GPRA Goal 5—FY 2002 Indicators

Goal 5 Objectives	FY 2002 Indicator
Objective 5.1: Conduct research to help to measure the current status of health care quality in the Nation.	Sponsor and conduct research to help measure the overall safety culture within health care institutions. Identify at least one private sector data source which will be incorporated into the national quality report by 31 December 2002.
Objective 5.2: Facilitate use of quality information to improve health care in the Nation.	Fund or conduct at least 3 projects bringing healthcare information to the public in an understandable, user friendly manner that facilitates its use in decision making.
Objective 5.3: Improve quality measurement.	Adoption of at least one quality measure to be developed from our vulnerable populations RFA by a national accrediting organization. Identify 3 examples of how the Quality Indicators were utilized by the public.

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2.2 Budget Line (2)—Medical Expenditure Panel Survey (MEPS)

Funding Levels

Fiscal Year 2001: $40,850,000 (Actual - Current Law)
Fiscal Year 2001: $40,850,000 (Actual - Proposed Law)
Fiscal Year 2002: $48,500,000 (Appropriation)
Fiscal Year 2002: $48,500,000 (Current Estimate)
Fiscal Year 2003: $53,300,000 (Request - Current Law)
Fiscal Year 2003: $53,300,000 (Request - Proposed Law)

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This budget line reflects AHRQ funding for the data collection and related activities conducted through the Medical Expenditure Panel Survey.

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GPRA Goal 6: Produce and release information from MEPS on health care access, cost, use, and quality.

Strategy: AHRQ's Medical Expenditure Panel Surveys collects detailed information regarding the use and payment for health care services from a nationally representative sample of Americans. No other surveys supported by the Federal Government or the private sector provide this level of detail regarding: the health care services used by Americans at the household level and their associated expenditures (for families and individuals); the cost, scope, and breadth of private health insurance coverage held by and available to the U.S. population; and the specific services that are purchased through out-of-pocket and/or third-party payments.

This level of detail enables public and private-sector economic models to develop national and regional estimates of the impact of changes in financing, coverage, and reimbursement policy and estimates of who benefits and who bears the cost of a change in policy. No other survey provides the foundation for estimating the impact of changes on different economic groups or special populations of interest, such as the poor, elderly, veterans, the uninsured, or racial/ethnic groups.

AHRQ will continue to assess the essential components of the MEPS program—development of new, updated, or otherwise enhanced databases; creation of products for use by researchers and policymakers outside AHRQ; and facilitation of the use of MEPS-related products.

Types of Indicators: Process and output

(Data collection begins with the treatment of common clinical conditions over time for a nationally representative portion of the population in support of the National Healthcare Quality Report.)

Use of Results by AHRQ:

The results provide the Agency with a thorough review of AHRQ's data collection and development activities and release of data products and publications associated with MEPS database. AHRQ uses the results for the management of the program.

Data Issues:

Many of these indicators are yes/no indicators where the data collection or product release happened as scheduled, or didn't. The evidence of successful completion of the indicators will be available on the AHRQ web site, where products can be accessed. Other data will come from contract monitoring files. Where deadlines have been missed, the Agency determined the cause for the delays and is making the necessary corrections. Beginning with the FY 2000 performance report, AHRQ will continue to include the results of evaluations of the use of the MEPS products in Section 4.2.

GPRA Goal 6—FY 2001 Results

Objective 6.1: Release and disseminate MEPS data and information products in timely manner for use by researchers, policy makers, purchasers, and plans.

1st Indicator: In FY 2001, 1997 Use and Expenditures, 2000 Point-in-Time, and

1998 Health Insurance and Demographics MEPS public use data files will be released.

Results: The following data files were released according to schedule:

• 1997 Use and expenditures were released in May 2001
• 1998 Health Insurance and Demographics were released in June 2001
• 2000 Point-in-time was released in July 2001
• 1996/97 longitudinal file was released in July 2001

2nd Indicator: Response time for requests received for information, assistance or specific products is as promised 95 percent of time.

Results: AHRQ continues to maintain a rapid response time to requests for MEPS data, with 95 percent of all technical assistance responded to within 5 working days.

Objective 6.2: Facilitate use of MEPS data and associated products as tools by extramural researchers, policy makers, purchasers, and plans.

1st Indicator: Establish baseline for Data Center use capacity.

Results: Between January and July 2001, 13 data center projects were approved. Applications are approved on a quarterly basis with the next review cycle being held in October 2001.

Objective 6.3: Modify MEPS to support annual reporting on quality, health care disparities, and research on long-term care in adults and children with special needs.

Quality

1st Indicator: Data collection begins on the treatment of common clinical conditions over time for a nationally representative portion of the population in support of the National Healthcare Quality Report.

Results: Beginning in February 2001, questions were added to the MEPS on priority conditions, accountability measures, and preventive care. An Adult self-administered questionnaire (SAQ), parent-administered questionnaire (PAQ), and Diabetes Care Supplement were administered to collect health status, satisfaction, and attitude information. These data will be used in concert with the point-in-time file to populate tables to be included in the National Quality Report.

The IOM has completed a recommended conceptual framework for the National Quality Report. AHRQ issued a call for measures to federal agencies to populate the framework and proposed measures have been received. An interagency workgroup is evaluating the proposed measures using criteria suggested by the IOM. A recommended set of measures for the first report is scheduled to be available for vetting in the Department and with external stakeholders in early Dec, 2001.

Long-term Care:

2nd Indicator: Have developed data use agreements (DUA) with CMS to assess and begin data development related to the MDS.

Results: The LTC enhancements in MEPS for 2001 were not funded. However, AHRQ did modify the SSS data processing contract to procure the statistical support necessary to start work on developing an over sampling strategy for adults with functional limitations and children with special needs. A Data Use Agreement (DUA) has been drafted and accepted by HCFA/CMS for use of Minimum Data Set (MDS) data. An initial set of data has been delivered covering 6 states (CA, OH, NY, TX, WA, AL) representing 1,085,720 people who had at least 1 MDS assessment during July 1999 to July 2000.

An analysis dataset is being created from this raw data to assess the overall MDS data quality. The results of this analysis will help frame a future agreement with HCFA/CMS regarding full access for all 50 states. These data are being considered for use as quality indicators in the institutional population in the AHRQ National Quality Report.

The data were received in late November, 2000. Social and Scientific Systems, Inc., data processing contractors, started processing them in late March, 2001. Preliminary data processing tasks have been happening since then and construction of the analysis dataset was initiated in July 2001. Initial analysis of the data was completed by Fall, 2001.

3rd Indicator: Design MEPS over sample of adults with functional limitations and children with special needs.

Results: The LTC enhancements in MEPS for 2001 were not funded as a result, this MEPS enhancement did not occur as planned.

4th Indicator: Produce one report related to LTC.

Results: The final report of the Expert meeting in community-based Long- Term Care is in its final stages of preparation. It has been sent for review internally and is expected to be finalized by September, 2001. This expert meeting was a gathering of researchers who identified gaps in knowledge and research priorities in the area of community-based long-term care. The report will be a summary of the meeting and will highlight some recommendations. It is intended to become an AHRQ publication.

5th Indicator: Have developed IAA with NCHS for LTC frame development activities.

Results: The LTC enhancements in MEPS for 2001 were not funded as a result, this MEPS enhancement did not occur as planned.

6th Indicator: Submit at least one peer-reviewed publication in the area of LTC.

Results: The following article appeared in a peer-reviewed publication:

• Rhoades, J. A., and Altman, B.M. Personal Characteristics and Contextual Factors Associated with Residential Expenditures for Individuals with Mental Retardation. American Association on Mental Retardation, 2001;39(2):114-29.

GPRA Goal 6—FY 2002 Indicators

Goal 6 Objective	FY 2002 Indicator
Objective 6.1: Release and disseminate MEPS data and information products in timely manner for use by researchers, policy makers, purchasers, and plans.	Develop a method to facilitate users' custom cross tabulations of MEPS data. Conduct six MEPS data user workshops. Expand MEPS list-server participation by 20 percent. Produce 4 descriptive data products (i.e., findings, chartbooks, highlights, or table compendia). Develop Frequently Asked Questions Section for MEPS web site.
Objective 6.2: Facilitate use of MEPS data and associated products as tools by extramural researchers, policy makers, purchasers, and plans.	Determine the feasibility of existing mechanisms to provide off-site access to confidential MEPS data. Expand data center capacity by 10 percent over FY 2001 level.

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2.3 Budget line 3—Program Support

Funding Level

Fiscal Year 2001: $2,500,000 (Actual - Current Law)
Fiscal Year 2001: $2,587,000 (Actual - Proposed Law)
Fiscal Year 2002: $2,600,000 (Appropriation)
Fiscal Year 2002: $2,688,000 (Current Estimate)
Fiscal Year 2003: $2,700,000 (Request - Current Law)
Fiscal Year 2003: $2,789,000 (Request - Proposed)

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GPRA Goal 7: Support the overall direction and management of AHRQ

This goal involves supporting the overall direction and management of AHRQ through prudent acquisition performance management, capital asset planning, personnel support and information technology planning.

Types of Indicators: Outcome indicators that document customer satisfaction with two major functions within the Agency are used.

Use of Results by AHRQ: The scores for each of the measures, in combination with the written comments received in the survey, continue to be used to improve the acquisition systems and the Intranet.

Data Issues: The data collection is accomplished through customer surveys administered to Agency staff annually.

GPRA Goal 7—FY 2001 Results

Objective 7.4: Establish and maintain a secure Agency computer network infrastructure.

1st Indicator: Preliminary policies and procedures to reduce security risks developed by the end of FY 2001.

Results: AHRQ published a final IT Security Plan on November 5, 2001. AHRQ further refined the security plan and published version 1.1 on December 27, 2001.

2nd Indicator: Initial criteria for reporting security incidents established by the end of FY 2001.

Results: AHRQ published an Incident Response Plan documenting criteria for reporting security incidents on November 6, 2001. The Response Plan works in conjunction with security procedures detailed in the Agency IT Security Plan issued on December 27, 2001.

3rd Indicator: Initial procedures for responding to security incidents established by the end of FY 2001.

Results: AHRQ published an Incident Response Plan documenting initial procedures for responding to security incidents on November 6, 2001

4th Indicator: Implementation of a Secure Phase 1 LAN for analysis of intramural research and survey data will be completed by end of FY 2001.

Results: AHRQ has completed the implementation of Phase I of the Secure LAN. Intramural research and survey data housed at AHRQ has been evaluated based on NIST criteria and now resides on the Secure LAN. This LAN is an air-gapped network which is protected by various security measures which include, but are not limited to: media-less workstations, Proximity Devices, Secure Printing Facility, Video Monitoring Equipment, and Fiber from the desktop to the Secure LAN Cabinets.

5th Indicator: Implementation of a Phase 1 firewall, intrusion detection and virus control system will be in place by December 2001.

Results: AHRQ has completed the implementation of a Phase I firewall, intrusion detection and virus control system. The following features are operational:

• Two Raptor Firewalls V6.5, one primary and one secondary, were installed and are currently in the Phase 2 hardening stage. An independent validation and verification of high-level security measures revealed "no glaring issues at this time."
• Two servers running Real Secure's Intrusion Detection System, Internet Security System (ISS) V5.5, have been implemented and are monitoring the internal AHRQ network traffic and the external traffic attempting to come through AHRQ's firewall.
• Various virus-control systems have been implemented. The agency desktops are running McAfee's Virus Scan V4.0.3. The Exchange Server is running Trend Micro's Scan Mail 3.5.1, which scans both incoming and outgoing mail. McAfee's Netshield V4.1 is run against the file servers.

6th Indicator: Initial security awareness training will begin by Dec 2001.

Results: AHRQ implemented web-based IT Security Awareness Training on December 28, 2001.

GPRA Goal 7—FY 2002 Indicators

Goal 7 Objectives	FY 2002 Indicator
02 Objective 7.4. Establish and maintain a secure Agency computer network infrastructure.	Perform initial tests, (periodically, beginning in 2nd quarter of FY 2002) to evaluate the preliminary policies and procedures.
02-03 Objective 7.5. Optimize work processes through implementation of AHRQ's workforce restructuring plan. (This measure will be initiated in FY 2002.)	Completed reports of findings and recommendations of at least one business process re-engineering studies. AHRQ passes all items on GISRA self-assessment checklist

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