DISCONTINUED MEASURES

• Health Centers Program
• Ryan White HIV/AIDS Program

HEALTH CENTER PROGRAM

DISCONTINUED MEASURES

1.D.I.A.2.  Increase the infrastructure of the Health Center Program to support an increase in utilization. 

(Indicator:  Total number of new or expanded sites)

(Baseline - 2002:  0)

(Target - 2007: 1200)

As a result of FY 07 activities, Health Center Patients were served through 4,033 comprehensive primary care delivery sites.  The Health Center Program supported a total of 337 new and expanded sites, exceeding its national goal.  This measure was deleted during the FY 07 OMB PART reassessment.

Long-Term Goal

Increase percent of the Nation’s poor below 200% of poverty level served by the Health Center Program.

(Baseline - 2002:  11%)

(Original Target: 2006, 16%)

1.D.II.A.1.  Continue to assure access to preventive and primary care for low income individuals.

(Indicator:  Percent of nation’s poor served by Health Centers)

With the potential growth in the number of individuals and families in poverty, the FY 07 target for the percentage of the Nation’s poor served by Health Centers was adjusted from 16% to 14% to account for external factors beyond the control of the Health Center Program.  In FY 06, Health Centers served 15.2% of the Nation’s poor.  This measure was deleted during the FY 07 OMB PART reassessment.

Long-Term Goal

Reduce low birth weight rates in health centers. 

(Baseline - 2002:  6.9%)

(Original Target - 2006:  6.53%)

1.D.II.B.1.  Decrease the percent of births to Health Center patients below 2500 grams (LBW).

Appropriate prenatal care management can have a significant effect on the incidence of low birth weight (LBW).  LBW is the risk factor most closely associated with neonatal mortality; thus improvements in infant birth weight can contribute significantly to reductions in infant mortality rates.  In addition, young mothers, particularly under age 15, and African American mothers are more likely to have LBW infants. These risk factors are reported at a higher rate among Health Center mothers, predisposing Health Center births to higher risk for low birth weight and adverse birth outcomes. 

According to UDS Health Center data for CY 2006, 7.7% of infants born to mothers who sought their prenatal care at Health Centers were born with LBW.  This rate is above the FY 06 target of 7.05, but is still lower than the national 2002 through 2005 rates of 7.8%, 7.9%, 8.1% and 8.2% respectively, despite the fact that Health Center mothers and infants are at greater risk of adverse birth outcomes.  The Health Center rate continues to follow a steady pattern of under 8%, unlike the increases observed in the national rate (Source: Martin JA, Hamilton BE, Sutton PD, et al. National Center for Health Statistics: 2006).   This measure was replaced with a similar measure that is benchmarked to national low birth weight rates, during the FY 07 OMB PART reassessment.

1.D.II.B.2.  Increase percent of adult diabetic patients with at least one testing of glycohemoglobin annually.

Health Center patients, including low-income individuals of racial/ethnic minority groups and persons who are uninsured, are more likely to suffer from chronic diseases such as hypertension and diabetes.  Clinical evidence indicates that access to appropriate care can improve the health status of patients with chronic diseases and thus reduce or eliminate disparities.  Managing the glycohemoglobin levels of individuals with diabetes and the blood pressures of individuals with hypertension can have a pronounced effect on their morbidity and mortality.

Based on information from the Health Disparities Collaboratives Program’s diabetes registry, performance in 2002 through 2006 was 74.8%, 70.9%, 72.5%, 73.8% and 84.7%, respectively.  The FY 06 and FY 07 Health Center targets are maintained at 71% of patients with at least one testing of glycohemoglobin annually, well above the HP 2010 goal of 50%.   These Collaboratives data suggest that Health Centers continue to exceed national goals, even with significant growth in the program’s diabetes registry.

Data will no longer be reported for this measure after FY 07 as beginning in 2009, BPHC will be collecting a core set of clinical quality and outcome measures, including measures that focus on the outcome of appropriate management of chronic conditions including diabetes.  These measures will be aligned with those of national quality measurement organizations such as the Ambulatory Care Quality Alliance and the National Quality Forum and will be reported on annually by all grantees through the Uniform Data System.  

1.D.II.B.3.  Increase the percent of Health Center women receiving age-appropriate screening for cervical and breast cancer.

Nationally, patients of racial/ethnic minority groups, of low income, and who are uninsured have less access to appropriate screening and preventive services which results in their higher rates of

• The 2002 Health Center User Survey pap-test rate (87.6%) is roughly comparable to the 1995 Health Center User Survey rate (88.5%) despite significant Health Center program growth and still exceeds the HP 2000 goal (85%).
   
• The Health Center pap-test rate does fall short of the HP 2010 goal (90%) and the original goal set for the program (95%).  Future targets are lower and comparable to the HP 2010 goal. 
  
• For mammograms, the 2002 Health Center User Survey program rate (75.7%) substantially exceeds the 1995 survey rate (62.5%), HP 2000 goal (60%), revised HP 2010 goal (70%), and program target (75%) (Definition of age-appropriate changed from 50 and over in 1995 to 40 and over in 2002). 

Data will no longer be reported for these measures as beginning in 2009, BPHC will be collecting a core set of clinical quality and outcome measures, including measures that focus on the quality of appropriate preventive care.  These measures will be aligned with those of national quality measurement organizations such as the Ambulatory Care Quality Alliance and the National Quality Forum, and will be reported on annually by all grantees through the Uniform Data System.  

1.D.II.B.4.  Increase the percent of Health Center adults with hypertension who report their blood pressure is under control.

Hypertension is the most prevalent chronic condition facing Health Center patients. Clinical evidence indicates that controlling blood pressure can reduce morbidity and mortality.

The 1995 Health Center User Survey, comparable to the NHIS, showed that 90% of Health Center patients reported their hypertension under control.  The 2002 Health Center User Survey found an overall comparable rate of 91% for Health Center patients with hypertension, and comparable rates to 1995 survey rates for the subgroups of men, women and patients from racial/ethnic minority groups.

Healthy People 2010 includes the following objective for adults generally:  At least 50 percent of patients with hypertension report that their blood pressure is under control.  Not only did the sample of Health Center patients show that they were more than three-times as likely to report blood pressure under control as a comparable national group, but the current rate far exceeds the HP 2010 objective.

Data will no longer be reported for this measure as beginning in 2009, BPHC will be collecting a core set of clinical quality and outcome measures, including measures that focus on the outcome of appropriate management of chronic conditions including hypertension.  These measures will be aligned with those of national quality measurement organizations such as the Ambulatory Care Quality Alliance and the National Quality Forum and will be reported on annually by all grantees through the Uniform Data System.

1.D.E.1.  Sustain the average cost per individual served at Health Centers.

(Indicator: Total cost divided by total patients)

It is essential that Health Centers maximize the number of patients served per dollar, and tracking their costs is an appropriate process to assure efficiency.  Performance once again exceeded the target in 2006 with an annual average cost per patient of $538, $18 below the national target. This measure was replaced with a similar measure that is benchmarked to national cost increases during the FY 07 OMB PART reassessment process.

1.D.E.2.  Annual number of encounters per medical worker.

(Indicator: Total number of encounters to physicians, nurse practitioners, physician assistants, and certified nurse midwives divided by their respective FTEs)

It is important that Health Centers maximize the number of patients served and assess the number of encounters per medical provider to track their productivity.   Historically, Health Center productivity has generally remained consistent with national standards for primary care, with only slight declines between 1996 and 2003. In the face of significant Health Center expansion, FY 04 and FY 05 figures show that productivity remained relatively stable from the FY 02 level with only a slight decline in FY 06. This measure was deleted during the FY 07 PART reassessment process as new measures were defined.   

HIV/AIDS: RYAN WHITE HIV/AIDS PROGRAM

16.D.I.A.1.  Increase by 2 percent every second year the number of persons provided services through the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act program.

The number of persons provided services through the Ryan White HIV/AIDS Program was selected as a measure of the program goal to improve access to health care for individuals infected with HIV/AIDS by increasing availability of and access to care and services.

In FY 04, an estimated 531,000 persons received Ryan White HIV/AIDS Program services, a decrease of 9% from the estimated 571,000 people served in 2002.  HIV care continues to become more complex as new drug therapies are introduced and the number of patients on advanced salvage therapies increases. The decrease in clients served may represent other decreases in funding and increases in cost across the health care system as the numbers represent all HIV infected clients served by our grantees, including those covered by entitlement programs and private insurers.

This measure was discontinued during the FY 2007 PART reassessment.

16.D.IV.A.1. Maintain the number of AIDS Drug Assistance Program (ADAP) clients served through State ADAPs during at least one quarter of the year.

(This measure has been changed. It previously was "Increase the number of AIDS Drug Assistance Program (ADAP) clients receiving HIV/AIDS medications through State ADAPs during at least one month of the year by at least 4 percent"; now it is as stated above.  This reflects client counts and how results are shown.)

The number of ADAP clients served through State ADAPs during at least one quarter of the year was selected as a measure of the program’s goal to eliminate health disparities among individuals with HIV/AIDS who are underserved by increasing availability and utilization of these medications.

The actual FY 06 performance resulted in 132,627 clients served in at least one quarter of the year.  This is 819 additional clients served over the FY 05 results. Many clients are enrolled in ADAP only temporarily while they await acceptance into other insurance programs, like Medicaid.

This measure was replaced by a revised performance measure during the FY 07 PART reassessment.

18.D.III.A.1. Maintain the number of ADAP clients served through State ADAPs during at least one quarter of the year.

(This measure has been changed.  It previously was "Increase the number of AIDS Drug Assistance Program (ADAP) clients receiving HIV/AIDS medications through State ADAPs during at least one month of the year by at least 4 percent"; now it is as stated above.  This reflects client counts and how results are shown.)

The number of ADAP clients served through State ADAPs during at least one quarter of the year was selected as a measure of the program’s goal to eliminate health disparities among individuals with HIV/AIDS who are underserved by increasing availability and utilization of these medications.

The ADAP program provides therapeutics and purchases health insurance with pharmaceutical coverage to treat HIV disease or prevent the serious deterioration of health arising from HIV disease for eligible individuals. Therapeutics provided by ADAPs includes anti-retrovirals, medications for the treatment and prevention of opportunistic infections, and medications to address side effects that may be experienced by individuals on HIV medications. The performance measure for the ADAP includes all therapeutics provided by the program, not just anti-retrovirals.

The actual FY 06 performance resulted in 132,627 clients served in at least one quarter of the year. This is 819 additional clients over the FY 05 results. Many clients are enrolled in ADAP only temporarily while they await acceptance into other insurance programs, like Medicaid.

This performance measure was revised during the FY 07 PART reassessment to relate to clients served annually.