"There's still plenty of work to do in the Bureau and throughout the agency," she said. "You may not be doing what you are now, but you will have a job at HRSA."

The Bureau's FY 2005 budget of $882 million is expected to drop to about $738 million once final FY 2006 numbers are released later this month. BHPr programs whose budgets were eliminated in 2006 include Health Education and Training Centers, Geriatric Programs, and the Quentin N. Burdick Program for Rural Interdisciplinary Training. Other programs, such as Centers of Excellence and the Health Careers Opportunity Program, had their budgets sharply cut.

Duke urged BHPr employees to see the upcoming changes as opportunities for growth by learning new skills and doing new tasks. New appointments introduce new people and places and give a chance to tackle challenges which would never be faced otherwise, she said.

Duke told employees she will consult with them and keep them informed as the restructuring process gains strength in the months to come. "We will get through this together as a team," she told employees. "I'm not going anywhere."

Included in that mass evacuation, the largest in U.S. history, were hundreds of New Orleans residents living with HIV/AIDS who had been enrolled in Ryan White CARE Act programs when Katrina struck. Continuing medical assistance to those patients was crucial, especially for those who relied on life-sustaining medications. (See the following story to find out how Texas ADAP officials expanded pharmaceutical services to evacuees.)

The effort to identify HIV-positive people in need of treatment among the mass of evacuees was led by the HIV Services Section for Harris County Public Health and Environmental Services (HCPHES). HCPHES is the Ryan White CARE Act Title I grantee in Harris County, responsible for administering close to $20 million in care and services for low-income, uninsured People Living with HIV/AIDS (PLWHA).

Starting on Sept. 3, some 25,000 people were bused from the Louisiana Superdome in New Orleans to Houston’s Reliant Astrodome complex, which became the triage site where all evacuees were screened. HCPHES employees were pressed into the general emergency management response at the Astrodome. Later, HCPHES subcontractors set up a booth in the Astrodome to help identify PLWHA among the evacuees.

Once identified, PLWHA were referred to the Harris County Hospital District’s Thomas Street Clinic, a CARE Act Title I subcontractor that runs the largest HIV/AIDS clinic in the Houston metro area. The clinic also is a Title III grantee.

Amid the crush, HCPHES staff saw two groups of HIV-positive evacuees. The first were PLWHA who evacuated to Houston before Katrina hit, thinking they’d be there only a short time. Those evacuees stayed with friends and families, and prepared by bringing a week’s supply of medications with them.

That first wave “got the evacuee situation for HIV/AIDS patients on the radar screen,” said Charles Henley, manager of HCPHES’ HIV Services Section.

The second, larger wave of PLWHA were those who came in by bus from the Superdome. They were far less prepared than the first group. Most of the second-wave evacuees had no medical records, no medications, and were at risk of “falling through the cracks,” Henley noted. As the emergency continued, physicians trained in both emergency care and HIV/AIDS treatment were assigned to the Astrodome and began to do outreach for PLWHA as they screened all evacuees.

Both groups of evacuees were able to access the broad range of HIV/AIDS services – including emergency medications – at the Thomas Street Clinic and at the Montrose Clinic, a CARE Act Title I subcontractor that also is a health center “look-alike.”

Henley said his staff learned important lessons about the delivery of HIV-related care during a disaster:

First: “PLWHA likely put their HIV-related health care last when they face extraordinary disasters like Katrina,” he noted. Up to now, about 140 PLWHA evacuees have entered into a system of care in Houston, meaning that they have located services, received treatment, and been tracked through the metro area’s Centralized Patient Care Data Management System. Henley thinks that the number of HIV-positive evacuees seeking care in Houston and other parts of Texas will rise as they see that health care systems in New Orleans cannot yet support their return.

“They’ll have to resolve themselves to the fact that the medical infrastructure they depended on remains fractured, at best, and probably will not be resolved anytime soon,” he said.

Second: In emergency situations, local officials are pressed to meet immediate basic needs, such as housing, emergency medical care and transportation, Henley said. Case management resources were quickly mobilized to help PLWHA access services, but there was no “one-stop shopping” for the full range of services, which stressed evacuees, he noted. One requested service that surprised service providers was the need for legal assistance. Because so many evacuees had family members who had died, many asked for legal advice on handling estates and related matters.

Third: It’s hard to plan when so much is unknown. Since many evacuees who were HIV/AIDS patients had apparently dropped out of care – “one of our biggest fears,” Henley said – his team compensated by facilitating access to care. They loosened intake and eligibility requirements because most HIV-positive evacuees had no documentation of their HIV status, and they encouraged providers to implement rapid-testing.

Fourth: Established networks help deliver services effectively during an emergency. Henley said that local agencies benefit greatly by having solid partnerships, often in the form of collaborative agreements or contracts, with Federal agencies.

“We learned that Federal funding streams get turned on quickly in a crisis, and having collaborations in place expedites emergency funding,” he said. Health centers, for example, were used to taking in new clients and qualifying them for Medicaid reimbursements, Henley explained.

In another instance, local agencies with good contacts with the U.S. Department of Housing and Urban Development tapped into emergency housing assistance made available through HUD’s Housing Opportunities for People with AIDS program. This was especially helpful for CARE Act patients, since housing is not a core service funded under the CARE program.

Dwayne Haught, manager of the Texas AIDS Drug Assistance Program in the Texas Department of State Health Services, knew that acting quickly was key.

Haught said he and his staff moved first to contact drug manufacturers and persuade them to provide in-kind replacements for evacuees’ drugs for the months of September and October. The pharmaceutical companies “stepped up to the plate, proving the power of the public-private partnership,” he noted.

ADAP officials also acted to simplify the ADAP application process so that services could be provided immediately to evacuees. ADAP staff worked hard to make enrollment “hoop-free,” whittling the standard six-page application down to a one-page emergency application so that services could be delivered as soon as possible.

Eventually, 270 evacuees were enrolled in the Texas ADAP, far fewer than what Haught initially imagined. Most ended up in Beaumont and Houston, close to the Louisiana border. The evacuees raised the number of state ADAP enrollees to 14,270.

Haught describes the situation today as “unfinished.” The Texas ADAP continues to absorb clients from Louisiana in need of medications, and staff struggles to keep help coming almost five months after the disaster.

“After the benevolence wears out, people still need assistance.” he noted. “There’s another chapter yet to be written.”

A report released Jan. 11 by HHS’ Agency for Healthcare Research and Quality found that racial disparities in health overall are slowly narrowing, but that the results for Hispanics, in particular, were less positive.

Last month HRSA announced the creation of a new Office of Health Information Technology (see following story) to make sure that the benefits of advanced computer and video technologies reach safety-net health care providers – many of whom are HRSA grantees – and the racial and ethnic populations who are the bulk of their patients.

Minority Americans make up a majority of the patients served at HRSA-supported health centers and HIV/AIDS clinics. Sixty-four percent of the almost 14 million patients who annually receive free or low-cost care at these sites are members of minority groups.

In her remarks, Duke noted that the evacuees from New Orleans following Hurricane Katrina helped highlight problems inherent in our nation’s “paper-based system of health care.”

Evacuees who arrived at health centers in outlying areas for treatment came “with no medical papers, no prescriptions, no evidence of current treatment, no way to verify their medical conditions without going through some initial assessment in the crush of the chaos.”

HRSA’s grantees did heroic work in the information void, she said. But the lack of a nationwide, accessible health information system prevented grantees from tapping into detailed health records of the people they treated. “They were in the dark because our current system keeps them there,” Duke said.

Over the past 10 years, HRSA has invested about $95 million in building electronic networks and other HIT improvements at health centers. HRSA funds currently support 50 networks, whose members include more than 400 health center grantees.

Additionally, HRSA’s Health Disparities Collaboratives, which have been implemented by two-thirds of the almost 1,000 health center grantees, use clinical information systems to improve the delivery of care and health outcomes for patients with chronic illnesses. These systems enhance patient care by using data to track and plan care and providing timely electronic reminders about needed services.

Duke spoke at the close of the three-day National Leadership Summit on Eliminating Racial and Ethnic Disparities in Health, sponsored by HHS’ Office of Minority Health.

The new office will help grantees select and use the health information technology (HIT) they need to improve the quality of care they deliver. The office also will concentrate on developing an HIT strategy that benefits safety-net providers and responds to the needs of the uninsured, underserved, and special needs populations.

Associate Administrator Cheryl Austein Casnoff brings considerable organizational experience to the task of establishing the office. Before accepting her current post, she helped design and launch the State Children’s Health Insurance Program and later directed the program at the Centers for Medicare and Medicaid Services. Austein Casnoff said staffing for the office could reach 20 in the near future, but added that resources and expertise would be leveraged to aid the office from throughout the agency.

She has already formed a policy council with representatives from HRSA’s bureaus and offices to enhance HIT collaboration and to assure that the agency’s programs are coordinated with the HHS Office of the National Coordinator. Austein Casnoff also will be working with other Department components to explain the HIT needs of HRSA’s grantees and promote their own contributions.

The new office will have three major entities. Two are new: a Division of HIT Policy and a Division of HIT State and Community Assistance. The third entity already exists -- the Office for the Advancement of Telehealth, which was recently housed in the HIV/AIDS Bureau. Dena Puskin will continue to head the Telehealth office, but the other two division heads have yet to be named.

The growth in nursing is promising, according to Denise Geolot, director of the Division of Nursing in HRSA’s Bureau of Health Professions. “These findings show we are making progress in increasing the supply of nurses, but we must continue these efforts to meet the ongoing and future demand for nurses in this country,” she said.

The survey revealed the following data and trends:

• The total number of licensed registered nurses (RNs) living and working in the United States was estimated to be 2.9 million.
  
  
• Of the total licensed RN population, 83.2 percent were employed in nursing in 2004. Of this number, 58.3 percent were working full-time, almost 25 percent were working part-time, and 16.8 percent were not employed.
  
  
• The “real” earnings of RNs employed full-time have increased 12.8 percent since 2000, the first significant up-turn in real earnings since 1988.
  
  
• The nursing population continues to age: the average age of the RN population was estimated to be 46.8 years.
  
  
• Of nurses who indicated their racial/ethnic background, 88.4 percent (almost 2.4 million) were White; 4.6 percent (122,495) were Black/African American; 3.3 percent (89,976) were Asian or Pacific Islander; and 1.8 percent (48,009) were Hispanic.

More than 35,700 RNs from all 50 States and the District of Columbia responded to the survey. Data collection began in March 2004 and responses were received through November 2005. The survey also explores educational background and specialty areas; employment status, position and salaries; geographic distribution; and personal characteristics, including gender, racial/ethnic background, age, and family status.

The complete Eighth National Sample Survey of Registered Nurses, March 2004 is expected to be published in March.

The report, an overview of broad health characteristics for children, brings together national and state-level data for the first time. It also points to a need to improve access to health care for children from low-income families, those with no health insurance, and children with special health care needs.

Measures in The Health and Well-Being of Children focus on children's physical and mental health, health care, and general well-being as it relates to their families, schools and neighborhoods. The report found that:

• 84 percent of children were in “excellent” or “very good” health. Just over 91 percent had health insurance, and 78 percent received an annual preventive health care checkup. Most parents were satisfied with their children's care: 66 percent of children had a culturally sensitive and communicative personal doctor or nurse.
  
  
• Seven in 10 children lived in households where no one smoked, and the parents of 92 percent of children did not report “usually” or “always” feeling aggravated due to parenting.
  
  
• 81 percent of children lived in neighborhoods parents characterized as “supportive.” About 84 percent of parents felt that their children were safe in their neighborhood, and 88 percent felt their children were safe at school.

The report also indicated that:

• children in low-income families were less likely to be in “excellent” or “very good” health. These children also missed more days of school due to illness and were more likely to live in households where someone smokes, and more likely to live in neighborhoods that do not feel safe or supportive, factors which put children at a disadvantage.
  
  
• children without health insurance are less likely to receive preventive medical and dental care, needed mental health services, or care that is culturally sensitive.
  
  
• children with special health care needs, who require more care and services than other children, are more likely to have conditions that are “moderate” or “severe,” more likely to have injuries that require medical care, and miss more days of school each year.

The report includes information for each state, easy-to-follow bar graphs as well as breakdown analyses by ethnic and racial group. Parents of 102,353 children ages 0-17 participated in the 2003-04 survey, supported by HRSA’s Maternal and Child Health Bureau and conducted by CDC’s National Center for Health Statistics.

Representatives from all of HRSA’s Bureaus and Offices participated in planning efforts meant to improve communications, reporting and technical assistance activities in advance of inevitable future emergencies. Meetings will initially be held bi-weekly, but will move to a monthly schedule later in the year.

Tim Miller, appointed last fall to head up the EOC, will be in charge of operations for the center, which is housed in the Healthcare Systems Bureau. He will work closely with Office of Planning and Evaluation staff, which charged with setting EOC policy.

Liaisons to the workgroup are expected to provide input in developing EOC policies and procedures, and will participate in periodic training exercises.

The guide is the third tool in the Bright Futures for Women’s Health and Wellness (BFWHW) series on healthy eating and physical activity. The first guide, focusing on young women, and the second, which focuses on what communities can do to help, are available online at www.hrsa.gov/womenshealth. The Bright Futures for Women initiative builds on an earlier approach used in the Bright Futures for Infants, Children, and Adolescents Program by developing and evaluating a variety of culturally competent consumer, provider and community-based products to increase awareness and use of preventive health services.

Also available online is Beyond Women's Health: Incorporating Sex and Gender Differences into Graduate Public Health Curricula, a comprehensive study of how women’s health issues are addressed in master of public health coursework in the 34 accredited U.S. schools of public health.