfficehasdevelopedanapplicationandpaymentprocesswhichrequiresaformalpetition.ThisprocesssupercedestheNoticeofIntentprocess.Therefore,asofMay31,2000,thedateofpublicationoftheinterimfinalregulationsintheFederalRegister,theNoticeofIntentprocessterminated.Inaddition,thereisnoneedtofileaNoticeofIntentpriortofilingapetition. TheRickyRayProgramOffice,maintainsahighlycontrolleddatasystem,whichcontains   detailedcasespecificdataforthepetitionsfiledundertheprogram.Thiscontroldatasystemincludeslegal,medical,diagnostic,andpaymentinformation,tobeusedinthereviewprocessfordeterminingwhetherapetitionmeetstherequirementsoftheAct.Petitionsarecrossreferencedinthedatabasetocheckforunwarrantedduplicatesaswellasotherrelatedpetitions,whichensuresthatpaymentsaremadetoonlyqualifiedpetitioners.Thedatasystemalsoprovidesperiodicreportsthatareusedforstatisticalmonitoringandprogrammanagementdecisions.TheRickyRayProgramOfficeutilizestheU.S.DepartmentofTreasurysElectronicFundsTransfer(EFT)formakingthecompassionatepaymentonanapprovedpetition.AftercarefulverificationofthepetitionersbankaccountandthefinancialinstitutionsAmericanBankingAssociationroutingnumber,acompassionatepaymentistransferredquickly,safely,andinamannerthatassurestheconfidentialityofthepayment.SubstantiallyallpetitionershavecompliedwiththeuseofEFTintheRickRaypaymentprocess 2.26.2GoalbyGoalPresentationofPerformance  l  GoalIII.C.1:IssueNoticeofIntentCaseNumberLettertoeachIndividualWhoFilesa D! NoticeofIntenttoFileaPetitionwithRRHRP. 󀀀 (MeasuretobeDeleted)  0"   Context:   $\" TheNoticeofIntenttoFileaPetitionsystemwasestablishedbytheSecretaryastheinitialprocedureforindividualswhomaywishtofileafullpetition.TheRRHRPdistributedthefinalpetitionpackagewhichincludedallformsandinstructionsregardingthecontent,formatanddeadlinesforfilingfullpetitionstoallindividualswhosubmittedaNoticeofIntent. Performance:  )$( Performancestandardswereconceptualized,developed,andimplementedfollowingcarefulconsiderationbyProgramofficials,inconcertwiththeOfficeoftheGeneralCounsel(OGC). p+&* Standardswere,inpart,basedonensuringstrictstandardstosatisfytheoftenurgentneedsofthebeneficiariesofthisProgram.AsofJune1,2000,theRRHRPhasissuedaCaseNumberletterto100%ofallindividualsthathavefiledaNoticeofIntenttoFileaPetitionwiththeRRHRP.TheNoticeofIntentprocessterminatedonMay31,2000,thedatetheinterimfinalregulationswerepublishedintheFederalRegister.SincegoalwassuccessfullyaccomplishedinFY2000,thisgoalshouldbeeliminatedinfutureperformancereporting.TheNoticeofIntentwasthemethodforpreservingtherightsofindividualsundertheActincasefundswerenotappropriatedinsufficienttimetoallowforareasonableprocessforfilingpetitionswithinthestatutorydeadline.Nowthatfundshavebeenappropriated,theRickyRayProgramOfficedevelopedanapplicationandpaymentprocesswhichrequiredaformalpetition.ThisprocesssupercedestheNoticeofIntentprocess.Therefore,asofMay31,2000,thedateofpublicationoftheinterimfinalregulationsintheFederalRegister,theNoticeofIntentprocessterminated.Inaddition,thereisnoneedtofileaNoticeofIntentpriortofilingapetition.#X*XXXHЁ #XHXXX* GoalIII.C.2:CompletetheDeterminationofaPetitionsCompliancewiththeActwithin120daysafterapetitionfiledwithRRHRPisdeterminedtobecomplete.Context:  H  PerformancestandardsaresetforthinSection103(d)oftheAct,whichrequirestheSecretary 4 todeterminewhetherapetitionisapprovedforpaymentnotlaterthan120daysafterthedatethepetitionisfiled.RRHRPreceivedmorethan5,200petitionswithinashorttimeoftheJuly31,2000effectivedateoftheregulation.RRHRPisimplementingthisprovisionbasedonthedateitdeterminesthatapetitioniscompletewithallinformationanddocumentation,asspecifiedintheProgramregulations.    Performance :  HRSAhasdevelopedregulationstodeterminethecontentandformatofafullpetition,thepoliciesandproceduresforsubmittingafullpetitionandthemethodforprioritizingpayments,asrequired.RRHRP acceptedpetitionsthatarepostmarkedbetweenJuly31,2000,(the p effectivedateoftheregulations)andNovember13,2001.Timely,efficientreviewofpetitionsandprocessingapprovedpetitionsforpaymentaretheprimaryobjectivesoftheRRHRP.InFY2001,theproposedtargetwas100%.TheactualperformancemeasureforFY2001was95%ofthecompletedpetitionshadadeterminationwithin120daysofwhethertheymettherequirementsoftheprogram.Thereasonforthe5%discrepancywasthat,duringthisperiod,therewere21continuingresolutionswhichappropriatedinsufficientfundstopayallpetitionswithin120days.  (#' GoalIII.C.3: SubjecttoAvailabilityofSufficientFunds,ProcessPaymentof90Percent  ofPetitionerPaymentAwardswithin30CalendarDaysafterreceiptofapprovedpetitionerspaymentinformation.    Context:  d  HRSAhasdevelopedregulationscontainingthepoliciesandproceduresforsubmittingafull P  petitionandthemethodforprioritizingpayments.RRHRPwillacceptpetitionsthatarepostmarkedbetweenJuly31,2000,(theeffectivedateoftheregulations)andNovember13,2001.HRSA,inconjunctionwithaDepartmentcontractor,willrevieweachpetitionandsupportingmedicalandlegaldocumentationandmakedeterminationsregardingwhichpetitionsareapprovedforcompassionatepayment.Subjecttotheavailabilityofappropriatedfunds,HRSAwillprocessawardpaymentonapprovedpetitionsforcompassionatepayment.Timely,efficientreviewofpetitionsandprocessingapprovedpetitionsforpaymentaretheprimaryobjectivesoftheRRHRP.Promptpaymentofpetitionerpaymentawardscontributesmateriallytoitssuccess. Performance:  t TheBHPrisprocessingpaymentof100percentofapprovedpaymentawardswithin30daysafterreceiptofpetitioner'spaymentinformation.Thestandardwas,inpart,basedonrequirementsofthePromptPaymentActandcustomarybusinesspracticesintheprivatesector,withemphasismadeonensuringstrictstandardstosatisfytheoftenurgentneedsofthebeneficiariesofthisprogram.#X*XXXH # ` _00  L  XHXXX*0@BXXH  OFFICEOFSPECIALPROGRAMS#XHXB0@% #OZ_DOXXH   D    #XHXDOOZ_ #FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   ۦ TheOfficeofSpecialPrograms(_00OSP_00)in_00HRSA_00ԀisresponsiblefortwoprogramactivitiesintheDivisionofTransplantationinvolvingthetransplantationoforgans,tissues,andbonemarrowtotreatthosewithlifethreateningdiseases.ItisalsoresponsiblefortheStatePlanningGrantProgramandtheVaccineInjuryCompensationProgram.Inthe10yearperiodbetween1990and2000,thetotalnumberoforgantransplantsincreasedby53%.Thenumberoftransplantcandidates,however,hasrisensubstantiallyfasterthanthenumberofdonors.In2000therewere5,984donors,a2.4%increasefromthe5,843donorsin1999.Bycontrast,thewaitinglistcontained79,500patientsattheendofDecember,2001comparedto73,951atyearsendin2000.Thisrepresentsa7.5%increase,andthegapbetweensupplyanddemandfororganscontinuestowiden.Asaconsequence,thenumberofwaitinglistdeathscontinuestoexceed6,089peopleperyear.The_00HRSA_00Ԁ_00OSP_00ԀtransplantationprogramsareauthorizedbytheNationalOrganTransplantActof1984,asamended;andtheNationalBoneMarrowRegistry_00Reauthorization_00ԀActof1998.Takentogether,theseprogramsreflectthe_00HRSA_00/_00OSP_00smajorstrategicorgan/tissueandmarrowtransplantationgoalsofincreasingthenumbersoforgandonorsnationally,increasingthenumberofminorityorgandonorsnationally,increasingthenumberofunrelatedpatientsreceivingmarrowtransplantsnationally,increasingthenumberofunrelatedmarrowdonorsnationally,increasingthenumberofminoritypatientsreceivingmarrowtransplantsnationally,andincreasingthenumberofunrelatedminoritydonorsnationally.#X*XXXH #XHXXX* > Programsincludedinthissectionare:2.270 S OrganProcurementandTransplantationS!#S!# 2.280 S NationalBoneMarrowDonorProgramS!#S!# 2.290 S StatePlanningGrantProgramv S!#S!# 2.300 S VaccineInjuryCompensationProgramb!S!#S!# 2.31 S HospitalInfrastructure(Laboratories,InfectionControl,andDecontamination)  N"     FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  ) 2.27ProgramTitle:OrganProcurementandTransplantation *(<)dd dd Sdd S4dd 4dd %<&!#!#, dd ,Pdd ,dd ,dd +  / ` /PerformanceGoals A,!" ATargets A,!" AActualPerformance A,! " AReference F1& "   F&&%%XXHI.ELIMINATEBARRIERS 0   ЀTOCAREC.FocusonTargetPopulation 1.Increaseby5%peryearthe    numberoforgandonorsnationally. (CurrentGoal)  h  1.Increaseby20%overtwoyearsthenumberoforgandonorsnationallyfromimplementationofthefinal_00HCFA_00ԀRuleonConditionsofParticipationofHospitals. (PreviousGoal)  (x  6,!( 6 FY03:6,927    FY02:6,597     FY01: 6,283 h  FY00:6,589FY99:5,990 '# 'FY01:(5/02)FY00:5,984FY99:5,812FY98:5,802 'x/ ' B> 241> > 130> NEWFY00DATA#XHX%%&&{ # 2@ 6" 2&&%%XXHII.ELIMINATEHEALTH D7 DISPARITIESB.IncreaseUtilizationfor_00Underserved_00ԀPopulations 1.Increaseby5%peryearthe ; numberofminorityorgandonors  |<  nationally. (CurrentGoal)  T= 1.Increaseby20%overtwoyearsthenumberofminorityorgandonorsnationallyfromimplementationofthefinal_00HCFA_00RuleonConditionsofParticipationofHospitals. (PreviousGoal) 6,!%h E 6FY03:1,657FY02:1,578FY01:1,503FY00:1,638FY99:1,489 '!P ' FY02:(5/03)FY01:(5/02)FY00:1,417FY99:1,402FY98:1,378 '<$^ ' B? 241? ? 130? NEWFY00DATA 2Te" 2TotalFunding:OrganProcurementandTransplantation ($in000s) 6,!)`$i 6 FY2003:$24,990 &!j FY2002:$19,990FY2001:$14,992FY2000:$10,000FY1999:$9,997FY1998:$2,778 +!*&o + Bx:page#budget &!p HP:HealthyPeoplegoal #XHX%%&&H #%`'"q   % @  @`  +'q  2.27.1ProgramDescription,ContextandSummaryofPerformance  ProgramDescriptionandContext:   The_00HRSA_00/OfficeofSpecialProgram(_00OSP_00)organprocurementandtransplantationprograms t areauthorizedbytheNationalOrganTransplantActof1984,asamended.TheDivisionofTransplantations(_00DoT_00)principalresponsibilitiesincludethemanagementoftheOrganProcurementandTransplantationNetwork(_00OPTN_00),ScientificRegistryofTransplantRecipients(_00SRTR_00),NationalMarrowDonorProgram(_00NMDP_00)contracts,publicandprofessionaleducation,technicalassistancetoorganprocurementorganizations_00OPOs_00,administrationofthe ModelInterventionstoIncreaseOrganandTissueDonationgrantprogram.Fororganprocurement  andtransplantationdata,_00OSP_00/_00DoT_00ԀisdependentupontheUnitedNetworkfor  8  OrganSharing(_00UNOS_00)whichholdstheFederal_00OPTN_00Ԁcontract._00UNOS_00Ԁcontinuallyverifiesandupdatesthisdataandprovidesittothe_00SRTR_00Ԁcontractor(UniversityRenalResearchandEducationAssociation)toperformdataanalysisandpublishanannualreportontransplantationactivities.The2000Annualreportcontainsdatafrom1990to1999inclusive._00DoT_00sactivitiessupporttheU.S.DepartmentofHealthandHumanServices(_00HHS_00)effortstoincreaseorganandtissuedonation.Theseactivities,whichhavebeenconductedinearnestsinceDecember1997,wererevitalizedbyincoming_00HHS_00ԀSecretaryTommyG.Thompsontoincorporateseveralnewinitiativesaimedatgarneringahigherlevelofpubliccommitmenttodonation.The$5millionincreaseintheFY2003_00DoT_00Ԁbudgetwillfundtheseefforts.MostprominentamongthesenewprogramsistheWorkplacePartnershipforLifeinitiative L involvingacollaborationwithcompaniesandemployeegroupsofallsizestomakeinformationonorgan,tissue,stemcell/marrow,andblooddonationavailabletoallemployees.Thisinitiative,launchedonApril17,2001bySecretaryThompsonandrepresentativesof10ofthenationsmajorcorporations,isintendedtoreachemployeesintheirworkplacesandencouragethemtobe_00proactive_00Ԁinmakingpublictheirdonationintentions.Integraltomakingpublicourdonationintentionsishavinganeffectivemechanismandanopportunitytodoso.In2001,_00HHS_00Ԁunveiledanewmodeldonorcardthatincludesprovisionsfordesignatingwhetherallorgansandtissuesmaybedonated,aswellaslinesforsignaturesbytwowitnesses.Thedonorcardisthemostfamiliar,easiest,andmostbasicwaytosharedonationintentionswithfamiliesandlovedones.However,experiencehasshownthatdonorcardsarerarelyavailableandaccessibletohospitalsandprocurementorganizationsatthetimeadeathoccurs.Forthisreason,strengtheningthesystembywhichindividualsmayregistertheirdonationintentionswhenapplyingfor,orrenewing,adriverslicenseisemergingasacriticalcomponenttoincreasingthenumberoforgandonors._00DoT_00Ԁwillsponsoraworkshopintendedtodevelopa modeldonorregistryandassesstheadvantagesanddisadvantagesofstatevs.nationalregistriesbeforetheendof2001._00DoT_00Ԁisexpandingits ModelInterventionstoIncreaseOrganandTissueDonationgrantprogramtopotentiallyincludeanadditional1520projectsintendedtolearnmoreaboutwhat l+&* _00workstoincreasedonation.TheDoTgrantprogramprovidesfundstoconsortiaoforganizationswithexpertiseinorganprocurementandsocialandbehavioralresearchtoimplementandevaluateprogramsaimedatincreasingsupportof,andcommitmentto,donation.Theinterventionsaretargetedtowardbothhealthcareprofessionalsandthepublic.WorkingwithHHS,DoTispartneringwithanarrayoforganizationsacrosstheU.S.buildingonmorethanadecadeofexperiencegainedfromgovernment,private,andvolunteereffortstoincreasedonation.#X*XXXH #XHXXX* 2.27.2GoalbyGoalPresentationofPerformance   L   GoalI.C.1:Increaseby5%peryearthenumberoforgandonorsnationally.(New $  Measure)GoalI.C.1Increaseby20%overtwoyearsthenumberoforgandonorsnationally.(Measuretobedeleted)Context:  p Previously,HHSsetagoalofa20%increaseinorgandonationinthetwoyearsfollowingtheAugust1998issuanceofCMSsrevisedruleonHospitalConditionsofParticipationfororgan,tissue,andeyedonation.Whilethenumberofdonorsin1998increasedbynearly6%over1997,thisrateofimprovementwasnotmaintainedinensuingyears.Cadavericdonationin1999increasedbyonly0.8%butin2000reboundedto2.4%.In1999thegoalsforannualdonationincreaseswerereassessedbasedonhistoricaldataandweredecreasedfrom10%to5%.Atthepresenttimeitappearsprudenttomaintainthistarget.ItisbelievedthatongoingimprovementsinimplementingCMSsConditionsofParticiptionforOrgan,Tissue,andEyedonation(CoP)andanincreasingnumberofdonationeducationactivitiesthroughoutthecountrywillenableattainmentofthisgoal.PriortothepublicationoftheCMSRule,donationhadbeenflatforseveralyears.Inthefirstpartialyearafterpublication,donationincreasedbyabout5%.WiththecombinedeffectoftheRuleandvariousnationalandlocaldonationinterventions,itisreasonabletostrivetowardsanannual5%increaseindonation.Indicator:NumberandpercentchangeoforgandonorsnationallyfromimplementationofthefinalCMSRuleonHospitalConditionsofparticipationforOrgan,Tissue,andEyeDonation. Performance:  %0!$ Asperthediscussionabove,theoriginaltargetforFY2000wasnotreached.ThetargetforFY2001reflectsamorerealisticgoalofa5%increase.Moreeffectivemethodsforreachingthecommunityarebeingdevelopedthroughtheorgandonationgrantprogram. h+&* TrendData:Therewere5,984cadavericdonorsfor2000comparedwith5,849in1999and5,801in1998.#X*XXXH #XHXXX*During2001,thenumberofpatientsonthenationalwaitinglistfororgansincreasedfrom t 73,951to79,500.Between1991and2001,thewaitinglistincreased222%.Althoughtherateofincreaseinpatientswaitingwasslowerin2001,itneverthelesscontinuestooutpaceincreasesincadavericdonation. GoalII.B.1:Increaseby5%peryearthenumberofminorityorgandonorsnationally.  L  (NewMeasure)   8   GoalII.B.1:Increaseby20%overtwoyearsthenumberofminorityorgandonors $  nationally . (MeasuretobeDeleted)     Context:    JustasimplementationoftheCMSRuleandtargeteddonationeducationinterventionsareexpectedtoleadtoa5%overallincreaseindonation,theyalsoareexpectedtoleadtoa5%increaseinminoritydonation.Basedondatafor2000,itappearsthatreachingthatgoalwillbeagreaterchallengeforminoritydonationthanforoveralldonation.Expandedpublicinformationandeducationeffortsmayberequired.Tothatend,11ofthe23projectsfundedthroughHRSADoTsgrantprogram, ModelInterventionstoIncreaseDonation,areintendedtoraisedonationratesinAfricanAmerican,Hispanic,Asian,andNativeAmericancommunities.Inaddition,DoTiscollaboratingwithHRSAsBureauofPrimaryHealthCareandtheNationalAssociationofCommunityHealthCenterstopromotedonationawarenessamongitsmultiethnicclientbase.#X*XXXH0 #XHXXX*  Indicator:Changeinannualnumberandpercentofminorityorgandonors. Performance:  p Asperthediscussionabove,theoriginaltargetforFY2000wasnotreached.ThetargetforFY2001reflectsamorerealisticgoal#X*XXXHt #XHXXX*.Moreeffectivemethodsforreachingtheminority H! communitiesarebeingdevelopedthroughtheorgandonationgrantprogram. S TrendData:  $\"  S  S FY1999ActualPerformance: S 638Blackdonors S 610Hispanicdonors S 107Asiandonors S 47Otherdonors )$( Ѐ1,402totalMinorityDonors(excludingunknowns),24%numberofminoritydonorsas%oftotaldonors,+.3%changefrom1998to1999. l+&*  S  S FY2000ActualPerformance:   S 675Blackdonors S 600Hispanicdonors S 110Asiandonors̀ S 32Otherdonors 8  Ѐ1,417TotalMinorityDonors(excludingunknowns),24.6%numberofminoritydonorsπas%oftotaldonors,+.6%changefrom1999to2000. DataIssues   8  Dataforperformancegoalswereobtainedfromthefollowingsources:1999AnnualReportbyUNOS,fundedinpartbyHHS   Unpublisheddata,UnitedNetworkforOrganSharing,May,20002000AnnualReportbyUNOS,fundedinpartbyHHS._00  p #X*XXXH #XHXXX*  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  5 2.28ProgramTitle:NationalBoneMarrowDonorProgram   *+</dd dd Pdd Pdd dd (<)!#!#, dd ,dd ,Udd ,dd +  0 ` d0 PerformanceGoals M8'"d dM Targets M8'"d dM Actual  Performance M8' "d dM Reference N9' "d ddN&&%%XXH I.ELIMINATEBARRIERS 0   TOCARE   X   C.FocusonTargetPopulation  0   1.Increaseby5%thenumberof    unrelatedbonemarrowdonors(nationalregistryofpotentialdonors)overpreviousyeartotals.  @   4*(l dd 4FY03:4.67m.donorsFY02:4.45FY01:4.24  @  FY01:(3/02)FY00:4.15m.donors  $ B@ 245@ 0  X& dd0 II.ELIMINATEHEALTH 4' DISPARITIES   \(  B.IncreaseUtilizationfor 4) _00Underserved_00ԀPopulations   * 1.Increaseby10%thenumberofunrelatedminoritybonemarrowdonors(nationalregistryofpotentialdonors)overpreviousyeartotals. 4*(D/dd 4FY03:1.30m.donorsFY02:1.18FY01:1.07FY00:1.00FY99:.90  l7 FY01:(3/02)FY00:1.04m.donorsFY99:.92FY98:.80  A BA 245A 0 4D dd0 TotalFunding:NationalBone 8E MarrowDonorProgram ($in000's) 4*(8Gdd 4FY03:$22,087FY02:$22,047FY01:$22,005FY00:$18,000FY99:$17,994FY98:$15,270  p!M Bx:page#budgetHP:HealthyPeoplegoal  Q #XHX%%&& # 8R   * Atotalof393,040newdonorswererecruitedinFY2000,ofwhom125,544werefrom x"R minoritypopulations. #X*XXXH #XHXXX*2.28.1ProgramDescription,Context,andSummaryofPerformance  @% U  ProgramDescriptionandContext:  'h"W TheNationalMarrowDonorProgrammaintainsandoperatesthenationalregistryofvolunteerswillingtodonatebonemarrowtopeoplewithleukemiaandotherlifethreateningbloodbaseddiseaseswhoneedabonemarrowtransplant,butlackarelativewithamatchingtissuetype.Throughtheprogram,volunteerdonorsarerecruitedandtissuetyped,thenationalregistryofpotentialdonorsismaintained,computerizedsearchesareconductedforpatients,marrowis +'\ collectedfromunrelateddonors,marrowisprovidedfortransplant,andascientificregistryoftransplantoutcomesismaintained.Adirectoryoftransplantcenters,includingananalysisofcenterspecifictransplantoutcomes,ispublished.Theprogramprovidesinformationandcasemanagementservicesforpatientsandtheirfamilies,publicandprofessionaleducationalmaterials,andresourcesfortransplantcenterstoconductsuccessfulsearchesforunrelatedmatcheddonors.Researchtoimprovethenumberandeffectivenessofstemcelltransplantsusingunrelateddonorsisconductedandsupportedbytheprogram.   k    8  Unrelatedtransplantsarenowperformedusingumbilicalcordbloodobtainedatbirthandperipheralbloodstemcellsderivedthroughtheprocessofapheresis,aswellasbonemarrow.Therehavealsobeenmanyimprovementsin_00HLA_00-typing,movingtowardmoreaccurateDNA-basedmethods,andinprocedurestoreduceGraftversusHostDisease(_00GVHD_00).AsoftheendofFY2000,the_00NMDP_00ԀRegistrywasmade-upofmorethan4.15 millionpotential   volunteerdonorsandtheProgramhadfacilitated11,700transplants(over1,700inFY2000).The_00NMDP_00'sprimarygoalcontinuestobetoprovidethebestpossiblesourceof_00hematopoietic_00stemcellsfromunrelateddonorsforpatientswhocouldnototherwisereceiveatransplant.Manydiseasesmaybepotentiallycuredwithstemcelltransplantation.Asstemcelltransplantationismorewidelyusedasatherapy,andasevidenceofitssuccessasatherapyaccumulates,itwilllikelybedevelopedasaneffectivetreatmentforadditionalconditions. 2.28.2GoalbyGoalPresentationofPerformance   p   S GoalI.C.1:Increaseby5%thenumberofpotentialunrelatedbonemarrowdonors(nationalregistryofpotentialdonors)overpreviousyeartotals.  4  Context:    Themissionofthe_00NMDP_00Ԁistoprovidestemcellsfortransplantsfromcompatibleunrelateddonorsforpatientsfromallracialandethnicgroups.Inorderfortransplantationtosucceedpotentialdonorsmustmatchpatientssearchingforadonor.ThelikelihoodofapotentialdonormatchingasearchingpatientincreasesasthenumberofpotentialdonorsavailableontheRegistryincreases. Performance: 0"   Thenumberofpotentialdonorshasbeenincreasingbyatleast8%duringeachofthelast3 #l! years,butthisincreaseisexpectedtoleveloffascostsoftissuetypingnewpotentialdonorsincrease(duetopolicychangesimprovingthescopeandaccuracyoftypingatrecruitment)andgreateremphasisisplacedonretentionofregisteredpotentialdonors.Indicator:Numberandpercentchangeinthenumberofpotentialunrelatedbonemarrow &"% donors(onthenationalregistry).Baseline:2.4millionpotentialbonemarrowdonorsontheRegistryattheendofFY96.BaselineisbasedonactualnumberofpotentialbonemarrowdonorsonthenationalRegistryattheendofFY96,ratherthantheendofcalendaryear1996. h+&* FY1998:3.36millionFY1999:3.76millionpotentialunrelatedbonemarrowdonors(increaseof398,203potentialbonemarrowdonorsinFY99,an11.9%increaseinthenumberofpotentialunrelatedbonemarrowdonorsonthenationalregistrycomparedtoFY98).FY2000:4.15millionpotentialunrelatedbonemarrowdonors(increaseof393,040or10.5%overFY1999).ThecumulativenumberofunrelatedstemcelltransplantsattheendofFY2000,facilitatedbytheRegistry,was11,710,anincreaseof15.3%overFY99.Thenumberoftransplantsisdirectlyrelatedtotheavailabilityofacompatibledonor. ,   FY00Goal:4.04millionpotentialdonors(revisedbasedonimproveddatabaseof3.76millionpotentialdonorsforFY99anda7.5%increaseforFY00).FY01Goal:4.24millionpotentialdonors*(Basedonimproveddatabaseof3.76millionpotentialdonorsattheendofFY99,aprojectedincreaseto4.04millionpotentialdonorsforFY00,anda5%increaseforFY01).FY02Goal:4.45millionpotentialdonors(Basedonanimproveddatabaseof4.04millionpotentialdonorsattheendofFY01anda5%increaseforFY02).FY03Goal:4.67millionpotentialdonors(Basedonanimproveddatabaseof4.45millionpotentialdonorsattheendofFY02anda5%increaseforFY03). S GoalII.B.1:Increaseby10%thenumberofpotentialminoritydonorsofunrelatedbone H marrow(nationalregistryofpotentialdonors)overpreviousyeartotals.  4  Context:    Themissionofthe_00NMDP_00Ԁistoprovidestemcellsfortransplantsfromcompatibleunrelateddonorsforpatientsfromallracialandethnicgroups.Inorderfortransplantationtosucceedpotentialdonorsmustmatchpatientssearchingforacompatibledonor.Thelikelihoodofapotentialdonormatchingasearchingpatientincreasesasthenumberofpotentialdonorsofthesamerace/ethnicityontheRegistryincreases.StatutorylanguagenotesthataprimaryfunctionoftheRegistryisto increasetherepresentationofindividualsfromracialandethnicminoritygroupsinthepoolofpotentialdonorsfortheRegistryinordertoenableanindividualinaminoritygroup,totheextentpracticable,tohaveacomparablechanceoffindingasuitableunrelateddonoraswouldanindividualnotinaminoritygroup.Thenumberofpotentialminoritydonorshasbeenincreasingbyatleast10%duringthelast3years,inpartbecauseoftargetedrecruitmentefforts.Special_00NMDP_00Ԁeffortstoincreasetransplantsofminoritypatientsandrecruitmentofminorityvolunteersincludethefollowing:L 023456789Gxx23456789L 23   23 2G3  0 S   FundingaspecialAfricanAmericanInitiativetohireandtrainrecruitersdedicatedto |*%) AfricanAmericanrecruitmentineachoffourdonorcenters.Anadditionaloutreach h+&* _00coordinatorwillsupportnationaloutreacheffortsintheAfricanAmericancommunitybycontactingandworkingwithorganizationsatthenationalandlocallevels.23  ݌ S!#S!# Ќ   23   23# 2G3  0 S   Recruitmentmaterials,consentformsanddonoreducationmaterialstranslatedinto  Spanish,Japanese,Chinese,VietnameseandKorean.23# N ݌ S!#S!# Ќ   23   23h 2G3  0 S   ParticipationintheSecretarysnewdonationcampaign,whichincludesrecruiting ` marrowdonorswithafocusontheneedforminoritydonors.Already17corporationsandtheUAWhavesignedontopromoteorgan,tissue,andmarrowdonationtotheiremployeesandmembersaspartofthe WorkplacePartnershipforLife.23h  ݌ S!#S!# Ќ   23   23p 2G3  0 S   Maintainingacontinuingrelationshipwithnational,regionalandlocalminorityfocused  ` organizations,e.g.NAACP,CongressofNationalBlackChurches,NationalCongressofAmericanIndians,NationalCoalitionofHispanicandHumanServicesOrganizations,AsianJournalistsAssociation.23p  ݌ S!#S!# Ќ  Indicator:Numberandpercentchangeofpotentialminoritydonorsofunrelatedbonemarrowdonors(NationalRegistryofpotentialdonors)nationally. Performance:  p Baseline:526,000potentialminoritybonemarrowdonorsonRegistryatendofFY96;increasingto1.04millionbytheendofFY2000. c    H FY98.Acumulativetotalof1,290minoritypatientsreceivedstemcelltransplantsfacilitatedbythenationalregistrybytheendofFY99,anincreaseof21.13%overFY98.Thenumberoftransplantsisdirectlyrelatedtotheabilitytofindacompatibledonorwhoisavailablefortransplant.#X*XXXH #XHXXX*FY99:924,000potentialminoritybonemarrowdonorsonRegistryattheendofFY99;115,000 4 potentialminoritybonemarrowdonorsrecruitedtoRegistryinFY99,anincreaseof14.2%over #X*XXXH  #FY00:1.04millionpotentialminoritybonemarrowdonorsonRegistryatendofFY00;126,000   potentialminoritybonemarrowdonorsrecruitedinFY00,anincreaseof13.6%overFY99.Acumulativetotalof1,664minoritypatientsreceivedstemcelltransplantsfacilitatedbythenationalregistrybytheendofFY00,anincreaseof29%overFY99. DataIssues  X  DataforperformancegoalswereobtainedfromtheNationalMarrowDonorProgram.DataareprovidedtoHRSA/DivisionofTransplantationmonthly.Thedataarecollectedonacomputerizedsystemthatcontainsinformationconcerningpotentialdonors,tissuetypingresults,potentialrecipientssearchingforacompatibledonor,andtransplantoutcomes.Thesedataarerevisedcontinuouslyasupdatedinformationbecomesavailable.Nationaldataareverifiedmonthlybydonorcentersandtransplantcenters.HRSA/DoTreviewsreportsandstatisticsasdotheBoardofDirectorsoftheNMDPandthevariousNMDPcommittees._00  (#'  XHXXX*  FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  v 2.29ProgramTitle:StatePlanningGrantProgram   *0<2dd dd dd Udd Udd +</!#!#, dd , dd ,dd ,dd +  /X ` /PerformanceGoals AX,!"X ATargets AX,!"X AActual  Performance AX,! "X AReference =(& "  X =&&%%XXH I.ELIMINATEBARRIERS 0   TOCAREA.IncreaseUtilizationfor_00Underserved_00ԀPopulations     1.IncreasethenumberofStatesparticipatingintheStateplanninggranteffortfocusedonaddressingtheproblemoftheuninsured.#&M'%%%&&W #&&%%'%&M $@  $FY03:NAFY02:30StatesFY01:20StatesFY00:11States#&M'%%%&&8 #&&%%'%&M h     FY02:(6/02)FY01:20StatesFY00:11States#&M'%%%&& #&&%%'%&M h $   @ % BB 247B   NEW  * FY01DATA #&M'%%%&&! # @ , ! &&%%'%&M#XHX%%&& # )h -" )&&%%XXH TotalFunding:State 4. PlanningGrantProgram   \/ ($in000's) $40 $FY2003:$0FY2002:$15,186FY2001:#&M'%%%&&`" #&&%%'%&M$15,135 43 FY2000:$14,996FY1999:!  l6 Bx:page#budgetHP:HealthyPeoplegoal#XHX%%&&" #49   #X*XXXH# #XHXXX* #X*XXXH$ #2.29.1ProgramDescription,ContextandSummaryofPerformance `:  TheStatePlanningGrantProgram,whichhasagoalofimprovingaccessfortheuninsured,provided$15millioninFY2000fundsto11Statesfordevelopingdesignsforprovidingaccesstohealthinsurancecoverage.Fundswereusedtoconductindepthsurveysandotheractivitiesnecessarytodeterminingthemosteffectivemethodsofprovidinginsurancecoveragefortheuninsured.InFY2001,anadditional$15millionwasappropriatedfortheStateplanningprogramtofundanadditional9States.TheprogramwascontinuedatthissamelevelinFY2002.Inaddition,fundswillbeusedtoprovidesupplementalgrantstoupto20Statesawardedgrantsin2000and2001tocompletethedatacollectionandanalysisactivitiesthattheyhavelaidout.Planninggrantswillbeawardedto10additionalStates.TheStateswillsubmitreportstotheSecretarythatidentifythecharacteristicsoftheuninsuredwithintheStateandapproachesforprovidingthemwithhealthcoveragethroughanexpandedstate,Federalandprivatepartnership.NofundingisrequestedinFY2003.  S  +4'M _002.29.2GoalbyGoalPresentationofPerformance    Context:   WhiletheStateChildrensHealthInsuranceProgramoffersnewopportunitiesforuninsuredchildren,alargenumberofadults,roughly32million,areuninsured,andoftheseabout17millionhaveincomesbelow200percentoftheFederalPovertyLevel.Theburdenofcareforthelowincomeuninsuredfallsdisproportionatelyonsafetynetproviders.Atthesametime,theseprovidershavehadtoadjusttotherapidgrowthofmanagedcareinbothprivateandpublicinsuranceprograms.ApproachesforimprovinghealthservicesfortheuninsuredhavebeendevelopedinanumberofStatesandcommunities.Whiletheydifferinscopeanddesign,theysharethecommonthemesofexpandingaccesstoacomprehensiverangeofservices,shiftingthefocusofcaretomoreefficientsettingsandemphasizingprimarycare,andbuildingintegratednetworksofproviders. Performance:    InFY2000,thefirstyearoftheprogram,fundssupported11Statesfordevelopingdesignsforprovidingaccesstohealthinsurancecoverage.InFY2001,fundingwasprovidedtoanadditional9Statestoinitiateactivity. GoalI.A.1.:IncreasethenumberofStatesparticipatingintheStateplanninggranteffort  \ focusedonaddressingtheproblemoftheuninsured. AsubstantialproportionofthefundingprovidedforFY2002wouldbemadeavailableto   furtherdeveloptheworkofthe20StatesthatarecurrentlyparticipatingintheStateplanninggrantprogramtofocusondevelopingdesignsforincreasingaccesstohealthinsurancecoverage.Inaddition,upto10moreStatesmaybeselectedtoparticipateintheprogram.NoadditionalfundingisproposedforFY2003._00  X     FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  K1  2.30ProgramTitle:NationalVaccineInjuryCompensationProgram(_00VICP_00)   *3<4dd dd  dd  dd dd 0<2!#!#, dd ,dd ,dd ,dd +  /X ` /PerformanceGoals AX,!"X ATargets AX,!"X AActual  Performance AX,! "X AReference =(& "  X = III.ASSUREQUALITY 0   OFCARE   l   C.Improve  X  Customer/PatientSatisfaction  0  1.Processpaymentofannuitieswithin60calendardaysofreceiptofaDepartmentofJustice(_00DOJ_00)clearanceletter. $| $FY03:95%FY02:95%FY01:95%FY00:90%FY99:90%    FY01:96.3%FY00:100%FY99:96.0%FY98:92.6%  |& BC 319C NEW  X) FY01DATA )0 +" )2.Processpaymentoflumpsumawardswithin30calendardaysofreceiptofa_00DOJ_00Ԁclearanceletter. $/ $FY03:93%FY02:93%FY01:93%FY00:90%FY99:90%  4 FY01:96.2%FY00:96.7%FY99:90.9%FY98:93.8%  : BD 319D NEW $= FY01DATA  ?  )A" )3.Processpaymentofattorneyfeeswithin30calendardaysofreceiptofa_00DOJ_00Ԁclearanceletter. $E $FY03:95%FY02:95%FY01:95%FY00:90%FY99:90%  J FY01:97.2%FY00:97.9%FY99:96.9%FY98:96.6%   P BE 319E NEW ,S FY01DATA  U  ) V" ) TotalFunding:National  "pW VaccineInjuryCompensationProgram(_00VICP_00)  $4 Z ($in000's) $% ![ $FY2003:$88,909FY2002:$84,696FY2001:$80,595FY2000:$48,828FY1999:$155,889($100millionforpreFY1988claims)  (#c Bx:page#budgetHP:HealthyPeoplegoal #\e     +&g Ї2.30.1ProgramDescription,ContextandSummaryofPerformance    ProgramDescriptionandContext :  TheNationalChildhoodVaccineInjuryActof1986establishedthe_00VICP_00Ԁtoequitablyandexpeditiouslycompensateindividuals,orfamiliesofindividuals,whohavebeeninjuredbychildhoodvaccines.The_00VICP_00Ԁservestostabilizeaonceperilousvaccinesupplybysubstantiallyreducingthethreatofliabilityforvaccinecompanies,physicians,andotherhealthcareprofessionalswhoadministervaccines.AnindividualclaiminginjuryfromacoveredvaccinefilesapetitionforcompensationwiththeUnitedStatesCourtofFederalClaims(theCourt).A_00DHHS_00ԀphysicianreviewstheclaimtodeterminethatitmeetsthecriteriaforcompensationandmakesarecommendationtotheCourt.IftheSpecialMaster,appointedbytheChiefJudgeoftheCourt,issatisfiedthataninjuryfromacoveredvaccineiscompensable,the_00VICP_00ԀmakestheappropriatepaymentsbasedonthedecisionrenderedbytheCourt.Awardsarepaidoutofatrustfundfinancedthroughcollectionofanexcisetaxleviedoneachdoseofcoveredvaccineadministered.The_00VICP_00ԀisadministeredinclosecoordinationwiththeU.S.CourtofFederalClaimsandtheDepartmentofJustice,whoseattorneysrepresentthe_00VICP_00ԀduringtheproceedingsbeforetheSpecialMaster.TheninememberAdvisoryCommissiononChildhoodVaccinesmeetsquarterlytoadvisetheSecretaryonprogramstructureandimplementation. ProgramPerformance:  L The_00VICP_00Ԁhasbeenveryeffective.Sinceitwasimplementedin1986thenumberoflawsuitsalleging_00DTP_00Ԁvaccinerelatedinjurydroppedfrom255tojust4in1997.Wedonothavecompletedatafor1998or1999,butoneofthefourcompaniesproducingthevaccinereportsnolawsuitswerefiledduringcalendaryears1998and1999.FilingsforinvestigationalnewdrugexemptionsfornonAIDSvaccinesrosefrom17in1987to49in1997.̀ ProgramDataIssues: t  The_00VICP_00Ԁmaintainsahighlycontrolledinternaldatasystem,whichcontainsdetailedcase `  specificdatavaluesforthenearly5,000claimsfiled.Thiscontroldatasystemincludeslegal,epidemiological,medical,diagnostic,andpaymentinformation,andisusedforoftenhighlycomplexcrosslinkingdataanalysis.InformationcontainedinthesetableshavebeenreviewedandvalidatedbytheOfficeofInspectorGeneral(_00OIG_00),theGeneralAccountingOffice(GAO),theCongressionalBudgetOffice,andAgencyandDepartmentalindependentactuarialcontractors.InJanuary2001,adatabaseconversioninitiativewascompleted,whichincludedacomprehensivedataqualityandintegrityreview,eliminatingredundanciesandfinalizingacompleteintegrationofalldatatables.The_00OIG_00ԀconductedacomprehensiveProgramstudyin1992,andreleasedaveryfavorablereportonthemanagement,operations,andsuccessofthe_00VICP_00.ThisstudywaseventuallysubmittedtoCongresstosatisfyastatutoryreportingrequirement.TheGAOalsorecently p+&* _00completedandreleasedanoverallpositiveprogramreviewonDecember22,1999.ThisGAOstudycameattherequestoftheSenateCommitteeonHealth,Education,Labor,andPensions.Further,theGAOalsorecentlyreleasedaveryfavorablefollowupreviewofspecificfinancialcomponentsoftheprogrampursuanttoarequestbytheHouseWaysandMeansCommitteeandtheSenateFinanceCommittee.ThatreportwasreleasedonMarch31,2000. 2.30.2GoalbyGoalPresentationofPerformanceXX*  8   #X*XkL #GoalIII.C.1:Processpaymentofannuitieswithin60calendardaysofreceiptofa J  DepartmentofJustice(DOJ)clearanceletter.XX*  6    #X*X`M #Context:  H  Timely,efficientresolutionofclaimsisoneoftheprimaryobjectivesoftheVICPandpromptpaymentofannuitiescontributesmateriallytoitssuccess. Performance:  L Performancestandardswereconceptualized,developed,andimplementedfollowingcarefulconsiderationbyprogramofficials,andinpartnershipwiththeDepartmentofJustice,OfficeoftheGeneralCounsel,VICPPetitionersAttorneys,andtheAdvisoryCommissiononChildhoodVaccines.Standardswere,inpart,basedonrequirementsofthePromptPaymentActandcustomarybusinesspracticesintheprivatesector,withemphasismadeonensuringstrictstandardstosatisfytheoftenurgentneedsofthebeneficiariesoftheprogram.Additionally,theVICPnegotiatesandpurchasesannuitycontracts,andrequiresthemonitoringofmarketconditions,necessitatingapaymentsystemthatmirrors(andexceeds)theprivatesector. Claims \ arepaidinaexceptionallytimely,efficientmanner.InFY2001,96.3percentofXX*Ԁ#X*XQ #annuitieswere L processedwithin60calendardays.Theaveragepremiumpaymentof33.1daysexceedstheperformancestandardby44.8%. GoalIII.C.2:Processpaymentoflumpsumawardswithin30calendardaysofreceiptofa " r DOJclearanceletter . !^  Context:  ":  Timely,efficientresolutionofclaimsisoneoftheprimaryobjectivesoftheVICPandpromptpaymentoflumpsumscontributesmateriallytoitssuccess. Performance:  &!$  Lumpsumawardsarepaidinanexceptionallytimely,efficientmanner.InFY2001,96.2 '"% percent(exceedingthetargetof90percent)oflumpsumawardswereprocessedwithin30days.  r(#&  XHXXX*#X*XXXHJU #  &,v'* GoalIII.C.3:Processpaymentofattorneyfeeswithin30calendardaysofreceiptofaDOJclearanceletter.Context:  t Timely,efficientresolutionofclaimsisoneoftheprimaryobjectivesoftheVICPandpromptpaymentofattorneyfeescontributesmateriallytoprogramsuccess. Performance : $ t SeetheperformancestatementforIII.C.1.Paymentsforattorneysfeesweremadeinaverytimely,efficientmanner.InFY2001,97.2percentofpaymentsforattorneysfeeswereprocessedwithin30days,comparedwithatargetof90percent.XHXXX*   C!XXH_00 +'& #X #XHX!C/X #FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  2.31ProgramTitle:HospitalInfrastructure(LaboratoriesInfectionControl,andDecontamination)  t *s<tdd dd dd dd dd 3<4!#!#, dd , dd ,dd ,dd +  /X L  /PerformanceGoals AX,! "X ATargets AX,! "X AActual   Performance AX,!  "X AReference =(&  "  X = &&%%XXHIV.IMPROVEPUBLIC  l  HEALTHANDHEALTHCARESYSTEMSC.PromoteSystemsandInfrastructureDevelopment  |  1.Increasehospitallaboratorycapacitytodiagnoseandreportonbiologicalandchemicalagentspotentiallyusedinterroristattacks. (Developmental) #XHX%%&&7\ ##X*XXXHX #XHXXX* $ $&&%%XXHFY03:_00TBD_00   FY02:N/A#XHX%%&&^ #   #X*XXXH] #XHXXX*  h  #X*XXXH^ #XHXXX*  |& F B251F #X*XXXH2_ #XHXXX* ) +" )&&%%XXH2.Assisthospitalswiththe H, purchaseofpersonalprotectiveequipment,decontaminationfacilitiesandotherbiologicalandchemicaldecontaminationequipment. (Developmental) #XHX%%&&_ # $X2 $&&%%XXHFY03:_00TBD_00 H3 FY02:N/A#XHX%%&&"a #   4   H5 G B251#X*XXXH_ #XHXXX*G  H6 &&%%XXH3.Assurethatimplementation t7 effortsaretiedtoState/Territorial/municipalneedsassessmentsandplanpriorities (Developmental) $$; $FY03:59consistentplansFY02:N/A  L=   t> H XHX%%&&B251#&&%%XXH{c ##&M'%%%&&b #&&%%'%&MH  t? TotalFunding:Hospital D!@ Preparedness  "lA ($in000's) $"DB $FY2003:$283,000FY2002:N/A#&M'%%%&&c #&&%%'%&M  "DE Bx:page#budgetHP:HealthyPeopleGoal"DH   #&M'%%%&&d #&&%%'%&M #&M'%%%&&e # &M'%'%&M2.31.1ProgramDescription,ContextandSummaryofPerformance $$ I  #&M'%'% &Me #b&&%%'%&MAspartofthePresidentsHomelandSecurityinitiative,theHealthResourcesandServices &!K Administration(_00HRSA_00)isprovidingfundingtohealthdepartmentsofStatesandothereligibleentitiesforthedevelopmentofStatebasedbiological,chemicalandradiologicalterrorism(hereafterreferredtoas _00bioterrorism_00)preparednessplansforhospitalsandemergencymedicalservicessystems#&M'%%%b&&f #r&>F%'%&M.#&M'%F%r&>h #b&&%%'%&MԀThese  )\$N preparednessplanswillincludeaneedsassessmentofpreparednesstorespondtoa_00bioterrorist_00Ԁincidentandaplanofactioninresponsetotheidentifiedneeds.#&M'%%%b&&h # &M'%'%&MԀ#&M'%'% &Mj #b&&%%'%&M * &P  +&Q _00ThroughtheHospitalInfrastructure(Laboratories,InfectionControl,andDecontamination)Program#&M'%%%b&&Kj #b&&%%'%&M,  HRSAwillfundthoseexpensesfornecessaryinfrastructureimprovementsandexpansionssothathospitalswillbepreparedtorespondtobioterrorismacts.HospitalapplicationsforinfrastructureexpensesconsistentwiththeStatepreparednessplanswillbeapprovedandfundedinaccordancewithaprioritizationandfundingscheduledevelopedandapprovedbytheStateinwhichthehospitalislocated.#&M'%%%b&&)k #b&&%%'%&M 8 ̀AspartoftheStatehospitalinfratstructureprogramforbioterrorism,theLaborities,InfectionControlandDecontaminationprogramhasthreeobjectives.ThefirstobjectiveistoensureadequatehospitallaboratorycapacitythroughouttheU.S.todiagnoseandreportonpotentialbiologicalandchemicalagentsthatmightbeusedbyterrorists.Thesecondobjectiveistohelphospitalsimprovetheircapabilitiestocontrolinfectionwhiletreatingindividualswhohaveorareatriskforacommunicabledisease.Thethirdobjectiveistoassisthospitalswiththepurchaseofpersonalprotectiveequipment,decontaminationfacilitiesandotherequipmentfordecontaminationofbiologicalandchemicalagents.#&M'%%%b&&m #b&&%%'%&M   #&M'%%%b&&=p #&&%%'%&M̀ 2.31.2GoalbyGoalPresentationofPerformance  X  GoalIV.C.1.:#&M'%%%&&p #&&%%'%&MIncreasehospitallaboratorycapacitytodiagnoseandreportonbiologicaland   chemicalagentspotentiallyusedinterroristattacks. #&M'%%%&&>q # &M'%'%&M   Context:  D #&M'%'% &Mr #b&&%%'%&MFollowingtheappropriationofFY2003funds,healthdepartmentsofStatesandothereligibleentities l willsubmitapplicationsforhospitalinfrastructureexpensesinresponsetothatStatesidentifiedneed,#&M'%%%b&&r #b&&%%'%&MandconsistentwiththatStatesbioterrorismpreparednessplans.Wewillbeworkingwithother  agencies,particularlyCDC,todevelopaplanthatassurescoordinationofeffortsandtodevelopimproveddata.#&M'%%%b&&s # &M'%'%&M | #&M'%'% &Mt # &M'%'%&M Performance:  ,| SinceFY2003isthefirstyearofawardunderthisprogram,morespecificperformancemeasuresthatwouldassesstheprogressoftheStatesandthehospitalsystemswillcontinuetobedeveloped. #&M'%'% &MDu # &&%%'%&M #&M'%%%&&yv # &M'%'%&MGoalIV.C.2.:#&M'%'% &Mv #&&%%'%&MԀ#&M'%%%&&w #&&%%'%&MԀAssisthospitalswiththepurchaseofpersonalprotectiveequipment, d!" decontaminationfacilitiesandotherbiologicalandchemicaldecontaminationequipment.#&M'%%%&&Qw #&&%%'%&M <"#  #&M'%%%&&Dx # &M'%'%&MContext: #&M'%'% &Mx #&&%%'%&M #<% Stateswillidentifytheirlevelofneedforassistancewiththepurchaseofequipmentandthatfundingwillbeallocatedbasedontheprioritizedneed.   % '  #&M'%%%&&x #&&%%'%&M  !z #&M'%%%&&z # &M'%'%&MPerformance:  L'") SinceFY2003isthefirstyearofawardunderthisprogram,morespecificperformancemeasuresthatwouldassesstheprogressoftheStatesandthehospitalsystemswillcontinuetobedeveloped.#&M'%'% &Maz #i7'%&MC!7i  (L$+ #&&%%!C{ #XHX%%&&GoalIV.C.3AssurethatimplementationeffortsaretiedtoState/Territorial/municipal *8&- needsassessmentsandplanpriorities. +$'. ЇContext: UndertheHospitalPreparednessProgram , Territoriesandmunicipalitieswillbe  developingneedsassessmentsandimplementationplans.ItisessentialthatprojectssupportedunderthisHospitalInfrastructureprogramaresupportiveofthoseplans.Performance:SinceFY2003isthefirstyearofthisprogram,guidancewillbedevelopedwhichpromotesthisgoal.  P    RURALHEALTH   x~   FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   ~ ThechargetotheOfficeofRuralHealthPolicyfromCongressin1987wastoserveasaproponentforruralinterestsintheDepartmentshealthcarepolicyprocess.TheOfficehasaspecificlegislativemandatetoreviewCMSproposalsandregulations,tomaintainaninformationclearinghouseandtoprovideinformationonruralhealthactivitiesinotherfederalagencies.TheOfficeofRuralHealthPolicyistheonlyofficeintheDepartmentsolelyconcernedwithruralhealthcareneeds.ItisactiveincoordinatingruralhealthcareprogramsandpolicieswithinHRSA,withCMS,andwithmanyFederalagenciessuchastheU.S.DepartmentofAgricultureandtheDepartmentofHousingandUrbanDevelopment.TheOfficeiscurrentlyprovidingleadershipfortheSecretarysRuralTaskForce.Becausethechallengestoprovidingadequatecareinruralcommunitiesaremanifestationsofmanystructuralissuesinthenationalhealthcaresystem,theOfficehasbecomestrategicallyinvolvedinefforts,largeandsmall,tobringaboutnationalreforms.TheOfficeengagesinawidespectrumofactivity,fromresearchandpolicydevelopmenttoconstituencybuilding,todemonstrationgrantsfornewruralservicedeliverysystems.TheOfficeadministerssixgrantprogramsandprovidesgranteesandcontractorswithtechnicalassistancethroughworkshops,phoneconferences,sitevisitsandotherefforts.Tocultivatelocalsupportforruralhealthissues,theOfficehaspromotedextensivenetworkingamongruralhealthinterestswithinandamongtheStates.Thishasresultedinanationalinformationnetwork.TheOfficesupportsStateandregionalconferencesandlendsfinancialandtechnicalsupportfornewruralhealthinitiatives. Section413ofH.R.2498,passedonNovember13,2000andsignedintolawasP.L.106505,  authorizedtheSecretaryofHealthandHumanServices,actingthroughtheOfficeofRuralHealthPolicyinHRSA,toawardgrantstocommunitypartnershipsforpurchasingequipment(automatedexternaldevices/defibrillators)andfortrainingintheiruse.TheSecretaryisalsorequiredtoprepareareporttoCongressinfouryearscontainingdatarelatedtotheincreasedavailabilityofdefibrillatorsandtheirimpactonsurvivalrates.Theprogramwasauthorizedat$25,000,000forfiscalyears2001through2003.TheFY2001appropriationforHRSAdidnotincludeanappropriationforthisprogram.HowevertheconferencereportlanguagestatesthattheconferreesaresupportiveofHRSAprovidingdefibrillatorstoruralareas.Inresponsetothatreportlanguage,theOfficeofRuralHealthPolicybegananewinitiativedealingwiththeuseofAutomaticExternalDefibrillators(AEDs)inruralcommunitiesthroughtwoactivities:L 023456789Gxx023456789L 23   23 2G3  0 S   DevelopedanassessmentofStateEMSDirectorstoidentifytheneedandcurrent (#' availabilityofAEDsinruralcommunities.ThissurveywillprovidevaluablefeedbacktoCongressontheaccessibilityofAEDsinruralareasandwillprovideguidanceonstrategicplacementofAEDsinruralcommunities.23 ̊ ݌h+&*S!#S!# Ќ   23   23 2G3  0 S   FundedthreeAEDsdemonstrationprojects(Vermont,MaineandWisconsin)toexplore  possiblefundingavenuestocommunitiesfortrainingoffirstrespondersandAEDsequipmentandmaintenance.23 Ό ݌ S!#S!# Ќ  BothactivitiesweredesignedtohelptheOfficegatherthecriticalinformationitwouldneedshouldfundingbeprovidedfortheAEDsgrantprogram.Asaresultoftheseactivities,theOfficehasbeenabletoworkwiththeStateOfficesofRuralHealthandtheStateEMSdirectorstounderstandhowtostructureapotentialAEDsgrantprogramthatfocusesontheCongressionalintenttoplaceAEDsinruralcommunitiesandprovidetrainingonhowtousethedevices.TheFY2002Appropriationincludes$12.5millionforruralaccesstoemergencydevices.TheOfficeiswellpositionedtoquicklydevelopguidanceandreviewprocedurestoimplementthisgrantprogram.AswewillbeimplementingtheprograminFY02,performancemeasureswillbedeveloped.ORHPmayhaveaseparategoalforthisprograminthenextGPRAcycle.InFY2003,fourRuralHealthProgramcomponents#X*XXXH{ #XHXXX*Ԁarediscussed: p 2.32:RuralHealthOutreachandNetworkDevelopmentGrants2.33:RuralHealthPolicyDevelopment2.34:RuralHospitalFlexibilityGrants2.35:StateOfficesofRuralHealth_00  4   FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport     2.32ProgramTitle:RuralHealthOutreachGrants*9: dd dd  dd  dd dd s<t!#!#, dd,4dd,dd,dd+  A<<11V, t dAd?+  hp x (#X?d ?/+Q " PerformanceGoals L<<11V7"6<<11Vd dL ?/+H.` hp x (# XHdB.l` hp x (#XBd ?/+Q``&Targets L<<11V7"6<<11Vd dL ?/+H.` hp x (#l` XHdB.` hp x (#XBdQ777kActual ?/+QCC5kPerformance L<<1<V7"" <<11Vd dL ?/+H.` hp x (#` XHdE1` hp x (#XEd ?/+QRRB Reference d<<11VO-6    <<1<Vd d d&&%%XXH ?/+H.` hp x (#XHddI.EliminateBarrierstoCareA.IncreaseUtilizationfor_00Underserved_00ԀPopulations ?/+ 1. OutreachProgram:Develop   andoperatecollaborativemodelsofhealthcareservicesinruralareaswhichwillserve_00underserved_00Ԁpopulations. @<<11-"*z <<11Vd  @ ?/+ddFY03:668,000FY02:671,000FY01:764,000FY00:764,000FY99:680,000FY98:616,000  N   ?/+ numbersrepresent &  numberofpersonsserved peryear  "  6<<11##<<11 6 ?/+dd FY01:675,500FY00:694,800FY99:681,000 ?/+FY98:630,000 6<<1<#T/<<11 6 ?/+dd ?/+BI 257I NEWFY01DATA #XHX%%&& # Z<<11VE#J 5   <<1< d Z&&%%XXH ?/+dd IV.IMPROVEDPUBLIC 57 HEALTHANDHEALTHCARESYSTEMSC.PromoteSystemsandInfrastructureDevelopment ?/+ 1.RuralNetworkDevelopment m< Program:Improveruralhealthcareaccessbydevelopingverticallyintegratedprovidernetworksthatinvolveruralhealthproviders. @<<11-"UA<<11Vd  @ ?/+dd FY03:220providers mH FY02:198FY01:198FY00:270FY99:270  }L  ?/+ representsnumberof UM providersinnetworks 6<<11#-}N<<11 6 ?/+dd FY01:204FY00:186FY99:318 ?/+ 6<<1<#\<<11 6 ?/+ddӀ ?/+BJ 257J NEW b FY01DATA Z<<<1VE#vd   <<1< d Z ?/+ddTotalFunding:RuralHealthOutreachGrants̀($in000's)  "h  A< @<<<1-"q#i<<<1Vd  @ A<dd FY2003:$37,852  9k FY2002:$51,472*FY2001:$59,711 * "m  FY2000:$36,473 u#n FY1999:$30,401 A<FY1998:$22,863*approx.$20Mwasforπearmarkedprojects 6<<<1#'a"r<<<1 6 A<ddBx:page#budget A<HP:HealthyPeopleGoal 6<<<<#"v<<<1 6 A<dd A<#XHX%%&& #3)' 9x    <<<< 3 A< S  +&| 2.32.1.ProgramDescription,ContextandSummaryofPerformance    ProgramDescriptionandContext:   TheRuralHealthOutreachandNetworkDevelopmentGrantProgramwasauthorizedin t Section330AofthePublicHealthServiceActasamendedbytheHealthCareConsolidationActof1996,Ԁب PublicLaw104299.TheRuralHealthOutreachgrantprogramwasestablishedtofundprojectstodemonstratetheeffectivenessofoutreachtopopulationsinruralareasthatdonotnormallyseekhealthormentalhealthservices.Theauthorizinglegislationspecifiesthatthefundedprogramsaretobenewdemonstrationsthatwillenhancelinkages,integrationandcooperationamonghospitals,medicalgrouppractices,publichealthdepartmentsandotherlocalprimarycareproviders.Recognizingthevastdifferencesinruralareasandtheirresources,Congressexpectsawidevarietyofapplicantsandproposedprojects.RuralHealthOutreachgrantsprovideessentialhealthcareservicesdirectlytohundredsof   thousandsofAmericanslivinginruralareasofthecountry.Thegoalsoftheprogramaretoimproveaccesstocarein_00underserved_00Ԁruralareasthroughthedevelopmentofnewhealthcaredeliverysystemsthatcreateandsustaingreatercollaborationamongproviders.Thegrantsrequirehealthcareorganizationsandthecommunitiestheyservetodevelopandimplementaconsortiumwithatleastthreedifferentproviderstostrengthenexistinghealthcareservicesorbringnewservicestothecommunity.RuralNetworkDevelopmentgrantsaredesignedtosupportthedevelopmentofintegratedprovidernetworksinruralcommunities.Ruralhealthcareprovidersarefindingthattheycannotsurviveintoday'shealthcaremarketwithoutformingallianceswithotherproviders.Thisprogramsupportslocallyownednetworksofruralprovidersintheireffortstoimproveaccesstocareinruralcommunities,bettercoordinatelocalhealthcareservices,improvethequalityofcare,achieveeconomiesofscaleandhelpruralcommunitiesrespondtochangesinthehealthcaremarketplace.TheNetworkprogramiscreatedonthepremisethatlocalownershipandcontrolaremoreresponsivetocommunityneedsandmorelikelytoresultinsustainablesystems.Thediversenatureofthegrantprogramrequirescoordinationandpartnershipswithotherlocalcommunityorganizations.Anexampleofatypeofgrantconsortiummightinvolveahospital,localphysicians,apublichealthdepartmentandlongtermcareproviders.Underthisprogram,thefocusisondevelopingtheorganizationalstructureandcapabilitiesofruralnetworksratherthantheactualdeliveryofservices,whichisthefocusoftheRuralHealthOutreachgrantprogram. ProgramPerformance: &"%  TheOutreachandNetworkgrantprogramsaremeetingtheprogramgoalsoutlinedbyCongress. '#& ServicessupportedbytheOutreachgrantsincludeprimarycare,mentalhealth,dentalcare,healtheducationandpromotion,healthrelatedtransportation,specialtycare,schoolbasedclinicsandothers.Granteesincluderuralhospitals,clinics,publichealthagencies,charitableorganizations,educationalinstitutionsandothernonprofitorganizationslocatedinruralareasof h+&* thecountry.Targetpopulationsincluderuralminorities,theelderly,pregnantwomen,childrenandadolescents,andruralAmericanswithspecialneeds.Weestimatethatcloseto2.9millionruralAmericanshavebeenservedbytheprogramsinceitsinceptioninFY1991.Morethan60percentofthegranteesreportacontinuationoftheiractivitiesafterthethreeyearsoffederalsupportisterminated.Awardshavebeenmadein47StatesandfourTerritoriesandtheDistrictofColumbia.B.` hp x (#XBTwoOutreachgrantsupportedorganizations,oneinGeorgiaandoneinMontanawererecentlyacknowledgedfortheireffortstoimproveruralhealthcareintheUnitedStates.TheBrooksCounty,Ga.,ChildHealthNetworkreceivedtheGeorgiaHospitalAssociations2001CommunityLeadershipAward,giventocommunity-basedcollaborationsthatimprovelocalhealth.TheNetwork,ledbythe_00Quitman_00,Ga.-basedBrooksCountyHospital,increasedaccesstohealthservicesforschool-agechildrenbyplacingnursesinfournewschool-basedclinics.Withinsevenmonthsofopening,morethan12,000studentsweretreated.Physicalandoccupationaltherapyservicesarealsoavailable._00TENKIDS_00,basedin_00Bozeman_00,Mont.,earnedthe_00Drucker_00'sFoundationNonprofit InnovationoftheWeekhonorforJune20-28._00TENKIDS_00Ԁinstalledcomputersin116of121ambulanceservicestocreateavirtualemergencymedicalservicescommunityacrossMontana.ThiscomputernetworkenablesruralEMSvolunteerstoaccesstrainingdirectlyfromtheirhomesthroughtwo-wayinteractivevideo,CD-ROMinteractiveprogramsandtheWeb.Asaresult,volunteerambulancesquadsandEMSproviderscancommunicatewitheachotherandthestateEMSofficemoreefficiently.EMSprovidersnolongerfeelisolatedandcankeepabreastofcurrentmedicalissues,regulationchangesandequipmentrecalls.#X*XXXHˑ #XHXXX* 4     TheNetworkgrantprogram strengthensthe localorregionalhealthcaresysteminmanyways.   Examplesincludehelpingruralprovidersachieveeconomiesofscaleinpurchasingandrecruitingandretainingprovidersandcoordinatingcaretoreduceduplicationofservicesanddecreaseuncompensatedcare.Networkgranteesimprovethequalityofcarebyimplementingdiseasemanagementprogramsandcoordinatingpatienttransferandreferralacrossnetworkmembers.SinceFY1997,awardshavebeenmadetonetworksincommunitiesin33States. ProgramDataIssues:  0"    EachOutreachandNetworkgrantisuniquewithdifferentobjectives,services,providertypesandtargetpopulations.Moreover,thelegislativelydirectedlifeofeachgrantisthreeyears.Whilethesecharacteristicsimpedeevaluationefforts,_00ORHP_00Ԁcontinuestoworkatgatheringmeaningfuldataongrantees.DatafromtheOutreachGranteesissubmittedannuallythroughthegrantrenewalprocessandthroughaspecialreportthatgranteesareaskedtosubmitintheirthirdandfinalyear.Sinceeachprojectisdifferent,ithasbeendifficulttoaggregatethedata.  TheOfficecontinuestobeinterestedinincreasingthenumberofapplicantsandthequalityoftheapplicationstoboththeOutreachandNetworkgrantprograms.DuringtheSpringofFY2001,theOfficegathered,via_00teleconference_00,agroupofitsmostrecentapplicantsandobjective h+&* _00reviewcommitteememberstodiscusshowtorevisetheapplicationinstructionsandthereviewersguidance.Theirinputhelpedusimprovetheguidancefortheprograminanefforttosimplifytheapplicationprocessforpotentialgranteesandimproveourpeerreviewprocess.    2.32.2.GoalbyGoalPresentationofPerformance `     GoalI.A.1:OutreachProgram:Developandoperatecollaborativemodelsofhealthservicesinruralareaswhichwillserveunderservedpersons.   B.4 <DL!!XBContext:B+ 4 <DL!X!B  E.` hp x (#4XE       B.4 <DL!!XBTheaimoftheOutreachGrantprogramistosupportprojectsthatprovidehealthservicestoruralpopulationsnotcurrentlyreceivingthemandthatenhanceaccesstoexistingservices.ServicesthatarebeingsupportedbyOutreachgrantsareverydiverseandincludeprimarycare,mentalhealth,dentalcare,healtheducationandpromotion,healthrelatedtransportation,mentalhealth,specialtycare,schoolbasedclinicsandothers.Informationsubmittedbygranteesprovidesanestimatednumberofpeopleservedbythegrant.Thenumbercanbequitelargeinthecaseofprojectsthatinvolvetheuseofmediapresentationsordistancelearningtechnologies.Ontheotherhand,someprojectsareprovidingveryspecializedservicestoasmallpopulation(e.g.,pregnantwomeninacommunity). < ݌̌  $ 4XX!$  B+ 4 <DL!4XB Performance:   p   ?+ 4 <DL!X?In1999ORHPawardedacontractwithanationalconsultingfirmtodevelopagranteedatareportingsystemthatwouldenableORHPtosetmoremeaningfulperformancestandardsforitsgrantees.ThecollectioninstrumentwastestedbyninegranteesinFY2000.InFebruary2001, thepackagewassenttoOMBforreview.Wehadanticipatedimplementingthenewsystemby   thetimenewawardsweretobemadeinFY2002.Internaldiscussionsarebeingconductedregardingthedatacollectiontoolanddevelopingnewmoremeaningfulperformancemeasures.ThenumberofactualpersonsseenintheOutreachgrantprogramislowerthanthetargetforthepastseveralyears.ThisisduetothefactthattheOutreachgrantprogramwassplitintotwodistinctprogramsin1997,theRuralHealthOutreachgrantprogramandtheRuralHealthNetworkDevelopmentgrantprogram.Unfortunately,theoriginalprojectionswerenotsufficientlyadjustedtotakeintoaccounttheadditionofthenewgrantprogram.Inaddition,inthepastseveralyears,thenumberofawardsfortheOutreachprogramwerefewerthananticipated.E.4 <DL!4XEInthefuture,itislikelythatthenumberservedwillbeslightlyreducedbecausetheOfficehasmadethedecisiontostartsplittingthefundsevenlybetweenOutreachandNetworkprogram.Targetshavebeenreadjustedtoreflectthischange. _00  '#& GoalIV.C.1:RuralNetworkDevelopmentProgram:Improveruralhealthcareaccessbydeveloping integratedprovidernetworks ofruralhealthproviders.  Context: Eachyearsincetheprogrambeganin1997,therehasbeenincreasedinterestintheRural ` NetworkDevelopmentGrantprogram.Theprogramhassupportedindividualprojectsdesignedtostrengthen the localhealth caresystemthroughformalcollaborativepartnershipsinvolving 8  sharedcommunityresources.Thenetworkscreatedareimportanttoruralresidentsbecausetheycreateformal arrangementstostrengthenruralhealthcaresystemstherebyimprovingaccessto  ` local,qualityservices.   L   Performance:  $  ComparedtotheFY00figureof186,theFY01numberofprovidersinthenetworkswas204,exceedingthetargetnumberof198.In theprogramsfiveyearsofexistence,the_00ORHP_00Ԁhascreatedthreemonitoringreports.The   firstreportstudiedthe firstsixmonthsofthe programandtheother coveredFY98andFY00. p Ineachcase,issueslikeorganizationalstructure,management,financing,services,leadership,and_00sustainability_00Ԁwereexamined.  H  Whilethedatacollectioninstrumentusedforthemonitoringreports hasproducedhelpful  p information,theprogramhasmaturedinthesefiveyearstothepointthatanewinstrumentisneeded,onethatcaptureslongertermoutcomesofgrantinvestment.The_00ORHP_00Ԁintendstoawardacontractthisyearforthedevelopmentandadministrationofsuchaninstrument. While 4 thenumbersofprovidersinvolvedinthesegrantsreflectsasignificantgroupofruralprovidersandruralcommunities benefittingfromthesestrategicalliances,the_00ORHP_00Ԁisworkingwith   _00HRSA_00s OfficeofPlanningandEvaluationtodevelopNetworkmeasuresthatwillmore  directlycapturethehealthsystemsimprovementgeneratedthroughthesegrantees.Moreover,infutureyears,itislikelythatwewillseeincreased"performance"fromtheNetworkprogrambecausetheOfficehasmadethedecisiontostartdividingthefundsevenlybetweenOutreachandNetworkprogram.TargetsfortheNetworkprogramwillbereadjustedtoreflectthischangeandadevelopmentalmeasureisanticipatedforthenext_00GPRA_00Ԁcycle.  0"     ӀFY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport     2.33ProgramTitle:RuralHealthPolicyDevelopment   *;= dd dd 4dd4dddd9:!#!#, dd,wdd, dd,Kdd+  A<<11V, t dAdH.% ` hp x (#, XHd ?/+ Q PerformanceGoals L<<11V7"6<<11Vd dL ?/+H.` hp x (#% ` XHdB.` hp x (#XBd ?/+Q$dTargets L<<11V7"6<<11Vd dL ?/+H.` hp x (#` XHdB.Y` hp x (#XBdQ4&Actual ?/+Q2&Performance L<<1<V7"" <<11Vd dL ?/+H.` hp x (#Y` XHdB.` hp x (#XBd ?/+Q88B Reference d<<11VO-6    <<1<Vd d d&&%%XXH ?/+H.` hp x (#` XHddIV:IMPROVEPUBLICHEALTHANDHEALTHCARESYSTEMSA.ImproveInformationDevelopmentandDissemination. ?/+ 1.RuralHealthPolicy N  Development:Conductanddisseminatepolicyrelevantresearchonruralhealthissues. @<<11-" <<11Vd  @ ?/+dd ?/+FY03:20researchπpapersFY02:24FY01:18FY00:25(5researchstudiesonthe1997_00BBA_00) 6<<11#% "<<11 6 ?/+ddFY01:19reportsFY00:27reportspublished,7reportsrelatedto_00BBA_00Ԁand_00BBRA_00 ?/+FY99:3researchstudieson_00BBA_00underway,5new_00BBA_00studiestobefunded 6<<1<#a1<<11 6 ?/+dd ?/+B254 NEW V ; FY01DATA  \=  Z<<<1VE#_>   <<1< d Z ?/+ddTotalFunding:RuralHealthPolicyDevelopment̀($in000's)  iB  A< @<<<1-"AC<<<1Vd  @ A<dd FY2003:$6,000  E FY2002:$16,808FY2001:$13,436  iG  FY2000:$12,676 AH FY1999:$6,583 A<FY1998:$5,386  AJ  6<<<1#UK<<<1 6 A<dd Bx:page#budget   M  A< HP:HealthyPeople N ЀGoal 6<<<<#iO<<<1 6 A<dd A<#XHX%%&& #3)' Q    <<<< 3 A<2.33.1ProgramDescription,ContextandSummaryofPerformance  'R  ProgramDescriptionandContext:  T TheSocialSecurityActauthorized_00ORHP_00Ԁandchargeditwith advisingtheSecretaryontheeffectsofcurrentpoliciesandproposedstatutory,regulatory,administrative,andbudgetarychangesintheprogramsestablishedundertitlesXVIIIandXIXonthefinancialviabilityofsmallruralhospitals,theabilityofruralareas(andruralhospitalsinparticular)toattractandretainphysiciansandotherhealthprofessionals,andaccessto(andthequalityof)healthcareinruralareas.InadditiontoadvisingtheSecretary,theOfficeischargedwithestablishingandmaintainingrelevantresearchfindingsrelatingtoruralhealthcare.ThisactivitysupportsthepolicydevelopmentfunctionsoftheOfficeofRuralHealthPolicy. 'K#] Thesefunctionsaredesignedtohelppolicymakers,bothinWashingtonandthroughoutthenation,betterunderstandtheproblemsthatruralcommunitiesfaceinassuringaccesstohealth +&a carefortheircitizens.Partofthisactivity,theRuralHealthResearchCenterProgram,istheonlyhealthservicesresearchprogramdedicatedentirelytoproducingpolicyrelevantresearchonhealthcareinruralareas. ProgramPerformance:  ` DuringFY2000,the_00ORHP_00Ԁsupportedfiveresearchcentersspreadgeographicallythroughoutthecountry.EachCenterdevelopeditsownareasofexpertise.InthefallofFY2000,grantstocurrentResearchCenterswereendedandnewawardsmadetosixcentersforFY200104.Thedecisionwasmadetofundanadditionalcenterthatwouldfocusmainlyongatheringinformationanddevelopingpolicypapersonthehealthissuesspecifictoruralminorities.Specificresearchtopicsforallsixcenterswereselectedconcomitantlywiththeapplicationreviewprocess.TwentyfourprojectswerefundedinFY2001with20tobecompletedinFY2002,becausetheyaremultiyearprojects.TheworkoftheCentersispublishedinacademicjournalsandothervenues.TheworkiswidelydisseminatedbytheRuralInformationCenter,describedbelow,andtheStateOfficesofRuralHealth.TheemphasisisonstudiesthatwillhaveatimelyimpactonpolicydecisionsatFederalandStatelevels.Forexample,oneoftheCentersproducedseveralreportsthisyearthatdescribedthepotentialimpactofMedicare'sareawageindexonhospitalsinruralcommunities.OtherCentersproducedreportsonMedicarereimbursementpoliciesastheyimpactlowvolume,ruralambulanceprovidersandMedicare+Choiceplans.ThesereportshavehadamajorimpactonpolicydebatesrelatedtoMedicaresprospectivepaymentsystem.InadditiontotheResearchCenters,thisactivitycontinuessupportfor:(1)theNationalAdvisoryCommitteeonRuralHealthwhichadvisestheSecretaryonruralhealthprogramsandpolicies;(2)disseminationofruralhealthinformationbytheRuralInformationCenter(theCenterrespondstohundredsofinquirieseachmonthanddisseminatesinformationthroughitswebsite);and(3)smallprojectsthatassisttheOfficeofRuralHealthPolicyand_00HRSA_00Ԁinidentifyingandclarifyingruralhealthcareissues.#X*XXXHp #bXHXXX*Inthepastyear,_00ORHP_00spolicyefforts  includedassistingintheongoingworkoftheNationalAdvisoryCommitteeonRuralHealth,whichworkedwithacontractortoproduceareportfortheSecretaryontheimplicationsofMedicarereforminruralcommunities.TheOfficealsousedthefundsprovidedunderthisbudgetlineitemtocontinuefundingtheRuralInformationCenterHealthService,whichactsasaclearinghouseforinformationrelatedtoruralhealthandrespondstoinquiriesfromthepublicthroughtheuseofa1800referralline.#X*XXbXH #bXHXXX*Thisfundingalsoprovidedresourcesthatallowed $X" Officestafftoworkwithruralhospitaladministratorsandresearchersonarangeofkeypolicyissues.ThatworkresultedinkeychangestoMedicareregulationssurroundingtheuseofcertifiedregisterednurseanesthetists#X*XXbXH5 #bXHXXX*Ԁincriticalaccesshospitals.Italsohelpedaddresscash &"% flowproblemsforruralhospitalsinrefiningtheimplementationofaholdharmlessprotectionforruralhospitalsunderthenewMedicareOutpatientProspectivePaymentSystem.#X*XXbXH #XHXXX* (#'  h+&* _00 2.33.2.GoalbyGoalPresentationofPerformance  GoalIV.A.1:Conductanddisseminatepolicyrelevantresearchonruralhealthissues.    Context:  ` WithintheFY2002target,thereisanemphasisonpolicyresearchconcerningtheimpactofproposedrestructuringofMedicareandchangesinmanagedcareforMedicareandMedicaid.Thesechangesareexpectedtohaveasignificantimpactonthehealthofruralcitizensandthefinancialhealthofruralhospitals.Throughthepolicyresearch,ORHPexpectstopredicttheimpactofthepaymentreformsonruralcitizens,theirhospitalsandcommunitiesand,mostimportantly,toidentifyoptionsforchangestolessenanynegativeeffects. Performance:    ForFY2003,theperformancegoalfortheResearchCenterGrantsfocusesonthetotalnumberofresearchpapersproducedbytheCenters.ThetargetforFY2003is20research/analyticpapers.AnotherfourprojectswereinitiatedinFY2002,butduetotheirmultiyearnature,willnotbeavailableuntilFY2004.InFY2001wesurpassedourgoalof18andcompleted19researchreports,mainlybecausetheanalysisoftheareawageindexhadsomanyfacetsthatitrequiredareportontheinfluenceofthelaborrelatedportionoftheindexandanothertoexaminetrendsintheequityoftheindexasregionalcostadjuster.ThesereportsinformedthepolicydiscussionofMEDPACsJune2001ruralreportonMedicarereimbursement.OtherCentersinformedthepolicydiscussiononimprovingaccesstocarebyexaminingtherecruitmentandretentionofinternationalmedicalgraduates,femalegeneralistphysiciansand_00pharmacists.      FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   1  2.34ProgramTitle:RuralHospitalFlexibilityGrants  *>? dd dd wddw dd KddK;=!#!#, dd,Pdd,1dd,Mdd+  A<<11V, t dAdB.' ` hp x (#XBd ?/+Q PerformanceGoals L<<11V7"6<<11Vd dL ?/+H.` hp x (#' ` XHdB.` hp x (#XBd ?/+Q  $RTargets L<<11V7"6<<11Vd dL ?/+H.` hp x (#` XHdB.k` hp x (#XBdQ4Actual ?/+Q2Performance L<<1<V7"" <<11Vd dL ?/+H.` hp x (#k` XHdB.` hp x (#XBd ?/+Q77B Reference [<<11VF-6    <<1<Vd d [&&%%XXHIV.IMPROVEPUBLIC  *  HEALTHANDHEALTHCARESYSTEMS:C.PromoteSystemsandInfrastructureDevelopment 1.100%ofeligibleStates @  willbeparticipatingintheRuralHospitalFlexibilityProgram. (Measuretobedeleted) 7<<11$"<<11Vd  7 FY03:NA  6  FY02:NAFY01:100%FY00:100%FY99:90% -<<11B <<11 - FY01:98%FY00:98%(47of48eligibleStates)FY99:90%(43of48eligibleStates) -<<1<,<<11 - BK 262K   0/ #XHX%%&& # NEW  6 1 FY01DATA Q<<11V<#d 3   <<1< d Q&&%%XXH2.Appropriateruralfacilities 4 willbeassistedinconvertingtoCriticalAccessHospital(_00CAH_00)statustohelpstabilizetheirfinancialstatus. 7<<11$"!9<<11Vd  7 FY03:540 : FY02:240  ;  FY01:222  <  (runningtotals) -<<11=<<11 - FY02:FY01: 500 -<<1<@<<11 -BL 262L NEW B FY01DATA Q<<11V<#D   <<1< d Q3.Facilitiesandcommunitieswillbeassistedinthedevelopmentofnetworks. @<<11-"uG<<11Vd  @ FY03:400 H FY02:320FY01:304  J  (runningtotals) ?<<11,!K<<11 ? FY02:#XHX%%&&Q #&&%%XXH M FY01: 378 6<<1<#!N<<11 6BM 262M NEW P FY01DATA Z<<11VE#R   <<1< d Z ?/+H.` hp x (#` XHdd4.Ruralcommunitiesinwhichfacilitiesareconsideringconversionto_00CAH_00Ԁwillbeassistedindevelopingaprocesstoengagethecommunityinhealthcaredecisionmaking. @<<11-"6$Z<<11Vd  @ddFY03:658FY02:658FY01:658   &^  (runningtotals)  !_  6<<11#%^ c<<11 6dd ?/+FY02:#XHX%%&&N #&&%%XXH ) yf FY01:658 6<<1<#,!|g<<11 6 ?/+dd ?/+BN 262N NEW ) yj FY01DATA  /"l #XHX%%&& # Q<<<1V<#>'"q   <<1< d Q&&%%XXH5.EMSoperationsassistedin F(#r integrationprocess. (NewMeasure)  !*q%t  7<<<1$"',w'v<<<1Vd  7FY03:425FY02:425(runningtotals) -<<<1O+&z<<<1 -FY02#XHX%%&&z #&&%%XXH: I)$| FY01:421 -<<<<L*%}<<<1 -BO 262O NEW I)$ FY01 DATA Z<<<1VE#O+&   <<<< d Z ?/+d dTotalFunding:RuralHospitalFlexibilityGrants̀($in000's)  "  A< @<<<1-"<<<1Vd  @ A< FY2003:$25,000    FY2002:$40,000*  FY2001:$24,996  n  FY2000:$24,995 F  FY1999:$24,992 A<FY1998: NA F  #XHX%%&& #XXH*InFY02an " r  additional$15mwasprovided._00ORHP_00Ԁwillassistsmallruralprovidersplanforandimplementsystemstodealwiththecomplexitiesof_00HIPAA_00,Qualit y R   improvement,and_00PPS_00 l  requirements.#XHX #&&%%XXH 6<<<1#2<<<1 6 A<dd Bx:page#budget "r  A<HP:HealthyPeopleπGoal 6<<<<#"<<<1 6 A<dd A<3)'"r    <<<< 3#XHX%%&& # A<2.34.1ProgramDescription,ContextandSummaryofPerformance  ProgramDescriptionandContext:  z  TheRuralHospitalFlexibilityGrantProgram(theFlexProgram)wasestablishedbyCongresstoprovidesupporttoAmericassmallestandmostvulnerableruralhospitals.ThefiveyearFlexProgramwasauthorizedintheBalancedBudgetActof1997,althoughthefirstappropriationfortheprogramwasinFY99.TheprogramprovidesgrantstoStatestohelpthemimproveaccesstoessentialhealthcareservicesinruralcommunities.GrantsareawardedtoStatesto:(1)developandimplementastateruralhealthplan;(2)designateCriticalAccessHospitalsthatwillbeeligibleforcostbasedpaymentsthroughtheMedicareProgram;(3)assisttheseCriticalAccessHospitalsandthecommunitiestheyserveindevelopingnetworksofcare;(4)improveruralEmergencyMedicalServices(EMS)byintegratingthemwithotherservicesinselectedruralcommunities,and(5)improvethequalityofcareprovidedinruralcommunities.Theprogramprovidessupportforlocalcitizens,employers,healthcareprovidersandothergroupstoconductthecommunitybasedactivitiesthatarenecessarytostabilizeatriskruralhospitalsandtodesignbettersystemstomeetlocalneeds.Forhospitalsandotherproviders,theprogramwillprovidetechnicalassistanceandsupportto:(a)developintegratednetworksofcare;(b)examineandimplementtheconversionprocessforhospitalsthatwishtobedesignatedasCriticalAccessHospitals;and(c)improveEMSinformationsystems,qualityimprovementprograms,Statelevelprogramevaluation,andotheractivitiesconsistentwiththegoaloftheauthorizinglegislation. AuthorizationfortheMedicareRuralHospitalFlexibilityProgram((Flex)expiresSeptember )&%5 30,2002.Giventheinterestfortheprogramacrossthecountry,_00ORHP_00Ԁanticipates_00reauthorization_00Ԁoftheprogram. +&7 _00 S 2.34.2.GoalbyGoalPresentationofPerformance     k     B.` hp x (#XBGoalIV.C.1:100%ofeligibleStateswillbeparticipatingintheRuralHospitalFlexibilityProgram.  `  Performance:  8  ThefirstgrantstostatesunderthisprogramwereawardedinAugust-September,1999.InFY1999,43of48eligibleStateswereparticipatingintheprogram.SeveralstatesdeferredthedecisiontoapplyforagrantinFY1999anddidapplyinfiscalyear2000.DuetorevisedlegislativelanguageintheBBA,thetwostatesoriginallyineligiblefortheprogrambecamepotentiallyeligibleinFY2000,dependentongubernatorialaction,butsuchactiondidnotoccur.Since47of48eligibleStatesappliedandwerefundedinFY2000,weplantodeletethismeasureafterFY2001.ORHPhascontractedwithsixresearchcenters  .   ݀totracktheprogramanddocumentitssuccessesandopportunitiesforimprovement.TheOfficeisalsoworkinginclosepartnershipwithStateOfficesofRuralHealthtoimplementtheprogram. TheTrackingProjecthasallowedtheOfficetofollowprogramactivitiesandalsotoprovide \ feedbackand bestpracticesinformationtotheparticipatingStates.Thetrackingefforthasalsohelpeddefine,morespecifically,whatpartsoftheprogramsaremeasurable,suchasthenumberofhospitalconversionsthattakeplace,thetypesofnetworksthataredevelopedaspartoftheconversionprocess,newstrategiesforlinkingEMStotheCriticalAccessHospitals,andotheroutcomesoftheprogram.ThenewlypresentedPerformanceGoalsandtargetsweremadepossiblebytheworkandfindingsoftheFlexTrackingProject.AlsoinFY2000,ORHPputinplaceatechnicalassistancecontractthatgivesgranteestateshelpwithprogramimplementation.ThroughtheTrackingProject,theOfficewillalsohaveaccurateinformationonhowwellwearerespondingtothestatesintermsoftheirneedsfortechnicalassistance. .  B.` hp x (#XB  .b3   ThetargetmeasuresforgoalsC.2.C.4.werederivedbasedonthenumberofruralhospitals X  thatareeligiblebasedonthelegislation,thatistheyareorwillbecomelessthan15beds,are35milesfromanotherhospitals,andagreetohave24houremergencyservicesavailable.Thecommunityfigureisanextensionoftheestimateofhospitals..b3 3 ݌̌   XX    GoalIV.C.2:AppropriateruralfacilitieswillbeassistedinconvertingtoCriticalAccessHospital(CAH)statustohelpstabilizetheirfinancialstatus.  &"%   ConversionofappropriateruralfacilitiestoCAHstatuswillhelpsustaintheruralhealthcareinfrastructuretoprovideaccesstohighqualitycareforruralMedicarebeneficiaries.ThisisacorecomponentoftheMedicareRuralHospitalFlexibilityProgram(MRHFP).MeetingstatutoryrequirementsforcertificationandConditionsofParticipationforCriticalAccess h+&* Hospitalsenablesthefacilitytobereimbursedonthebasisofreasonablecost.Thisdemonstrablyimprovesfinancialperformanceofthesemostvulnerablefacilities,therebysustainingaccess.InFY01,ORHPsignificantlyexceededitsgoal(Target222,Actual500(runningtotals)).AsofDecember,2001,thenumberofconversionhaveclimbedto473.Duetothedesperatefinancialconditionofsmallruralhospitals,andduetothefactthatseveralStateshaveexperienceddelaysinprogramimplementation,conversionrelatedactivitieswillcontinuetobethemajoremphasisoftheprogramduringFY02. GoalIV.C.3Facilitiesandcommunitieswillbeassistedinthedevelopmentofnetworks.   8    BuildingrelationshipsbetweenCAHsandotherproviders,bothwithinthecommunityandbeyondthecommunityforthoseservicesnotappropriatelocally,isacriticalcomponentofinfrastructureandsystemsdevelopmenttosustainingviabledeliverycapabilityinruralcommunities.Networkdevelopmentispromotedtoreduceduplication,reduceoverheadcosts,improveservicesandimprovequalityofcare.InFY01,ORHPexceededitsgoal(Target304,Actual378(runningtotals)). GoalIV.C.4 RuralcommunitiesinwhichfacilitiesareconsideringconversiontoCAHwill 4 beprovidedtechnicalassistanceindevelopingaprocesstoengagethecommunityinhealthcaredecisionmaking.  `     ConsideringCAHconversionprovidersauniqueopportunityforcommunityengagementtoimproveserviceandquality,andtolearnthevalueofcommunitybasedhealthcare.Developingasustaineddialoguebetweenprovidersandconsumersatthecommunitylevelisinstrumentalinimprovingservicesandqualityofcare.Providersbecomemoreresponsivetocommunityinterestswhileconsumersbecomemuchmorelikelytouselocallyavailableservicesandcontributetotheirimprovement.Thepositivefinancialimpactforruralhealthcareissubstantial.Utilizationisimprovedandoutmigrationdecreased.Communityengagementiscriticaltothesurvivaloftheruralhealthcareinfrastructure,andisandintegralcomponentoftheFLEX.InFY01,ORHP,metitsgoal(Target658,Actual658(runningtotals)).Again,inFY02,thesamecommunitieswillbeassisted,withnoincreaseinthenumbersexpected.Thisisbecausemanyofthehospitalseligibleforthisdesignationhavealreadymadetheconversion. GoalIV.C.5:EMSoperationsassistedinintegrationprocess. (NewMeasure)  $L #  Content:  &("% ImprovingandintegratingEMSoperationswithinthelocalhealthcaredeliverysystemisanimportantcomponentoftheRuralHospitalFlexibilitygrantprogram.ThisareofFlexhasmajorimplicationsinbioterrorismprograms,developmentofsustainableruralhealthcareinfrastructure,andpatientsafetyissues. t+&*  Performance:   AsofApril2001,421EMSsystemshavebeenassistedbyimprovementsinaccesstorelevanttrainingandinthefirststepsintheintegrationprocess,meetingsandongoingdiscussionwiththelocalhospitalsandtherestofthehospitalcaredeliverycontinuum.AsofDecember,2001,noadditionalsystemswerecontacted,asworkcontinuedwiththeexistinguniverse.Again,readjustmentofthegoalsmayberequiredbasedonemergingrealitiesandStatepriorities._00   ` L @3456789WIhx023456789L   FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   CF  2.35ProgramTitle:StateOfficesofRuralHealth  *AB dd dd PddP1dd1MddM>?!#!#, dd,Pdd,1dd,Kdd+  A<<11V, t dAdd ?/+PerformanceGoals L<<11V7"6<<11Vd dL ?/+dd ?/+Targets L<<11V7"6<<11Vd dL ?/+dd ?/+ActualPerformance L<<1<V7"6 <<11Vd dL ?/+dB.` hp x (#XBd ?/+Q88B Reference d<<11VO-6    <<1<Vd d d&&%%XXH ?/+H.` hp x (#` XHddI.EliminateBarrierstoCareA.IncreaseUtilizationfor_00Underserved_00ԀPopulations ?/+ 1. StateOfficesofRural   Health:AllStateswillhaveimplementedperformanceoutcomemeasurementindicatorsandreportedasummaryoftheiroutcomes. @<<11-"A <<11Vd  @ ?/+dd FY03:N/AFY02:50FY01:50FY00:32 ?/+FY99:19 6<<11#b !<<11 6 ?/+dd FY01:50StatesFY00:50  : * FY99:23 ?/+ 6<<1<#> ,<<11 6 ?/+dd ?/+BP 264P NEW  X2 FY01DATA Z<<<1VE#^ 4   <<1< d Z ?/+ddTotalFunding:StateOfficesofRuralHealth̀($in000's)  I8  A< @<<<1-"!9<<<1Vd  @ A<dd FY2003:$4,000 I; FY2002:$7,999FY2001:$4,000  I=  FY2000:$3,000 !> FY1999:$2,999 A<FY1998:$2,986 6<<<1#@<<<1 6 A<ddBx:page#budgetHP:HealthyPeople A<ӀGoal 6<<<<#ID<<<1 6 A<dd A<#XHX%%&&ZK #3)'IF    <<<< 3 A< 2.35.1ProgramDescription,ContextandSummaryofPerformance SG  TheStateOfficesofRuralHealth(_00SORH_00)programofmatchinggrantssupportsStatesto:(1) ?H collectanddisseminateinformationonruralhealthintheirStates;(2)coordinateruralhealthresourcesandactivitiesstatewide;(3)providetechnicalandotherassistancetoruralprovidersandcommunities;and(4)helpcommunitiesrecruitandretainhealthprofessionals.ThisFederalandStatepartnershipreachesouttoprovideruralcommunitieswiththetoolsandresourcestheyneedtoaddresstheirhealthcareproblems.TheStateOfficesplayamajorroleinimplementingtheMedicareRuralHospitalFlexibilityProgramauthorizedbytheBalancedBudgetActof1997.MostofthemaremanagingthegrantsthathavebeenawardedtoStatesforthisnewprogram.With50StateOfficesofRuralHealthitistobeexpectedthatthereisawidevarietyofmodelsandcapacity._00ORHP_00Ԁworkstofosterandencourageall_00SORH_00,whateverthestageoforganizationaldevelopment.DevelopingandimplementingoutcomemeasuresforthisprogramhasbeendifficultbecausesomeOfficeshavetheresourcestoaddressthisareawhileothersdonot. S     [      c  ''w"V   +'[ 2.35.2GoalbyGoalPresentationofPerformance    GoalI.A.1:AllStateswillhaveimplementedperformanceoutcomemeasurementindicatorsandreportedasummaryoftheiroutcomes.  Performance:  L    BytheendofFY2000,all50StateOfficesofRuralHealth(_00SORHS_00)haveimplementedperformanceoutcomemeasurementindicators.Areportwithasummaryoftheoutcomesisbeingdeveloped.Findingsfromthisreportarebeinganalyzedwiththeintentofdevelopinganewperformancegoal. InAprilof2001,_00ORHP_00Ԁsponsoredaprojecttoidentifyapproachesfor Quantifyingthe $  BenefitsoftheStateOfficeofRuralHealthProgram.Theprimaryobjectiveofthestudywastodesignaflexible,easytousemodel,toassist_00SORHs_00Ԁinquantifyingtheiraccomplishmentsas ReturnsOnInvestmentsfordollarsflowingtoandthroughthe_00SORHS_00Ԁandtootherorganizationssupportedbythe_00SORHs_00.Whilethiswillbeavaluableinformativestudy,itrecognizesonlytheactivitiesofthe_00SORHs_00Ԁprogramthatcanbemeasuredineconomicterms.Manyofthefunctions,programsandactivitiesof_00SORHS_00Ԁdonotreadilylendthemselvesto_00quantification_00Ԁandwhicharecertainlydifficult,ifnotimpossibletoquantifyineconomicterms.Leadership,facilitationofmultiorganizationalprocessesanddialog,educationandbuildingawarenessofruralhealthissues,the brokerageofrelationships,thedevelopmentofpartnershipswithotherorganizations,andthedevelopmentandsupportofruralhealthassociationsarguablyrepresentthegreatestvalueofthe_00SORHs_00.Improvingaccesstocare,healthandqualityoflifeareimportantgoalsof_00SORHs_00Ԁthatcannotbegivenaneconomicvalue.However,thereismuchtobelearnedaboutthoseareasthatcan,conceivably,begivenadollarweight.ThisstudyattemptstodetermineeconomicreturnonFederalandStateinvestmentsfromthe_00SORHs_00.Workingwiththe_00HRSA_00ԀPerformanceandEvaluationteam,_00ORHP_00Ԁwillusethefindingsofthisefforttoexplorethefeasibilityofrevisedperformancemeasuresforthisprogram.  X   InFY2002anadditional$4,000,000wasprovidedforthe_00SORHs_00Ԁprogram.The_00ORHP_00distributedalmostallofthesefundstothe_00SORHs_00Ԁthatareabletomeetingthestatutorilyrequiredfundingmatch.Theremainingfundswereusedtoprovidetechnicalandothertypesofassistance.#X*XXXH # $D #  XHXXX*C!XXH   +l&) _00ԇTELEHEALTH#XHX!C+e #  Je   @@<<FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport  e  TheTelehealthProgramhasbeencreatedtocoordinateHRSAstelehealthactivities.Telehealth  istheuseofelectronicinformationandtelecommunicationstechnologiestosupportlongdistanceclinicalhealthcare,patientandprofessionalhealthrelatededucation,publichealth,andhealthadministration.HRSAsOfficefortheAdvancementofTelehealth(OAT)buildsuponandadvancesHRSAspreviouseffortstousetelecommunicationstoimprovetechnicalassistancetoitsgrantees,tomoreeffectivelytrainhealthcareproviders,toencouragelinkagesforknowledgeexchange,andtocapitalizeandreplicatelessonslearnedinprovidingqualityhealthcaretounderservedindividuals,families,andcommunities.TheOfficesresponsibilitiesincludetelehealthpolicyandprogramdevelopment,telemedicinedemonstrationsinmedicallyunderservedandhardtoreachareas,technicalassistancetoHRSAgrantees,andtolocalandstatehealthofficials,andtheproductionofmediatoolstofacilitatethedisseminationofhealthcareinformationtohealthcareprovidersandthepublic.Theprogramincludedinthissectionis:2.36Telehealth_00  H    @@ FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport @@*  ;k #X*XXXH e #EX*XXX* 2.36ProgramTitle:_00Telehealth_00*<dd dd PddP1dd1KddKAB!#!#, SS , SS ,4SS ,4SS +  ! ` !  PerformanceGoals 8#!  8m   Targets 8#!  8n   ActualPerformance 8#!   8n   Refer-_00ence_00 8#!    8E&*XXEX*I.ELIMINATE  l  BARRIERSTOCAREA.IncreaseUtilizationfor_00Underserved_00ԀPopulations 1.Evaluate_00telehealth_00   programsinurbancommunitieswhicharedesignedtoovercomebarrierstohealthcarefor_00underserved_00Ԁindividuals. /<<<h /FY03:N/AFY02:N/AFY01:1needassessmentstudy.FY00:N/AFY99:1studyfunded /<<<T <<< / FY01:(06/02)FY00:NAFY99:1studyfunded /<<<T+<<< /BQ 26Q S 8S R Q 2Q R S R R S / 0<<< / IV.IMPROVEPUBLIC $1 HEALTHANDHEALTHCARESYSTEMS  3  A.ImproveInformation 4 DevelopmentandDissemination  p6 1.Developimprovedperformancemeasuresfor_00telemedicine_00Ԁgrantprograms,evaluate rural  p: _00telemedicine_00Ԁgrantprogram. #&M'%XE&*l #E&*X'%&M  `; #&M'%XE&*8t #E&*X'%&M 6<<<<#!8= 6 FY03:Performance $> granteedatacollectionsystemongoing.FY02:Expandeddatacollectionsystemrefinement;#&M'%XE&*t #F&*X'%&MԀFinalsurvey pC packagesubmittedtoOMB;#&M'%XF&*u #E&*X'%&M#EX*XXE&*[o #E&*XXEX*Ԁ HE FY01:Metaanalysiscompleted;Preliminary_00GPRA_00Ԁdatacollectioninstrumentincorporatedintoprogressreports.#&M'%XE&*v #E&*X'%&M !4J FY00:metaanalysisfromongoingindividualprogramevaluationscompleted;  % N  FY99: 1paperon &!O interimresults ?<<<<,!p'"P<<<< ? FY01:2000Data T ReportAnalysiscompleted;Metaanalysiscompleted;_00GPRA_00Ԁ_00Telehealth_00ԀRep.Systemdesigncontractawarded;TAPest.FY00:Frameworkforadatacollectiontooldeveloped.FY99:Formsrevisedandlimitedfieldtest.FY98:Preliminaryformsdeveloped 8<<<<#!% a<<<< 8 BV 268V U T 1T U V U U V  $b NEWFY01DATA#EX*XXE&*Sv #E*XXEX* 8#f<<<< 8 2.Increasethepercentof d _00HRSA_00Ԁgranteesthatareelectronicallylinkedto_00HRSA_00.  (  ?<<<<,! ? FY03:80% d FY02:75%FY01:65%FY00:50%FY99:35% ?<<<<,! <<<< ? FY01:DatanotcollectedFY00:DatanotcollectedFY99:30% 6<<<<#! <<<< 6#i7XE*:w #E*X7i B#i7XE*} #E*X7iW 268W /d<<<< /TotalFunding:_00Telehealth_00($in000's) 6<<<<# X 6 FY2003:$5,609  l FY2002:$39,192FY2001:$35,976   D   FY2000:$20,518 0  FY1999:$13,118FY1998:n/a C<<<<0! <<<< C Bx:page#budget  l HP:HealthyPeoplegoal 4*( D   <<<< 42.36.1ProgramDescription,ContextandSummaryofPerformance    Context:  ! _00Telehealth_00Ԁistheuseofelectronicinformationandtelecommunicationstechnologiestosupportlongdistanceclinicalhealthcare,patientandprofessionalhealthrelatededucation,publichealth,andhealth#EX*XXE*uz #administration.#X*XXEX*^} #XHXXX*ԀModernhealthcareincreasinglyinvolvestheeffectiveuseof H$ _00telehealth_00Ԁtechnologiestobringcaretowherethepeopleare._00HRSA_00Ԁhasestablishedagoalofreaching100percentaccessand0percenthealthdisparities.#X*XXXHp #XHXXX*Thus,thesetechnologiesareand  p& willcontinuetobeessentialtoolsinachieving_00HRSA_00sgoal.Theyareintegraltothedevelopmentofinformationsystemsanddistancelearningprogrammingthatfacilitatelinkagesbetweenhealthcareinstitutionsoverdistanceandprovideeducationalopportunitiesforthosewhowouldotherwisenothaveorwouldhavedifficultyaccessingsuchopportunities._00Underserved_00Ԁcommunities,betheyurbanorruralcontinuetofacesignificantchallengesinobtainingthefinancial,physical,andhumanresourcestotakeadvantageofthesetechnologies.#X*XXXH #EX*XXX*TheAgencyestablishedtheOfficefortheAdvancementof_00Telehealth_00ԀinMay1998tocoordinate_00HRSA_00s_00telehealth_00Ԁactivities.TheOfficeofficiallybecameoperationalinAugustof1998.InFY2000,itprovided_00HRSA_00ԀbureauswithtechnicalassistanceE*XXEX*Ԁintheproductionof X#0 distancelearningprogrammingandadministered37_00telehealth_00ԀgrantsundertheRural_00Telemedicine_00ԀGrantProgram,theRuralOutreachGrantProgram,andspecialprojectsdesignatedbyCongress.In2001,theOfficeadministered53_00telehealth_00Ԁgrants.ThegrantprogramsareauthorizedunderSections301and330AofthePublicHealthServiceAct,asamendedbytheHealthCareConsolidationActof1996.Thesegrantsaredesignedtodemonstratetheuseof_00telehealth_00Ԁtechnologiesinimprovingaccesstohealthcareandaccesstoeducationalandtrainingprogramsforhealthprofessionals. +&9 InFY1998,theOfficeconductedanassessmentof_00HRSA_00ԀgranteesadvancedtelecommunicationscapacitytoestablishabaselinefortheAgencysobjectiveofachievinglinkageto75%ofitsgrantees.InFY1999,itcompletedapilotprojectin7communityhealthcentersand3regionalofficestoassesswhetheradigitalsatellitesystemforlowcost,desktop_00videoconferencing_00ԀwouldprovideadequateconnectivitytomeettheAgencysobjectives.ResultsofthepilotwereevaluatedbyNovember,1999.TheseresultswerewidelysharedwithintheAgency.Basedonthefindingsfromthepilot,aninvestmentstrategyisbeingconsideredthatwouldallow_00HRSA_00sgranteestocommunicateviaauniformdesktopvideoconferencingnetwork(_00HRSA_00ԀNetwork)._00Telehealth_00Ԁisanevolvingfield,reflectingtherapidtechnologicaldevelopmentsinboththecomputerandtelecommunicationsindustries.KeepingupwiththesechangesrequiresknowledgeandskillsthatoftengobeyondtheexperienceofanyoneagencyorDepartment.TheOfficehasbeenveryfortunateinhavingtheopportunitytostafftheJointWorkingGroupon_00Telemedicine_00,thefederalcoordinatinggroupwithrepresentationfromallfederalagenciesactivein_00telemedicine_00.Throughthisgroup,ithasbeenabletoidentifyareasofmutualinterestwithotherfederalagenciesandavoidduplicationofeffort.TheOfficehascollaboratedwiththeCMSonastudyofcurrentMedicare_00telemedicine_00Ԁpaymentpolicies,basedondatafromtheOfficesrural_00telemedicine_00Ԁgrantees.OthergranteedatahasbeenusedtodocumentfortheFCCregulatorybarrierstotheeffectiveimplementationoftheuniversalservicetelecommunicationsdiscountprogramforruralhealthcareproviders.TheOfficealsohascollaboratedwithCDConproductionoftheHealthyPeople2000updateforMaternalandChildHealthandonavarietyofdistancelearningactivities,includingthelaunchofHealthyPeople2010.InFY2000,theOfficecochairedthePublicHealthCouncilDistanceLearningWorkGroup,whichpreparedaseriesofrecommendationsfortheSecretary,onfuturedirectionsfortheDepartmentsdistancelearningactivities.WithintheAgency,theOfficehasworkedcloselywiththeBureausinthedevelopmentofseveraldistancelearninginitiativesrelatedtoqualityofcare,compliancewithY2K,andruralhealth.IthasestablishedaDistanceLearningWorkingGrouptocoordinatedistancelearningactivitieswithintheAgencyandtoassistinevaluationofthepilotprojectforestablishingthe_00HRSA_00Ԁvideoconferencinginfrastructure.InFY2000,the_00HRSA_00ԀWorkingGroupdevelopedanactionplanfordistancelearningactivitieswithintheagency.Italsoinitiatedamajorcontracttodevelopdistancelearningevaluationstrategiesfortheagency.#i7XE* #E*X7iԀTheOfficehasprovided #l! extensivetechnicalassistancetothebureausinthedevelopmentofprogrammatic_00telehealth_00initiativesindomesticviolenceprevention,schoolbasedhealth,andemergencymedicalservicesforchildren.PerhapsthemostimportantpartnershipsfortheOfficearethosewithourgrantees.Thesepartnershipsprovidecriticalinformationonthefactorsthatcontributetoorhinderthesuccessfuldevelopmentof_00telehealth_00Ԁprogramsin_00underserved_00Ԁcommunities.Asnotedabove,thegranteeshaveprovideddatatoCMSandcongressionalagenciesonanumberof_00telemedicine_00Ԁpaymentissuesthatarecriticaltotheirdecisionsonreformingtheprogram. h+&* Ongoinggranteefeedbackthroughtheprogressreports,businessplans,andclinicalprotocolshaveprovedinvaluableinourdevelopmentofnewprogrammaticinitiatives.ButperhapsmostvaluableistheongoingdialogthatoccursamongthegranteesandbetweenthegranteesandtheOfficethroughtheRural_00Telemedicine_00Ԁ_00Listserv_00,a_00Listserv_00Ԁmanagedbyoneofthegrantees. ProgramPerformance:  L  Thepromiseoftelecommunicationsandinformationtechnologiesforovercomingthebarrierstohealthcareofgeography,culturaldiversity,racialdisparities,andpovertyhasnotbeenrealizedinmanyofourmostisolatedruralandinnercityurbancommunities.TheultimatesuccessoftheOfficewillbeinpromotinganddevelopingaffordable_00telehealth_00Ԁprogramsthatimproveaccesstohealthservicesandtoeducationalandtrainingprogramsforhealthprofessionalswhoservethesecommunities.Givenitsresponsibilitiestodevelop_00HRSA_00sinfrastructureforcommunicatingwithitsgrantees,theOfficesperformancecandirectlybeevaluatedbythedevelopmentofthatinfrastructureandtheextenttowhichitisused.    ProgramDataIssues:    Oneofthemostdifficultchallengesinthefieldof_00telehealth_00Ԁisdefiningexactlywhatisbeingmeasured._00Telehealth_00Ԁtechnologiesareneitheronetechnologynoroneapplication,butarapidlygrowinggroupofhealthcareanddistancelearningapplicationsthatemploydiversetelecommunicationsandcomputertechnologies.Becauseofrapidlychangingtechnologies,thecosteffectivenessoftheseprogramsmaybedifficulttogeneralizeacrossprogramsorovertime,butprogrammaticevaluationsshouldprovidevaluableinformationonconsumerandprovidersatisfaction,programmaticcosts,utilization,andchangesinaccessandavailabilityofservices.TheOfficehasputinplaceseveraldifferentdatacollectionstrategiestocollectthenecessaryinformationtobroadlyassessthefactorscontributingtothelongtermsuccessandviabilityof_00telehealth_00Ԁprogramsin_00underserved_00Ԁcommunities.Theseeffortsaredescribedfurtherunderthespecificobjectiveforimprovinginformationdevelopmentanddissemination(IV.A.1).   2.36.2GoalbyGoalPresentationofPerformance  GoalI.A.1Evaluate_00telehealth_00Ԁprogramsinurbancommunitieswhicharedesignedtoovercomebarrierstohealthcarefor_00underserved_00Ԁindividuals.Context:   #p! Despiteagrowthininvestmentandincreasedmediaattention,_00telehealth_00Ԁtechnologiesremainlargelyuntested.Thisisparticularlytrueforapplicationsinurban_00underserved_00Ԁareasbecausemostoftheattentionandpublicmoniesfor_00telehealth_00Ԁhavebeenfocusedontheneedsofruralcommunities.Urbanresidents,especiallyiftheyarepoorordisabled,facesignificantbarrierstoobtaininghealthservices.Thesebarrierscanbecultural,economic,and/orrelatedtoinadequatetransportation.Anelderly,poorwoman,livinginaninnercityandtravelingfor1hourstothespecialistviapublictransportation,facesequallydifficultbarrierstoovercomeasonelivingonafarm. l+&* _00InFY1999,OATmanagedapilotprojectatDrewMedicalSchooltoexpandteleophthalmologyscreeningtootherservicesininnercityhousingprojects.#EX*XXE*\ #Fromthislimited  studyandothersimilarstudiesinschoolsandcommunitybasedsettings,itisclearthat#X*XXEX*! #XHXXX*urban  projectshavethepromiseofimprovingaccesstohealthservicesforunderserved,innercitypopulation,aswellasforexpandingtheinformationavailableontheeffectivenessoftelemedicine.Mostcurrentprojectshavelargelybeenlimitedtoruralareas,wheresparsepopulationsoftenresultinalowvolumeofservicesthatcanbeanalyzed.Byaddinginformationfromurbanprojects,thedataavailablecanbeexpandedtoassessthevalueaddedoftelemedicineprogramsandprovidesupportforpolicyinitiativesrelatedtotelemedicine.C!XXH#i7!C #E*X7iIntheFY2001,alimitedurbaninitiativewasdevelopedfortheOffice.Apreliminaryscanof ^  theliteratureonurbanprojectshaveclearlydemonstratedthevalueoftelehealthservices,especiallyfortheschoolbasedservices,andhomecareelderlyordisabledlivinginurbanunderservedcommunities.ThisinitiativeisfundingoneprojectinthebeginningofFY2002tosynthesizeandevaluateresultsfromcurrentongoingurbantelemedicineprojectsinurbaninnercitycommunities,comparingandcontrastingthemwiththoseinrural#EX*XXE* #communities.#X*XXEX*3 #XHXXX*ԀAfinal   reportfromthisprojectisscheduledtobesubmittedattheendofFY2002.C!XXH#i7!C֯ #E*X7i   Performance: FY1999: 1grantawardedtoDrewasapilot Z FY2000:0 0grants;OfficefundinglimitedtoruralprojectsonlyF !# !# FY2001:0 Specificationsforurbangrantdeveloped2 !# !# FY2002: 1urbangrantawarded  n GoalIV.A.1Developimprovedperformancemeasuresfortelemedicinegrantprograms,evaluateruraltelemedicinegrantprograms.#i7XE* #E*X7iContext:   Althoughtelehealthtechnologiesarehardlyuniqueamonghealthservicestechnologiesinlackingevidenceoftheireffectiveness,increasingly,patients,clinicians,healthcarefacilities,andgovernmentandprivatepayersareaskingforsuchevidence.Assuch,theychallengeagencieslikeHRSAtocarefullyexaminethepracticality,value,andaffordabilityofthesetechnologies.Thisisespeciallytruewithregardtounderservedcommunitieswhichcanillaffordtoinvestintechnologiesthatareoflittlevalueinimprovinghealthcareservices.Indicators:Finalreportandpaperssubmitted/acceptedinrelevantjournals;preliminaryreportsavailablebothonthewebandinprint. Performance: InbothFY2000andFY2001,twoevaluationeffortswereunderwayaprospectivestudyof )%( encountersinalltheruralgranteeprojects,andametaanalysisoffindingsfromindividualruraltelemedicinegrantevaluationefforts.Theencountersurveywasoriginallytobeconductedin +&* FY99,butbasedonareviewofthedraftinstrument,itwasdeterminednottogoforwardwithafullsurveyinstrument.Theapproachwillbetoincorporatepartialresultsintogranteeprogressreports.#i7XE* #C!7iԀ  #XHX!C` #InFY2000,athirdevaluationeffortwasbegun.UndercontractwithAbtAssociates,HRSA  developedapreliminaryframeworkofindicatorsforuniformdatareportingthatcouldbeeasilycollectedfromprogressreportssubmittedbyallgrantees.Underthisframework,informationonutilizationandperformanceofourgranteeswasgatheredandanalyzedfromthe2000ProgressReports,andhasbeenbuiltintoafinalreportthatwillbedisseminatedtoourgranteesandinterestedparties.InFY2001,acontractwasawardedtoAbtAssociatestoassistOATintheredesign,improvement,andimplementationofpreviouslydevelopedtelehealthindicators.Theoutputofthisinitiativewillbeadatareportingtool,bothpaperandpencilandautomatedversiontofacilitatedatareportingbyourgrantees.Theoutcomewillbetoobtainanaccurateassessmentoftheperformanceofourgranteesintheareasofaccess,quality,efficiencies,physiciansbuyin,andsustainabilityoftelehealthprograms.Theprojectiscalledthe GPRATelehealthPerformanceMeasurementSystem.Assistingthecontractorwillbeatechnicaladvisorypanel(TAP),composedofgranteeswithstrongevaluationprograms.Atperiodicintervals,thecontractorwillalsoreportontheprojectsprogresstotheJointWorkingGrouponTelemedicinetoobtainfeedbackfromotherFederalagenciesandtopromoteopportunitiesforcollaborationacrossFederalagencies.BytheendofFY2002,thepaperandpencilphaseofthedatareportingsystemwillbefullyimplemented,andstartingin2003thewebbasedautomateddatareportingsystemwillbefullyoperational.FY1999: Surveyformssignificantlyrevisedandreviewedbyproviders. 0 FY2000:0 Basedonproviderreviewofsurveyforms,itwassuggestedthatdatacollection l wouldbeproblematic,andthatdatashouldbeincorporatedintogranteeprogressreports..  !# !# FY2001:0 Datacollectionfrommetaanalysiscompletedandreportmadeavailable.0 !# !#  S  TAPformed.0 S 0 S!#S!#ContractawardedtodevelopandimplementGPRATelehealthPerformanceMeasurementSystem(GPRATPMS).  !# !# FY2002:0 GPRATPMSdeveloped,fieldtested,automatedandrefined.! !# !# FY2003:0 FullimplementationofGPRATPMS|"  !# !#  DataIssues:󀀀 T$"  Rapidchangesinboththetelecommunicationsandcomputerindustriescomplicatethe @% # evaluationofthesetechnologies.Costsarerapidlydecreasingasnewapplicationsforthetechnologiesaredevelopedeachday.̀ +'*  GoalIV.A.2:IncreasethepercentofHRSAgranteesthatareelectronicallylinkedto  HRSA.Context: Theexplosionoftechnology,associatedwithcomputersandtheInternet,aswellastheadvent ` ofincreasedwirelesscommunications,requiredevelopmentofnewandmoretimelystrategiesfortheAgencytocommunicatewithitsgranteesandconstituents.Andperhapsevenmoreimportant,theAgencyisconcernedthatwithoutaconcertedeffortonitspart,includinginvestments,manyofitsgranteeswillnothaveeitherthetechnicalorfiscalresourcestoinvestinthetechnologiestheyneedtoremaincurrentintheirfields.ThustheAgencydevelopedthestrategicgoalthatby2003,atleast75%ofitsgranteesareelectronicallylinkedtoHRSAsoastobeabletoparticipateindistancelearning,transmitmedicaldataelectronically,andlinktheirstaffandpatientswithexpertsindistantcommunities.     Indicators:NumberandpercentofHRSAgranteesthathavevideoconferencingcapabilities. S PercentofHRSAgranteesthatarelinkedtotheInternet. Performance:󀀀 \  Althoughseveralindicatorscouldhavebeenchosen,wehaveselectedvideoconferencing H capabilityasanexcellentindicatorofagranteeselectroniclinkagecapabilities.Inparticular,lowcostdesktopvideoconferencingsystemsprovidegranteeswithcapabilitiestomoreeasilyparticipateinarangeofdistancelearning,informationsharing,anddependingontheclinicalservice,significantexchangeofclinicalinformation.InFY1999,HRSAassessedthetelecommunicationsandcomputercapabilitiesofitscurrentgrantees.Inbrief,theassessmentfoundthatonly30%ofHRSAgranteeshavevideoconferencingcapabilitiesintheirfacilities,although83%hadaccesstotheInternet.Affordablilityandaccesstogreaterbandwidthcontinuestobeabarrierforgrantees.Giveninitialresultsfromthepilotstudy,HRSAembarkedonastrategytoensurethatallgranteeswouldhaveavailablesomelevelofdesktopvideoconferencing.InFY2001,theOfficeworkedwithseveralofitsgranteestopilottesta2waydigitalsatellitesystemasoneapproachtogettinglowcost,higherqualitytransmissionservicestosomeofthisnationsmostremotesites.ItalsobegantoworkwiththeDepartmentandGSAtodevelopaDepartmentwidestrategyforfacilitatinggranteeaccesstotheGSApricingschedulefortelecommunicationsandotherservicesthatwouldmakedesktopvideoconferencingmoreaffordable.Baseline(FY1999):  35%havevideoconferencingequipment;83%connectedtoInternet $D # FY2000:   50%havevideoconferencingequipment;90%connectedtoInternet %0!$ FY2001:   65%havevideoconferencing;95%connectedtoInternet &"% FY2002:0 0 !# !#75%havevideoconferencing;97%connectedtoInternet'#& !# !# FY2003:   80%havevideoconferencing;100%connectedtoInternet;75%of !  (#'  S granteessubmittheirprogressreportsandapplicationselectronically. S  S #X*XXXHY #XHXXX*Ԁ h+&*  DataIssues:   AssessingtheextenttowhichHRSAgranteesarelinkedelectronicallyisarelativelysimple  exercise,usingassessmenttoolsalreadyunderdevelopment.Thekeydatacollectionchallengeiscapturingtheactualusageofthenetworksinceonceinplace,thenetworkcanandshouldbeusedtomeetawiderangeofcommunicationneeds,notjustcommunicationwithHRSA.AfutureindicatormightbethepercentofHRSAgranteesthatsubmittheirprogressreportselectronically.BytheendofFY2002,strategieswillbeimplementedtoassessprogressinthisarena.#X*XXXH4 # $ t X*XXX* n   i7XX* ,X'* Ї#X*X7it #XX*HEALTHYCOMMUNITIESINNOVATIONINITIATIVE#X*X #   h  S    FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   v #X*XXX*6 # X*XXX*TheHealthyCommunitiesInnovationInitiative(HCII)isanew,interdisciplinaryinitiativethat  willbringtogetherdepartmentwideexpertisetofocusonthepreventionofseveralchronicdiseasesthatarerapidlyincreasinginprevalencewithintheU.S.population.ThepurposeofHCIIistoencouragethedevelopmentofinnovativecommunitybasedinitiativestoaddressHealthyPeople2010goalsaroundasthma,diabetes,andobesitypreventionthroughimprovedhealtheducation,screening,andprimarycareservices.#X*XX X*$ #XHXXX*  p  Theprogramincludedinthissectionis:2.370 S HealthyCommunitiesInnovationInitiative S!#S!#  #X*XXXH # X*XXX*_00  l   FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001Performance Report    &  d     X*XX X*    dD   2.37ProgramTitle:HealthyCommunitiesInnovationInitiativedD   Ԍ  Ќ     X*XX X*           X*XX X*       '8     Ԍ̌         X*XX X*  A@ 2ddA*T[ dd SS  SS  4SS 44SS 4<!#!#, YY,YY,YY,6YY+  .<<<<X d .           X*XX X*    J     PerformanceGoalsJ   Ԍ A<<<<X,!l <<<<X AЌ         X*XX X*           X*XX X*         Targets N  6 Ԍ A<<<<X,!l"<<<<X AЌ X*XX X*XQXX X* X*XXXQ           X*XX X*    \     Actual l Performance\   Ԍ A<<<<X,!X "<<<<X AЌ X*XX X*XQXX X* X*XXXQ           X*XX X*         Reference  }  e Ԍ P<<<<;,l "   <<<<X PЌ X*XX X* X*XX X*W W           X*XX X*           &M'%X X*I.EliminateBarriersto T   Care    Ԍ̌ X*X'% &M X*XX X*XQXX X* X*XXXQ   &M'%X X* C.FocusonTarget  T  Population# X*X'% &M> #   ,   &M'%X X*1.Conveneaworkinggroup    withbroadparticipationfromotherfederalagenciesinvolvedinasthma,diabetesorobesityresearch,monitoring,andserviceprovisiontodevelopactionplans,grantguidance,andmoredetailedperformancemeasures. (Developmental)# X*X'% &M # L  6<<<<#(x<<<< 6         X*XX X* X*XX X*        &M'%X X*FY03:NA    Ԍ T  Ќ X*X'% &M X*XX X*W W   &M'%X X*FY02:1# X*X'% &M: # , |  ?<<<<,! T<<<< ?         X*XX X* X*XX X*        &M'%X X*FY02:(1/03)# X*X'% &MW # 5   Ԍ T  Ќ X*XX X* X*XX X*W W  ?<<<<,!, |<<<< ?         X*XX X* X*XX X*    z    &M'%X X*BX 223X z    Ԍ T  Ќ X*X'% &M X*XX X*X X W W   &M'%X X*           X*X'% &M X*XX X*     &M'%X X*A   A   Ԍ̌ &M'%'% &M &M'%'% &MX X W W           X*X'% &M X*XX X*     &M'%X X*    j  3 Ԍ̌ &M'%'% &M &M'%'% &MX X W W           X*X'% &M X*XX X*     &M'%X X*#   HP24(asthma)#   Ԍ  ,! Ќ &M'%'% &M &M'%'% &MX X W W  HP5(diabetes)   " HP19(obesity)# X*X'% &M5 # P<<<<;, #   <<<< P         X*XX X* X*XX X*      b    &M'%X X*2.Providegrantstotarget $t$ communitiestosignificantlyreducethenumberofnewcasesofasthma,diabetes,andobesity,andincreasethenumberofadultsandchildrenatahealthyweight. (Developmental) :More  \+ detailedmeasurestobeestablishedinconjunctionwiththeworkinggroupestablishedasgoal1above.)# X*X'% &M) #b    Ԍ p / Ќ X*XX X* X*XX X*X X W W  6<<<<#H!0<<<< 6         X*XX X* X*XX X*        &M'%X X*FY03:5# X*X'% &Mr # P  8 Ԍ $t1 Ќ X*XX X* X*XX X*X X W W             X*XX X* X*XX X*    z   z    Ԍ ?<<<<,!83<<<< ?Ќ X*XX X* X*XX X*X X W W           X*XX X* X*XX X*        &M'%X X*FY03:(1/04)# X*X'% &M #   Ԍ $t4 Ќ X*XX X* X*XX X*X X W W   ?<<<<,!86<<<< ?         X*XX X* X*XX X*        &M'%X X*BY 223Y    Ԍ $t7 Ќ X*X'% &M X*XX X*Y Y X X W W   &M'%X X*           X*X'% &M X*XX X*     &M'%X X*     c Ԍ̌ &M'%'% &M &M'%'% &MY Y X X W W           X*X'% &M X*XX X*     &M'%X X*i   i !   Ԍ̌ &M'%'% &M &M'%'% &MY Y X X W W           X*X'% &M X*XX X*     &M'%X X*      q Ԍ̌ &M'%'% &M &M'%'% &MY Y X X W W           X*X'% &M X*XX X*     &M'%X X*w   w /   Ԍ̌ &M'%'% &M &M'%'% &MY Y X X W W           X*X'% &M X*XX X*     &M'%X X*       Ԍ̌ &M'%'% &M &M'%'% &MY Y X X W W           X*X'% &M X*XX X*     &M'%X X*    =   Ԍ̌ &M'%'% &M &M'%'% &MY Y X X W W           X*X'% &M X*XX X*     &M'%X X*         Ԍ̌ &M'%'% &M &M'%'% &MY Y X X W W           X*X'% &M X*XX X*     &M'%X X*   HP24(asthma) K   Ԍ 4? Ќ &M'%'% &M &M'%'% &MY Y X X W W  HP5(diabetes)  @            X*X'% &M X*XX X*     &M'%X X*r   HP19(obesity)# X*X'% &M #r *   Ԍ<20A    <<<< <Ќ &M'%X X* &M'%'% &MY Y X X W W  @ <" @*\] dd YY YYYY6YY6T[!#!#, YY,YY, YY+  .<<<< <"A .         X*X'% &M X*XX X*        &M'%X X*TotalFunding:Healthy D"B CommunitiesInnovationInitiative# X*X'% &M # f  N Ԍ ?<<<<,!#DD<<<< ?Ќ &M'%X X* &M'%'% &M&:(%'% &M &M'%(%&:           X*X'% &M X*XX X*         &M'%X X*FY2003:$20,000     Ԍ D"E Ќ &M'%'% &M &M'%'% &MY Y X X W W  FY2002:0# X*X'% &M # #lF  ?<<<<,!$0 H<<<< ?         X*XX X* X*XX X*    H    &M'%X X*Bx:page#budgetH    Ԍ D"I Ќ X*X'% &M X*XX X*Y Y X X W W   &M'%X X*HP:HealthyPeopleGoal# X*X'% &M #7-+#lJ  <<<< 7         X*XX X* X*XX X*        2.37.1ProgramDescription,Context,andSummaryofPerformance '   Ԍ &"K Ќ X*XX X* X*XX X*XQXX X* X*XXXQ  d     X*XX X* X*XX X*    da   ProgramDescriptionandContextda    Ԍ (#M Ќ     X*XX X* X*XX X*    TheHealthyCommunitiesInnovationInitiative(_00HCII_00)isanew,interdisciplinaryinitiativethat )$N willbringtogetherdepartmentwideexpertisetofocusonthepreventionofseveralchronicdiseasesthatarerapidlyincreasinginprevalencewithintheU.S.population. \+&P _00ԇ  ThepurposeofHCIIistoencouragethedevelopmentofinnovativecommunitybasedinitiativestoaddressHealthyPeople2010goalsaroundasthma,diabetes,andobesitypreventionthroughimprovedhealtheducation,screening,andprimarycareservices.Thisisanimportantnewinitiative.Asthma,diabetes,andobesityarechronicdiseasesthatalreadyimposeastaggeringburdenontheU.S.healthcaresystem,andtheyarerapidlyincreasinginprevalence,especiallyamongracial/ethnicminoritiesandchildren.Currently,morethan16millionAmericanshavediabetes,andstatisticsshowthatitisthesixthleadingcauseofdeath.Anestimated60percentofadultsandnearly15percentofchildrenandadolescentsareoverweightorobese.Since1980,theprevalenceofoverweightchildrenhasnearlydoubled,andtheprevalenceofoverweightadolescentshasnearlytripled.Asthmawasthe10thmostcommonprincipaldiagnosisinemergencydepartmentvisitsin1996;anestimated $  10millionadultsandnearly5millionchildrensufferfromit.Thisnumberhasnearlydoubledoverthepasttwodecades.Thetotaldirectandindirectcostsofthesediseasesarestaggering.In1997,thetotalcostsattributabletodiabeteswereestimatedatabout$100billion.Thecostsattributabletoobesitywereestimatedat$99billionin1995.Thecostsattributabletoasthmawerealittleover$6billionin1990,andhaveundoubtedlyincreasedsincethen.(Source:HealthyPeople2010)    Whilethecausesofthesediseasesarecomplexandnotfullyunderstood,researchcontinues,andtherehavebeensignificantimprovementsintreatmentofthemoverthelastfewyears.Infact,manyoftheproblemsassociatedwiththesediseasescannowbeavertedthroughacombinationoftimelyandculturallycompetentmedicalmanagement,followinguptodateguideline;monitoring;patienteducation;andpatientbehavioralchanges(Source:HealthPeople2010).HRSAwilloperatethisnewgrantprogram,withscientificandtechnicalinputfromotherfederalagencies.Applicantswouldberequiredto(1)coordinatetheiroperationsandgrantactivitieswithotherprogramsthatservepersonswithasthma,diabetesandobesity;(2)assessserviceutilizationandevaluatehealthstatusoutcomesandmakeuseofasthma,diabetesandobesitydatarequirementsprescribedbyCDC;and(3)ensurethatqualityservicesareprovidedthatreflectthelatestNIHandAHRQresearch.Itisanticipatedthatinthefirstyear,about10communities(subjecttoappropriations)willbeselectedthroughacompetitiveapplicationprocess.Criteriaforevaluatingapplicationswillincludehighdiseaseincidenceandprevalence,evidenceofStateandlocalleadershipcommitmenttotheproposedinitiative,andaconcreteplanformobilizingthecommunityinsupportoftheeffort.Althoughcommunitiesarethetargetpopulationforthisinitiative,minoritiesandchildrenwillbeaprimaryfocus.Minoritiesbearadisproportionateshareoftheburdenofthesediseases.ChildrenwillbeaprimarytargetforHCIIefforts,becauseofthepreventivefocusoftheprogram,andtheincreasingincidenceandprevalenceofasthma,diabetesandobesityamongchildren.Targetingchildrenalsoaffordsagreateropportunitytoinfluencelongtermbehaviorandhealthstatus,andpreventtheonsetofdisease. h+&* ЇThekeyprinciplesofHCIIare:1)innovationinservicedelivery,2)community/individualcommitment,3)increasedaccesstopreventive,healthandsocialservices,3)integrationofcomplexpreventionandeducationalservices,and4)multiagencyparticipation.BuildingonthesuccessesofMCHBsHealthyStartModel,HCIIwillworktofosterpublic/privatepartnershipwithincommunities,linkingprevention,medical,social,educational,business,civic,andreligiousorganizations.Theprimaryemphasiswillbeonpreventionandbehavioralchange,althoughlinkagetohealthandsocialserviceswillalsobeacomponent.Examplesofactivitiesthatcouldbefundedunderthisprograminclude:effortstoincreasetheproportionofchildrenwhowalktoschool;effortstodecreasetheamountoftimefamilieswatchtelevision;promotinghealthfoodoptionsatschoolsandworksites;localmediacampaigns,andschoolhealthprogramsaimedatimprovingnutritionandincreasingphysicaleducation.Becauseofthedifficultyinvolvedinbringingaboutlongtermbehavioralchangeandthelimitedsuccessesachievedwithcurrentmethods,particularlyamongchildrenandadolescents,emphasiswillbeplacedoninnovativeprogramsthatappeartooffergreaterpotentialforachievingandmaintaininglongtermbehavioralchange.Sincethereissubstantialscientific,technical,andclinicalexpertiseontheseissuesamonganumberoffederalagencies,oneofthefirststepswillbetoestablishandconveneaninteragencyworkinggrouptodevelopanactionplan,andamoredetailedsetofperformancemeasuresforthiseffort.  &       X*XX X* X*XX X*    X-   2.37.2GoalbyGoalPresentationofPerformanceX- -  - Ԍ   Ќ     X*XX X* X*XX X*    'L- GoalI.C.1.Conveneaworkinggroupwithbroadparticipationfromotherfederalagencies  involvedinasthma,diabetesorobesityresearch,monitoring,andserviceprovisiontodevelopactionplans,grantguidance,andmoredetailedperformancemeasures.(Developmental)Context : D!   AgreatdealofworkhastakenplacewithinHHSaroundasthma,diabetes,andobesity.TheinteragencyworkinggroupwillbringtogetherthekeyplayersintheseareasfromagenciessuchasNIH,AHRQ,CDC,CMS,IHS,ACFandHRSA.Theparticipationofthesegroupsisneededtoensurethehighestqualityfederalexpertise,technicalassistanceandtrainingtograntees,andwillensurethatHCIFbenefitsfromtheclinical,research,andmonitoringexpertiseofallHHSagencies,withoutduplicatingworkthathasalreadybeendoneelsewhereintheDepartment. Indicator:  (#' TheworkinggrouphasbeenestablishedwithbroadHHSparticipation,andanactionplanhasbeenproduced.(byFY03).   p+&* Performance:     Thisisanewinitiative.HRSAwillbeabletoreportperformanceonthisinitial,developmentalmeasurebyJanuary2003.      X*XX X* X*XX X*     3   GoalI.C.2.Providegrantstotargetcommunitiestosignificantlyreducethenumberof P  newcasesofasthma,diabetes,andobesity,andincreasethenumberofadultsandchildrenatahealthyweight.(Developmental;moredetailedmeasurestobeestablishedinconjunctionwiththeworkinggroupestablishedasGoalI.C.1above.) 3 {4 ݌̌     X*XX X* X*XX X*            X*XX X* X*XX X*   6   Context: 6 7 ݌  <  Ќ     X*XX X* X*XX X*  HRSAwillissuenewgrantguidanceinthefirstquarterofFY2003,basedonthedeliberations (  oftheinteragencyworkinggroupestablishedingoalI.C.1.(above).Theguidancewillprovidemoredetailedinformationconcerningspecificcriteriafortargetcommunityselection,funding,datacollectionandevaluation,communitypartnerships,andotherfederalrequirements,andapplicationsubmission.Proposalswillbesolicited,reviewed,andthefirst5communities(subjecttoappropriations)willreceivetheirawards. Indicator :Thenumberofcommunitiesreceivingawards. L   Performance : (x   Thisisanewinitiative.HRSAwillfocusondevelopmentofmeasureswhichfocusontwotypesofoutcomes:(1)whethermorbidityandmortalityassociatedwithasthma,diabetesandobesityhavebeenreduced;and(2)theproportionofStates/communitiesthathaveservicesystemsinplaceforchildren,youthandfamilieswithspecialhealthcareneedsincludingasthma,diabetesandobesity.#X*XX X*e #XHXXX*#X*XXXH%< #XHXXX* _00#X*XXXHj< #  $d"    eX*XXX*i7XX*TITLEXFAMILYPLANNING#X*X7i= #XX*    @' #X*Xy= #   FY2003PerformancePlan,RevisedFinalFY2002PlanandFY2001Performance : Report TheTitleXprogramistheonlyFederalprogramdevotedsolelytotheprovisionoffamilyplanningandreproductivehealthcare.Theprogramisdesignedtoprovideaccesstocontraceptivesuppliesandinformationtoallwhowantandneedthembutwhocannotaffordthem,withprioritygiventolowincomepersons.Abroadrangeofeffectiveandacceptablefamilyplanningmethodsandservicesareavailableonavoluntaryandconfidentialbasis.Inadditiontocontraceptiveservicesandrelatedcounseling,TitleXsupportedclinicsalsoprovideanumberofpreventivehealthservicessuchas:patienteducationandcounseling;breastandpelvicexaminations;cervicalcancer,_00STD_00ԀandHIV_00screenings_00;andpregnancydiagnosisandcounseling.Formanyclients,TitleXclinicsprovidetheonlycontinuingsourceofhealthcareorhealtheducation.#X*XXX*< # X*XXX*TheTitleXprogramalsosupportsthreekeyfunctionsaimedatassistingclinicsinresponding " toclientsneeds:(1)trainingforfamilyplanningclinicpersonnelthroughgeneraltrainingprograms,aswellastrainingforclinicians;(2)informationdisseminationandcommunity-basededucationandoutreachactivities;and(3)datacollectionandresearchtoimprovethedeliveryoffamilyplanningservices.TheTitleXfamilyplanningprogramisacriticalcomponentofanationalstrategytoreduceunintendedpregnancyandpreventadolescentpregnancy.Familyplanningclinicsarealsokeycontributorstohealthyfamiliesandhealthybabies.TitleXfamilyplanningclinicsalsoplayanimportantroleinaddressingthehiddenepidemicofsexuallytransmitteddiseases,includingthepreventionofHIVtransmission.TheprogramisadministeredbytheOfficeofPopulationAffairs(_00OPA_00)withintheOfficeofPublicHealthandScience(_00OPHS_00),althoughitsbudgetlineislocatedwithintheHealthResourcesandServicesAdministration(_00HRSA_00)appropriation.Therefore,the_00OPA_00Ԁfamilyplanningprogrameffortsarereflectedintwoperformanceplans(1)generallydescribedintheprogramofficecontributionstowardtheprioritiescontainedinthe_00OPHS_00Ԁperformanceplanand(2)intheprogramspecificmeasurescontainedinthe_00HRSA_00Ԅwideperformanceplan.Theprogramincludedinthissectionis:2.380 S TitleXFamilyPlanning.'~"%S"S"  X X* S   S   +&) # B #%4 #XHX4%H #  FY2003#X*XXXHkI #XHXXX*ԀPerformancePlan,#X*XXXHI #X*XXX*ԀRevisedFinalFY2002PlanandFY2001PerformanceReport   #X*XXX*=J #I XHXXX* 2.38ProgramTitle:  #X*XXXHJ # X*XXX*TitleXFamilyPlanning X X*# SK #%4  #XHX4%K ##X*XXXHK #XHXXX*&&%%XXH *<dd YY YY YY \]"", dd , dd ,dd ,`dd +  /X  /PerformanceGoals AX,!L"X ATargets AX,!L"X AActual L Performance AX,! $"X AReference =(&L "  X = I.ELIMINATEBARRIERS @   TOCAREA.IncreaseUtilizationfor_00Underserved_00ԀPopulations     1.Increasethenumberofservicedemonstrationgrantsinthefamilyplanningprogramfocusingon_00underserved_00Ԁpopulations,includingmales,adolescents,substanceabusers,andincarceratedpopulations. (Measuretobedeletedin ` FY2002.)  8 #&M'%%%&&OL #&&%%'%&M#XHX%%&&nL #&&%%XXH $"0& $ #&M'%%%&&Q #&&%%'%&MMaleGrants   *  FY02:N/A  + FY01:15FY00:15FY99: 15  (x . AdolescentGrants FY02:N/A 2 FY01:8FY00:8FY99:8  d5 SubstanceAbuseGrants FY02:N/A t9 FY01:3FY00:1FY99:1  L< IncarceratedGrants FY02:N/A ? FY01:6FY00:3FY99:3   "\B  #XHX%%&&VQ #&&%%XXH#&M'%%%&&Q #&&%%'%&M  "4C #&M'%%%&&T #&&%%'%&M#XHX%%&&S #&&%%XXHFY01:9grantsFY00:9grantsFY99:15FY98:17FY97:10  (M  FY01:35projectsFY00:35projectsFY99:8FY98:15FY97:10  T  FY01:4projectsFY00:4projectsFY99:1̀FY01:4projectsFY00:4projectsFY99:3FY98:1#XHX%%&&T #&&%%XXH#&M'%%%&&bT #&&%%'%&M  "0` B#&M'%%%&&[V ##X*X'%&MV #&M'%XX*&&%%'%&MZ 277Z Z 158Z  @ a  NEW  @c FY01DATA   e  \  .x f" } .\ \ )x f" )\ C.FocusonTarget P$g Population  (%x h 1.IncreasethenumberofindividualsservedbyTitleXclinics. (Measurerevisedfor '#k FY2002seebelow)#&M'%%%&&V #&&%%'%&M#XHX%%&&V #&&%%XXH $(#l $#&M'%%%&&X #&&%%'%&M UnduplicatedUsers  (%x n FY02:N/A &P!o FY01:4.792millionFY00:5.25FY99:5.00#&M'%%%&&Y ##X*X'%&M9Y # XHXXX*&&%%XXH (#r   8*%t #&M'%%%&&Z #&&%%'%&MFY01:(11/02)FY00:4.545FY99:4.442FY98:4.408  `)${  FY97:4.477#&M'%%%&&)[ #&&%%'%&M 8*%| FY96:4.562#&M'%%%&&[ ##X*X'%&MZ #XHXXX*&&%%XXH  +`&} B[ 277[ [ 158[ NEW &P! FY00DATA #XHX%%&&r\ #&&%%XXH#&M'%%%&&S\ #&&%%'%&M '#   )`)$" )1.Continuetoassurethat priorityisgiventofurnishingfamilyplanningservicestopersonsfromlowincomefamilies.(Totalnumberofclientsservedandtheproportionofclientswithincomesatorbelow200percentoftheFederalpovertylevel.) (Revisedmeasurefor   FY2002)    #XHX%%&&] #&&%%XXH#&M'%%%&&Y] #&&%%'%&M $  $ UnduplicatedUsers  Xd  #&M'%%%&&_ #&&%%'%&MFY03:90%4.792million 0< FY02:90%4.792million   FY01:4.792FY00:5.25FY99:5.00#&M'%%%&&` #&&%%'%&M#XHX%%&&?_ #&&%%XXH  h t FY02:(11/03)FY01:(11/02)FY00:91%4.545FY99:90%4.442FY98:89%4.408 FY97:90%4.477 @ L #&M'%%%&&` #&&%%'%&MFY96:90%4.562#XHX%%&&:a #&&%%XXH#&M'%%%&&b #&&%%'%&M   #&M'%%%&&b ##X*X'%&Mqb #XHXXX*&&%%XXHB] 277]  Xd  NEW    FY00DATA #XHX%%&&Uc #&&%%XXH#&M'%%%&&6c #&&%%'%&M  " #XHX%%&&c #&&%%XXH#&M'%%%&&%d #&&%%'%&M ) #" ) II.ELIMINATEHEALTH Xd DISPARITIES #&M'%%%&&d ##X*X'%&M|d #XHXXX*&&%%XXH 0<  A.Reduce   Incidence/PrevalenceofDiseaseandMorbidity/Mortality    1.Ensurewomenreceivescreeningforcervicalandbreastcancer. (Newmeasure $  inFY2002.)    (a)#ofPapTestsprovided̀(b)#ofBreastexamsprovided̀ $ $FY03:3.0millionpaptestFY02:3.0millionpaptestsFY03:2.8millionFY02:2.8millionbreastexams̀  HT4 FY02:(11/03)FY01:(11/02)FY00:2.906millionFY99:2.970millionFY98:2.937millionFY97:3.130millionFY02:(11/03)FY01:(11/02)FY00:2.779millionFY99:2.812million FY98:2.774millionFY97:2.961million#XHX%%&&e #&&%%XXH#&M'%%%&&e #&&%%'%&M  $W #&M'%%%&&Ti ##X*X'%&Mi #XHXXX*&&%%XXHB^ 277^  XdX  NEW  Z FY00DATA #XHX%%&&i #&&%%XXH#&M'%%%&&i #&&%%'%&M   \ #&M'%%%&&j ##X*X'%&M{j #XHXXX*&&%%XXH2.AssureaccesstoHIVtests Xd performedinfamilyplanningclinics.(NewmeasureinFY2002.) $@ L $FY03:383,360FY02:383,360̀  $ FY02:(11/03)FY01:(11/02)FY00:392,126FY99:365,883FY98:#XHX%%&&kk #&&%%XXH#&M'%%%&&Lk #&&%%'%&MԀ418,437   FY97:324,234FY96:353,956  @ L #&M'%%%&&m ##X*X'%&Ml #&M'%XX*&&%%'%&MB_ 277_ _ 158_  Xd  NEW   FY00DATA #&M'%%%&&m #&&%%'%&M#XHX%%&&m #&&%%XXH    IV.IMPROVEPUBLIC  HEALTHANDHEALTHCARESYSTEMS#&M'%%%&&n #&&%%'%&M#XHX%%&&n #&&%%XXHB.PromoteEducationand   " TrainingofthePublicHealthandHealthCareWorkforce   % 1.Improveskilllevelofallclinicalpersonnelthroughcontinuingeducation.  (( (MeasuretobedeletedinFY2002) $* $#&M'%%%&&to #&&%%'%&MFY02:N/AFY01:21,000trainedFY00:21,000FY99:21,000#&M'%%%&&&q #&&%%'%&M  1   (4 #&M'%%%&&q #&&%%'%&MFY01:21,000FY00:21,000FY99:21,000FY98:21,000#&M'%%%&&r #&&%%'%&M lx<   ? #&M'%%%&&r ##X*X'%&Mo #XHXXX*&&%%XXHBb 277b a ` 277` a b a 񀀀a b  @   NEWFY01DATAa a #XHX%%&&Ks #&&%%XXH#&M'%%%&&,s #&&%%'%&M ) E )s    TotalFunding:Family <HF Planning   G ($in000's) $H $t   FY2003:$265,877FY2002:$265,607FY2001:$#&M'%%%&&Lt ##X*X'%&M t #XHXXX*&&%%XXH254,419 K FY2000:$238,885 L FY1999:$214,932FY1998:$202,903  tN =u *Bx:page#budget̀HP:HealthyPeoplegoal% P    %#&M'%%%&&u #&&%%'%&M#XHX%%&&u #%4XXH#4%w ##X*XZw # 2.38.1ProgramDescription,ContextandSummaryofPerformance   Q TheTitleXfamilyplanningprogramistheonlyFederalprogramsolelydedicatedtofamilyplanningandreproductivehealthwithamandatetoprovideabroadrangeofacceptableandeffectivefamilyplanningmethodsandservices.Theprogramsupportsanationwidenetworkofabout4,600clinicsandprovidesreproductivehealthservicestoapproximately4.4millionpersonseachyear.TitleXservicefundsareallocatedtotheten_00DHHS_00ԀRegionalOfficeswhich,inturn,managethecompetitivereviewprocess,makegrantawardsandmonitorprogramperformance.Infiscalyear2000,TitleXprovidedfederalfundsforservicedeliverygrantsto91publicandprivateorganizationstosupporttheprovisionofcomprehensivefamilyplanningservicesandinformation.ServicesaredeliveredthroughanetworkofcommunitybasedclinicsthatincludeStateandlocalhealthdepartments,hospitals,universityhealthcenters,independentclinics,andpublicandnonprofitagencies.Innearly75percentofU.S. +$] counties,atleastoneproviderofcontraceptiveservicesisfundedbytheTitleXfamilyplanningprogram.TitleXfundsarecriticaltomaintainingandoperatingclinicswhichensuretheavailabilityoffamilyplanningservicestolowincomeanduninsuredindividualsintheUnitedStates.Overthelastthirtyyears,thenetworkofTitleXfamilyplanningclinicshasplayedacriticalroleinensuringaccesstoconfidentialcontraceptiveservicesformillionsoflowincomeoruninsuredwomenforfreeoratareducedfee.TitleXalsoprovidesaccessformanyinsuredwomenwhodonothavecoverageforcontraceptiveservices,devicesordrugs.Formanywomen,TitleXservesanentrypointintothehealthcaresystem,aswellasasourceofprimaryhealthcareservices,includingbutnotlimitedtoscreeningforbreastandcervicalcancer,aswellas_00STD_00andHIVpreventioneducationand_00screenings_00.TitleXfundedservices,availableregardlessofabilitytopay,helpensureaccesstoreproductivehealthcareforlowincomeanduninsuredpersons,apopulationwhichisdisproportionatelycomposedofracialandethnicminorities.Nearlytwothirds(64%)ofTitleXclientshaveincomesbelow100percentofthepovertylevel,and91percenthaveincomesbelow200percentofthepovertylevel.ThecontraceptivecounselingandservicesavailableinallTitleXfundedclinicsettingshelpcouplesspacebirthsandplanintendedpregnancies,animportantelementinensuringpositivebirthoutcomesandahealthystartforinfants.Eachyear,publiclysubsidizedcontraceptiveserviceshelpwomenavoidanestimated1.3millionunintendedpregnancies.Estimatesalsoshowthateverypublicdollarspentforcontraceptiveservicessavesanaverageof$3inMedicaidcostsforpregnancyrelatedhealthcareandformedicalcareofnewborns(Forest,JDandSamara,R,ImpactofpubliclyfundedcontraceptiveservicesonunintendedpregnanciesandimplicationsforMedicaidexpenditures.FamilyPlanningPerspectives,199628(5):188195).TitleXservicesalsoassistindividualsinavoidingsexuallytransmissibleinfectionsandconcomitantcomplications.Forexample,overthelastdecade,thefamilyplanningprogramhasbeenworkingincollaborationwiththeCentersforDiseaseControlandPreventiontoimplementeffectivepreventionstrategiesdesignedtoreducetheprevalenceofchlamydiaanditsdebilitatingcomplications.Chlamydiascreeninginfamilyplanningclinicsisanopportunitytopreventinfertility,aswellastheotherseriousandcostlycomplicationsresultingfromthiscommonsexuallytransmitteddiseasewhichisfrequentlyasymptomaticinwomen.Onestudyestimatesthatthedirectandindirectcostofchlamydiainfectionin1994was$2.1billion.(InstituteofMedicine.Theneglectedhealthandeconomicimpactof_00STDs_00.In:EngTR,Butler_00WT_00,_00eds_00.TheHiddenEpidemic:ConfrontingSexuallyTransmitted Diseases.Washington,DC:NationalAcademyPress;1997:59)X\>XXX*   k   #X*X>XX\ʈ # X*XXX* $D # _00#X*XX X*0 #X*XXX*pq<,(`~0 `..EH]pTheTitleXprogramisthe gluethatholdsthenationalfamilyplanningsystemtogetherlargely  determiningbothitsstructureandthesubstanceofservicesthatareprovided.Assuch,TitleXfundingisanimportantsourceofrevenuewhichleveragesothersourcesoffundingtosupporttheprovisionofsubsidizedfamilyplanningcare.AlthoughTitleXisakeyfundingsource,itcomprisesapproximatelyonefourthoftheoperatingbudgetsofclinicsprovidingservices.VariousothersourcesoffundingsupplementtheTitleXgrantfundstosupportthetotalcostofclientcare.In2000,TitleXservicegranteesreportedtotalrevenuesof$751.7milliontosupporttheprovisionoffamilyplanningservices.Slightlymorethanhalfofthesefundscomefromfederalsources,includingfederalgrants(includingabout26percentfromTitleXgrants)andMedicaidreimbursements.Theotherhalfofallrevenuescomefromsourcessuchasstateandlocalfunds,patientfeesandthirdpartycollections.#X*XXX* # X*XXX*TitleXclinicscontinuetofacea  8  challengeinmaintainingthecurrentlevelofcareinlightoftheincreasingcostofsomecontraceptivemethodsandadvancedtechnologies,thedesiretoserveadditionalclients,includingthegrowingnumberofuninsuredwomen,andexpandingservicestohardtoreachpopulations.AlltheseeffortsaredependentonnotonlysupportfromTitleXfunds,butoncontinuedsupportatthesameratefromotherrevenuesourcesinordertosupportthetotalcostofclientcare.  p  S  Theprogramremainscommittedtoimprovingservicedeliveryforitstargetpopulation, H addressingHIVpreventionamongwomen,andincreasingutilizationofservicesforunderservedpopulations.TitleXservesapopulationatincreasingriskforHIVinfection!  p young,lowincomeandminoritywomen.TheprogramhasboththeclinicalfacilityandfocusnecessarytodelivereffectiveHIVpreventionservices,anditisimperativethataconcertedpreventioneffortinthisareabeundertaken.TitleXcurrentlyhasanumberofinitiativesinplacetoreachunderservedgroupsandplanstocontinuethem.T hefamilyplanningprogramiscommittedtoincreasingservicestomales,and  emphasizingsharedresponsibilityforpreventingunintendedpregnancyandSTD/HIV >">"""infection.Additionaleffortsareneededinordertoservemalesgiventhefactthatreproductivehealthserviceshavetraditionallytargetedwomen,andthefactthatitisdifficulttodrawmenintotheclinicalsetting.Nationally,thereportedmaleclientsrepresentonly4percentofallTitleXfamilyplanningusers,butthisnumberrepresentsa34percentincreaseinmaleh+&*>">" clientsservedbetween1999and2000,andan81percentincreaseinmaleclientsservedsince1995.Inresponsetothis,theprogramhasbegunfundingvariouscommunitybasedorganizations,whichalreadyprovideavarietyofservicestomales,inordertoexaminewaystodeliverreproductivehealtheducationandclinicalservicestomen.Partofthisstrategyincludesthedevelopmentofanidentifiablemaleservicescomponentinservicedeliverygrantprograms.#X*XX X*[ #bXHXXX*#X*XXbXH— # X*XXX*TheTitleXfamilyplanningprogramworksinpartnershipwithavarietyoffederaland 8  externalpartners,includingstateandlocalgovernments,nationalprofessionalorganizations,andcommunitybasedorganizations.Overthelastdecade,akeyfamilyplanningpartnershiphasdevelopedincollaborationwiththeCentersforDiseaseControlandPrevention(CDC)toimplementeffectivepreventionstrategiesdesignedtoreducetheprevalenceofchlamydiaanditspotentiallydebilitatingcomplications.Begunin1987asademonstrationprojectinPHSRegionX,theefforthasbeenexpanded,throughaphasedinprocess,toalltenPHSregions.Thesuccessofthisapproachhasbeendemonstratedbythefactthatchlamydiaprevalenceratesdecreasedbyasmuchas69percentinRegionX,wherethechlamydiascreeningprogramhasbeeninplaceformorethan10years.TheprogramisstudyingthedevelopmentofaprogramspecificmeasureaimedatmonitoringtheproportionofwomeninTitleXclinicswhoreceivechlamydiatesting.Collaborationwillcontinueaswecontinuetoworkwithexistingpartnersandpursuenewlinkages.Examplesoffamilyplanningpartnershipsinclude:L 234567897Jhh@3456789L 23   23- 27J3  0 S   OngoingcollaborativeeffortswithCDCinregionalinfertilitypreventionprojectsand H HIVtraininginfamilyplanningclinics.23- X ݌ S"S" Ќ  L 23456789GJhh23456789L 23   23 2GJ3  0 S   MembershipintheSTDPreventionPartnership,apublicprivateconsortium,managed   throughCDC.23 ݌ S"S" Ќ  L 23456789WJhh23456789L 23   23% 2WJ3  0 S   Sponsorshipofactivitieswithcrosscuttingbenefitssuchasfundingforandanalysisof  datafromtheNationalSurveyofFamilyGrowth(NCHS/CDC),theNationalSurveyofAdolescentMales(UrbanInstitute)andtheNationalLongitudinalStudyofAdolescentHealth,morecommonlyknownastheAddHealthSurvey(NICHD/NIH).23% P ݌ S"S" Ќ  L 23456789gJhh23456789L 23   23s 2gJ3  0 S   Projectswithcommunitybasedorganizationstoexaminewaysinwhichtodeliver #l! reproductivehealthservicestomalesadolescentsandothermen.23s ݌ S"S" Ќ   S     [      c TheFY2002andFY2003familyplanningperformanceplanswererevisedtobetterreflectcurrentactivitiesandprogramgoals.Twomeasuresweredeleted(thenumberofservicedemonstrationprojectsandthenumberofindividualstrained)becauseofthedifficultyincollectinguniforminformationonaregularbasis.Thegoalonnumbersofclientsservedwasrevisedtomeasuretheproportionofclientswhoarelowincomeindividuals.Newgoalswereaddedtomonitortheprovisionofrelatedpreventivehealthservices.TheOPA,inconsultationwithproviders,currentlyisexaminingwaysinwhichfamilyplanningmeasuresanddata h+&* collectioneffortscanbeimprovedinordertobettermonitorprogramperformanceandqualityofservices. 2.38.2GoalbyGoalPresentationofPerformance  t  GoalI.A.1:Increasethenumberofservicedemonstrationgrantsinthefamilyplanning L  programfocusingonunderservedpopulations,includingmales,adolescents,substanceabusers,andincarceratedpopulations. (MeasuredeletedforFY2002)  $ t  Context:   P  Oneoftheprogramprioritiesisincreasedservicestohardtoreachpopulationsbypartneringwithcommunitybasedorganizationsandothersthathaveastakeinthepreventionofunintendedpregnancy.Underservedpopulationsincludeadolescents,males,substanceabusers,thehomelessandincarceratedpopulations.Currently,targetedgrantsareawardedinonlyoneofthelistedcategoriesofunderservedpopulationsmales.Fortheotheridentifiedcategories,projects(subgrants)thatfocusonspecialpopulationsarefundedthroughexistingTitleXfamilyplanningservicesgrantees.TitleXfundsmaleinvolvementprogramsasdemonstrationprojectstodevelop,implement,andevaluateprogramcomponentstodeliverfamilyplanningservicesandpromotereproductivehealthamongmales.Nineofthesearefundedasdirectgrantsfromthecentraloffice,and21arespecialprojectsfundedthroughexistingTitleXgrantees.Theseprogramsarebasedinavarietyofsettings,includingclinics,socialservicesagencies,andyouthdevelopmentorganizationstotestanumberofapproachesforreachingandworkingwithyoungmen.ddWhiletheprogramwillcontinueitsongoingeffortstoincreaseaccesstoservicesfortheseallofthesepopulations,themeasureitselfisbeingdeletedinFY2002.Sincethereisnouniformmethodforidentifyingandreportingonvariousspecialinitiativeprojectstargetingundeservedpopulations,thisisnotausefulmeasureforassessingprogramperformance.dd Performance: p  Indicator:Numberofgrants/projectsaimedatundeservedpopulations.  \  I.C.1:IncreasethenumberofindividualsservedbyTitleXclinics. (Measurerevisedfor  #p! FY2002seebelow.)  $`" GoalI.C.1:#X*XX X* #XHXXX*Continuetoassurethatpriorityisgiventoprovidingfamilyplanning &$"% servicestopersonsfromlowincomefamilies.(Proportionofclientswithincomesatorbelow200percentoftheFederalpovertylevel.) (RevisedmeasureforFY2002)#X*XXXH #  (#'  Context: TitleXclinicsplayanessentialroleinprovidingfamilyplanningandreproductive *%) healthservicestoindividualswhocanleastaffordsuchserviceslowincomepersons,manyof x+&* whomhavenoinsuranceorlackinsurancecoverageforfamilyplanningandrelatedreproductivehealthcareservices.Mostprivatehealthinsuranceplanseitherdonotcoverbirthcontrolorprovidemorelimitedcoverageforcontraceptivesthanforotherprescriptiondrugsandsupplies.Medicaid,thepublichealthinsuranceforthepoor,doescovercontraception,butmanylowincomewomendonotqualityforMedicaid.TheTitleXprogramisasafetynetforthosewomenwithoutthefinancialresourcestopayforreproductivehealthcareservices.Intheabsenceofsuchresources,manywomenwillforegobirthcontrolaltogether,willusecontraceptionsporadically,orwillusealessexpensivemethodthatmaynotbethemostappropriateforthem.pq<,(`~0   `..EH  Ii pThefundamentalpurposeoftheTitleXprogramistoprovidereproductivehealtheducationandservicestoallpersonswhodesirethem,andassureaccessbygivingprioritytolowincome f"f"""persons.Servicesareprovidedwithoutregardtoanindividualsabilitytopay,andifthepersonsincomeisbelowthepovertylevel,theservicesarefreeofcharge.In2000,themostrecentyearforwhichdataareavailable,4.545millionclientswereseeninTitleXclinics.Nearlytwothirds(64percent)ofTitleXclientshaveincomesatorbelow100percentofthefederalpovertylevelandareprovidedservicesfreeofcharge.Twentyfourpercenthadincomesbetween101and200percentofthe ""f"f"povertylevel,whileonly9percentofusershadincomesthataremorethan200percentofthepovertylevel.TitleXservicesareofferedonaslidingfeescaletoclientswithincomesbetween101and250percentofthefederalpovertylevel.TheconferencereportlanguageaccompanyingtheprogramsFiscalYear2002fundingdirectsthat X*XXX*Ԁ increasedfundingbeusedtoaddressincreasingfinancialpressuresintheireffortto 0"  providehighquality,subsidizedfamilyplanningservices.Thesepressuresincluderisingcostsofnewerandlongerlastingcontraceptivemethods,pharmaceuticals,andscreeninganddiagnostictechnologies,aswellasarisinguninsuredpopulation.oԀŻ #X*XX X*, # X*XXX* TheFiscalYear2003 $D # performanceplanassumescontinuedlevelfundingwithservicedeliveryprioritiesdirectedatmaintainingtheprogramshighstandardsofqualityhealthcareandcomprehensivenessofservices,includingpreventivehealthservices.TheCentersforDiseaseControlandPreventionidentifiedfamilyplanningasoneofthe TenGreatPublicHealthAchievementsofthe20th (#' centurybecauseofthepreventivehealthopportunitiesenabledbytheprogramandtheimpactthatfamilyplanninghasonimprovingreproductivehealth.d h+&* Їd Performance:   Indicator:ProportionofTitleXfamilyplanningclientswithincomeatorbelow200percentoftheFederalpovertylevel.FinalprogramdatashowthattheFY1999baselineforclientservedwasactually4.4millionindividuals,ratherthantheinitialprojectedestimateof5.0millionclients.Thebaseline,therefore,hasbeenadjusted,aswellastotheprojectedestimatesforFY2000andFY2001.TheFY2000goalofincreasingclientsby250,000remainsaperformancegoal,howevertheFY2001goalhasbeenreviseddownward.ThenumbersofadditionalclientsanticipatedinFY2001assumedenactmentoftheprogramsproposedrequestof$35millioninadditionalfunds;however,theenactedlevelprovidedfor$15millioninnewfunds($13millionofwhichisdevotedtofamilyplanningclinicalservices.)TherevisedFY2001targetof100,000newclientstakesintoaccountseveralfactors:theleveloffundsavailableforclinicalservicedelivery,thecontinuingcostofmaintainingcare,andpreliminaryprojections(basedonpartialinformationfromregionaloffices)ofthenumberofnewclientsservedwithFY2000funding.ddInaddition,duetothenaturallagtimebetweendatacollectionandreportingoffinaldata,itisimportanttonotethattheactualnumberofnewclientsservedwithFY2000fundswillprobablynotbereflectedinthe2000programdata,giventhefactthattheobligationofalmosthalfofthefundingincreaseforserviceswasdelayeduntillateinthefiscalyear.(TheFY2000appropriationsbillincludedaprovisionrequiringcertainagenciestodelaytheobligationofaportionofthe2000fundinguntilSeptember29,2000.)TheprogramguidancefortheuseoftheadditionalfundshighlightedtheFY2000performancegoalofservingadditionalclientswhoarenotcurrentlyconnectedtothepublichealthdeliverysystem,aswellastheneedtoreachthosewhoareundeserved.Thisincludesindividualswhomaybeuninsured/underinsured,malesinneedofclinicalservices,adolescents,substanceabusers,migrantworkersandthehomeless!populationsthatareoftenhardtoreachandforwhomservicedeliveryisoften  moreintensiveandexpensive. DataIssues: ThisinformationiscurrentlycollectedthroughtheFamilyPlanningAnnual l Report. S  GoalII.A.1Ensurethatwomenreceivescreeningforcervicalandbreastcancer. (New  #p! measureinFY2002.)  $`" Context: Familyplanningclinicsprovideabroadrangeofpreventivereproductivehealthservices, &$"% includingbreastexaminationsandpaptests,toapopulationthatispredominatelylowincomeandwhohavelessaccesstoappropriatehealthscreeningandpreventiveservices.Breastandcervicalcancerscreeningarecrucialtoreducingfuturemorbidityandmortality,particularlyamongpoor,minorityanduninsuredwomen.EarlydetectionwithPaptestscanpreventasignificantpercentageofpotentialinvasivecervicalcancers.Accesstotheseservicescan p+&* helpeliminatedisparitiesinhealthandpreventbreastandcervicalcancersinwomenofreproductiveage.Althoughallsexuallyactivewomenareatriskforcervicalcancer,thediseaseismorecommonamongwomenoflowsocioeconomicstatus,thosewithahistoryofmultiplepartnersorearlyonsetofsexualintercourseandsmokers.In2000,TitleXclinicsprovided2.9millionPaptestsand2.8millionbreastexaminationstofamilyplanningclients.BasedonhistoricaldatatheFY2002and2003targetsassumesthatbetween6and7papsmearsandbreastexamsareperformedforevery10femalefamilyplanningusers.Inthefuture,theprogramisworkingtodevelopmeasuresthatalsomonitorthenumberofabnormaltestsandappropriatereferralsforfollowup.Theprogramexpectstopursuethisfurtherinconsultationwithproviders. Performance: Indicator:TotalnumberofPaptestsandbreastexamsprovidedinTitleXfamilyplanning   clinics.    DataIssues:    TheFamilyPlanningAnnualReportcurrentlycollectsinformationonthenumberofPaptestsandbreastexamsprovided. GoalII.A.2AssureaccesstoHIVtestingperformedonsiteinfamilyplanningclinics. (NewmeasureinFY2002.)  `  Context:  8 TitleXfamilyplanningclinicsplayacriticalroleinaddressingthepreventionofHIVbyprovidingconfidentialHIVpreventioneducationandcounseling,screeningandreferralfortreatment.TitleXclinicsprovideservicestoapopulationthatmatchesthedemographicsofthepopulationofwomenmostatriskforHIVprimarilyyoung,lowincome,andminority.TheseclientsaresexuallyactiveandthereforeatriskforSTDandHIVinfection.SinceTitleXclinicsserveclientswhomaybeatincreasedriskforHIVinfection,ensuringaccesstoHIVtestingisanessentialservice.#X*XX X* # X*XXX* `  In2000,427,732HIVtestswereprovidedtobothmaleandfemaleusersintheTitleXfamilyplanningservicesgrantprogram.TheFY2002and2003targetsassumethatfamilyplanningclinicswillcontinuetoprovideclientswithaccesstoHIVtestingservicesconsistentwithpreviouspatterns.In2000,theratioofHIVteststototalusersis.09oraboutonetestforeveryelevenusers,aratiothatisupslightlyfromthe1999.InadditiontomonitoringthenumberofHIVtestsprovidedonsitetoclients,theprogramisexaminingimprovedmethodsformonitoringtheproportionofHIVtestswhicharepositiveandformakingcertainthatHIVpositiveclientsreceiveappropriatereferral.HIVservicesinfamilyplanningclinicsisanimportantinterventionforreachingpeoplewithpreventionco#X*XX X* #! X*XXX*!uns% X*XXX* %! X*XXX*!elingandanopportunitytolinkinfectedindividualswithneededcareand p+&* treatmentservices.% X*XXX* %! X*XXX*!ԀInFY2001,forthefirsttime,thefamilyplanningprogramdedicateda  totalof$5million($3millionfromtheSecretarysDiscretionaryFundand$2millioninTitleXfunds)toimplementaninitiativedirectedatenhancingandextendingHIVprevention,counseling,testingandreferralservicesinselectedfamilyplanningclinicsprimarilyincommunitieswithhighratesofHIV,andinareaswhereracialandethnicminoritiesareundeservedordisproportionatelyimpactedbyHIV.ThirtyfoursupplementalawardsweremadetoTitleXfamilyplanninggranteestoprovideenhancedHIVrelatedservicestoclientsatrisk.Thisinitiativewillhelpincreaseawarenessofthediseaseanditsprevention,provideHIVrelatedservicestoindividualsatincreasedriskofHIV,andhelpthoseindividualswhoareidentifiedasHIVpositivetogetcareandtreatment.% X*XXX* %! X*XXX*!  L  #X*XXX*G #bXHXXX* S #X*XXbXH # X*XXX* Performance: $   Indicator:ThetotalnumberofHIVtestsprovidedinTitleXfamilyplanningclinics.    DataIssues: 󀀀   TheFPARcurrentlycollectsinformationonthenumberofHIVtestsprovidedinfamilyplanningclinics. S GoalIV.B.1:Improveskilllevelofallclinicalpersonnelthroughcontinuingeducation. 8  (MeasureisdeletedforFY2002.) $t  Context:  L Boththegeneraltrainingandthenursepractitionertrainingprogramsareundergoingchangeswhichaffectourabilitytomeasurethisgoal.Inordertomoreefficientlyaddressthechangingtrainingneedsintheindividualregions,theOfficeofFamilyPlanningshiftedadministrationofthegeneraltraininggrantstotheregionaloffices.ForFY2000and2001,noincreaseisprojectedinthenumberofclinicalpersonneltrained.ThismeasureisbeingdeletedinFY2002becausecountingthenumberofindividualstrainedisnotausefulmeasureofprogramperformanceinthisarea.TheprogramisexaminingwaysinwhichtobetterassessTitleXprovidertrainingandeducationinthefuture. Performance: 8"   Indicator:ThenumberofindividualsparticipatinginTitleXtrainingprograms.Thenumber $#t! remainsat21,000.  DataCollectionandValidation : &$"% FamilyPlanningAnnualReport '#& AllservicegranteesreceivingfundingundertheTitleXservicesprogramarerequiredtosubmitannualdataonthenumberoffamilyplanningusersbyselecteddemographiccharacteristics,contraceptivemethodadoptedorusedatthetimeoflastvisit,numberofpaptests,breastexamsandSTDtests,staffingprofiles,andfundingsources.Theresponsibility t+&* forthecollectionandtabulationofannualservicedatafromTitleXgranteesrestswiththeOfficeofPopulationAffairs,whichisresponsiblefortheadministrationoftheprogram.Reportsaresubmittedannuallyonacalendaryearbasis(January1December31)totheregionaloffices.Granteereportsaretabulatedandanannualreportispreparedsummarizingtheregionalandnationaldata.Theannualreportdescribesthemethodologyusedbothincollectionandtabulationofgranteereports,aswellasthedefinitionsprovidedbyOPAtothegranteesforuseincompletingdatarequests.Inthe1998report,nationaltotalsandregionalhighlightsarepresentedand,insomecases,trendsbetween1995and1998arediscussed.AlsoincludedinthereportarelengthynotesthatprovidedetailedinformationregardinganydiscrepanciesbetweentheOPArequesteddataandwhatindividualgranteeswereabletoprovide.Alldatainconsistenciesandtheirresolutionarenotedinanappendixtothereport.Theseareincludedfortworeasons:(1)toexplainhowadjustmentsweremadetothedata,andhowdiscrepanciesaffecttheanalysisand(2)toidentifytheproblemsgranteeshaveincollectingandreportingdata,inhopeofimprovingtheprocess. #X*XX X* #XHXXX*C!XXH    (+x&& Ї  PROGRAMMANAGEMENT#XHX!C #  $   FY2003#X*XXXH #XHXXX*ԀPerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport    #X*XXXH #XHXXX*TheHealthResourcesandServicesAdministrationProgramManagementactivityisthe t  primarysupportmechanismfortheAgencythatprovidesnationalleadershipinhealthcareandpublichealthbyassuringqualityhealthcaretounderservedandvulnerablepopulationsandpromotingprimarycareeducationandpractice.ProgramManagementsupportsstafftoplan,direct,administer,andprovidetechnicalassistanceandprogramguidancetoclientsofmostoftheAgencysprograms. #X*XXXHz #XHXXX* `   S Programsincludedinthissectioninclude:#X*XXXH #XHXXX*2.39:ProgramManagement#X*XXXHM #XHXXX*   _00      FY2003#X*XXXH #XHXXX*ԀPerformancePlan,RevisedFinalFY2002PlanandFY2001PerformanceReport   2.39ProgramTitle:ProgramManagement #X*XXXHI #XHXXX*  *<dd dd  dd  dd `dd `<"", dd ,dd ,dd ,dd +  /X t /PerformanceGoals AX,!("X ATargets AX,!("X AActual ( Performance AX,!"X AReference#X*XXXH) #XHXXX* =(&("  X =&&%%XXH IV.IMPROVEPUBLIC D   HEALTHANDHEALTHCARESYSTEMS#&M'%%%&& # &&%%'%&M  D   A.ImproveInformation    Development#&M'%%%&& #&&%%'%&MԀand    Dissemination  |  1.FinancialStatements:Obtainacleanauditopinionfor_00HRSA_00.#&M'%%%&&F #&&%%'%&M $T  $FY03:CleanopinionFY02:CleanopinionFY01:CleanopinionFY00:CleanopinionFY99:Cleanopinion   FY01:(3/02)FY00:CleanOpinionFY99:CleanOpinionFY98:4materialweaknesses;10reportableconditions  d) Bc 274c   #XHX%%&&) # )T 0 )&&%%XXH#&M'%%%&&& # &&%%'%&M  2.InformationTechnology  1 Management:Utilizationofthe_00HRSA_00ԀDataWarehouseforProgram,GrantandManagementDecisionSupport. (RevisedMeasure)  07 2.InformationTechnologyManagement:Improve h< Accessibilitytothe_00HRSA_00DataWarehouse.#&M'%%%&&C #&&%%'%&MԀ (Previous  > Measure)  !?  $|"@ $b   FY03:Basedonsurveyfindings,theutilizationoftheDataWarehousewillprovide considerableimprovementtomanagementdecisionmaking.FY02:300usersFY01:125usersFY00:60users#&M'%%%&& # &&%%'%&M @M  FY01:283usersFY00:92FY99:10FY98:#&M'%%%&& #&&%%'%&MԀ10  !\ Bd 274d NEW _ FY01DATA  0a  #&M'%%%&&= #&&%%'%&M  #XHX%%&& # )d )&&%%XXH#&M'%%%&& #  &&%%'%&M  C.PromoteSystemsand d InfrastructureDevelopment #&M'%%%&& #&&%%'%&M X< 1.#&M'%%%&&e #&&%%'%&MInformationTechnology 0  Management:EnsureCritical   InfrastructureProtection.#&M'%%%&& #&&%%'%&M    (NewMeasure)    #&M'%%%&&} #&&%%'%&M  -#! t  -#&M'%%%&& #&&%%'%&MFY03:Tenpercent 0   reduction(yeartoyear)FY02:#&M'%%%&&} #&&%%'%&MԀTenpercent    reduction(yeartoyear)#&M'%%%&& #&&%%'%&M h L FY01: Violationratio @$ of.000324(tenpercent yeartoyearreduction)#&M'%%%&& #&&%%'%&M   #&M'%%%&&C#&&%%'%&MFY01:264detected/2PCsinfected(violationratiois.007575)FY00:25,000detectedviruses/9personalcomputersdestroyed(violationratiois.00036,or.036%chanceofviolationperdetection)#&M'%%%&&#&&%%'%&M   #   B#&M'%%%&&#&&%%'%&Me 274e  0 &  NEW  ) FY01DATA #XHX%%&&z # )h L+ )&&%%XXH2.InformationTechnology lP, Management:ImplementEGovernmentSolution. (NewMeasure) #&M'%%%&&#&&%%'%&M $/ $FY03:_00HRSA_00Ԁportalsupportstheelectronicsubmissionofgrantapplications(andsupportingdocumentation)forallfundingopportunities.FY02:N/AFY01:N/A#&M'%%%&&#&&%%'%&M  ,8 FY01:N/A#&M'%%%&&#&&%%'%&M  lP9 B#&M'%%%&& #&&%%'%&M#XHX%%&&#f 274f )lP:" )&&%%XXH #&M'%%%&&m#&&%%'%&M3.StrategicManagementof |; HumanCapitalInitiative:#&M'%%%&&-#&&%%'%&MԀAs pT< partofamanagementreview,_00HRSA_00Ԁwillimplementa_00Delayering_00ԀManagementandStreamliningOrganizational#&M'%%%&&#&&%%'%&M "@ Plan. (NewMeasure) $#A $FY03:Budget/FinancialManagementOfficeGrantsManagementOffice#&M'%%%&&#&&%%'%&M  FY02: "G LegislationOfficeCommunicationOffice#&M'%%%&&#&&%%'%&M#&M'%%%&&B #&&%%'%&M 0&K  FY01:N/A#&M'%%%&& #&&%%'%&M |L #&M'%%%&& #&&%%'%&M  X%<T B#&M'%%%&&M #&&%%'%&M#XHX%%&&#g 274g )|U" )&&%%XXH#&M'%%%&& #&&%%'%&M Goal_00IV.C._00.4:Strategic d ManagementofHumanCapitalInitiative:Implementthe_00HRSA_00ԀScholarsProgram.#&M'%%%&&h #&&%%'%&M    (NewMeasure) $  $#&M'%%%&&h #&&%%'%&MFY03:50scholars d FY02:50FY01:48     FY01:48scholars #&M'%%%&& #&&%%'%&M   t h B274h NEWFY01DATA ) " ) TotalFunding:Program   Management   ($in000's) $ $FY2003:$154,639FY2002:$156,086FY2001:#&M'%%%&& #&&%%'%&M$145,601  FY2000:$124,761FY1999:$118,712FY1998:$114,059  4  Bx:page#budgetHP:HealthyPeoplegoal#XHX%%&&& #    #X*XXXH#XHXXX* 2.39.1ProgramDescription,ContextandSummaryofPerformance   " TheHealthResourcesandServicesAdministrationProgramManagementactivityistheprimarysupportmechanismfortheAgencythatprovidesnationalleadershipinhealthcareandpublichealthbyassuringqualityhealthcareto_00underserved_00Ԁandvulnerablepopulationsandpromotingprimarycareeducationandpractice.ProgramManagementsupportsstafftoplan,direct,administer,andprovidetechnicalassistanceandprogramguidancetoclientsofmostoftheAgencysprograms. Specificallyaddressedarepreparationoffinancialstatements, ( informationmanagementandemployeedevelopment.  p)  PreparationofFinancialStatements:ThemanagementoftheHealthResourcesandServices dH+ Administrationisresponsibleforcomplyingwithlawsandregulationsapplicableto_00HRSA_00.AmongthesearetheprovisionsoftheChiefFinancialOfficersActwhichmandatethattheDepartmentprepareanannualaccountabilityreportonitsperformanceandfinancialintegrity.Thebasisforthe_00HRSA_00ԀaccountabilityreportisanannualauditoftheAgencysfinancialstatusbyacommercialpublicaccountingfirm.The_00HRSA_00ԀChiefFinancialOfficersAnnual "0 ReportispreparedforsubmissionbyMarch1ofeachyearforthepreviousfiscalyearbythe "1 DivisionofFinancialManagement,OfficeofManagementandProgramSupportwiththeassistanceoftheDivisionofFinancialOperations,ProgramSupportCenterwhichprovidesaccountingservicesto_00HRSA_00. InformationTechnologyManagement:(1)providesadviceandassistancetotheAdministrator 'l 6 andotherseniormanagementpersonneltoensurethatinformationtechnologyisacquiredandinformationresourcesaremanagedinamannerthatimplementsthepoliciesandproceduresofthe_00Clinger_00ԄCohenActandtheprioritiesestablishedbytheSecretary;(2)develops,maintains, andfacilitatestheimplementationofasoundandintegratedinformationtechnology 8+$: architecturefortheagency;and(3)promotestheeffectiveandefficientdesignandoperationof allmajorinformationresourcesmanagementprocessesfortheagency,includingimprovementstoworkprocessesoftheagency. EmployeeDevelopment:Amajorfocusisonincreasinginvestmentinworkplacelearning. ` Throughthe_00HRSA_00ԀCareerResourcesCenter,employeeshaveaccesstoworkshops,printedmaterialsandcomputerprogramswhichincreasetheirparticipationinworkplacelearning.The_00CRC_00ԀstaffiscontinuingtodevelopworkshopstoaddresstheissuesidentifiedintheTrainingNeedsAssessment,includingleadership,coaching,timemanagement,and_00mentoring_00._00HRSA_00ԀisalsoofferinganumberofspecialopportunitiesacrosstheAgencyincludingpublichealthtrainingandwomensleadershipprograms. 2.39.2GoalbyGoalPresentationofPerformanceGoalIV.A.1:FinancialStatements:Obtainacleanauditopinionfor_00HRSA_00.*e, e XX*Context:  p DuringFY2003,theHealthResourcesandServicesAdministration(_00HRSA_00)planstoobtainacleanauditopinionconsistentwiththeobjectivesoftheDepartmentofHealthandHumanServicesandthePresidentandinaccordancewiththeChiefFinancialOfficersAct.TheannualaudithelpsensuretheintegrityoftheAgencysfinancialsystemsandthereliabilityofthefinancialdataprovidedto_00HRSA_00ԀbytheProgramSupportCenter(_00PSC_00)._00HRSA_00Ԁcontinuestobecommittedtoprovidingaccurate,comprehensiveinformationforFederalpolicyandprogramdecisions.Aswithanybusinessorgovernmententerprise,deliveryofanauditreportwhichistimelyandcompleteisacrucialpartofthemanagementinformationsystemandanimportanttoolforthedirectionandimplementationofprograms.AchievementofacleanauditopinionindicatesthattheAgencyanditsaccountingserviceprovider(the_00PSC_00)haveattainedahighlevelofaccuracyand_00reportability_00Ԁinfinancialrecordsandcontrols.Thisachievementprovidesasolid,rationalbasisforpolicyandbudgetdecisionsbytheExecutiveBranchandtheCongress.FinancialManagementdataisprovidedbytheDivisionofFinancialManagement Performance:  #l! Baseline:Thefull,independentauditof_00HRSA_00Ԁforfiscalyear(FY)1998wasconductedbyClifton_00Gunderson_00Ԁ_00L.L.C._00,CertifiedPublicAccountantsandConsultantsundercontracttotheOfficeoftheInspectorGeneral.Theauditorsreportednoqualificationstotheirauditopinion,4materialweaknesses,and10reportableconditions.Allofthematerialweaknessesandmostofthereportableconditionswererelatedtothesystemsandprocessesthe_00PSC_00Ԁutilizesinprovidingaccountingservicesto_00HRSA_00.Actual:ForFY1999,_00HRSA_00Ԁreceivedacleanauditopinion.TheFY1999auditwasinitiatedwithanauditentranceconferenceonJune2,1999.AuditactivitiescommencedlaterinJune h+&* _00andproceededtopreliminaryfindingsinDecember1999.TheHRSAChiefFinancialOfficers  AnnualReportforFY1999wassubmittedinMarch2000forincorporationintheDHHS  AccountabilityReport:FiscalYear1999.Inaddition,HRSAreceivedacleanauditopinionfor  FY2000.DuringthecourseoftheFY1999auditHRSAworkedcloselywiththePSCtoimprove,enhanceandcorrectthoseaccounting,dataandproceduralelementswhichledtomaterialweaknessesandreportableconditionsinpreviousaudits.OneadjustmenthasbeentostaggertheschedulingoftheHRSAauditfromtheauditsofotherOPDIVsprovidedaccountingservicesbythePSCinordertoassurethatboththePSCfinancialoperationsstaffandtheauditorshavesufficienttimeandhumanresourcestothroughlyinvestigateandexamineallrelevantdataandaccounts.HRSAtrackstheprogressoftheauditthroughtheassignmentofaDivisionofFinancialManagementstaffmembertoprovideoversightinfrequentscheduledandadhocmeetingsandreviews.   Planned:TheSecretaryhasdeclaredtheachievementofanunqualifiedauditasanobjectivefortheDepartmentconsistentwithgoalsexpressedbythePresidentandtheOfficeofManagementandBudget.ThissimilarperformanceobjectiveofHRSAissupportiveoftheSecretarysintentandwillprovidemanagementandpolicyofficialswithaccurate,comprehensiveinformationonwhichtobasefundingandoperatingdecisions.TheobjectivewillalsoleadtoimprovementsinHRSAsaccountingandotherfinancialsystemsandtoimprovementsinthequalityofsuchservicesprovidedtotheAgencybythePSC. GOALIV.A.2:InformationTechnologyManagement:UtilizationoftheHRSAData   WarehouseforProgram,GrantandManagementDecisionSupport.(RevisedMeasure)ImproveAccessibilitytotheHRSADataWarehouse.(PreviousMeasure)    Context:   AsreportedintheAnnualPerformancePlans/ReportsforFY2000,2001and2002,theprimaryobjectiveoftheDataWarehouseistoexpanddesktopaccesstotheenterprisewide X  datastoragesystemknownastheDataWarehouse.However,measuringtheperformanceoftheDataWarehousebaseduponaccessaloneisaonedimensionalapproachthatdoesntreflectifandhowWarehousedataisusedtosupportprogrammaticormanagementdecisionmaking.Therefore,inFY2003,HRSAwillmoveawayfrommeasuringtheperformanceoftheDataWarehouseintermsofaccess,andwillinsteadaddresstheuseoftheDataWarehousetosupportHRSAbusinessoperations.  %0!$  r BeginninginFY2001,HRSAembarkedonatransitionfromaclientserverapproachtoawebenabledapplicationtoimproveaccessibilitytoWarehousedataandimprovetheapplicationadministration.Therefore,agencypersonnelwithconnectivitytotheHRSAIntranetcanvisittheDataWarehouseandgeneratequeriesandreportsviaaBriosoftwaretool.πHRSAsOfficeofInformationTechnologyoffersintroductoryBriotraining(alongwithall h+&* otherHRSAsupportedsoftwareapplications)toacclimateenduserswiththesoftwarecapabilitiesforqueryandreportdevelopment.HRSAiscurrentlydevelopingathreeyearDataWarehouseStrategicPlanthatwillbuilduponourexistingprototypeplatformandexpanditsdatacontentandfunctionality.InFY2003,theDataWarehousewillincorporatecrossbureaureportingofindividualgranteeperformancedata(summarylevel),andacquirenewcontextual(external)data.̀ Performance:   ` TheDataWarehouseincludesvaluableinformationobtainedfromHRSAgrantprograms,U.S.CensusBureau,andotherhealthrelatedandstatisticaldata(suchastheAmericanMedicalAssociation,AmericanAssociationofNursing,etc.)andintegratescertainprogrammaticdataintoawarehousestructure. Datawarehousing"isdefinedasanessentialsetofenablinginformationsystemsthroughwhichtoachievekeybusinessobjectives. r Byeliminatingduplicatedatacollectionandvalidationeffortsamongindividualoffices,divisions,andbureaus,thecentralizedDataWarehousehasprovidedacosteffective,valueaddedcontributiontotheHRSAenterprise.TheDataWarehousewillworkbetterandcostlessifHRSAemployeescollaborateeffectivelyandshareinformation.Thebroaderthescopeofinformationsharing,thegreaterthebenefitswillbe.InFY2003,thefocusoftheDataWarehousewillshiftfromimprovedaccessibilitytoimprovedutilization.MeasuringtheutilizationoftheDataWarehousewillrequirethesurveyingofprogram,grantandmanagementstafftogaugetheimpactofWarehousedata.Amongotherquestions,thesurveywillmeasurewhethertheDataWarehouseprovidesaconsiderable,moderate,minimal,orzeroimpactformanagementdecisionsupport.*<Zdd dd dd dd dd <"",dd ,3dd ,3dd ,3dd ,3dd ,Rdd +  /S  /ImproveAccessibilitytotheHRSADataWarehouse N9)H"  S NMeasure E0!x" EFY2000 H3$x" H @ FY2001 D/$x" DFY2002 ;1&x "   ;UniversalaccesstotheDataWarehouseforHRSAemployees. '" # '  Planned  H$ 060users '" & '  Actual  H' @192users '!4( 'Planned  H) 125users '!4* 'Actual  H+ 283users '" - '  Planned  H. T2300users  "" 0   "2 r     [   #<0 *<Zdddd 3dd 33dd 33dd 33dd 3Rdd R<"",dd ,kdd +  /S  /NEWb4:UtilizationoftheHRSADataWarehouseforProgram,Grant, d andManagementDecisionSupport. N9)P"  S NMeasure A,!" AFY2003 ;1&"   ;ThecrosssharingandstorageofagencyinformationwithintheDataWarehousewillimprovethequalityofmanagementdecisionmaking. '  'Planned:  P  Surveyresultsofprogram,grantandmanagementstaffwillindicate considerablemanagementdecisionsupport viatheutilizationoftheDataWarehouse.  ̀"t   " GOALIV.C.1:InformationTechnologyManagement:EnsureCriticalInfrastructure h  Protection(NewMeasure) T  #X*XXXH #XHXXX*#X*XXXHF8#XHXXX* Context:  ,| K+ 4 <DL!e, e XK#X*XXXH8#X*XXX*InFY2002,HRSAcontinuedtoimplementathreefoldCriticalInfrastructureProtection(CIP) h planthatincludesthedeploymentofanintegratedsecuritypolicyandinfrastructuresolution,validationofsecuritypoliciesthroughvulnerabilitytesting/monitoring,andproactivetrainingeffortsforagencypersonnel.#X*XXX*99#?+ 4 <DL!X?X*XXX*ԀPriortothis,HRSAinitiatedseveralmeasurestoeliminate , vulnerabilitiestophysicalandcyberattacksonourcriticalinfrastructure,andcontinuedtoworkwithprogrammaticstaffandprogram/projectmanagerstoassistwithriskassessmentandmitigationstrategies.#X*XXX* ;# X*XXX*HRSAisconfidentthatthereCIPeffortshavebeeneffectiveandavoidedmanypotential x securityviolations.Forexample,inFY2000HRSAemployeeswereinundatedwiththeelectronicreceiptofthousandsofemailmessageslinkedtotheILOVEYOUcomputervirus.Sincethatincident,HRSAhasimplementedaninternalVirusAlertteamandtakenotherprecautionstoavoidthedisruptionofservices,andhaveconsiderablyreducedthenumberofdetectedsecurityviolationsinFY2001.AlthoughHRSAssecurityviolationratiohasslightlyincreasedfromFY2000toFY2001,theabsolutenumberofsecurityviolationshasdroppedfromseven(7)totwo(2).#X*XX X*s<#X*XXX* #<% RecentlegislationsuchastheGovernmentInformationSecurityReformAct(GISRA)of2000imposessignificantcomputersecurityrequirementsincludingperiodicassessmentsofsecurityriskstoinformationsystemsanddatasupportingitscriticaloperations.  #X*XXX*^?#X*XXX*#X*XXX*@#XHXXX*DuringFiscalYear2002and2003,theOfficeofInformationTechnology(OIT)willcontinue t)$+ toactivelyguardagainstthebroadrangeofsecurityviolationsthatcreateamajorrisktotheHRSAtechnicalinfrastructure.Forreportingpurposes,HRSAhasdefineda securityviolationas#X*XXXHA#X*XXX*anyactivityorincident,whethermaliciousorunintentional,thathassubstantial 8,'. adverseaffectsupontheperformanceorconfigurationoftheITinfrastructureoranyofitscomponents.#X*XXX*B#XHXXX**~<Ydddd kdd k<""~,dd ,add ,3dd ,]dd ,Ydd ,dd +  ( t (NHXXHEnsureCriticalInfrastructureProtection#XHXHNE#&&%%XXH N9)("  S NMeasure A,!l " ABaseline l  FY2000 E0!D " EFY2001#&M'%%%&&C# &M'%'%&M# X*X'% &MrE# &M'%X X* D/$l " DFY2002 A,!l  " AFY2003 2(&l  "   2ReducethenumberofsecurityviolationsthatcreateamajorrisktotheHRSAtechnicalinfrastructure     Detected :25,000   emailmessages(58differenttypesofvirusattacks) Violated :9   personalcomputersdestroyedbyvirus(4virusesILOVEYOU,Navidad,Columbia,andPrettyPark) Violationratio : 8# .00036(or.036%chanceofviolationperdetection)  ' # X*X'% &MF# &M'%X X* PlannedViolationratio : X , .000324or.0324%# X*X'% &MI# &M'%X X*#&M'%'% &MF#&&%%'%&M#XHX%%&&lJ#&&%%XXH(ten B1 percentyeartoyearreduction)#&M'%%%&&J# &M'%'%&M# X*X'% &MJ# &M'%X X* 5 # X*X'% &MK# &M'%X X*  R7  Detected :264  8 emailmessages Violated :2 b < personalcomputerswereinfectedby#&M'%'% &MlK#&&%%'%&M#XHX%%&&L#&&%%XXHvirus t @ (W32/SirCam@MM#XHX%%&&-M##X*XXXHL# X*XXX* &M'%X X*) $tB  Violation $D ratio : E .007575(or.7575%chanceofviolationperdetection)  4J Tenpercent(10%)reduction(yeartoyear)  8 P Tenpercent(10%)reduction(yeartoyear) 8 V  # X*X'% &MM##X*XX X*M#XHXXX* GOALIV.C.2.:InformationTechnologyManagement:ImplementEGovernment |X Solution. (NewMeasure)  h Y  #X*XXXHjO# X*XXX*Context : D"[ ElectronicGovernmentisanessentialcomponentofthepublicsectoragenda,andlegislationsuchastheGovernmentPaperworkEliminationAct(GPEA)requiregovernmentorganizationstotransitionfromtraditionalbusinesspracticestoEGovernment.BeginninginFY2000,HRSAbegantothoroughlyassesstheadministrativeprocessesthatsupportitscorebusiness(i.e.,administrationofgrants)andexploredelectronicsolutionsthatcouldbeemployedviatheweb.#X*XX X*FP# X*XXX*TheimplementationofelectroniccommercewillincreaseHRSAsadministrative ' #a efficiencybystandardizingandautomatingbusinesstransactionsthatwillreducethetime,cost,andburdenassociatedwiththeseprocesses.Thiswillalsogreatlyimprovecustomerrelationshipsthroughmoreenrichedandreadilyaccessibleinformation. +&e   #X*XX X*|R#?+ 4 <DL!X? X*XXX*InFY2001,HRSAemployedaprocessandrequirementsgatheringmethodologycalled  ElectronicHandbooks(EHBs)andapplywebbasedtechnologiestocreateonlinehandbookstoguidecustomersthroughavarietyofgrantrelatedprocesses.TheEHBsincludeagraphicalinterfaceonthefrontendthatprovidemenusandforms,abackenddatabase,andunderlyingsoftwarethatdirectsthedatainformationfromtheforms.Oncecomplete,thenewsystemwillemployanumberofproventechnologies,alongwithsecurityandauthenticationtools,toestablishawebbased,interactive,environmentforelectronicapplicationdevelopment,submission,reviewandaward,andpostawardadministration,andeffectivelyimplementtheprovisionsofGPEA.  #X*XX X*T#?+ 4 <DL!X? X*XXX* Performance :  8  HRSAsEGovernmentsolutionwillbedesigned,developed,andtestedduringFY20012003andwillfollowaphasedapproachforthefollowingmodules:grantsprogramdevelopment,application,review,award,postaward,andcloseout.Target:BySeptember2003,HRSAwillhaveafullyoperationalportalthatwillaccepttheelectronicsubmissionofgrantapplications(andsupportingdocuments)forallHRSAfundingopportunities.#X*XX X* X#X*XXX*#X*XXX*&Z#XHXXX* GOALIV.C.3: #X*XXXHiZ#XHXXX*Ԁ StrategicManagementofHumanCapitalInitiative:#X*XXXHZ#XHXXX*ԀAspartofa ` managementreview,HRSAwillimplementaDelayeringManagementandStreamliningOrganizationalPlan.#X*XXXH4[#X*XXX*  < #X*XXX*[#XHXXX* Content:  d OneofthePresidentsGovernmentwideReformsisdelayeringmangementlevelstostreamlineorganizations.ToenhancetheadministrationandoperationofHRSA,HRSAisundertakingaManagementReviewwhichwillhelpinthedevelopmentandimplementationofaDelayeringManagementandStreamliningOrganizationalPlan.Thisplanwillassistinimprovingitsgovernmentfunctionsandefficienciesinoperations. Performance:   TheinitialrecommendationsinHRSAsDelayeringManagementandStreamliningOrganizationalPlanarecurrentlybeingimplemented.Resultsareasfollows:#X*XXXHY\#XHXXX* L! ЄConsolidationofLegislativeandPublicAffairsstaffwithinHRSA,withappropriatereportingrelationshipstoOShasbeencompleted.̄Budget/FinancialManagementandGrantsManagementstaff:Developmentaleffortsareunderwaytoconsolidatethesefunctionsandtocomeupwithspecificproposals.#X*XXXH!_# $L #  p+&*  GoalIV.C..4:StrategicManagementofHumanCapitalInitiative:ImplementtheHRSA  ScholarsProgram. Content:  t ToassistinaccomplishingthePresidentsStrategicManagementofHumanCapitalInitiative,HRSAhasdevelopedtheHRSAScholarsProgram.Thisprogramwillincreasecareerdevelopmentopportunitiesanddevelopanewapproachtohiringstaffexperiencedprofessionalsandyounggraduates.ThisapproachfocusesonbringinginhonorstudentsattheGS5,7and9levels. Performance:   8  DuringFY01,theHRSAScholarsprogramwasdevelopedandimplemented.FortyeightScholarswerehired. X*XXX*XX*      *8&$ ЇAPPENDIXTOTHEPERFORMANCEPLANc#X*Xc#A.1ApproachtoPerformanceMeasurement H  Overall,HRSAsfocusisonprogramsthatpromoteitsprimarygoalofincreasingaccessto   healthcareandreducinghealthdisparities.Towardsthoseends,theAgencyisinternallystrengtheningitsstaffandpositioningitselftorespondastheenvironmentchanges.HRSAhasmadeastrongefforttobuildaperformancemanagementapproachintothewayitconductsitsbusiness.TheagencystructuredthedevelopmentofitsinternalstrategicplanningprocesstobeconsistentwiththerequirementsoftheGovernmentPerformanceandResultsAct(GPRA).ThegoalsdevelopedintheprocesshaveguidedthedevelopmentofourAnnualPerformancePlans.ThisAnnualPerformancePlanincludesaFY2003Plan,aRevisedFinal#X*XXX*c#X*XXX*ԀFY2002Plan D  andtheFY2001PerformanceReport.   l    HRSAinitiateditsGPRAperformancemeasurementeffortwithanassessmentofallprogramsandtheirreadinessformeasuringperformance,beginningwiththeGPRArequirementsasthebasisforthereview.TheAgency,usingeachmajorprogrambudgetline:L 23456789Ihh23456789L 23   #X*XXX*g#X\AXXX*23i2I3  0 S   #X*XAXX\i#X*XXX*Identifiedbothstrengthsandweaknessesintermsofabilitytomeasureperformance.23ij݌S"S" Ќ  L 23456789Ihh23456789L 23   #X*XXX*jj#X\AXXX*23mk2I3  0 S   #X*XAXX\k#X*XXX*Assessedthecurrentavailabilityofindicatorsanddatathatcanbeusedtoensure  effectivemanagementofresources.23mkk݌ S"S" Ќ  L 23456789Ihh23456789L 23   #X*XXX*Cl#X\AXXX*23tm2I3  0 S   #X*XAXX\m#X*XXX*Identifiedkeyareaswheredevelopmentalactivitiesareneededandhavechanneled X agencyresourcestotheseareas.23tmm݌ S"S" Ќ  Theagencyoutlinedthecentralassessmentquestionoforganizationalperformance: XCanthisorganization,withagivensetofresources,throughaseriesofactionsand F decisions,produceoutputsthathavethedesiredeffectsandoutcomestobenefitthoseitserves?    XB.` hp x (#XBTechnicalassistancehasbeenprovidedtoeachoftheoperatingcomponentstoenhanceabilitytodefineperformancegoalsandmeasures.FortheFY2003budget,AnnualPerformancePlansareincludedforallmajorprogramactivities.  j% # 3 p x (#X3& J Q7 TheEssentialPerformanceQuestion   H.` hp x (#XH* dddd add a3dd 3]dd ]Ydd Ydd <"",kk,kk,kk,kk,kk,kk+  5<<<<"  5lXX*d'Jqd &C0Canthisorganization 6<<<<#<<<< 6 &C0dd &C0...withtheseresources... 6<<<<# <<<< 6 &C0dd &C0...throughtheseactions,processesanddecisions... 6<<<<# <<<< 6 &C0dd &C0...yieldingtheseproducts... 6<<<<#<<<< 6 &C0dd &C0...havetheseeffects... 6<<<<#<<<< 6 &C0dd &C0...forthesepeople? N<<<<;#   <<<< N &C0ddHHSHRSA4BureausPrograms &C0Activities 6<<<<#L <<<< 6 &C0ddLegislativeAuthorityBudgetAuthorityStaffEquipment/Supplies &C0InformationandDataSystems 6<<<<#*/<<<< 6 &C0ddDataCollectionResearch/AnalysisProblem/NeedsAssessmentMethodsDevelopmentStandardSettingGrantmakingContractAwardsProgramCoordinationEvaluationPartnerships &C0 6<<<<# G<<<< 6 &C0ddServiceDeliveryTrainingTechnicalAssistanceDemonstrations/ExperimentsKnowledge/AwarenessSkill/Capacity &C0Guidelines 6<<<<#fX<<<< 6 &C0ddAccesstoCareImprovedUtilizationImprovedQualityLowerMortality/MorbidityIncreasedLifeExpectancy &C0ImprovedHealthStatus 6<<<<#~m<<<< 6 &C0ddVulnerablePopulationsMedicallyUnderservedPersonswithHIV/AIDSChildrenwithSpecialHealthCareNeedsPersonsinBorderCommunities q=0#X*Xl9t#3)',|    <<<< 3 q=0&  OrganizationInput   [ Process   c   Output   k Outcome !   CustomersLevel'~Theplancontainsamixofprocess,output,andoutcomeindicators.Basicdistinctionsamongtheseareasfollows:L 23456789Ihh23456789L 23   #X*XXX*Jn#X\AXXX*232I3  0 S   #X*XAXX\# X*XXX*Process :Aprogram#X*XX X*# X*XXX*sinternalactivities(e.g.,trainingapproachused).23݌"hS"S" Ќ  L 23456789Ihh23456789L 23   #X*XX X*܀#X\AXXX*232I3  0 S   #X*XAXX\# X*XXX*Output: Aprogram#X*XX X*# X*XXX*sdirectproductsorservices(e.g.,numberofpeopleprovided  #Z healthservices,numberofpeopletrained),includingproduct/servicecharacteristicssuchastimeliness,qualityandefficiency.23/݌ S"S" Ќ  L 23456789Ihh23456789L 23   #X*XX X*#X\AXXX*23l2I3  0 S   #X*XAXX\# X*XXX*Outcome :Resultsofprogramoutput(e.g.,changesinhealthstatus,mortalityor %$! morbidity).23l܄݌ S"S" Ќ  Althoughtheultimatetargetistoproduceoutcomeorientedperformancegoals,sincethesearethedesiredindicatorsofprogramresults,itshouldberecognizedthatoutputandprocessmeasuresarealsoimportantandfrequentlythemostrealisticandroutinelymeasurableindicatorsofperformance.Theyareoftentheonlyindicatorscurrentlyavailableonanannual b+& basisandreflectthelevelofcontrolanagencycanbringtobearthroughparticularprograms.HRSAwillworktoincreasetheuseofoutcomemeasuresandtodemonstratetherelationshipbetweenitsprocess/outputmeasuresandthedesiredoutcomes.ThroughouttheHRSAplan,thereareperformancegoalsofeachofthesetypes.WithintheMaternalandChildHealthprogram,forexample,outcomemeasuresareemphasized.DataiscollectedoncoreperformancemeasuresfromallStates,includingtrackingoftheinfantmortalityrateandthedisparitybetweentheblackandwhiteinfantmortalityrate.TheBureauofHealthProfessionshasdevelopedaComprehensivePerformanceMonitoringSystemwhichhasbeguntocapturecommonactivitiesacrossitsprogramsandtomeasuretheaggregateeffectsofgranteeachievements.Anexampleofsuchacrosscuttinggoalistoincreasethenumberofgraduatesand/orprogramcompleterswhoenterpracticeinunderservedareas. DataVerificationandValidationIssues:     General    Therearenumerousconcernsabouttheavailabilityandcostofdatatomeasureperformanceandresults.Datasystemsoftenhavebeeninitiatedtomeasuretheresultsofindividualprograms,usuallyasalegislatedrequirement.ManyprogramstargetthesamepopulationswithinandoutsideofHRSA,sothereisthepotentialforindividualprogramstryingtoobtaindifferentinformation,indifferentformatsandatdifferenttimes,fromthesamesource,therebyincreasingthereportingburdenatthegranteelevel.BecauseHRSAprogramsaregenerallycarriedoutbygranteesattheStateandlocallevel,whooftenusesubgranteesorcontractorstoperformthework,thesystemisnotstructuredtoproducearoutineflowofdataongranteeperformanceandoutputs.HRSAisworkingtoestablishusefulandefficientsystemsforgatheringperformanceandaccountabilityinformation.Anotherdataissueisthecompetingneedtocollectessentialperformancemeasurementinformationwhile,atthesametime,attemptingtomeettherequirementsofthePaperworkReductionActwhichaimstoreducethereportingburdenassociatedwithparticipationinFederalprograms.Thesecompetingneedsattimesaredifficulttoresolve.Thisvarietyofdataissueswillcontinuetobeaddressedasweproceedwiththedevelopmentofourperformancemeasurementstrategy.Itisclearthatadditionaleffortisneededtomovetowardincreaseduseofcommon,structured,andstandardizeddatastrategiestocarryoutaneffectivesystemofperformancemeasurement.Agooddealofworkhasalreadybeeninitiatedinthisarea. S  h+&*  PrimaryCare  (BureauofPrimaryHealthCare) A.GeneralDescriptionoftheSources/Systems t  InordertopreparefortheimplementationofGPRA,severalyearsagotheBureauofPrimary ` HealthCareinitiatedathreepartdataandevaluationstrategy.First,aUniformDataSystem(UDS)wasdevelopedandimplementedtocollectaggregateadministrative,demographic,financial,andutilizationdataannuallyfromeachorganizationreceivingsupport.Thissystem,whichcombinedfivepreviouslyseparatereportingformats,isinitsfourthyearofoperationprovidingstandardizedinformationacrossallgranteesforallyears.TheBureaussecondpartofitsdataandevaluationstrategyusessurveys(UserVisitsSurveys)ofarepresentativesampleofhealthcenterusersandprovidervisitsdevelopedincollaborationwiththeNationalCenterforHealthStatistics.ThesesurveysprovideindepthinformationonindividualsandthecaretheyreceivebasedonandcomparabletotheNationalHealthInterviewSurvey(NHIS)andtheNationalHospitalAmbulatoryMedicalCareSurvey,(NHAMCS),respectively.Theuseofinstrumentsdevelopedfromalreadyestablishedsurveysassuresthecollectionofreliableandcomparabledataonhealthcenterusers.Nationalresultsareusedasbenchmarksofprogramperformance.ThissurveyisbeingconductedagaininFY2000andwillbeexpandedtoincludesitesatwhichNationalHealthServiceCorps(NHSC)cliniciansserve.Third,BPHCreorienteditsportfolioofotherevaluationefforts,shiftingfromadescriptivecasestudyapproachtotheuseofpreviouslyvalidatedsecondarydatasourcesthatenableacomparisonofusersandsimilarpopulationsofnonusers,andsystematicsamplingoforganizationsandusers.OnesuchevaluationusesStateMedicaidResearchFiledatafromCMSonidentifyambulatorycaresensitiveconditions(ACSC;aproxyforaccesstoambulatorycare)toexaminedifferencesbetweenMedicaidbeneficiaryhealthcenterusersandusersofotherformsofprimarycare.Thesedifferencesassessthequalityofcarethatusersand #X*XX X*E# X*XXX*nonusers#X*XX X*# X*XXX*Ԁreceive.AlsoinFY1999,theBureaulaunchedtheBreakthroughSeriesin l Diabetes,Hypertension,andAsthma,thechronicconditionsofhighestprevalenceamonghealthcenterusers.TheseCollaborativesbuildappropriatedatagatheringandpatientmanagementinfrastructureswithinhealthcentersandatNHSCsitestomanage,treat,andmeasuretheimprovementinuserhealthstatuswiththesechronicconditions.TheseCollaborativeswillbeexpandedtoassesspreventivestrategiessuchasintobaccouseandsmokingcessationandinthemanagementofdepression. B.DataQuality TheUDSisvalidatedthroughongoingeditchecks,aswellasonsitereviewsconductedduring '#& eachorganization#X*XX X*F# X*XXX*sprojectperiod.The ValidityReportfromthesechecksandreviewsare (#' centraltotheeditingprocess.Thisreportincludesnumerouscrosschecksofthedataincludingmathematicalerrors,discrepanciesandlogicaldiscrepancies.Asdataarecollectedovertime,internalinconsistenciescanbeidentifiedandaddressed. h+&* ЇThedatafromUDSdirectlymeasureprogramperformanceonkeyGPRAindicators:numberofusersovertimetodetermineincreaseinaccess;andsociodemographicdatatoassurethatprogramsaretargetingthepoor,uninsuredandmembersofminoritygroupstoincreasetheiraccessandeliminatetheirhealthstatusdisparities.InFY1999,theUDSwasexpandedtoincludesitesatwhichNHSCcliniciansareservingtoobtainamorecompletepictureofBureauprogramimpact.ThesedataareusedtodrivebudgetdecisionsattheAgencylevel.TheyarealsocompiledattheRegionalleveltobeusedbyFieldOfficestoprovideassistancetogranteeswherenecessary.TheresultsoftheUser/VisitSurveyof1995willbecomparedwiththeresultsoftherepeatsurveyinFY2000.Thesedataprovideimportantmeasuresoftheextenttowhichhealthcentersareeliminatinghealthstatusdisparities.Theyalsoprovideimportant #X*XX X*u# X*XXX*customer $  #X*XX X*գ#X*XXX*informationaboutsatisfactionwithcareandperceivedhealthstatus.Currently,mostofthe   GPRAmeasuresofhealthstatusdisparityreductionrelyontheseresults(e.g.,glycohemoglobintestsfordiabetics,bloodpressurecontrolforhypertensives,uptodatePap,clinicalbreastexamination,andmammographyforatriskwomen).StudiesofthedataobtainedfromtheseCollaborativeswillbeusedtovalidatethepatientspecificdataobtainedthroughothermethodssuchastheUser/VisitSurvey.Also,thedatawillassurethatBureauperformancemeasureswillextendfromproxiesforoutcomestoactualoutcomes(i.e.,measuringactualglycohemoglobinlevelsinadditiontomeasuringthepercentofhealthcenterdiabeticswhohaveuptodatetestingatrecommendedintervals).Individualsiteswillbeabletousethesedatatoassesstheirownperformanceovertime.TheBureauisworkingcloselywithCMStoexpanditsACSCanalysestoaddressthequalityofcarereceivedbyallMedicaidbeneficiariesincludinghealthcenterusers.ThesecomparisonswillenableHCFAtocontinuouslyimprovethehealthservicesdeliveredtoMedicaidbeneficiariesatavarietyofsitesbeyondhealthcenters.TheBureauconductsitsownaccreditationprocesswhichisintendedtovalidatesomeoftheinformationcollectedthroughtheUDS.StudiesofthedataobtainedfromtheCollaborativeswillbeusedtovalidatethepatientspecificdataobtainedthroughothermethodssuchastheUser/VisitSurvey.Insummary,theBureauwilluseitscertificationprocessathealthcentersandsitestodeterminethevalidityofdatacollectedbothintheUDSandfromtheUser/VisitSurvey.Inestablishingthedatainfrastructureforthemanagementofchronicdiseases,theBureauwillbeabletoobtaininformationtovalidatethedatacollectedfromtheUDSandtheUser/VisitSurvey.TheanalysesofclaimsdataonMedicaidbeneficiariesatmultiplesitesbeyondhealthcentersalsowillbeusedtojudgethevalidityoftheinformationcollectedonhealthcenterusersfromthisandothersources.  (#'   h+&* ЇC.PerformanceInformationonDataSources   TheBureauhasusedhealthcentereffectivenessstudies,literaturereviews,NHISandNHAMCSresults,andotherspecialstudiestodevelopbaselineestimates.Insomecases,thebaselineestimatesarenotdirectlycomparable.WithanadditionalyearofUDSdata,theBureauwillbeabletouseitsowntrenddatatobenchmarkitsperformance.TheUser/VisitSurveywaslaunchedagaininFY2000,allowingtheBureautheabilitytohavecomparativedatatoassessitsmeasuresofhealthstatusdisparities.TheBureauisexpandingandmodifyingthesurveyinstrumenttoobtaincriticalinformationonmeasuresofaccesstocareandperceivedfunctionalcapacity.TheBureauhasusedHP2000/2010targetstoassessitsprogramperformancecurrently.Whereperformancehasmetorexceededthosetargets,ithassetnew stretchtargetstocontinuouslyimproveperformance.TheBureauiscurrentlydevelopingitsintegratedmanagementinformationsystem(MIS)toassuredirecttransmissionofdatatoacentralrepository.Thissystemwillhaveeditchecksandinternalvalidationmonitoringprogrammedintoitscomponents.ThisMISwillassistinassuringthevalidityofperformancedatacollected. S D.DataLimitations  \ Overthe19961998period,UDSdatahavebeencollectedfromnearly100%ofhealthcentergrantees.TheUDScontractorworkscloselywithgranteestoprovidetechnicalassistancewhennecessarytoassurecompletenessofreports.Somegranteesneglecttosubmitoneormorespecifictables,butthe Nforthesetableshasneverbeenbelow95%ofthetotalnumberofgrantees.GranteeshaveuntilFebruary15tocompletetheirreports.PreliminarytablesummariesareprovidedbyearlyAprilandfinaltablesummariesbymidJune.Thistimeframehasbeennecessarytoassurethereceiptofresponsesfromallgranteesandthecompletenessofeachreport.ProgrammanagershavestatedthatreceiptofdatabymidJuneisbarelysufficienttoassistinimportantdecisionmaking.TheBureauismakingeveryefforttoshortenthesetimeframes.First,itwillmakevirtuallynochangesintheFY1999tablessothatgranteescanbecomeevenmoreaccustomedtoformat.Second,itimplementedtheelectronicsubmissionofreportsandtrainingofgranteesinsubmissionofreportsinFY1999and2000.ApilottestoftheelectronicsubmissionforhealthcentersinRegionXrevealedsignificantreductioninerrorsinreportsandlesstimespentonassuringcompletenessofthereports.AlthoughtheUser/VisitSurveysamplesizeissufficientlysensitivetoobtainNationalestimates,itisnotrobustenoughtoobtainsubstantialdetailedinformationonsubgroupsoftheminorityuserpopulation.TheBureauwillconductspecialsurveysto#X*XXX*8# X*XXX*oversample#X*XX X*P# X*XXX*Ԁhealth $D # centersandsitesthatarelikelytoprovidethisdetailedinformation,consistentwiththePresident#X*XX X*# X*XXX*sInitiativeonRace. &"% TheBreakthroughseriesisalaborintensiveprocesswheretheBureauanticipatesthat100siteswillparticipateinthefirstyearandthatnumberwillgrowoverthenext35years.TheCollaborativesusea#X*XX X*d# X*XXX*trainthetrainer#X*XX X*#X*XXX*Ԁmethodologytoenhancethe#X*XXX*# X*XXX*spread#X*XX X*U# X*XXX*Ԁtootherhealthcenters |*%)  h+&* andsites.UntilCollaborativesareinplaceatallBureausupportedsites,itwillnotbeabletoachieveitsultimatevalidationgoals. HIV/AIDSDataCollectionEfforts ` (HIV/AIDSBureau)  L  #X*XX X*#B.4 <DL!!XB  X*XXX*A.GeneralDescriptionoftheSource/System #X*XX X*W# X*XXX* $ t HRSAsHIV/AIDSBureauhasdevelopedasingledatareportingsysteminordertostreamlineandsimplifyreportingbyRyanWhiteCAREActgranteeswhileestablishingaminimumsetofdatareportingrequirementsforallCAREActTitleprograms.ThissystemisreferredtoastheRyanWhiteCAREActDataReport._6#X*XX X*Ƚ#   X*XXX*     #X*XX X*# X*XXX*B+ 4 <DL!X!B   B.4 <DL!!XB   z  TheHABOfficeofScienceandEpidemiology(OSE)staffhavebeenworkingwithTitlesI,II,   III,andIVprogramrepresentativesforthepastthreeyearsonthetaskofintegratingtheaggregatereportscompletedbyCAREActgranteesfromTitlesI-IVintoonereportform.IndividualTitlesdatareportformshavebeenconsolidatedinordertoreducereportingburden,standardizedatacollectedacrosstitlessoCAREActprogramscanbeexaminedasawhole,andtoprovideamoredetailedaccountofthetypesofclientsservedandservicesutilized." z݌̌  ! XX!!   #X*XX X*# X*XXX* 4   (#X*XX X*8# X*XXX*The#X*XX X*# X*XXX*newCARE#X*XX X*# X*XXX*ActDataReportformiscomposedofacoversheetthatshouldbecompleted  p bythegranteeandeightsectionsthatshouldbecompletedbyeachserviceprovider.Thesesectionswereconstructedtogathergranteeandprovider-levelinformationinthefollowingareas:#X*XX X*C#X*XXX*0 S #X*XXX*# X*XXX*Section1:ServiceProviderInformation S"S" 0 S Section2:ClientInformation S"S"   0 S Section3:ServiceInformation S"S" 0 S Section4:HIVCounselingandTesting#X*XX X*#  X*XXX*S"S"   #X*XX X*:# X*XXX*0 S Section5:MedicalInformationS"S" 0 S Section6:DemographicTables/TitleSpecificDatafor S"S"    S TitlesIIIandIV0 S Section7:ADAPInformation S"S" 0 S Section8:HealthInsuranceProgramInformationPk S"S" #X*XX X*#   X*XXX*Throughaseriesofexternalreviews,thatincludedCAREActgrantees,HIV/AIDSNational $X" GroupssuchastheNationalAssociationofStateandTerritorialAIDSDirectors(NASTAD),theCentersforDiseaseControlandPrevention(CDC),otherfederalagencies,andHRSARegionalHIVstaff,HABhasreachedaconsensusonwhatdataelementsareusefultocollectinanaggregatereportingsystem.HABhasalsoreachedaconsensusonhowdatashouldbecollectedandmovedfromprovidersthroughgranteestoHRSA.HABsapproachwillbetorequireaggregatereporting,usingtheRyanWhiteCAREActDataReportform,butencouragegranteestodevelopclient-levelreportingsystemsinordertocapturethereportinformation.TheBureauwilloffertechnicalassistancetoallgranteesthatarewillingtodevelopand h+&* maintainaclient-levelreportingsystem.TheBureauwilloffergranteesdatabasesoftware,#X*XX X*# X*XXX*RW#X*XX X*# X*XXX*  CAREWare,forindividualclient-leveldatacollectionandaggregatereportingofthenewCAREActdata.#X*XX X*# X*XXX*RW#X*XX X*# X*XXX*CAREWareisfree,clientlevelsoftwaredesignedtocapturealldata  elementsincludedintheRyanWhiteCAREActDataReport,developedbytheOfficeofScienceandEpidemiologyintheHIV/AIDSBureau.Itprovidesaclear,userfriendlyplatformforentering,collectingandreportingdemographic,serviceencounter,mentalhealth,substanceabuseandclinicalinformationsuchasCD4lymphocytecount,viralload,typeofantiretroviraltherapy,developmentofAIDSdefiningconditionsandreceiptofrecommendedpreventativetherapies.ItalsocontainsbuiltinreportfunctionstogeneratetheCAREActDatareport,andavarietyofadditional,customizablefunctionstoproduceagranteesownanalyses,reports,andadditionaldatafields.ps#X*XX X*#   X*XXX* $    O#X*XX X*_# X*XXX*OSEalsocollectsclient-leveldatafromaselectgroupoffivegranteesthathaveagreedto   participateindemonstrationprojectsforthepurposeofcollectingsuchdata.Thedevelopmentoftheclientdatasetbeganin1991,andimplementationbeganin1994.Developmentgrewoutofadesiretoperformanalysesonindividualsratherthanexclusivelywithsummarydata.Thepurposeoftheclientdatasetistocollectandanalyzedemographicinformation,healthindicators,andserviceutilizationdataonindividualswhoreceiveservicesfromproviderswhoarefundedbytheCAREAct.CAREActgranteesfrom2citiesand1county(LosAngeles,CA;Denver,CO;OrangeCounty,CA#X*XX X*# X*XXX*)and2states(MichiganandVirginia)participateinthe 4 clientleveldemonstrationprogram.ProviderscollectintakeandencounterdatausingprescribeddataspecificationsfromHABandgranteesreceivetheproviderdata,verifyandunduplicatethesedata,andsendthedatasettoHABevery3months.Thegreatestlimitationoftheclientleveldatasystemisthatthenon-representativenessofthesitesparticipatingintheseclient-leveldatacollectioneffortslimitsthegeneralizabilityoftheirresults.c}Ԁ#X*XX X*#   X*XXX*     k#X*XX X*{# X*XXX*HRSAsHIV/AIDSBureaualsoiscollaboratingwithfederalagenciesonimplementinghealth  outcomemeasurementsystemsforHIV/AIDS.AjointCDC/HRSAeffortisunderwaytoimprovetheusefulnessofsurveillancedataformonitoringoutcomesofcareprovidedbyRyanWhiteCAREActgrantees.Currently,bothagenciesareconductingajointpilotdemonstration,theSurveyofHIVDiseaseandCare,toproduceestimatesofpopulationparameters,withconfidenceintervals,ofclinicaloutcomesforpersonslivingwithHIVinfectionand/orAIDS.TheprojectisbeingimplementedinsevenU.S.localities.VariablestobecollectedincludediagnosesofAIDS-definingopportunisticconditions,receiptofprophylactictreatments,andprescriptionofantiretroviralmedications.Ifthesedemonstrationsaresuccessful,themethodologywillbeimplementedinalljurisdictionswithatleastoneRyanWhiteCAREActEligibleMetropolitanArea(EMA).Thepilotstagewillcontinuethroughtheyear2000.Q#X*XX X*#   X*XXX* &"%   l#X*XX X*|# X*XXX*AjointAHRQ,SAMHSA,ASPE,andHRSAeffortisfundingaHIVQualityCareNetwork '#& studythatcollectsmedicalresourceutilizationdataonabout20,000peoplelivingwithHIVinabout20sites.Demographic,stageofillness,andtreatmentdataarecollected.Thestudyiscreatingastandardsetofdataelementsfortheparticipatingsites,mostofwhichareCAREAct h+&* funded,toreportonaregularbasisrealtimeestimatesofHIVmedicalresourceuse.Thiseffortiscontinuingthroughtheyear2000andisexpectedtocontinueforseveralyears.̀  hWhiletheselargescaledatacollectioneffortsarebeingdeveloped,HRSAisfundingsentinelgranteesitestoanalyzeexistingmultiproviderdatasetsforCAREActrelatedimpactandoutcomedata.Studiesfocusonspecificquestionsandspecificpopulations,suchastheimpactofnewtreatmentsonperinataltransmissionofHIVinselectedTitleIVsitesandtheimpactoftheprovisionofancillaryservicesontheentryintoandretentioninprimarymedicalcare.Thenumberaswellasthevaryingcharacteristicsofparticipatingsiteslimitsthegeneralizabilityoftheresultsfromlocalevaluationstudies.Also,Thesitesthatarenotparticipatinginlocalevaluationstudieslimitthegeneralizabilityoftheirresults.#X*XX X*# X*XXX*  8  #X*XX X*#  X*XXX*B.DataQuality[     *#X*XX X*# X*XXX*AllgranteeswhoreceivefundingfromanyoftheTitlesI,II,III,andIVwillbeaskedto   completetheRyanWhiteCAREActDataReportaccordingtotheirpreferredformat,i.e.,completingahardcopyorcompletingthesurveyonlineontheHABwebsite.AlldatawillbesenttothedatacoordinationcontractorforOSE,whowillberesponsibleforcleaningandeditingthedataandproducingacorrectmasterdatabaseforanalysisbyOSEstaff.TheoveralldataresultswillbereportedontheHABwebsiteandautomateddatareportswillbemailedtoallgrantees.DatacollectedusingtheRyanWhiteCAREActDataReportwillprovidemeasuresofthenumbersofclientsservedandtypesofservicesofferedbyeachgranteeandtheirprovidernetwork.N C.PerformanceInformationonDataSources 4  #X*XX X*# X*XXX*HABcurrentlyhasvaliddatafromgranteesreceivingfundingfromanyoftheCAREActtitle   programsfor1997,1998,and1999,andiscurrentlyanalyzingdataforCY2000.#X*XX X*R# X*XXX*    #X*XX X*S# X*XXX*D.DataLimitations   #X*XX X*# X*XXX*DatareportedaspartoftheCAREActDataReportsystemwillbeaggregateleveldata.One  limitationofthistypeofdataisthetypeofquestionsthatcanbeansweredusingthesedata.Forexample,datafromthissystemwillprovidethenumberofclientsservedbyeachgranteeusingCAREActfunding;however,itisnotpossibletodeterminetheexactnumberorcombinationofservicesreceivedbyeachindividualclient.Asecondlimitationisthatthesystemcontainsduplicateddataforclients,i.e.,itisimpossibletodetermineifanindividualclientreceivedCAREAct-fundedservicesfrommorethanoneprovider.#X*XX X*# X*XXX* $X" #X*XX X*# X*XXX*Theselimitationshavebeenaddressed,first,bygivinggranteestheoptiontoparticipateina %0!$ client-levelreportingsystem,whichcanaddressquestionsconcerningtherelationshipsacrossvariablesforindividualclients.CAREActgranteeswhomalreadycollectorarewillingtocollectclient-leveldataandsubmitittoHABcancompeteforHABfundingtodoso.HABalsofundsspecialevaluationprojectstoexaminesignificantCAREActserviceissues.#X*XX X*@# X*XXX* )$(   #X*XX X*a#  X*XXX* |*%)    [   -eeX N XX-   c      k    h+&*   #X*XX X*#   X*XXX*MaternalandChildHealthBureau#X*XX X*# X*XXX*Ԁ(MCHB)  A.GeneralDescriptionoftheSources/System s  ThissectiondescribesdatasourcesandsystemsforthefollowingMaternalandChildHealthBureauPrograms:1)MaternalandChildHealthBlockGrant,2)theStateAbstinenceEducationProgram,and3)otherMCHprograms,includingtheincludingSpecialProjectsofRegionalandNationalSignificance(SPRANS)andCommunityIntegratedServicesSystems(CISS),TraumaticBrainInjury,HealthyStart,UniversalNewbornHearingScreeningandEarlyIntervention,theEmergencyMedicalServicesforChildren,PoisonControlCenters,Trauma/EmergencyMedicalServices,andtheCommunityBasedAbstinenceEducationProgram. 23   23_2I3  0 S   MaternalandChildHealthBureau(MCHB)BlockGrant23_݌ S"S" Ќ  Inlate1997theMaternalandChildHealthBureau(MCHB)completedanextensivecollaborativeeffortwiththeStatestoreengineerandstreamlinetheMaternalandChildHealth(MCH)BlockGrantAnnualReportandApplicationGuidance.Aspartofthiseffort,MCHBandtheStateslaidthegroundworkforintroducingperformancemeasurementintotheTitleVBlockGrantprogram.TheannualreportandapplicationsubmittedoncomputerdisksbyeachStatecontains18nationalperformancemeasures,6nationaloutcomemeasures,and710Statespecificperformancemeasures,and1Statespecificoutcomemeasure.EachStatesetstargetvaluesforeachofthemeasuresforafiveyearperiodandreportsannuallyonactualperformance.Thedata,submittedeachJuly,reportachievementsforthepriorfiscalyear,andsetgoalsforthesubsequentfiscalyear.ThisinformationisavailabletothepublicthroughtheTitleVInformationSystem(TVIS)at4RE O  5  www.mchdata.net.6Octr  7REGԀ 8  23   232I3  0 S   StateAbstinenceEducationProgram.23݌S"S" Ќ  StatesthatreceivefundingforabstinenceeducationunderSection510ofTitleVoftheSocialSecurityActarerequiredtosubmitdatatoMCHBintheirannualformulagrantapplications.Ontheseapplications,Statessummarize5yeartargets,andprogressmadeon4nationalperformancemeasuresand2additionalStateselectedmeasuresthatreflecteachStatesspecificprogrampriorities. 23   23>2I3  0 S   OtherMCHGrantPrograms23>i݌4" S"S" Ќ  TheMaternalandChildHealthBureauistakingthesameapproachusedfortheMCHBTitleVBlockGrantSystemtodevelopasystem,orpossiblysystems,foritsothergrantprograms,includingMCHBTitleVDiscretionaryGrants(SPRANSandCISS),HealthyStart,andEmergencyMedicalServicesforChildren,TraumaticBrainInjury,UniversalNewbornHearingScreeningandEarlyIntervention,PoisonControlCenters,andTrauma/EmergencyMedicalServices.Thedevelopmentofperformancemeasuresfortheseprogramsisnowinprocess.Oncetheselectionofperformancemeasuresfortheseprogramshasbeencompleted,approvalwillberequestedfromtheOfficeofManagementandBudget(OMB)toimplementtherequireddatacollection. l+&* MCHBhasestablishedsixperformancemeasuresfortheSPRANSCommunityBasedAbstinenceEducationProjectGrantProgram.Whilegranteesarenotresponsibleforestablishingandachievingindividualprogramperformancetargets,granteesarerequiredtosubmitanannualreporttoMCHBinwhichtheyreportdatatobeaggregatedbyMCHBintomeasuresofprogramwideperformancethatcanbecomparedwithpreestablishedperformancetargetstoassesswhethertheprogramasawholeisbeingimplementedasplanned,andismeetingitscoreobjectives. &  B.DataQuality   ` StatessubmitdataontheirTitleVprogramsthroughtheautomatedTitleVElectronicReportingPackage(ERP).TheERPprovidespreformattedandinteractive' +ԀdataentrythathelpsassurestandardizeddataacrossStates,andgreatlysimplifiesthedataentryprocess.Allcalculations(ratios,rates,percentages,aswellastotals)aredoneautomatically,tablesareinterlockedwheredataoverlap,andhistoricaldataarepreservedsothatonlytheannualdatafortheyearinquestionneedtobenewlyentered.RequireddatamustbeenteredbeforetheERPwilltransmit,andthesystemperformsimmediatechecksformanycommonerrors(outofrangevalues,alphaentriesinnumericfields.invertedratios,etc.)Certainvalueswhichexceedstatutoryallowablelimitstriggerelectronicflags,opennotationfields,and/orpromptforajustificationorwaiverrequest.StatedatasubmittedelectronicallythroughtheERPisenteredintotheTitleTVIS.DataforotherMCHgrantprograms,includingtheStateandCommunityBasedAbstinenceEducationProgramsareobtainedprimarilyfromgrantapplications.Thequalityofthedataisvariable,becausemanygrantees,particularlycommunitybasedgrantees,donotalwaysstartwiththedatasystemsneededtoprovidetherequireddata.However,MCHBprovidestechnicalassistanceandadvicetogranteestoassistthemintheirdatacollectionefforts.Thequalityofthedataisexpectedtoimprovewiththeimplementationofnewperformancemeasures,andthedevelopmentofareportingtoolsimilartotheBlockGrantProgramsERP.Greatcareisbeingexertedinthedevelopmentofnewperformancemeasurestoensurethattheyarevalidindicatorsforthespecificconcernsofeachprogram.Detaileddefinitionsheetshavebeendevelopedforeachmeasurewhichaddress,amongotherthings,thesignificanceandrelevanceofthemeasure.Statedevelopedmeasuresmustmeetsimilarrequirements.Allofthestandardmeasuresrelatetotheoverallobjectivesofeachprogram. C.PerformanceInformationonDataSources  $D # TheTVISrepresentsthefirstautomateddatasetcontainingperformancedataonMCHprogramsinall59StatesandJurisdictions.MCHBbeganenteringStatedatafromtheirTitleVprogramsintotheTVISin1997.Reportinghasimprovedsteadilysincethefirstyear,andMCHdataontheTVISisimprovingandbecomingmorecomplete.Thevariationsindatacollectionanddatasourcesusedbydifferentstatesareknown,andclearlydocumented.  |*%) Somedata,especiallyvitalstatisticsdata,havetraditionallyrequiredextensiveediting,atthe caselevel,beforetotalsandindicesareconsideredreliable.Forthisreason,MCHBsometimesusesCDCdata,insteadofthemorecurrent,butpotentiallylessaccuratedatareportedbytheStates,indevelopingitsperformanceindicesforthisannualperformanceplan. &  D.DataLimitations  L  Asnotedabove,notallStatesandcommunitybasedgranteesareabletoreportallrequireditems'L Ԁforthesameuniformtimeperiods,andforeachyear.MCHBhaslaunchedaninitiativetoimproveStatesabilitytocollect,tabulate,edit,analyze,disseminate,andusedata.ThiseffortisbeingcloselycoordinatedwiththeStateMCHDirectors,andotherprogramgranteestoassuretheirdataneedsaremet. &M'%X X*  8  #&M'%'% &Mt##X*X'%&M# bXHXXX*HealthProfessions   (BureauofHealthProfessions)1.ComprehensivePerformanceManagementSystem(CPMS)A.GeneralDescriptionoftheSource/System TheBureauofHealthProfessions(BHPr)hasbeenworkingforseveralyearstodevelopa  p systematicapproachtocollectingandmeasuringoutcomeperformancedataontheBureausTitlesVIIandVIIIhealthprofessionsandnursingeducationprograms.AtthecoreoftheComprehensivePerformanceManagementSystem(CPMS)arecrosscuttingoutcomeindicatorswhichmeasureactivitiescommontomostprogramsandmeasuretheaggregateeffectsofgranteeachievementsinsupportofthegoal.Theindicatorsare,inturn,associatedwithgoalsestablishedbyHRSA.Theoutcomesandindicatorshavebeenvalidatedbyrepresentativesfromhealthprogressionsassociationsandleadersinhealthprofessionsschools.    TheBureauismakingsteadyprogressincollectingdatadirectlyfromitsgranteestomeasure l progressforalloutcomeareasassociatedwitheachcrosscuttinggoal.ACPMSdemonstrationprojectin1998showedthatitwouldbebothfeasibleanddesirabletocapturerequiredperformanceinformationinamorestreamlinedmanner.ThefirstdatafromthisprojectbecameavailabletousinDecember1999.TheFY2000performancedatabecameavailableinNovember,2001.TheBHPrisnowdevelopinganautomatedversionoftheCPMSdatacollectioninstrument.WiththeautomatedinstrumenteachgranteewillbeabletoaccessthedatacollectioninstrumentfromtheBHPrWebsite,downloadtheinstrumenttotheircomputer,completetheformandsenditbacktoBHPrelectronically.Therequirementsfortheautomatedinstrument,includingthebuiltinedits,arebasedonfindingsfromthedemonstrationprojectandanadvisorygroupcomposedofrepresentativesfromgranteeinstitutions.DemonstrationsoftheCPMScomponentofthesystemwereconductedinSummer,2000andmetexpectations.  h*%)  B.DataQuality @,'+  Asindicatedabove,theBHPrhasworkedforseveralyearstodevelop,testandrefinethe  CPMS,thedatacollectioninstrumentsandtheeditingstandardsandmethodstobeusedduringdatainput.    ThefirstCPMSdatacollectionfromgranteeswasconductedinthefirstandsecondquartersof ` FY1999wheneachgranteedownloadedadatacollectioninstrumentfromtheBHPrWebsite.ThegranteethenfilledintheinformationbyhandandmailedittoBHPr.BHPrpersonnelreviewedthedatainputtablescontainedineachreportforcompletenessandinternalconsistency.Thereviewer,forinstance,wereexpectedtoperformrangevalidationchecks,checkthesummationofrowsandcolumnsandthecalculationofpercentages,andmakecomparisonsbetweenlogicallyrelatedfields.Thosereportswhichdidnotmeetthestandardswerereturnedtotheprogramofficesandprogramofficerscontactedthegranteeorganizationtomakethenecessarychanges.Thosereportswhichpassedtheeditchecks,includingthosethatwerecorrectedafterinitialrejection,weresenttothecontractorfordataentry.BHPrusedthesemethodstoprocessthegranteereportsforFY1999whichweresubmittedduringthefirstandsecondquartersofFY2000.TheBHPrmodifiedthetablesandproceduresbasedonlessonslearnedintheFY1998datacollectionactivity.Forinstance,wehavedevelopedextensivebusinessrulesforvalidationandcorrectionofsubmitteddataandextensivefederalqualityassurancehasprovidedassurancethatdataentryfortheFY1999datawasatleast98%accurate.TheBHPrusedthesesamemethodstocollect,evaluateanddatatoentertheFY2000data.TheCPMSdata,collectedfromallgranteesasaconditionforcontinuationofthegrant,isenumerative.BHPrusescounts,sumsandotherbasicdescriptivestatisticstoanalyzeandreportthedata. C.PerformanceInformationonDataSources   Thebaselinedata,goingbacktoFY1998,iscomposedofdatacollectedfromgranteespriortobeginningtheCPMS.Thoseperformancedatasourceswascompiledfromprogramrecords,granteeapplicationsandprogressreport. D.DataLimitations  0"  BHPrinitiatedtheCPMSinresponsetotheneedtoimprovedataavailability,qualityandtimeliness.ItisrecognizedthatthequalityofCPMScanbenobetterthanthequalityofdatasubmittedbygrantees.AspartofimplementingPublicLaw105392,BHPRdefineddatarequirementstobeaddressedincompetitivegrantapplications.Toemphasizetheimportanceofhighqualitydata,BHPralsoisrequiringorganizationswhichsubmitapplicationsforcompetitivegrantsbeginninginFY2000todescribethemethodsandsystemsthatwillbeusedtoaccuratelycollectandsubmitCPMSandotherperformancedata.Granteeswithdeficientsystemsarerequiredtopresentacorrectiveactionplanforgettingthemtoanacceptablelevel.  |*%) DuringFY2001programofficialsevaluatedgranteedatacollectionandreportingmethodsand thevalidityofCPMSdataduringtechnicalassistancevisitstograntees.BHPrprogramofficialswillcompareCPMSdataagainstdatasubmittedbygranteesintheircompetitivegrantapplicationstodetermineifthedataisreasonableinrelationtodatacollectedfromothersources.&  K+ 4 <DL!eeX N XK          '  2.DivisionofStudentAssistanceHEALDatabaseSystem'( 'Ԍ 8  ЌbXbXHYKb lKY   X*X l '8 h' ,B.4 <DL!XB C * $h23456789CA. ' GeneralDescriptionoftheSource/System  `   ,E+ 4 <DL!4XE TheHealthEducationAssistanceLoan(HEAL)programinsuresloansmadebyprivatelenders  L  againstborrowerdefault,bankruptcy,deathanddisability.LendersmustcomplywithHEALprogramregulationsandpoliciestobeapprovedforprogramparticipation.Theserequirementsincludereportinginformationonborrowers,loansandthestatusofborrowers(e.g.inschoolorinrepayment)tokeeptheHEALdatabaseinformationuptodate.Whenaborrowerfallsintooneoftheaboveinsurancecategories,theHEALlendersubmitsaninsuranceclaimtotheHEALbranchforpayment. TheHEALDatabaseSystemmaintainspersonalandfinancialinformationonover160,000 \ individualswhohavetakenHEALloanstoassistthemintheircompletionofaprogramofinstructioninahealthprofessionsdiscipline.Associatedwiththeseborrowersareover450,000loansforwhichinformationismaintainedonthesystemaswell.Besidesoriginalloaninformation,dataareenteredintothedatabaseforborrowerswhohavechosentorefinance(consolidate)theirloansintoasingleloanatamorefavorableinterestrate.Besidesborrowerandloaninformation,processingofinsuranceclaimssubmittedbyHEALlendersisamajorfunctionsupportedbytheHEALdatabase,withclaiminformationbeingenteredandretainedinthedatabase. DataintheHEALdatabaseisusedtoprocessclaimssubmissionsfromlenders,tomonitor  programcompliance,touseinanalysesaimedatrefiningandoptimizingHEALpolicyandformanagementreporting. & $ d     d0  ,B.4 <DL!XB B. ' DataQualityd001 1Ԍ D! Ќ     ,E+ 4 <DL!4XE Sincetheearly1990s,theHEALprogramhasmadenumerousrefinementstotheHEAL 0"  databasetoimprovedataquality.HundredsofdataeditshavebeendevelopedtoassurethatdatasubmittedbyHEALlendersisvalid.TheseeditshavebeensharedwithlenderssotheycanprescreenfordatavaliditybeforedataissubmittedtoHEALandsubjectedtoHEALedits,providingadoublecheckondataqualityandmakingthedatasubmissionprocessmorestreamlined.TheHEALdatabasehasbeenreconciledwithlenderdatabasesasnecessarytoassureongoingdataquality.Inadditiontodataedits,eachloanandeachclaiminthedatabasehasbeengivenauniqueidentifier(inadditiontoborroweruniqueidentifiers).TheseidentifiersareintheHEALdatabaseandlendersdatabases,thusbetterassuringdataqualityandreconciliationprecision.'$ D!0  h+&*   Tofurtherensuredataquality,theHEALprogramisintheprocessofdevelopinganOracle  relationaldatabasesystemtoreplacethecurrent,hierarchicalModel204database.TherelationaldatabasewillpermitgreatercontroloverdataqualitythaniscurrentlyavailableintheModel204structure. HEALdataqualityisessentialforprocessinglenderclaimsubmissionsefficiently,for L  developinganalysesfromwhichvalidconclusionscanbedrawn,andforpolicyanalysisandmanagementreporting.  $ t C.PerformanceInformationonDataSources   L  ?+ 4 <DL!X? TheimprovementsincorporatedintoandplannedfortheHEALdatabasehavegreatly  8  improvedthefunctionalityofHEALdata.Sinceprimarydatacollection(exceptforcertainaspectsofclaimsprocessing)isviaHEALlenders,editsprovidedtolendersandrunbyHEALagainstdatasubmittedbylenders,aswellasdatareconciliationbetweentheHEALdatabaseandvariouslenderdatabaseshassignificantlyimprovedconfidenceintheHEALdata.Improveddatahaspermittedtheprogram,forexample,toperformanalysesthathavesignificantlyreducedprogramsubsidyrequirements,resultedinrefinementofprogrampolicy,andimprovedmanagementreportingofthesignificantsavingstoborrowersandtaxpayersyieldedthroughprogrammaticrevisions.#X*XX X*#bXHXXX*  H   , & L B.4 <DL!XB 4 D. ' DataLimitations   p   ,E+ 4 <DL!4XETheprimarylimitationsonHEALdatainvolvetheuseofdataplacedintothesystemintheearlieryearsofprogramoperation.Duetothepopularityandgrowthoftheprogram,theoriginaldatastoragestructurecouldnotbemodifiedinatimelywaytokeepupwithsomeoftherequirementswhichassurecompletelysounddata.Fortunately,suchlimitationsonmorerecentandmorepertinentdatadonotexist,andundertheOracledatabasesystembeingdeveloped,datalimitationswillbefurtherreduced.'L4v<Ԁ 3.DivisionofQualityAssuranceNationalPractitionerDataBank(NPDB)and l HealthcareIntegrityandProtectionDataBank(HIPDB)  X   A.GeneralDescriptionsofthePerformanceDataSourceandSystem  0"  PerformancedatausedtoassesstheperformanceoftheNationalPractitionerDataBankandHealthcareIntegrityandProtectionDataBankarebasedonroutinelyproducedmonthlyandweeklyoperationssummaryreportsprovidedtotheDivisionofQualityAssurancebytheDataBankcontractor.Inaddition,theDivisionofQualityAssurancereceivesfourcomputerdatasetseachyearfromthecontractor.ThesedatasetsprovideinformationonthereportingandqueryingactivitiesbyeachentityregisteredwiththeDataBanksaswellasinformationconcerningthenumberofmatchedresponseseachentityreceivesinresponsetoitsqueries.Thisinformationisused,amongotherpurposes,toconfirmthesummaryinformationpresentedinthemonthlyandweeklysummaryreports.Inaddition,sinceafeeischargedforeachquery,querycountsareconfirmedbytheamountofrevenuepaidbyqueriers. h+&* Ї B.QualityofPerformanceData   OvertheyearsthedataonqueryingandmatchingusedtoassessperformanceoftheDataBankhasbeenfoundtobehighlyaccurateandreliable.Theroutinereportsanddatasetsareproducedbycomputerwithminimalhumanintervention.Furthermore,thedatasetsaretestedforaccuracyandcompletenessbyaseriesofcomputertestsperformedbytheDivisionofQualityAssuranceeachtimeadatasetisreceived. C.PerformanceInformationonDataSources  $ t InformationonthenumberofdecisionsaffectedbyDataBankresponsesareestimatesbasedonactualcountsofmatchedqueryresponses(asdiscussedabove)andestimatesoftheproportionofmatchedqueryresponseswhichaffectdecisionmakingbyhospitalsandmanagedcareorganizations.TheestimatesoftheproportionofdecisionsaffectedarebasedonfourindividualsurveysconductedbytheDHHSOfficeofInspectorGeneralattherequestoftheDivisionofQualityAssurance.Theresultsofeachofthesesurveyswereconsistentwiththeresultsoftheothersurveys.Thesurveyresultsareconsideredtobeaccurate.Inaddition,theDivisionofQualityAssuranceiscurrentlyconductinganewsurveywithalargersampletoupdateinformationontheuseofDataBankmatchedresponsesindecisionmakingbyqueryingentities. D.DataLimitations  4 Webelievethatnocaveatsarerequiredconcerningcountsofqueriesandmatchedresponses.Therearealsonospeciallimitationsconcerningestimatesofthenumbersofdecisionsaffectedbymatchedresponsesbeyondgeneralcautionswhichapplytotheresultsofeventhebestdesignedsurvey. OfficeofSpecialPrograms:NationalVaccineInjuryCompensationProgram     A.GeneralDescriptionoftheSource/System   TheNationalVaccineInjuryCompensationProgram(VICP)isaninnovativeFederalprogramthatservesasaprototypeintheareaoftortreformbysubstantiallydiminishingthethreatofliabilitytovaccinecompanies,andtophysiciansandotherhealthcareprovidersthatadministerrecommendedchildhoodvaccines.TheVICPawardscompensationtopetitionersallegingvaccinerelatedinjuriesthroughanofaultadministrativehearingprocessconductedbySpecialMastersoftheU.S.CourtofFederalClaims.TheVICPhasimplementedseveralimportantperformancestandardsandfinancialmanagementinitiativesthathaveproventobepivotaltothepublicandmediaperceptionsoftheVICP'smanagement,anditsabilitytosuccessfullyfulfillitsmission.TheVICPhasimplementedasophisticatedParadoxbasedcrosslinkingrelationalautomateddatacollection,measuring,andreportingsystemthattrackspetitioner,medical,epidemiological,legal,andpaymentdataonclaimsfiledundertheprogram.Dataelements andvaluescontainedwithinthesystemareculledfrompetitionersattorneysfilings, |*%) petitionersmedicalrecords,medicalreports,andCourt,DepartmentofJustice(DOJ),andOfficeoftheGeneralCounsel(OGC)documentation. B.DataQuality  t TheVICPemploysasenioranalystwhoseprimaryfunctionistoensuredataintegrityandqualitycontrolforDVICsinternaldatacontrolsystem.Dataentryerrorsormissingdataisoftendiscoveredbydataconversiontootheranalyticalsoftwareprogramswhenformulas/calculationsareapplied. LookupTablesisanapplicationfeatureemployedtoensureconsistentdataentryforoftenuseddatavalues.Additionally,inpreparingforitsDecember1999reportentitled VaccineInjuryCompensation!ProgramChallengedtoSettleClaimsQuicklyandEasily,theGeneralAccountingOffice(GAO)performedacomprehensiveanalysisofVICPsprimaryinternaldatacontrolsystemanditsdatavalues. C.PerformanceInformationonDataSources    Generally,dataisabsoluteasopposedtorelative,andrequireslittleornointerpretation,suchasspecificinjuriesallegedinaclaim,orthedateofafiling,aCourtdecision,oraFinalJudgment.CommunicationbetweenFederalcomponentsparticipatinginthejointadministrationoftheVICPisstrong,anddatareconciliationeffortsareregularandongoing. D.DataLimitations  4 Asadditionallegislationwasenactedandtheprogramevolved,theoriginaldatabasestructurethatwasdevelopedinthelate1980'sbecameinsufficient,andadditionaldatafieldshavebeenaddedthroughthelastdecade,whichleavesearlyrecordsincompletebycurrentstandardsandpotentialuses.Also,theCourtwillacceptanyclaim,howeverinsufficient,sooftentherearenoattendantrecordsorinformationavailabletoincludeinthespecificrecord.Thesecasesaretypicallydismissedbeforetheneedforadditionalmedicalrecords.Additionally,actualdiagnosticdataisincompleteasdeterminedaftercomprehensivereviewofthesubmittedmedicalrecords,sotheonlyinformationregardingvaccinerelatedinjuriesarethoseallegedbythepetitioner.#X*XXbXH<# X*XXX* RuralHealth D! (OfficeofRuralHealthPolicy)  0"   1.RuralHealthOutreach  $X"  A.GeneralDescriptionoftheSource/System  %0!$ TheRuralHealthOutreachGrantprogramisdesignedtosupportnewandinnovativemodelsofhealthcareinruralareasthatlackessentialhealthservices.Amajorgoaloftheprogramistopromotecollaborationamonghealthcareprovidersinruralareasthroughthecreationofconsortiaamonglocalproviders.Todate,thedatacollectedbytheOfficeofRuralHealthPolicyontheOutreachprogramgranteesincludestheprimaryfocusoftheproject(e.g.casemanagement,consumerhealtheducation,emergencycare,etc.);anestimateofthetimespent h+&* ontheservice;thepercentofthepopulationgroupsserved;andanumericestimateofthepopulationmix(e.g.adults,children,elderly,etc.),andinformationonprojectparticipantsandotherdata.InFY1999theOfficerevisedthedatacollectionformslightlyforclarityandalsoaddedtwoquestions,1)todetermineiftheprojectservesanMUAorHPSA,and2)tofindoutifthegranteeisreplicatingapreviouslysuccessfulproject.Theseeffortswillprovideshortterminformationontheprogram.ThegrantperiodfortheOutreachgrantsisthreeyears,makinglongrangestudiesnotpossible.Therehasbeenlittlesystematicinformationavailableabouttheneartermeffectivenessofalternativemodelsofservicedeliveryofconsortiaarrangementandtheirlongertermsustainability.However,theOfficehascommissionedanationallyknowncontractortodevelopinformationabouttheeffortsofOutreachgranteesandidentifykeydeterminantsofsuccessandsustainability.Inaddition,thecontractorwilldevelopagranteereportingsystemthatwillprovideORHPwithbetterinformationformakingresourceallocationdecisions.Towardthisend,thecontractorhasbeguntoidentifythecriticalfactorsthatcontributetothesuccessorfailureofservicedeliverymodels.Thesecriticalfactorshavebeenincorporatedintothegrantprogramguidanceissuedtopotentialapplicantsandareusedintheevaluationofapplications.InFY2001,ORHPcontinuedtoworkwiththecontractortodevelopmethodstobetterunderstandthevalueofoutreachgrantstoruralcommunitiesandtheimpactonlocalservices.ThecontractorwilldesignasetofdatacollectioninstrumentsfortheOutreachgrantprogramandtodevelopagranteedatareportingsystemthatwillenableORHPtosetmoremeaningfulperformancestandardsforitsgrantees.Thecollectioninstrumentisbeingtestedbyexistinggrantees.#X*XX X*X#EX-XXX*   #X*X-XEXc# X*XXX*#X*XX X*d# X*XXX*?+ 4 <DL!X?     i7X X* i77 iOjL7 i;rMLOj    d  #;OM;r)#;XQXO;#X*XQX;X\d#XHXXX*2.DataSystems,FLEXdxe݌  Ќ  XHXXXHXHXXXH X*XXXH X*XX X*   #X*XX X*e#XHXXX* A.GeneralDescriptionoftheSource/System#X*XXXH$g#XHXXX*#XXHe#XHX   TheMedicareRuralHospitalFlexibilityProgram(Flex),managedbytheFederalOfficeof l RuralHealthPolicy(ORHP)isauthorizedatalevelof$25millionperyeartoprovidegrantstostates(47grantees).Thesegrantssupportthedevelopmentofstateruralhealthplans,facilitatingconversionofappropriatesmallruralhospitalstoCriticalAccessstatus,developmentofruralhealthnetworks,strengtheningruralEMSoperations,andimprovingthequalityofcareinruralfacilities.Dataontheeffectivenessofthisprogramareobtainedfromtwoprincipalsources.First,andannualstatusreportisrequiredofgranteesinwhichtheyreporttheiraccomplishmentsinapplyinggrantdollarstopromotethegoalsoftheFlexprogramintheirstate.Second,andmuchmoreelaborate,ORHPhascontractedwithsixresearchcenters(Univ.ofNorthCarolina,Univ.ofSouthernMaine,ProjectHope,RUPRI,Univ.ofWashington,andUniv.of Minnesota)tocollaborativelytracktheprogressofFlex.Bothquantitativeandqualitative |*%) measuresarestudied,andtheglobalimpactoftheprogramonhealthcareinruralAmericaisassessed.Thesecondannualreportiscurrentlyinthedraftstage.#X*XXXHg##lXX*g#X*XlXHXXX*   B.DataQuality t  Dataarecollectedthroughtelephoneinterviews,email,surveyinstrumentsandsitevisits. ` Theyareorganizedandmanagedbythecollectingresearchcenterandpresentedineasilyusableform.DataaremaintainedontheRUPRIwebsite.Sincethereisafiniteuniverseofgrantees,potentialCAHs,andcommunitiestosupport,thedegreeofcompletenessandaccuracyofdataisrelativelystraightforwardtoascertain.SomedatacanbecrosscheckedwithCMS;theFlexTechnicalAssistanceCentermaintainsdatafromallgranteeswhichservesasacrosscheckformanyelements;often,verificationisdonedirectlywiththesource.Additionally,visibilityofthedataontheRUPRIwebsitesendstocontinualopportunitytoverifyaccuracybyknowledgeableusersofthedata.#X*XXXHWm#XHXXX*#XXH8m#XHX    C.PerformanceInformationonDataSources #XXHGq#XHX#X*XXXHq#XHXXX*Thedatacollectionprojectspansthelifeofthisprogram,whichwasinitiatedin1999.All   partiesendeavortocontinuouslyimprovethecollectionandqualityofdata,thoughnomajorrevisionsoftheprocesshavebeendeemednecessaryofappropriate.TheTrackingTeam(researchcenterrepresentativesandPRHP)annuallydeterminesthescopeofworkforthetrackingprojecttomaintainprogramrelevanceofdatacollectedandreported.Dataonnetworks,communitydevelopmentefforts,andqualityimprovementprojectsarebeingexpanded;thesameistrueoftheglobalimpactsonruralhealthcarebytheprogram.#X*XXXHr#XHXXX*#XXHq#XHX   \ D.DataLimitations#XXHu#XHX#X*XXXHt#XHXXX* 4  Sincethedataarelargelyselfreportedbygranteesandsmallfacilities,theyaresubjectto   minnowinaccuraciesfromthesourceandduetoincompletereporting.TheselimitationsappeartobeminorandarecontinuouslyaddressedthroughthemechanismsdescribedaboveinsectionBondataquality.#X*XXXHu#XHXXX*#XXHu#XHX  #X*XXXHew#XHXXX* 3.#X*XXXHx# X*XXX*GrantManagementInformationSystemAccesscompatibledatabase #X*XX X*Hx# X*XXX*# lX X*w# X*X l X   A.GeneralDescriptionoftheSource/System 0"   Thisisasmallsystemthathasbeendeveloped,andwhichisstillbeingperfected,fortheofficebyourcontractor,IQSolutions.Thedatabasecontainsinformationonthegranteesinalltheofficesfivegrantprograms.ThesystemallowsfordatatrackinginformationfortheRuralHealthOutreachandNetworkDevelopmentprograms.Theinformationlistedfortheotherofficegrantprogramsisstrictlyorganizationalanddemographicinformation.  |*%) TheOutreachProgramfundsthedirectdeliveryofhealthorhealthrelatedservices.The informationcollectedfortheOutreachGrantProgramincludestypeofservicesdelivered,informationontheethnicityofthetargetpopulation,thenumberofpersonsservedandtheusualgranteeorganizationalanddemographicinformation.Theinformationiscollectedfromtheoriginalapplicationandupdatedintheprogressandfinalreportsubmittedbythegranteesoverthethreeyearprojectperiod.TheRuralHealthNetworkDevelopmentprogramobjectivesfocusonthedevelopmentofnetworkinfrastructuresuchasshareddatacollection,managementsystemsandinformationsystems.ThedatacollectedfortheNetworkDevelopmentprogramincludesinformationontheindividualorganizationsthatmakeupnetwork,networkmanagementcomponentsandthestrategiestoprovideseamless,qualityhealthcareinsmallruralareas. S B.DataQuality    X     XThequalityofdataisdependentonthetrackingandmanagementsystemsinplaceinthenetworkorganizations. \  C.PerformanceInformationonDataSources H  TheofficeiscurrentlyworkingwiththeOfficeforPlanning,EvaluationandLegislationon 4 developingamorecomprehensivebutsimplecollectioninstrumentthatwouldbeappropriatefortheOfficeofRuralHealthsgrantclients. H #X*XX X*x##lXX*y#X*XlXHXXX* 4  #X*XXXH# X*XXX*A.2ChangesandImprovementsOverPreviousYear #X*XX X*##lXX*#X*XlXHXXX*      #X*XXXHт# X*XXX*HRSAhasmadeanumberofimprovementsintheFY2003versionofitsAnnualPerformance  Plan.#X*XX X*=#XHXXX*#XXH#XHX    #X*XXXH# X*XXX* ContinuedImprovementinDataSourcesandInformation  l Theagencyhasmadeaconcertedefforttostrengthenthelevelofdatasourcesandinformationusedtomeasureperformancegoals.Thisisanareathatwillrequirecontinuousattention.ManyofthesedataissuesarediscussedaboveinthesectiononApproachtoPerformanceMeasurement.Thisalsoprovidesadditionalinformationonthedatasourcesthatarebeingutilizedandprogressmadeinimprovingdatasystems. $D #  ImprovedLinkagetoStrategicPlans  %0!$ HRSAhasstructureditsperformancegoalsfortheFY2003Planinthecontextoffourstrategies: XE1` hp x (#XEӄEliminateBarrierstoCare  (#'  EliminateHealthDisparities )$( ЄAssureQualityofCarēImprovePublicHealthandHealthCareSystems h+&*  XK1` hp x (#XKEachperformancegoalistargetedtooneofthesefourstrategies,andisshownassuchinthesummarychartsdevelopedforeachprogramactivity.#X*XX X*# X*XXX*# lX X*2# X*X l  Inaddition,sincetheDepartmentofHealthandHumanServiceshassubmittedarevisedStrategicPlantotheCongressinSeptember,2000,HRSAhasbeenbetterabletolinkitsperformancegoalswiththegoalsandobjectivesinthatStrategicPlan.ForeachofthesixHHSgoals,HRSAhasprovidedexamplesofprogramactivityandFY2003performancegoals.AmatrixisincludedlaterintheAppendixwhichprovidesexamplesofthislinkage.During2000,HRSAcompleteditsownStrategicPlan.HRSAworkedcloselywiththeDepartmentasitreviseditsStrategicPlanfortheperiodFY20012006.   L   # lX X*׉# X*X l#X*XX X*# X*XXX*  8   ReviewofPerformanceGoals #X*XX X*# X*XXX*# lX X*# X*X l $  #X*XX X*]##lXX*#X*Xl X*XXX*HRSAhascontinuedtoreviewitsperformancegoalstodetermineopportunitiesfor   improvement.TheperformancegoalsfortheHealthCentersprogram,forexample,havebeenexpandedtoincludetheextenttowhichNationalHealthServiceCorpsphysiciansareretainedinservicetotheunderserved.TheHealthCentergoalswhichrelatetoHealthyPeople2000   targetsnowshowboththeHP2000targetandthecomparableHealthCentertarget.#X*XX X*8#XHXXX*#XXH#XHX p  \ #X*XXXH_# X*XXX*TheProgramManagementperformanceplanincludesnewperformancegoalsaimedat H improvedinformationtechnologymanagement.TheseincludegoalstoimproveaccessibilitytotheHRSAdatawarehouse;andtoensurecriticalinfrastructureprotection.#X*XX X* ##lXX*#X*XlXHXXX*  \ #X*XXXH# X*XXX*TheBureauofHealthProfessionshascontinuedtorefineitapproachtointegrating H performancegoals.Inthefirstyearofperformanceplanning,individualperformanceplansweredevelopedforeachofsome26healthprofessionsandnursingtrainingprograms.For2003,theperformanceplansfortheseprogramsareintegratedintooneplanwhichispresentedintermsofsevencrosscuttingindicators.Itfocuses,forexample,ontheeffectofallhealthprofessionsprogramsonincreasingdiversitybyincreasingthenumberof#X*XX X*#XHXXX*#XXH~#XHX  #X*XXXHZ# X*XXX*minority/disadvantagedgraduatesandenrollees.#X*XX X*##lXX*#X*XlXHXXX*   l  #X*XXXH# X*XXX*FocusonEvaluation X   HRSAhasincludedadiscussionofhowtheevaluationprogramsupportsperformance D! planning.ThisincludesbotheffortstoutilizetechnicalassistanceandtrainingtostrengthentheAgency#X*XX X*#X*XXX*#X*XXX*S# X*XXX*scapacitytoassessprogramperformance,andthroughindividualstudiesto #l! complementthedatadevelopedthroughmonitoringsystemsrelatedtoGPRA.AdiscussionoftheEvaluationProgramisincludedlaterintheAppendix.#X*XX X*##lXX*#X*Xl XHXXX* $D #  ,#XXH##l#E.4 <DL!XE   ll X*X l  %0!$  #X*XX X*# X*XXX* X,K1` hp x (#, XK A.3 S LinkagetoHHSandOPDIVStrategicPlans &"%   XK1` hp x (#XK Asnotedabove,theDepartmentofHealthandHumanServicessubmittedarevisedStrategic '#& PlantotheCongressinSeptember,2000.HRSAhasbeenbetterabletolinkitsperformancegoalswiththegoalsandobjectivesinthatStrategicPlan.ForeachofthesixHHSgoals,HRSAprovidesexamplesofprogramactivityandFY2003performancegoals.Thematrixwhichfollowsprovidesexamplesofthislinkage.  h+&* # lX X*#   X*X lIllustrationofHRSAPerformanceGoalsthatSupportHHSStrategicObjectives# lX X*# X*X l  *ddkkkkkkkkkkkk"",( kk,!kk,/ kk+  7<<<<"  7# lX X*9# &M'% lE.` hp x (#XEdE1` hp x (#XEd 40HHSStrategicObjective A<<<<,!J<<<< A 40E.` hp x (#XEdE1` hp x (#XEd 40HRSAActivity A<<<<,!J<<<< A 40E.` hp x (#XEdE1` hp x (#XEd 40FY2003HRSAPerformanceGoals W<<<<D,J  <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 40Goal1:ReducetheMajorThreatstotheHealthandProductivityofallAmericans ?<<<<,! * <<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40 ?<<<<,!R<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40 W<<<<D,R   <<<< W#&M'%'% &Mt# 40E.` hp x (#XEdE1` hp x (#XEd 40 1.1:ReduceTobaccoUse, 2  EspeciallyamongYouth ?<<<<,! Z<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40PrimaryCare:HealthCenters ?<<<<,! Z<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40Performancegoalsaimedatreducingdisparities,suchasthosefocusedonappropriatescreeningforcancerandcontrolofhypertension,includeeffortsaimedathealtheducationandhealthpromotionforthetargetpopulation(includessmokingcessationcounseling). &M'%'%&M W<<<<D,B    <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 401.2:ReducetheIncidenceandImpactofInjuriesandViolenceinAmericanSociety ?<<<<,!J#<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40MaternalandChildHealth:EmergencyMedicalServicesforChildren ?<<<<,!"r(<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40IncreasethenumberofStatesthatrequireallEMSCrecommendedpediatricequipmentonAdvancedLifeSupportAmbulances. W<<<<D,"r-   <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 401.6:ReduceUnsafeSexualBehaviors ?<<<<,!R0<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40MaternalandChildHealth:AbstinenceEducationPrograms ?<<<<,!*z4<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40Reducetherateofbirthstoteenagersaged1517in50percentoftheparticipatingStates. W<<<<D,*z8   <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 40 ?<<<<,!:<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40FamilyPlanning ?<<<<,!<<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40IncreasethenumberofuninsuredpersonsservedbyFamilyPlanningclinics. W<<<<D,Z?   <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 40 ?<<<<,!A<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40HIV/AIDS:HIVPediatricGrants ?<<<<,!D<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40Increasethenumberofenrolledfemaleclientsprovidedcomprehensiveservices,includingappropriateservicesbeforeorduringpregnancy,toreduceperinataltransmission. W<<<<D,bJ   <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 40Goal2:ImprovetheEconomicandSocialWellBeingofIndividuals,FamiliesandCommunitiesintheUnitedStates ?<<<<,!#P<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40 ?<<<<,!j R<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40 W<<<<D,j T   <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 402.5:IncreasetheProportionofOlderAmericanswhoStayActiveandHealthy ?<<<<,!&""X<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40HealthProfessionsandNurseTrainingPrograms ?<<<<,!&""\<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40Promoteahealthcareworkforcewithamixofthecompetenciesandskillsneededtoimproveaccesstocosteffectivequalitycare. W<<<<D,'"a   <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 40Goal3:ImproveAccesstoHealthServicesandEnsuretheIntegrityoftheNation#&M'%'% &MĬ# &M'%'%&Ms *&e HealthEntitlementand +&f SafetyNetPrograms ?<<<<,!<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40 ,j' Ї ?<<<<,!<<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40 )R$  W<<<<D,   <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 403.1:IncreasethePercentageoftheNation#&M'%'% &M# &M'%'%&MsChildrenand F> AdultswhohaveHealthInsuranceCoverage ?<<<<,! <<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40MaternalandChildHealthBlockGrant ?<<<<,!F> <<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40IncreasethepercentofChildrenwithSpecialHealthCareNeedsintheStateprogramwithasourceofinsuranceforprimaryandspecialtycare. W<<<<D,    <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 403.2:EliminateDisparitiesinHealthAccessandOutcomes ?<<<<,!& <<<< ? 40E.` hp x (#XEdE1` hp x (#XEdPrimaryCare: 40HealthCenters ?<<<<,!& <<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40IncreaseproportionofHealthCenteradultswithhypertensionwhoreporttheirbloodpressureisundercontrol. W<<<<D,    <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 403.3:IncreasetheAvailabilityofPrimaryHealthCareServicesforUnderservedPopulations ?<<<<,! <<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40PrimaryCare:HealthCenters ?<<<<,!.& <<<< ? 40E.` hp x (#XEdE1` hp x (#XEd 40IncreasethenumberofuninsuredandunderservedpersonsservedbyHealthCenters,withemphasisonareaswithhighproportionsofuninsuredchildreninordertohelpimplementtheStateChildHealthInsuranceProgram.# l'% &M# &M'% l W<<<<D, '   <<<< W 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<# )<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40PrimaryCare:HealthCenters 6<<<<#,<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40Assureaccesstopreventiveandprimarycareforlowincomeindividuals. N<<<<;#/   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<#1<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40PrimaryCare:HealthCenters 6<<<<#4<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40Assureaccesstopreventiveandprimarycareforminorityindividuals. N<<<<;#7   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<#F>9<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40PrimaryCare:HealthCentersandNationalHealthServiceCorps 6<<<<#><<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40IncreasethefieldstrengthoftheNationalHealthServiceCorpsthroughscholarshipsandloanrepaymentagreements. N<<<<;#C   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<#&E<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40HealthProfessionsandNursingTrainingPrograms 6<<<<#I<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40Increasethenumberoffacultyandtraineesinsettingsservingunderservedareas. N<<<<;#M   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<#.&O<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40HealthProfessionsandNursingTrainingPrograms 6<<<<# S<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40Increasethenumberofminority/disadvantagedgraduatesand/orprogramcompleters.# l'% &M# &M'% l N<<<<;# W   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<#6".Y<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40RuralHealth:RuralHealthOutreach 6<<<<##\<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40Developandoperatecollaborativemodelsofhealthcareservicesinruralareaswhichwillserveunderservedpopulations. N<<<<;#$a   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<#& c<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40RuralHealth:RuralHealthOutreach 6<<<<#& f<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40NetworkDevelopment:Improveruralhealthcareaccessbydevelopingverticallyintegratedprovidernetworksthatwillinvolveruralhealthproviders. N<<<<;#("k   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<#)#m<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40HIV/AIDS:HIVEarlyInterventionServices 6<<<<#+%q<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40IncreasethenumberofpeoplereceivingprimarycareservicesunderRyanWhiteEarlyInterventionServicesprograms. N<<<<;#+%u   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 403.7:IncreasetheAvailabilityandEffectivenessofServicesfortheTreatmentandManagementofHIV/AIDS 6<<<<# <<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40HIV/AIDS:HIVEmergencyReliefGrants(PartA) 6<<<<#2 * <<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40Increasethenumberofvisitsforhealthrelatedcaretoalevelthattakesaccountofnewclientsintheprogram. N<<<<;#*"   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<# <<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40HIV/AIDS:HIVCareGrantstoStates(PartB) 6<<<<#: 2<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40Increasethenumberofvisitsforhealthrelatedcaretoalevelthattakesaccountofnewclientsintheprogram.# l'% &M# X*X l N<<<<;#: 2   <<<< N# lX X*# &M'% l 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<# <<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40HIV/AIDS:HIVCareGrantstoStates(PartB) 6<<<<#B: <<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40IncreasethenumberofADAPclientsreceivingappropriateantiretroviraltherapythroughStateADAPsduringatleastonemonthoftheyear. N<<<<;# #   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 403.9:IncreasetheAvailabilityandEffectivenessofHealthServicesforChildrenwithSpecialHealthCareNeeds 6<<<<# (<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40MaternalandChildHealthBlockGrant 6<<<<#JB +<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40IncreasethepercentofChildrenwithSpecialHealthCareNeedsintheStateprogramwithasourceofinsuranceforprimaryandspecialtycare.# l'% &MF# X*X l N<<<<;# 0   <<<< N# lX X*{# &M'% l 40E.` hp x (#XEdE1` hp x (#XEd 40 Goal4:ImprovetheQuality RJ2 ofHealthCareandHumanServices 6<<<<#4<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<#RJ6<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40 N<<<<;#RJ8   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 404.1:EnhancetheAppropriateUseofEffectiveHealthServices 6<<<<# <<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40HealthProfessionsandNursingTrainingPrograms 6<<<<# @<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40Promoteahealthcareworkforcewithamixofthecompetenciesandskillsneededtoimproveaccesstocosteffectivequalitycare. N<<<<;#E   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<#:2G<<<< 6 40E.` hp x (#XEd'C <XX'd 40PrimaryCare:HealthCenters 6<<<<# J<<<< 6 40H.` hp x (#C <XHdE1` hp x (#XEd 40Decreasetheproportionofhealthcenteruserswhoarehospitalizedforpotentiallyavoidableconditions(i.e.,conditionssensitivetoambulatorycareinterventions). N<<<<;#P   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 404.2:IncreaseConsumerandPatientUseofHealthCareQualityInformation 6<<<<#"T<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40SpecialPrograms:OrganProcurementandTransplantation 6<<<<#"X<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40Increaseby5percentthenumberofminorityorgandonorsnationallyfromimplementationofthefinalHCFARuleonConditionsofParticipation. N<<<<;#z#r]   <<<< N 40E.` hp x (#XEdE1` hp x (#XEd 40 Goal5:ImprovetheNation#&M'%'% &M# &M'%'%&Ms $_ PublicHealthSystems 6<<<<#%`<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40 6<<<<#$b<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40# l'% &M # X*X l N<<<<;#$d   <<<< N# lX X*# &M'% l 40E.` hp x (#XEdE1` hp x (#XEd 405.1:ImprovetheCapacityofthePublicHealthSystemtoIdentifyandRespondtoThreatstotheHealthoftheNation#&M'%'% &M #?&Ou*%'%&M=#&M'%*%?&Ou# &M'%'%&MsPopulation b*Z$j  6<<<<#j+b%k<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40HealthProfessionsandNursingTrainingPrograms 6<<<<#("o<<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40Promoteahealthcareworkforcewithamixofthecompetenciesandskillsneededtoimproveaccesstocosteffectivequalitycare. N<<<<;#)#t   <<<< N 40E.` hp x (#XEd ^,V&u E1` hp x (#XEd 40 Goal6:Strengthenthe  Nation#&M'%'% &M#?&Ou*%'%&M=#&M'%*%?&Ou{!# &M'%'%&MsHealthScience  ResearchEnterpriseandEnhanceitsProductivity    6<<<<# <<<< 6 40E.` hp x (#XEd ^,V& E1` hp x (#XEd 40 6<<<<#<<<< 6 40E.` hp x (#XEd ^,V& E1` hp x (#XEd 40 N<<<<;#   <<<< N 40oXX` hp x (#XodK1` hp x (#XXKd 406.3:EnhanceourUnderstandingofHowtoImprovetheQuality,Effectiveness,Utilization,Financing,andCostEffectivenessofHealthServices 6<<<<#  <<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40RuralHealth:RuralHealthPolicyDevelopment 6<<<<# <<<< 6 40E.` hp x (#XEdE1` hp x (#XEd 40RuralHealthResearchGrantProgram:ToconductanddisseminatepolicyrelevantresearchstudiesineachofORHP#&M'%'% &M!#?&Ou*%'%&M=#&M'%*%?&Ou9)# &M'%'%&Msruralresearchcenters,witha   particularfocusontheimplicationsoftheBalancedBudgetActof1997.# l'% &M# X*X l3)'H@    <<<< 3 40 # lX X*;*# X*X lA.4PerformanceMeasurementLinkageswithBudget,HumanResources,Cost  Accounting,InformationTechnology,CapitalPlanningandProgramEvaluation# lX X**# X*X l     E.` hp x (#XE # lX X*+# X*X lBudget   IntheFY2003HRSAbudget,performancemeasurementislinkedwitheverysignificant  programelementforwhichfundingisrequested.Asrequiredbystatute,theHRSAbudgetproposalsincorporateperformancemeasureswhichattempttogaugeandidentifytheoutcomesandbenefitstobeachievedbytheimplementationoftheprogramincrements.ItisexpectedthattheinclusionofperformancemeasurementsinannualfundingrequestswillenabletheCongressandExecutiveBranchpolicy-makerstoassessthevalueandsuccessofHRSA#X*XX X*|)#X*XXX*#X*XXX*.# X*XXX*s *" programsinthecontextofnationalprioritiesandbenefitstotheAmericanpeople. HumanResources #X*XX X*3/#XHXXX*OneofthePresidentsGovernmentwideReformsisdelayeringmangementlevelstostreamline  # organizations.ToenhancetheadministrationandoperationofHRSA,HRSAisundertakingaManagementReviewwhichwillhelpinthedevelopmentandimplementationofaDelayeringManagementandStreamliningOrganizationalPlan.Thisplanwillassistinimprovingitsgovernmentfunctionsandefficienciesinoperations. TheinitialrecommendationsinHRSAsDelayeringManagementandStreamlining b&Z ) OrganizationalPlanarecurrentlybeingimplemented.Resultsareasfollows:#X*XXXH/#XHXXX* :(2"+ ЄConsolidationofLegislativeandPublicAffairsstaffwithinHRSA,withappropriatereportingrelationshipstoOShasbeencompleted.̄Budget/FinancialManagementandGrantsManagementstaff:Developmentaleffortsareunderwaytoconsolidatethesefunctionsandtocomeupwithspecificproposals.#X*XXXH2#XHXXX* +%/ #X*XXXH/4# X*XXX*# lX X*d,# X*X l#X*XX X*4#XHXXX*EmployeeDevelopment:Amajorfocusisonincreasinginvestmentinworkplacelearning.  ThroughtheHRSACareerResourcesCenter,employeeshaveaccesstoworkshops,printedmaterialsandcomputerprogramswhichincreasetheirparticipationinworkplacelearning.TheCRCstaffiscontinuingtodevelopworkshopstoaddresstheissuesidentifiedintheTrainingNeedsAssessment,includingleadership,coaching,timemanagement,andmentoring.HRSAisalsoofferinganumberofspecialopportunitiesacrosstheAgencyincludingpublichealthtrainingandwomensleadershipprograms.#X*XXXH 5# X*XXX*# lX X*4# X*X l#X*XX X*7# X*XXX* CostAccounting  L   HRSAproducesfinancialstatementsforeachofitssixmajorGPRAprogramareas:Primary  8  Care,HealthProfessions,MaternalandChildHealth,HIV/AIDS,theOfficeofSpecialProgramsandRuralHealth.Inaddition,statementsareproducedforFamilyPlanningandBureauofPrisonsactivitieswhicharefinanciallyunderHRSAbutarelocatedinotherorganizations.ThestatementsreportfinancialpositionandthenetcostofoperationsandarebasedonaccountingrecordsmaintainedforHRSAbytheProgramSupportCenter.Costaccountingisanimportanttoolfordecision-makersinassessingthevalueandpotentialofbudgetincrementsandprograminitiatives.  H InformationTechnology#X*XX X*48# Asignificantmanagementpriorityistostrengthentheuseofinformationtechnologyand  \ improvethedatasystemsoftheagency.HRSAhasmadegreatprogressinimprovingitsinformationtechnology,investinginworkforcetrainingandautomatingfunctionsthatsupportthecoremissionoftheagency.AhighprioritywillbegiventoCriticalInfrastructureProtection(CIP)tomeetthegoalofareliable,interconnectedandsecureinformationsystemasmandatedbyFederaldirectives.Additionalprioritywillbegiventoelectroniccommerce,movingtowardthegoalofprovidingelectronictransactionsforallgovernmentbusiness,procurement,andtherangeofdealingwithgranteesincludingapplications,meetingreportingrequirements,andimproveddatasystems.EX-XXX* l  #X*X-XEX># X*XXX* `  X   ` CapitalPlanning FollowingthelegislativerequirementsandguidanceforcapitalplanningaddressedintheGPRA 0"  andtheClingerCohenAct(CCA)of1996,HRSAischallengedtomaketechnologydecisionsinabusinesscontexttoensureanacceptablereturnoninvestment(ROI)anddirectlinkagetotheDepartment#X*XX X*># X*XXX*smissionandstrategicobjectives. $D # In1997,HRSAestablishedanInformationTechnologyBoard(ITB)todevelopacapitalplanningandinvestmentreviewprocesswhichmeetstherequirementsofCCA,andstandardizetheinformationrequirementsforreviewandapprovalofinformationtechnology(IT)investments.TheultimategoaloftheITBistoassistHRSAinmakingbetterITdecisionsthatmeasurablyimproveorganizationalperformance.  h+&* ЇProgramEvaluation ThepurposesoftheHealthResourcesandServicesAdministration(HRSA)evaluationprogram  aretoenhancestrategicandperformanceplanningandreporting,strengthenbudgetandlegislativedevelopment,andimproveprogramsandpolicies.HRSAsevaluationprioritiesareto(1)developandsupportperformancemeasurement,(2)evaluateprogrameffectivenessandimpact,(3)assessandmonitorprogramimplementation,and(4)conductcrosscuttingpolicyanalysisandenvironmentalassessments.EvaluationsarefundedbyacombinationofHHS1%evaluationsetasideandprogramfunds.3 p x (#X3Q77+7H.` hp x (#XHӈPerformancemeasurementincludestechnicalassistanceandtrainingtostrengthentheagency#X*XX X*@#X*XXX*#X*XXX*XF# X*XXX*s  8  capacitytorespondtotherequirementsoftheGovernmentPerformanceandResultsAct(GPRA),andcontinuingenhancementofHRSAsabilitytomonitorprogramperformanceovertime.In1995,HRSAcompletedanevaluationthatestablishedaperformancemeasurementframeworkforalloperatingprograms,usingacommonframeworktodevelopprogramspecificlogicmodels.Sincethen,HRSAhasinvestedsubstantialevaluationfundingoverthepastfiveyearstoprovideassistancewithperformancemeasurementdevelopmenttailoredtotheneedsofindividualagencyprograms.Theseeffortshavebeenfocusedon(1)assistingwithidentificationofindicatorsandmeasuresanddevelopmentorrefinementofdatasystems;and(2)helpingHRSAcomponentstoenhancetheircapacitytoplanfor,collect,analyzeandusetheperformanceinformationsubmittedbygranteesforprogrammanagementaswellasforpreparingGPRArelateddocuments.OneresultofthisassistancewasapartnershipbetweentheMaternalandChildHealthBureau(MCHB)andtheStatestodevelopasetofstandardperformancemeasuresfortheMaternalandChildHealthBlockGrantthatarenowbeingusedbyMCHBandtheStatesingoalsetting,performancereporting,andperformancemonitoring.Buildingontheseprogramspecificefforts,workbeganin1998tolinktheHRSAstrategicplan,annualperformanceplansandbudgetsthroughasetofHRSAwideperformancestrategies:eliminatebarrierstocare;eliminatehealthdisparities;assurequalityofcare;andimprovepublichealthandhealthcaresystems.Anevaluationproject,CrosscuttingHRSAWidePerformance  Strategy,hassupportedthiseffort. l Programeffectivenessstudiesassessintermediateandlongertermoutcomesorimpactofprogramsinrelationtotheirintendedgoals.Forexample,theImpactofCommunityHealth 0"  WorkersonAccess,UseofServicesandPatientKnowledgeandBehaviorshowedthatuseof #l! communityhealthworkersinHRSAfundedprogramsledtoincreasedaccesstocareforpatients,andtoincreasedknowledgeofnutritionandothertopicstopromoteahealthylifestyle.ThestudyEffectivenessoftheNationalHealthServiceCorpsassessedtheprogramovertime, %0!$ usingretentioninprimarycareandrelatedprofessionsasonemeasureofeffectiveness.TheNationalEvaluationoftheHealthyStartProgramisamultiyearstudywithbothoutcomeand '#& processcomponents.ThefinalreportpresentedfindingsontheimpactoftheprogramoninfantmortalityandbirthoutcomesinHealthyStartsites,comparedwithmatchedcomparisoncommunities.Anotherongoingproject,ComparisonofServicesReceivedandHealthOutcomesforPersonsFundedbytheCAREActandbyOtherSources,comparesdemographic h+&* characteristics,servicesneededandprovided,andhealthoutcomesbetweenpersonsreceivingCAREActfundedservicesandthegeneraltreatmentpopulation.Finally,thestudy,EmploymentSitesofNursingGraduatesSupportedbytheProfessionalNurseTraineeship  Program,isassessingtheimpactofafundingpreferenceinthegrantsprocessonthe t achievementoftheprogramobjectiveofincreasingaccesstocareinunderservedcommunities.#X*XX X*F#EnvironmentalassessmentconcernsthewaysinwhichforcesinthelargersocietyaffectHRSA $ t programsorprogresstowardachievingcrosscuttinggoalsandobjectives.Forexample,theprojectManagedCareandSafetyNetProvidersisexaminingtheimpactofMedicaidmanaged  L  careandotherchangesinhealthcarecoverageonthefutureviabilityofsafetynetprovidersoperatinginprimarycaresettings,includinggranteesofHRSAfundedprogramssuchasCommunityHealthCenters.Acompletedstudy,PacificPartnershipsforHealth:Chartinga   NewCourseforthe21stCentury,outlineshealthstatusandaccessissuesforthepopulationsof   sixislandjurisdictionsandrecommendsapproachesforimprovements.Findingsfromaproject,   APilotStudytoIdentifyInfrastructureBuildingAcrossHRSAPrograms,willimproveHRSAs   understandingoftheinteractionandeffectsofitsprogramsinthecontextofhealthsystemchangesandshiftingpopulationneeds. X*XXX*Programmanagementstudiesprovideinformationfordevelopingandimplementingaprogram.Thecompletedstudy,DataCollectionandBudgetForecastingStrategies:APrimerforState  \ AIDSDrugAssistancePrograms,producedaprimerthatwillenabletheStateadministered H AIDSDrugAssistanceProgramstoestimatetheirexpendituresmoreaccuratelyand,consequently,administerthefederalfundsmoreefficiently.TheStrategiesfortheRecruitment,   Retention,andGraduationofHispanicsintotheBaccalaureateLevelofNursing,developeda   modelthatcanbeusedbyinstitutionsofhighereducationseekingtoincreasetheproportionofHispanicAmericansadmittedtobaccalaureateprogramsastheirinitialentryintonursingeducation.Inaddition,HRSAsupportsactivitiestoenhancethequalityofevaluationAgencywideincludingfundingshortcoursesinevaluationforstaff,encouragingpresentationofHRSAstudiesatnationalconferences,andexpandingthecapacityofAgencyprogramstafftoprovideskilledtechnicalassistanceontheframing,designandimplementationofstudies.Broadeningofdisseminationofstudyproductsthroughavarietyofelectronicandotherapproachesalsowillcontinuetobeaprioritythrough2003.  $D #   HEALTHRESOURCESANDSERVICESADMINISTRATIONA.5.COMPARISONOFORIGINALFY2001MEASURESWITHREVISEDFY2002ORFY2003MEASURES# lX X*7# X*X l )$(    h+&* *<d!d( kk( !kk!/ kk/ "",dd , dd , dd +  /  /# lX X*^# &M'% lProgramTitle A,!d AOriginalFY2001Measures A,!< ARevisedFY2002or2003Measures ;1&d   ;AIDSEducationandTrainingCenters#&M'%'% &MX# &M'%'%&M '0 'IncreasethenumberofminorityhealthcareandsocialserviceproviderswhoreceivetraininginAETCs. ' 0  '#&M'%'% &Ma# &M'%'%&MIncreasetheproportionofAETC X  traininginterventionsprovidedtominorityhealthcareproviders.  X  PoisonControlCenters  $ t IncreasethenumberofuniformandevidencebasedguidelinesavailableforapprovalbytheAmericanAssociationofPoisonControlCenters,tobeusedinPoisonControlCenters. '\  'Developandfieldtestuniformandevidencebasedguidelinesforthetreatmentofpoisoning.  L OrganProcurementandTransplantation    Increaseby20%overtwoyearsthenumberoforgandonorsnationallyfromimplementationofthefinalHCFAruleonConditionsofParticipationofHospitals. 'P! 'Increaseby5%peryearthenumberoforgandonorsnationally. x$ OrganProcurementandTransplantation#&M'%'% &Mb# &M'%'%&M  D& Increaseby20%overtwoyearsthenumberofminorityorgandonorsnationallyfromimplementationofthefinalHCFAruleonConditionsofParticipationofHospitals.#&M'%'% &Mf# &M'%'%&M ', 'Increaseby5%peryearthenumberofminorityorgandonorsnationally. l/ NationalBoneMarrowDonorProgram  2 Increaseby7.5%thenumberofunrelatedbonemarrowdonors(nationalregistryofpotentialdonors)overpreviousyeartotals.  p 7 Increaseby5%thenumberofunrelatedbonemarrowdonors(nationalregistryofpotentialdonors)overpreviousyeartotals.  ; Telehealth  !,< Completeevaluationofruraltelemedicinegrantprogramandpublishfindings.  #? Developimprovedperformancemeasuresfortelemedicinegrantprograms,evaluateruraltelemedicinegrantprogram.  d$C FamilyPlanning  % !D IncreasethenumberofindividualsservedbyTitleXclinics.  '"G Continuetoassurethatpriorityisgiventofurnishingfamilyplanningservicestopersonsfromlowincomefamilies.(Totalnumberofclientsservedandtheproportionofclientswithincomesatorbelow200percentoftheFederalpovertylevel). +'O  Ї#&M'%'% &Mg# &M'%'%&M#&M'%'% &Mnl#  #l'%&Mi`#