DISCONTINUED
MEASURES
HEALTH
CENTER PROGRAM
DISCONTINUED MEASURES
Discontinued
Measure |
I. IMPROVE ACCESS TO HEALTH
CARE
A. Expand the capacity of
the health care safety net |
Long-Term Goal: By
2007, establish an additional 1,200 new or expanded
sites.
(Baseline - 2002: 0)
(Target - 2007: 1200) |
Measure |
FY |
Target |
Result |
1.D.I.A.2. Increase the infrastructure
of the health center program to support an increase
in utilization via:
a) New Starts |
2009 |
NA |
|
2008 |
NA |
|
2007 |
91* |
|
2006 |
53 |
|
2005 |
43 |
|
2004 |
31 |
|
2003 |
40 |
|
b) New Satellite Sites |
2009 |
NA |
|
2008 |
NA |
|
2007 |
91* |
|
2006 |
35 |
|
2005 |
47 |
|
2004 |
30 |
|
2003 |
60 |
|
Total New Sites |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
182* |
202 |
2006 |
88 |
86 |
2005 |
90 |
94 |
2004 |
61 |
63 |
2003 |
100 |
100 |
Total Sites |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
4013* |
4033 |
2006 |
3,833 |
3,831 |
2005 |
3,741 |
3,745 |
2004 |
3,649 |
3,651 |
2003 |
3,588 |
3,588 |
c) Expanded Sites |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
120* |
135 |
2006 |
33 |
36 |
2005 |
63 |
64 |
2004 |
63 |
66 |
2003 |
80 |
88 |
d) Total New or Expanded
Sites
(Outcome) |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
302* |
337 |
2006 |
121 |
122 |
2005 |
153 |
158 |
2004 |
124 |
129 |
2003 |
180 |
188 |
Data Source: The Bureau
of Health Care Delivery and Assistance Network
(BHCDANET) maintains data on all sites that
are included in the Health Center grantee's
approved scope of project. HRSA Electronic Handbooks
(EHBs), a HRSA-wide web based grants management
portal, also compiles and maintains Notice of
Grant Awards which are issued when new and expanded
site funding is awarded to health centers. |
Data Validation: BHCDANET
is an agency mainframe system with hard code
editing checks built into the operating platform
of the mainframe system. |
Cross Reference: HHS
Strategic Objective 1.2 |
Notes: * FY 07 target
differs from that shown in the FY 08 Congressional
Justification due to a higher than expected
continuing resolution funding level. The FY
07 target may differ from that shown in budget
narrative tables. Whereas budget narrative
tables are continually updated, performance
reporting guidelines do not permit (except as
noted above) changing a previously established
target for the “reporting” year. This measure
was deleted during the FY 07 PART reassessment.
|
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.
Discontinued Measure
|
II. IMPROVE HEALTH OUTCOMES
A. Expand the availability
of health care, particularly to underserved,
vulnerable and special needs populations. |
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%) |
Measure |
FY |
Target |
Result |
1.D.II.A.1. Continue to assure
access to preventive and primary care for low
income individuals
(% of Nation’s poor served)
(Outcome) |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
14%* |
Oct-08** |
2006 |
16%* |
15.2% |
2005 |
14% |
14.2% |
2004 |
14% |
13.2% |
2003 |
13% |
12.4% |
Data Source: The
Uniform Data System (UDS) collects data on patients
and services provided. National Data: Annual
Social and Economic Supplement (ASEC) to the
Current Population Survey (CPS), U.S. Census
Bureau. |
Data Validation:
UDS data are validated using over 1,000 edit
checks, both logical and specific. These include
checks for missing data and outliers and checks
against history and norms. |
Cross Reference: HHS
Strategic Objective 1.2 |
Notes:
*As the Nation’s poor may increase or decrease
in number due to external factors beyond the
control of Health Centers, an increase in the
percentage of the nation’s poor served may not
be feasible nor an accurate reflection of the
Health Center Program’s performance.
**Dates have been changed
to align with the annual availability of U.S.
Census data on national poverty levels. This
measure was deleted during the FY 07 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.
Discontinued
Measure |
II. IMPROVE HEALTH OUTCOMES
B. Increase the utilization
of preventive health care and chronic disease
management services, particularly among underserved,
vulnerable and special needs populations. |
Long-Term Goal: Reduce
low birth weight rates in health centers.*
(Baseline - 2002: 6.9%)
(Original Target - 2006:
6.53%) |
Measure |
FY |
Target |
Result |
1.D.II.B.1. Decrease percent
of births to health center prenatal care patients
below 2500 grams (LBW).
(Outcome) |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
7.05% |
Aug-08 |
2006 |
7.05% |
7.7% |
2005 |
7.05% |
7.3% |
2004 |
7.05% |
7.01% |
2003 |
6.89% |
7.05% |
Data Source: The Uniform
Data System (UDS) collects data on patients and
services provided. |
Data Validation: UDS
data are validated using over 1,000 edit checks,
both logical and specific. These include checks
for missing data and outliers and checks against
history and norms. |
Cross Reference: HHS
Strategic Objectives 1.2, 1.3; HP 2010 (16) |
Notes: This measure was
deleted during the FY 07 PART reassessment and
was replaced by a similar measure. |
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.
Discontinued Measure
|
II. IMPROVE HEALTH OUTCOMES
B. Increase the utilization
of preventive health care and chronic disease
management services, particularly among underserved,
vulnerable and special needs populations. |
Measure |
FY |
Target |
Result |
1.D.II.B.2. Increase percent
of adult diabetic patients with at least one
testing of glycohemoglobin annually
(Outcome) |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
71% |
Aug-08 |
2006 |
71% |
84.7%
363,474 |
2005 |
71% |
73.8%
258,000* |
2004 |
75% |
72.5%
193,000* |
2003 |
|
70.9%
124,000* |
2002 |
|
74.8%
47,600* |
1.D.II.B.3. Increase percent
of health center women receiving age appropriate
screening for cervical and breast cancer:
a) Up-to-date PAP Tests
(Outcome) |
2008 |
NA |
NA |
2008 |
NA |
NA |
2007 |
NA |
NA |
2006 |
NA |
NA |
2005 |
D/N/A |
D/N/A |
2004 |
D/N/A |
D/N/A |
2003 |
D/N/A |
D/N/A |
2002 |
95% |
87.6% |
b) Up-to-date Mammograms
(Outcome) |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
NA |
NA |
2006 |
NA |
NA |
2005 |
D/N/A |
D/N/A |
2004 |
D/N/A |
D/N/A |
2003 |
D/N/A |
D/N/A |
2002 |
75% |
75.7% |
1.D.II.B.4. Increase percent
of health center adults with hypertension who
report their blood pressure is under control.
(Outcome) |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
NA |
NA |
|
2006 |
NA |
NA |
2005 |
D/N/A |
D/N/A |
2004 |
D/N/A |
D/N/A |
2003 |
D/N/A |
D/N/A |
2002 |
96% |
91% |
Data Source: Diabetes
data are from the Health Disparities Collaboratives
(HDC) Database. Cancer screening and hypertension
data are from the 2002 CHC User Survey. |
Data Validation:
HDC database is maintained by a coordinator
that collects health center participant patient
data. CHC User Survey was conducted on a random,
representative sample of health centers and
patients. |
Cross Reference: HHS
Strategic Objectives 1.2, 1.3, 2.3; 1.D.II.B.2.:
HP 2010 (5) rate of 50%; 1.D.II.B.3.a.: HP 2010
(3) rate of 90%; 1.D.II.B.3.b.:HP 2010 (3) rate
of 70%; 1.D.II.B.4.: HP 2010 (12) rate of 50% |
Notes: NA = Not
Applicable D/N/A = Data not available. *Size
of the diabetes patient registry in given year.
1.D.II.B.2, 1.D.II. B.3.,
1.D.II.B.4: Other clinical quality and outcome
data will be collected annually through the
Uniform Data System beginning in 2009. |
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
morbidity and mortality. Access to these services
can help to eliminate these health status disparities.
Healthy People 2000/2010 include the following national
targets for women generally, as tracked by data from
the National Health Interview Survey (NHIS):
1.
At least 85/90 percent have up-to-date PAP Tests.
2.
At least 60/70 percent have up-to-date mammograms.
The 2002 Health Center User Survey, comparable to
the 2000 National Health Interview Survey showed the
following results for Health Center women on mammograms
from the most vulnerable population subgroups that
traditionally experience access disparities.
Overall, Health Center women from the most vulnerable
groups reported being up-to-date on these examinations
in higher proportions than did low-income women in
the general population. Moreover, uninsured Health
Center patients are comparable to the nation’s patients
with insurance. These results demonstrate the Health
Center program contribution to reducing national disparities
in access to these services. Screening rates have
remained consistent or increased in Health Centers,
despite significant program growth and expansion.
- 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.
Discontinued Measure
|
Efficiency
Measures |
FY |
Target |
Result |
1.D.E.1. Sustain the average
cost per individual served at health centers*
(Approved by OMB) |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
$583 |
Aug-08 |
2006 |
$556 |
$538 |
2005 |
$529 |
$515 |
2004 |
$503 |
$504 |
2003 |
$465 |
$479 |
1.D.E.2. Annual number of
patients per medical provider. |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
3,475 |
Aug-08 |
2006 |
3,475 |
3,470 |
2005 |
3,475 |
3,510 |
2004 |
3,475 |
3,501 |
2003 |
3,475 |
3,521 |
Data Source: The
Uniform Data System (UDS) collects data on patients
and services provided. |
Data Validation:
UDS data are validated using over 1,000 edit
checks, both logical and specific. These include
checks for missing data and outliers and checks
against history and norms. |
Cross Reference:
No cross reference. |
Notes: *This measure
was deleted during the FY 07 PART reassessment
and has been replaced with a similar measure.
|
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
DISCONTINUED MEASURES
Long-Term Goal: By
2010, increase the national proportion of people
living with HIV receiving primary medical care
and treatment to 50 percent (includes all persons
who know and those who do not know their serostatus).
(Baseline - 2000: 33%) |
Discontinued
Measure |
FY |
Target |
Result |
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.
(Outcome) |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
NA |
NA |
2006 |
2% increase
over FY 04 or 594,068 |
Oct-08 |
2005 |
NA |
NA |
2004 |
582,420 |
531,000 |
2003 |
|
NA |
2002 |
|
571,000 (baseline) |
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.
Discontinued
Measure |
FY |
Target |
Result |
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.*
(Outcome) |
2008 |
NA |
NA |
2007 |
NA |
NA |
2006 |
131,808 |
132,627 |
2005 |
4%
over FY 04 or 93,530 |
131,808 |
2004 |
|
|
2003 |
|
|
Notes:
NA = Not applicable. This measure has been
replaced by a revised performance measure.
*The way the program collects
this data has changed. Previously the program
collected monthly data and currently quarterly
data is collected. The 2005 target is based
on the ADAP Monthly Report (AMR). But the 2005
result and 2006 - 2008 targets are based on
the ADAP Quarterly Report. The program no longer
expects to increase ADAP users by 4% per year
as originally targeted. Accordingly, wording
of this measure has been revised slightly. |
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.
HIV Care Grants to States (Part B)
Discontinued Measure
Discontinued
Measure |
FY |
Target |
Result |
18.D.III.A.1. Maintain the
number of ADAP clients served through State
ADAPs during at least one quarter of the year.
(Outcome) |
2009 |
NA |
NA |
2008 |
NA |
NA |
2007 |
NA |
NA |
2006 |
131,808 |
132,627 |
2005 |
91,314 |
131,808 clients |
2004 |
|
|
Notes:
NA = Not applicable.
The way the program collects this data has
changed. Previously the program collected monthly
data and currently quarterly data is collected.
The 2005 target is based on the ADAP Monthly
Report (AMR). But the 2005 result and 2006
- 2008 targets are based on the ADAP Quarterly
Report. |
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.
|