MATERNAL
AND CHILD HEALTH
Programs
included in this section are:
MATERNAL
AND CHILD HEALTH CARE BLOCK GRANT -TITLE V
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
|
FY
2008 Target |
FY
2009 Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Expand the capacity of the health
care safety net |
10.
1 |
Decrease
the number of uninsured children
(Baseline - 2000: 8.4 M) |
|
|
|
|
|
|
|
8
M |
NAa |
NAa |
Long-Term
Objective: Promote outreach efforts to reach
populations most affected by health disparities |
10.
IV.
B.1 |
Decrease
the ratio of the black infant mortality
rate to the white infant mortality rate |
2.44
to 1 |
2.38
to 1 Prelim. datab |
2.2
to 1 |
8-Nov |
2.2
to 1 |
9-Nov |
|
2.2
to 1 |
2.1
to 1 |
|
Long-Term
Objective: Promote effectiveness of health
care services |
10
III.
A.1 |
Reduce
the infant mortality rate
(Baseline - 2000: 6.9/1,000) |
6.8
/1000 |
6.9
/1000 Prelim. datab |
6.8/1000 |
8-Nov |
6.8/1000 |
9-Nov |
6.8
/c1000 |
|
6.7
/1000 |
NAa |
10.
III.
A.2 |
Reduce
the incidence of low birth weight births |
8.10% |
8.20% |
7.40% |
8-Nov |
7.50% |
9-Nov |
7.40% |
|
7.30% |
|
10
III.
A. 3 |
Increase
percent of pregnant women who received prenatal
care in the first trimester |
83.90% |
83.9 |
84% |
8-Nov |
84% |
9-Nov |
85% |
|
86% |
|
10.
2 |
Reduce
neonatal deaths to 4.5 per 1,000 live births
(Baseline - 1999: 4.7/1,000 live births)
|
|
|
|
|
|
|
4.5
/1000 |
|
NAa |
NAa |
10
III.
A.
4 |
Increase
percent of low-birth weight babies who are
delivered at facilities for high-risk deliveries
and neonates |
73.30% |
67.70% |
77% |
68.10% |
76% |
8-Nov |
76% |
|
77% |
|
10.
3 |
Increase
maternal survival rate
(Baseline-1999:8.3 deaths/ 100,000 live
births |
|
|
|
|
|
|
8
/100,000 |
|
NAa |
NAa |
10
III.
A.
5 |
Reduce
maternal illness and complications due to
pregnancyd |
36.8
/1000 |
39.2
/1000 |
30.0
/1000d |
8-Nov |
30.0
/1000d |
9-Nov |
37.0
/1000d |
|
36.0
/1000d |
|
# |
Key
Outputs |
FY
2004 Actual |
FY
2005Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Expand the capacity of the health
care safety net |
10.I.A.1 |
Increase
the number of children served by Title V. |
26.8
M |
27.8
M |
22.5
M |
29M |
22
M |
Nov-08 |
28
M |
29
M |
|
10.
I.A.2 |
Increase
the number of children receiving Title V
services who are enrolled in and have Medicaid
and SCHIP coverage |
9.8
M |
10.1
M |
6.2
M |
11M |
9.8
M |
Nov-08 |
11
M |
11.5
M |
|
Efficiency
Measure |
10.E |
Increase
the number of children served by the Title
V Block Grant per $1 million in funding |
31,515 |
38,402 |
32,394 |
41,868 |
32,500 |
Nov-08 |
38,000 |
39,000 |
|
|
Appropriated
Amount($
Million) |
$729.8 |
$723.9 |
|
$692.5 |
|
$693.0 |
$666.2 |
$666.2 |
|
Notes:
a Long term measure with 2008 established
as out-year target date.
b Vital statistics compiled by the National
Center for Health Statistics, Centers for Disease
Control and Prevention (CDC) 2007. Deaths: Preliminary
Data for 2005, Health E-Stats, September 12, 2007.
c The target for FY 2008 was changed from
6.5/1000 to 6.8/1000 to reflect the complexity of
the infant mortality problem.
d Indicator: Hospitalizations per 1000
deliveries due to illness and complications resulting
from pregnancy. Actual data reported for FY 2004 and
2005 are based on the average rates for the two most
common illnesses in pregnancy (i.e., diabetes and
pregnancy-induced hypertension). The targets for FY
2006 and 2007 were developed based on earlier data
which included three conditions of pregnancy (i.e.,
diabetes, pregnancy-induced hypertension and anemia.)
These targets are not appropriate for the data as
it is currently collected. This difference in data
collection is due to changes in the revised 2003 Certificate
of Live Birth.
INTRODUCTION
Since
its inception, the Title V Maternal and Child Health
(MCH) Block Grant program has provided a foundation
for ensuring the health of the Nation's mothers,
infants, children, adolescents, including children
and adolescents with special health needs, and families.
The MCH Block Grant supports a wide variety of services
that address the Title V legislative requirements
and the strategic goals outlined by HHS, HRSA and
MCHB. Consistent with other HRSA programs, State Title
V programs use their appropriated MCH Block Grant
funds to address three overarching goals: 1) improving
access to health care; 2) eliminating health disparities;
and 3) improving the quality of health care. Progress
in meeting these goals is assessed through the examination
of the annual performance measure and indicator data
that is reported by States. While each measure addresses
a different aspect of health care delivery specific
to pregnant and breastfeeding women, infants, children
and adolescents, the measures collectively provide
a snapshot into the health, safety and well-being
of the Nation's MCH population. The Program
utilizes these findings to identify emerging public
health needs and critical issues relative to MCH.
A strategy used in efforts to improve performance
is to provide needed technical assistance to States
in areas identified in their needs assessment plans
and in their annual applications. Another strategy
is to identify and promote promising practices that
can be used by State MCH programs to improve MCH outcomes.
The program also supports States in their efforts
to do outreach to increase participation in Medicaid
and SCHIP.
DISCUSSION
OF RESULTS AND TARGETS
Long-Term
Objective: Expand the capacity of the health care
safety net.
10.1.
Decrease the number of uninsured children.
(Baseline - 2000: 8.4 million; Target -
2008: 8 million)
Long-Term
Objective: Promote outreach efforts to reach populations
most affected by health disparities.
10.IV.B.1
Decrease the ratio of the black infant mortality rate
to the white infant mortality rate.
While
there has been progress in reducing infant mortality
rates for both racial groups, the proportional discrepancy
between Blacks and Whites has remained largely unchanged.
Preliminary data indicate that the Black/White Infant
Mortality Ratio declined slightly in
FY 05 to 2.38 to 1. The target of 2.1 to 1 was not
met; however, there was progress in moving towards
the target. (See section on "Targets Substantially
Exceeded or Not Met.") Rates for FY
03 and FY 04 were essentially unchanged at 2.43 to
1 and 2.44 to 1, respectively. The target for FY 09
continues to be 2.1 to 1.
Long-Term
Objective: Promote effectiveness of health care services.
10.III.A.1.
Reduce the infant mortality rate.
All
countries of the world measure the infant mortality
rate as an indicator of general health status. The
U.S. has made progress in reducing this rate; however,
since 2002, the rate has been rising. Race/ethnicity,
maternal age, education, smoking, and number of pregnancies
are all factors that contribute to the infant mortality
rate.
The
overall infant mortality rate decreased slightly from
7.0 per 1,000 lives births in 2002 to 6.8 per 1,000
live births in 2004. Based on preliminary data, the
rate increased slightly in FY 05 to 6.9 per 1,000
live births. The 2004 performance for this goal slightly
exceeded the target of 6.9 per 1,000 live births;
for 2005, the target was tentatively met pending the
release of the final data. The FY 09 target for this
measure is 6.7/1,000.
10.III.A.2.
Reduce the incidence of low birth weight (LBW) births.
In
the past 15 years, the distribution of birth
weights in the U.S. has shifted towards lower
weights. The percentage of infants weighing
less than 3,500 grams at birth has risen. Birth
weight is an important predictor of early death
and long-term disability. The lower an infant's
Birth weight, the greater the risk for a poor
outcome.
The
LBW rate (less than 2,500 grams) increased from 7.8
percent in 2002 to 8.2 percent in 2005, which is the
highest level reported since 1969. The FY 05 program
target of 7.4% was not met. (See section on "Targets
Substantially Exceeded or Not Met.") The FY
09 target for this measure is 7.3%.
10.III.A.3. Increase percent of pregnant women
who received prenatal care in the first trimester.
Overall,
the proportion of pregnant women entering prenatal
care in the first trimester has increased over the
last decade (from 75.8% in 1990 to 83.9% in 2005).
The percent of pregnant women who received prenatal
care in the first trimester remained unchanged at
83.9% for
FY 04 and FY 05. While the FY 05 rate was slightly
below the FY 03 rate of 84.1%, the target of 84% was
essentially met. The FY 09 target for this measure
is 86%.
It
is important to note that prenatal care data based
on the 1989 and 2003 Standard Certificates of Live
Birth are not directly comparable, due to substantive
changes in information reported on the timing of prenatal
care in the 2003 Certificate. For 2005, data based
on the 1989 Certificate (unrevised) are available
for 37 States and data based on the 2003 Certificate
(revised) are available for 12 States. For consistency
purposes, the data presented through 2005 and the
established targets through 2009 reflect the data
that were reported by States using the unrevised Certificate.
Prenatal
care is one of the most important interventions for
ensuring the health of pregnant women and their newborn
babies. High quality prenatal care begins early in
the pregnancy (preferably in the first trimester),
and continues throughout the pregnancy, according
to accepted standards of periodicity. Accordingly,
getting pregnant women into early and regular prenatal
care has been a key area of emphasis for the Title
V program. The program is strongly committed to achieving
the Healthy People 2010 goal of getting 90% of all
pregnant women into prenatal care in the first trimester.
10.2. Reduce neonatal deaths to 4.5 per 1,000
live births.
(Baseline - 1999: 4.7/1,000 live births; Target
- 2008: 4.5/1,000 live births)
10.III.A.4.
Increase percent of low-birth weight (LBW) babies
who are delivered at facilities for high-risk deliveries
and neonates.
The
Title V program plays an important role in the delivery
of appropriate and effective care for high-risk pregnant
women and infants. Delivering LBW babies, who are
at higher risk for mortality and morbidity than non-LBW
babies, at facilities with specialized equipment and
personnel capable of the highest standard of care
for these babies, significantly assists in reducing
their associated mortality.
The
percent of LBW babies delivered at facilities for
high-risk deliveries and neonates declined from 76.1%
in FY 03 to 68.1% in FY 06. Compared to the FY 05
rate of 67.7%, there was slight improvement in the
percent of LBW infants delivered at facilities for
high-risk deliveries and neonates in FY 06. Despite
this improvement, the rate remains lower than the
baseline of 72.5% in 1997 and the FY 04 rate of 73.3%.
The FY 06 target of 77% was not met. (See section
below on "Targets Substantially Exceeded or
Not Met.") The target for FY 09 continues to
be 77%.
10.3. Increase maternal survival rate.
(Baseline - 1999: 8.3 deaths/100,000 live births;
Target - 2008: 8/100,000 live births)
10.III.A.5.
Reduce maternal illnesses and complications due to
pregnancy.
Medical
risk factors, such as diabetes and pregnancy-induced
hypertension, can contribute to serious complications
during pregnancy as well as maternal and infant morbidity
and mortality, particularly if they are not properly
identified and treated. The level of pregnancy-associated
hypertension for 2005 (39.9/1,000 births) is the highest
reported since these data became available. Diabetes
prevalence rose by more than two-thirds between 1990
and 2005 (from 21.3/1,000 births to 38.5/1,000 births.)
The
average rate for the two most common conditions in
pregnancy (i.e., diabetes and pregnancy-induced hypertension)
increased from 36.8 per 1,000 deliveries in FY 04
to 39.2 per 1,000 deliveries in FY 05. Due to changes
in the revised 2003 Certificate of Live Birth, previous
years' data are not comparable. Data reported
prior to FY 04 were based on the three most common
conditions in pregnancy (i.e., diabetes, pregnancy-induced
hypertension and anemia.) Given the change in how
data are reported for this measure, comparisons of
actual performance
in FY 05 with the established target of 30% are not
appropriate. The FY 09 target for this measure is
36 per 1,000 deliveries.
Long-Term
Objective: Expand the capacity of the health care
safety net.
10.I.A.1.
Increase the number of children served by Title V.
Services
for children supported under the Title V MCH Block
Grant program include: the provision of direct health
care, enabling services, population-based services,
and infrastructure building activities. Since FY 03,
the number of children served by Title V has been
increasing. Due to increases in screening services,
the number of children served by Title V increased
by
4 million between FY 03 and FY 04. The number of children
served by Title V varies within a State from year
to year. In FY 06, the largest number of children
(29 million) were served by Title V since data collection
began in the Title V Information System in the 1990's.
The number served exceeds the FY 06 target by 6.5
million. (See section below on "Targets Substantially
Exceeded or Not Met.") The FY 09 target for
this measure is that 29 million children will be served
by Title V.
10.I.A.2.
Increase the number of children receiving Title V
services who are enrolled in and have Medicaid and
SCHIP coverage.
The
number of children receiving Title V services covered
by Medicaid and SCHIP increased from a baseline of
5.9 million in FY 02 to 11 million in FY 06. The number
served exceeded the FY 06 target by 4.8 million. (See
section below on "Targets Substantially Exceeded
or Not Met.") Between FY 02 and FY 03, the number
of children served by Title V who received these services
increased by 3.8 million. The Title V program has
continued to served an increasing number of children
with Medicaid and SCHIP coverage since FY 04, with
annual increases ranging between 0.1 million between
FY 03 and FY 04 and 0.9 million between FY 05 and
FY 06. These increases reflect the efforts of State
MCH programs to provide outreach to populations eligible
for Medicaid and SCHIP coverage. The FY 09 target
for this measure is that 11.5 million children with
Medicaid and SCHIP coverage will be served by Title
V.
10.E.
Increase the number of children served by the Title
V Block Grant per $1 million in funding.
The
Title V Block Grant program provides States with Federal
funds for a wide variety of health projects to improve
the lives of all women and children. These funds are
spent by the States to support services for the maternal
and child health populations, including children with
special health care needs, at four levels -
direct services, enabling services, population-based
services, and infrastructure-building.
Per
$1 million in funding, the number of children receiving
direct, enabling and population-based services through
the Title V MCH Block Grant in FY 06 reached its highest
level at 41,868 since data reporting for this measure
began. This level of service exceeded the FY 06 target
of 32,394 by 29 percent. (See section below on "Targets
Substantially Exceeded or Not Met.") The FY
09 target for this measure is 39,000.
TARGETS SUBSTANTIALLY EXCEEDED OR NOT MET
Measure:
Decrease the ratio of the black infant mortality rate
to the white infant mortality rate.
FY 05 Target: 2.1 to 1
FY 05 Result: 2.38 to 1 (Preliminary data; Final data
are not available for FY 05.)
While the U.S. has made progress in reducing the overall
infant mortality rate, the significant disparity that
still exists seriously impacts selected racial groups.
The Black infant mortality rate is more than twice
the White rate. Research has suggested that a higher
rate of very low birth weight among Blacks may contribute
to, but does not fully explain, racial differences
in infant mortality rates. Additional research is
needed to identify factors that contribute to the
black/white infant mortality disparity and to examine
potential solutions.
The
Program continues to monitor the Black/White Infant
Mortality Ratio and to explore promising models and
effective strategies for addressing this issue. Despite
the slow rate of progress, the Program's targets
of 2.2 to 1 and 2.1 to 1 for FY 08 and FY 09, respectively,
reflect the Program's ongoing commitment for
continued improvement in this area.
Measure:
Reduce the incidence of low birth weight (LBW) births.
FY 05 Target: 7.4%
FY 05 Result: 8.2 % (Preliminary data; Final data
are not available for FY 05.)
The
increasing rate of LBW births is a recognized concern
across the Nation. The percentage of infants born
LBW has increased 17 percent since the mid-1990s and
22 percent since 1984. Recent increases are influenced
by the rise in the multiple birth rate, greater use
of obstetric interventions, and increases in maternal
age at childbearing. While multiple births are much
more likely to be born LBW than singletons, the LBW
rate for infants born in single deliveries has also
been on the increase. Singleton LBW rose from 6.3
to 6.4 percent for 2004-2005, and the rate has risen
7 percent since 2000. LBW levels also increased for
2004-2005 among each of the largest racial/ethnic
groups (non-Hispanic White births rose from 7.2% to
7.3%; non-Hispanic Black births rose from 13.7% to
14%; and Hispanic births rose from 6.8% to 6.9%).
The
Program continues to monitor the rate of LBW and its
causes. The full reasons for the increasing rate of
LBW births are unclear and are under investigation.
Despite recent increases, the Program remains committed
to improvement in this area. The Program's performance
targets for FY 08 and FY 09 are 7.4% and 7.3%, respectively.
Low
birth weight is associated with short-term morbidity
and mortality, as well as long-term disabilities,
such as cerebral palsy, autism, mental retardation,
vision and hearing impairments, and other developmental
disorders. The reduction of the incidence of low birth
weight babies would substantially reduce the risk
of, and therefore the number of, babies that die in
their first year of life, or suffer from long-term
disabilities.
Measure: Increase percent of low-birth weight
(LBW) babies who are delivered at facilities for high-risk
deliveries and neonates.
FY 06 Target: 77%
FY 06 Result: 68.1%
A
noted decline occurred in the percent of low birth
weight babies delivered at such facilities between
FY 04 and FY 05, with the rate dropping from 73.3%
in FY 04 to 67.7%. The full reasons for this decline
are unclear and are under investigation. The rate
slightly improved in
FY 06 to 68.1%.
To ensure that high-risk pregnant women have access
to appropriate levels of obstetric care, many States
have implemented perinatal regionalization strategies
and protocols for the transfer of high-risk women
to level III facilities. Evidence, however, indicates
that these systems may be eroding as health care networks
and financing systems change.
The
Program continues to monitor the percent of LBW babies
delivered at facilities for high-risk deliveries and
neonates. In addition, the Program's continuing
efforts to examine the reasons for the recent decline
will support the development and implementation of
effective strategies to address the problem. The proportion
of very low birth weight (VLBW) infants who are delivered
in the level III obstetric hospitals needs to continue
to be measured to monitor the continuing appropriateness
and effectiveness of the level of care delivered to
high-risk pregnant women and infants.
Much
research has demonstrated the benefits of delivering
high-risk infants in settings that have the technological
capacity to care for them. Specifically, research
has shown that VLBW infants have lower death rates
when they are delivered at level III hospitals, which
are equipped to care for very small infants. The Title
V program continues to play an important role in the
delivery of appropriate and effective care for high-risk
pregnant women and infants.
Measure:
Increase the number of children served by Title V.
FY 06 Target: 22.5 million
FY 06 Result: 29 million
The
number of children served by Title V is a critical
measure of the degree to which the program is successful
in reaching and providing services to one of its key
target populations.
From 1997 through 1999, the number of children served
by Title V increased steadily. In 2000, there was
a temporary slight decrease from 23.0 million to 22.8
million. Increases in screening services contributed
to a large increase in the number of children served
by Title V in FY 04. Given the variability in screening
services provided for children within the States from
year to year and the reductions in State MCH Block
Grant allocations since FY 04, participation data
for multiple years were collected to determine if
the increases in the number of children served by
Title V performance could be maintained.
The
Program continues to monitor the number of children
served by Title V. Targets for
FY 08 and 09 were adjusted to reflect the current
program participation levels for children in the Title
V program.
Measure: Increase the number of children receiving
Title V services who are enrolled in and have Medicaid
and SCHIP coverage.
FY 06 Target: 6.2 million
FY 06 Result: 11 million
Between
FY 02 and FY 03, the number of children receiving
Title V services who had Medicaid and SCHIP coverage
increased from 5.9 million children to 9.7 million.
The continuing increases in the number of children
served by Title V who have Medicaid and SCHIP coverage
since FY 03 reflect the ongoing efforts of the State
to do outreach to eligible populations and to increase
participation in these programs.
The
Program continues to monitor the number of children
served by Title V who have Medicaid and SCHIP coverage.
Targets for FY 08 and 09 were adjusted to 11 million
and 11.5 million, respectively, to reflect current
performance.
Increased
coverage under Medicaid and SCHIP for children receiving
Title V services assures greater access, availability
and continuity of care for the Nation's children
through the provision of a wide range of services.
Measure:
Increase the number of children served by the Title
V Block Grant per $1 million in funding.
FY 06 Target: 32,394
FY 06 Result: 41,868
The
number of children receiving services through the
Title V MCH Block Grant funding mechanism has increased
annually since FY 03. Per $1 million of funding, the
number of children who have received direct, enabling
and population-based services through the Title V
program has increased from 31,515 in 2004 to 41,868
in 2006. The FY 06 performance was impacted by an
increased number of children being served by the Title
V program. This increase has been largely due to a
greater number of screening services being provided
to school-aged children in the States. Performance
for this measure was further impacted by a reduction
in the Title V MCH Block Grant funding from FY 04.
The Program continues to monitor the number of children
served by Title V and to explore opportunities for
greater program efficiencies. Performance targets
for FY 08 and 09 were adjusted to 38,000 and 39,000,
respectively, to reflect program funding and the increasing
number of children that are being served by Title
V.
The
increase in the number of children served per $1 million
in Title V funding shows some level of improvement
in program efficiency in using Federal funds as well
as a shift toward more population-based services.
Programs have also had to rely more heavily on other
sources for program funding, including Medicaid and
SCHIP, and to increasing the level of payments made
by those receiving services.
TRAUMATIC BRAIN INJURY PROGRAM
# |
Key
Outputsa |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Increase collaborative efforts
to improve the capacity and efficiency
of the public health and health care system. |
11.
V.
B.1 |
Increase
the number of States and Territories that
have achieved a minimum TBI core capacity
(including State Action Plan, Statewide
Needs and Resources Assessment, designated
State agency staff, and State Advisory
Board). |
49 |
51 |
50 |
50 |
51b |
Nov-08 |
51 |
NA |
11.
V.
B.2 |
Increase
by 3 per year the number of States/Territories
that have begun to implement their TBI
plan of action.
(Baseline
- 2004) |
39 |
45 |
45 |
45 |
48
b |
Nov-08 |
51 |
NA |
11.
V.
B.3 |
Increase
by 6 per year the number of States/Territories
that have completed at least 50% of the
objectives contained in their TBI plan
of action.
(Baseline
- 2004) |
0 |
12 |
12 |
17 |
18
b |
Nov-08 |
24 |
NA |
Efficiency
Measure |
11.E |
Decrease
the application and reporting time burden
of grantees by 5% per year for 4 years,
thereby collecting more accurate and timely
data.
(Baseline
- 2004) |
180
hours |
171 |
162 |
162 |
154
b |
155 |
147 |
NA |
|
Appropriated
Amount
($
Million) |
$9.4 |
$9.3 |
|
$8.9 |
|
$8.9 |
$8.8 |
|
Notes:
a
A long-term health outcome measure has been proposed
and tentatively accepted by OMB.
b
The FY 07 target was changed from that shown in the
FY 08 Congressional Justification to reflect full-year
CR funding
for FY 07.
NA
= Not applicable because the program has no proposed
budget.
INTRODUCTION
The
Traumatic Brain Injury Program’s performance measures
link to HRSA’s Strategic Plan goal to improve public
health and health care systems, and to the related
objective to increase collaborative efforts to improve
the capacity and efficiency of these systems. Performance
data are used to inform the Program’s strategies to
provide guidance and technical assistance to grantees
in efforts to improve performance.
DISCUSSION
OF HEALTH CARE MEASURES
Long-Term
Objective: Increase collaborative efforts to improve
the capacity and efficiency of public health and health
care systems.
11.V.B.1.
Increase the number of States and Territories that
have achieved minimum TBI core capacity.
Coordinated,
community-based and culturally competent systems that
address the needs of individuals with TBI advance
the goal of access to high quality care that can improve
health outcomes. The number of States and Territories
that have achieved minimum core capacity to serve
individuals with TBI and their families is an indicator
of the extent to which the U.S. is able to provide
systematic, appropriate care for individuals with
TBI, including veterans with TBI who return home to
continue their post-acute care in the community.
In FY 06, the number of States with core capacity
was 50, meeting the target. This measure does not
have a FY 09 target because the program is not proposed
for funding.
11.V.B.2.
Increase by three the number of States and Territories
that have begun to implement their TBI plan of action.
As
states actually begin to put in place their Statewide
Action Plan (based on their Statewide Needs and Resources
Assessment) they are demonstrating their ability to
correctly assess and meet the needs of individuals
with TBI and their families. The number of States
increased from 39 in 2004 to 45 in 2005 and 2006,
meeting the target. This measure does not have a
FY 09 target because the program is not proposed for
funding.
11.V.B.3.
Increase by 6 per year the number of State/Territories
that have completed at least 50% of the objectives
in their TBI plan of action.
Moving
to completion of 50% of program (action plan) goals
indicates steady progress towards implementation of
a coordinated, community-based and culturally competent
system of care for individuals with TBI and their
families. The number of States that have completed
at least 50% of their objectives increased from 12
in FY 05 to 17 in FY 06. This measure does not have
a FY 09 target because the program is not proposed
for funding.
11.E.
Decrease the application and reporting time burden
of grantees by 5% per year for 4 years, thereby collecting
more accurate and timely data.
(Baseline
– 2004)
A
new on-line application and reporting system was implemented
in FY 05 and was fully operational in FY 06. This
system provides grantees with information from previous
years, including budget and service data. This alleviates
the grantees from having to supply information that
was previously provided. Also, the system pre-populates
figures into subsequent forms so that grantees do
not have to enter the same data more than once. Reporting
is also easier on the on-line system and provides
program management with performance data that are
far more reliable and valid, with a shorter lag time.
The number of hours of application and reporting time
burden of grantees decreased from 171 in 2005 to 162
in 2006, meeting the 5 percent target reduction; but
the time for reporting only decreased to 155 in 2007,
reflecting a slower than expected adjustment to on-line
processing. This measure does not have a FY 09 target
because the program is not proposed for funding.
Universal
Newborn Hearing Screening and Early Intervention
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Promote effectiveness of health
care services |
Increase
the percentage of children with non-syndromic
hearing loss entering school with developmentally
appropriate language skills
(Baselline-2004) |
20%
(Est.) |
|
|
|
|
|
|
|
2012:
85% |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective : Promote effectiveness of health
care services |
13.2 |
Increase
the percentage of infants with hearing loss
enrolled in early intervention before 6months
of age(Baseline-2004) |
57% |
|
|
|
|
|
|
|
2012:85% |
13.III.A.1 |
Percentage
of infants suspected of having a hearing
loss with a confirmed diagnosis by 3 months
of age |
50% |
55% |
60% |
Jul-08 |
62%a |
Jul-09 |
63%a |
NA |
|
13.
III.A.2 |
Percentage
of infants with a suspected or confirmed
hearing loss referred to an ongoing source
of comprehensive health care (i.e. medical
home) |
77% |
80% |
85% |
Jul-08 |
87%
a |
Jul-09 |
88%a |
NA |
|
13.III.A.3 |
Percentage
of infants screened for hearing loss prior
to hospital discharge |
93.2% |
95% |
96% |
Jul-08 |
97%
a |
Jul-09 |
98%a |
NA |
|
Efficiency
Measure |
13.E |
Increase
the percentage of infants suspected of having
hearing loss (based on the results of their
newborn hearing screen) who receive a confirmed
diagnosis by 3 months of age while maintaining
a constant Federal expenditure |
50% |
55% |
60% |
Jul-08 |
62% |
Jul-09 |
63%a |
NA |
|
|
Appropriated
Amount
($11.79 Million) |
$9.9 |
$9.8 |
|
$9.8 |
|
$9.8 |
$11.8 |
|
|
Notes:
a
The FY 07 target was changed from that shown
in the FY 08 Congressional Justification to reflect
full-year funding for FY 08.
NA
= Not applicable because no budget is proposed.
Introduction
The
performance measures of the Universal Newborn Hearing
Screening program link to the long-term objective
to promote effectiveness of health care services under
the overarching goal to improve the quality of health
care. Performance measure data is used by the program
for quality improvement. A current strategy to improve
performance is to shift program emphasis to reducing
the number of children who are lost to follow-up.
DIscussion
of results and Targets
13.1.
By 2012, increase to 85% the percentage of infants
with hearing loss enrolled in early intervention before
6 months of age.
(Baseline
- 2004: 57%)
13.2.
By 2012, increase the percentage of children with
non-syndromic hearing loss entering school with developmentally
appropriate language skills to 85%.
(Baseline
- 2004: 20%, est.)
13.III.A.1.
Percentage of infants suspected of having a hearing
loss with a confirmed diagnosis by 3 months of age.
While
major success has been achieved in screening infants
for hearing loss before hospital discharge, those
suspected of a hearing loss are receiving timely re-screening
and diagnostic services only about 55 percent of the
time, as reported for 2005. Many of the reasons,
such as health provider information about hearing
loss in infants, a dearth of audiologists capable
of caring for infants, and inadequate data and tracking
systems have been identified and mechanisms to address
these problems are being developed and implemented.
Trends in results for this performance measure include
an increase from 50 percent in 2004 to 55 percent
in 2005. This measure does not have a FY 09 target
because the program is not proposed for funding.
13.III.A.2.
Percentage of infants with a suspected or confirmed
hearing loss referred to an ongoing source of comprehensive
health care (i.e. medical home).
Limited
research on health outcomes for CSHCN indicates that
those children who are in a medical home fare better
than those receiving health care in settings where
there is no mechanism for care coordination. States
are encouraged to identify a medical home for each
infant suspected of a hearing loss, and to assist
the medical home in assuring appropriate and timely
follow-up for those infants and their families. A
variety of tools have been developed in conjunction
with the American Academy of Pediatrics (AAP) to support
the medical home in caring for infants with a suspected
(or confirmed) hearing loss and their families. Available
data for 2005 indicate that 80 percent of infants
with a suspected or confirmed hearing loss were referred
to an ongoing source of comprehensive care. This
was an increase from 77 percent in 2004. This measure
does not have a FY 09 target because the program is
not proposed for funding.
13.III.A.3.
Percentage of infants screened for hearing loss prior
to hospital discharge.
The
number of infants receiving a physiologic screening
test for hearing loss prior to discharge from the
newborn nursery has increased dramatically over the
past several years. In 2005, States reported that
95 percent of infants were screened. This was an
increase from 93.2 percent of infants screened in
2004. Despite this level of success there are additional
gains to be achieved by focusing on infants born at
home or in other out-of-hospital settings, transferred
infants who require neonatal intensive care, and births
in small hospitals where screener experience is
limited.
This measure does not have a FY 09 target because
the program is not proposed for funding.
13.E.
Increase the percentage of infants suspected of having
hearing loss (based on the results of their newborn
hearing screen) who receive a confirmed diagnosis
by 3 months of age while maintaining a constant Federal
expenditure.
Increasing
the percentage of infants who receive a confirmed
diagnosis by 3 months of age while maintaining a consistent
level of Federal funding, should that funding continue,
would indicate increased program efficiency. In 2005,
55 percent of infants screened received a confirmed
diagnosis by three months of age, as compared to 50
percent in 2004. This measure does not have a FY 09
target because the program is not proposed for funding.
EMERGENCY
MEDICAL SERVICES FOR CHILDREN
|
Key
Outputsa |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Increase collaborative efforts to
improve the capacity and efficiency of the public
health and health care system. |
14.
V.
B.1 |
Increase
the number of awardees that demonstrate the
operational capacity to provide pediatric emergency
care, including all core capacity elements related
to: (a) on-line and off-line medical direction
at the scene of an emergency for Basic Life
Support (BLS) and Advanced Life Support providers,
(b) essential pediatric equipment and supplies,
(c) designation of pediatric specialty care
hospitals, and inter-facility transfer agreements.
(Baseline
- 2005) |
NA |
20 |
25 |
20 |
28b |
July-08 |
21 |
NA |
14.
V.
B.2 |
Increase
the number of awardees that have adopted requirements
for pediatric emergency education for the re-certification
of paramedics.
(Baseline
- 2005) |
NA |
37 |
41 |
21 |
43b |
July-08 |
22 |
NA |
Efficiency
Measure |
14.E |
Decrease
the application and reporting time burden of
grantees by 5% per year for 4 years, thereby
collecting more accurate and timely data.
(Baseline
- 2004) |
84
hours |
90 |
171 |
125 |
90
b |
Dec-08 |
90 |
NA |
|
Awards
to States |
55 |
55 |
|
55 |
|
54 |
54 |
-- |
|
Awards
to Medical Schools |
23 |
23 |
|
23 |
|
22 |
20 |
-- |
|
Appropriated
Amount
($
Million) |
$19.9 |
$19.8 |
|
$19.8 |
|
$19.8 |
$19.5 |
|
Notes:
a
A long-term health outcome measure has been proposed
and tentatively accepted by OMB.
b
The FY 07 target was changed from that shown in the
FY 08 Congressional Justification to reflect full-year
CR funding for
FY 07.
NA
= Not applicable because the program has no proposed
budget.
INTRODUCTION
The
performance measures of the Emergency Medical Services
for Children (EMSC) Program are linked to HRSA’s Strategic
Plan objective of increasing collaborative efforts
to improve the capacity and efficiency of the public
health and health care system. These performance measures
are designed to assist State EMS programs to measure
progress toward achieving high quality services for
children’s emergencies. The measures help States
to focus their resources on pediatric program components
in greatest need. Tracking progress also helps the
Federal program implement its strategies to target
technical assistance and fiscal resources to States
needing help, and to identify successful State programs
which then are used as models to assist States that
need to improve.
DISCUSSION
OF RESULTS AND TARGETS
Long-Term
Objective: Increase collaborative efforts to improve
the capacity and efficiency of the public health and
health care system
14.V.B.1.
Increase the number of awardees that demonstrate the
operational capacity to provide pediatric emergency
care, including all core capacity elements related
to: (a) on-line and off-line medical direction at
the scene of an emergency for Basic Life Support (BLS)
and Advanced Life Support providers, (b) essential
pediatric equipment and supplies, (c) designation
of pediatric specialty care hospitals, and inter-facility
transfer agreements.
The
EMS System was originally designed to address the
needs of adults. The purpose of this program is to
increase awareness of the specific needs of children
in emergency situations, and increase EMS capacity
to address them. The number of States that demonstrate
the operational capacity to provide pediatric emergency
care provides a critical indicator of the degree to
which the appropriate care for children has been integrated
into the EMS system.
In
2006, 20 States were considered to have met the operational
capacity to provide pediatric emergency care, based
upon reports from individual States. This did not
meet the target. (See section below on “Targets Substantially
Exceeded or Not Met.”) Collection of the data is a
requirement of the State Partnership grant program.
This measure does not have a FY 09 target because
the program is not proposed for funding.
14.V.B.2.
Increase the number of awardees that have adopted
requirements for pediatric emergency education for
the re-certification of paramedics.
The
adoption of guidelines for pediatric emergency care
training/education for pre-hospital providers is an
integral component of the EMSC Program and helps to
ensure the provision of appropriate pediatric emergency
care across the continuum of care. In 2006, the number
of awardees that met this goal was 21, and is expected
to increase annually. This, however, did not meet
the 2006 target. (See section below on “Targets Substantially
Exceeded or Not Met.”) This measure does not have
a FY 09 target because the program is not proposed
for funding.
14.E.
Decrease the application and reporting time burden
of grantees by 5% per year for 4 years, thereby collecting
more accurate and timely data.
A
new on-line application and reporting system was implemented
in FY 05 and became fully implemented in FY 06 through
grants.gov and HRSA’s Electronic Handbook. This system
provides grantees with information from previous years,
including budget and service data. This alleviates
the grantees from having to supply information that
was previously provided. Also, the system pre-populates
figures into subsequent forms so that grantees do
not have to enter the same data more than once. Reporting
is also easier on the on-line system and provides
program management with performance data that are
far more reliable and valid, with a shorter lag time.
The
previous baseline estimate of 180 hours per application
in 2004 has been revised to 84 hours per application
based on more complete information from grantees.
In 2005 the application reporting time was 90 hours.
The time burden increased because some grantees were
learning to use the electronic process. The time
increased again in 2006, but the increase to 125 hours
was lower than the expected 171 hour increase. This
is most likely due to the grantees having an additional
year of experience in utilizing HRSA’s Electronic
Handbook. The program has adjusted future targets
to reflect performance in FY06. This measure does
not have a FY 09 target because the program is not
proposed for funding.
TARGETS
SUBSTANTIALLY EXCEEDED OR NOT MET
Measure:
Increase the number of awardees that demonstrate the
operational capacity to provide pediatric emergency
care.
FY
06 Target: 25
FY
06 Result: 20
The
fact that the target was not met is due to a change
in 2006 in the definition of what is required to meet
the performance standard. The current definition
and method of data collection are more rigorous than
when the baseline was established. As a result, many
States that reported meeting all components in 2005
did not meet the requirement for the 2006 reporting.
In areas such as "essential pediatric equipment
and supplies," for example, some States may be
missing only one piece of equipment, but these States
are now considered as not meeting the essential pediatric
equipment requirement. States must completely meet
all three categories of core elements in order to
be considered as demonstrating the operational capacity
to provide pediatric emergency care.
Measure:
Increase the number of awardees that have adopted
requirements for pediatric emergency education for
the re-certification of paramedics.
FY
06 Target: 41
FY
06 Result: 21
The
target was not met because the requirements for pediatric
emergency education for the re-certification of paramedics
were made more rigorous based on feedback from national
stakeholders to add the specification that the requirement
for recertification be state-mandated through statute,
rules, or regulations. This change resulted in fewer
states being able to meet the performance standard.
While the number of States meeting this performance
measure decreased from 37 to 21, the amount of pediatric
emergency education in the removed State did not diminish.
Rather, training in these States is not yet mandated
through statute, rules or regulation.
HEALTHY
START
# |
Key
Outcomes |
FY
2004
Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Expand the availability of health
care, particularly in underserved, vulnerable,
and special needs populations |
12.1 |
Reduce
the infant mortality rate (IMR) among Healthy
Start program clients.
(Baseline
– 2004) |
7.65/
1000 |
|
|
|
|
|
|
|
2013:
4.28/
1000 |
12.2 |
Reduce
the neonatal mortality rate among Healthy Start
program clients. |
4.3/
1000 |
|
|
|
|
|
|
|
2013:
2.70/
1000 |
12.
3 |
Reduce
the post-neonatal mortality rate among Healthy
Start program clients. |
2.82/
1000 |
|
|
|
|
|
|
|
2013:
1.58/
1000 |
Long-Term
Objective: Promote the effectiveness of health
care services |
12.
III.A.1 |
Increase
annually the percentage of women participating
in Healthy Start who have a prenatal care visit
in the first trimester. |
70% |
66% |
75% |
Oct-08 |
75% |
Oct-09 |
75% |
75% |
|
12.
III.
A.2 |
Decrease
annually the percentage of low birth weight
infants born to Healthy Start program participants. |
10.5% |
10.1% |
10.5% |
Oct-08 |
9.2% |
Oct-09 |
9.7% |
9.6% |
|
# |
Key
Outputs |
FY
2004
Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008
Target/
Est. |
FY
2009
Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Promote the effectiveness of
health care services |
12.
II.
B.1 |
Increase
annually the number of community members
(providers and consumers, residents) participating
in infant mortality awareness public health
information and education activities.
(Baseline – 2004) |
300,000 |
333,225 |
NA |
338,800 |
337,000 |
Oct-08 |
340,000 |
350,000 |
|
12.E |
Increase
the number of persons served by the Healthy
Start program with a (relatively) constant
level of funding.(Baseline
- 2002: 288,800 ($343/participant)) |
410,000
($238/
Partici-
pant) |
503,411
($196/
Partici-
pant) |
310,000
($327/
Participant) |
Oct-08 |
420,000
($242/
Partici-
pant) |
Oct-09 |
475,000
($228/
Partici-
pant) |
485,000
($194/
partici-
pant) |
|
|
Appropriated
Amount($
Million) |
$98.3 |
$102.5 |
|
$101.4 |
|
$101.5 |
$99.7 |
$99.7 |
|
INTRODUCTION
To
reduce the factors that contribute to the Nation’s
high infant mortality rate, particularly among African-American
and other disparate racial and ethnic groups, Healthy
Start (HS) provides intensive services tailored to
the needs of high risk pregnant women, infants and
mothers in geographically, racially, ethnically, and
linguistically diverse communities with exceptionally
high rates of infant mortality.
The
Healthy Start program’s capacity to achieve its ambitious
performance and outcome objectives is challenged by
the multiple risk factors faced by the families they
serve.
Each
of the Healthy Start projects is committed to reducing
disparities in perinatal health and infant mortality
by transforming their communities, strengthening community-based
systems to enhance perinatal care and improving the
health of the women and infants in their vulnerable
communities. The performance measures chosen reflect
access to care and major factors, at the individual
and community level, that must be overcome in order
to have positive perinatal outcomes.
The
Healthy Start program performance measures allow the
program to track progress toward achieving the HRSA
goals to improve health outcomes and expand the availability
and utilization of health care. Fluctuations that
occur in the measures alert program to potential problems
within the community and emerging national trends.
Strategies used by Healthy Start to improve performance
are to provide technical assistance, share best practices,
support peer mentoring, and strengthen collaborative
linkages with States and other partners both public
and private. The program has undertaken a learning
collaborative to enhance its projects’ ability to
unify the varied systems of care in their communities
and increase the capacity of local providers to incorporate
emerging evidence-based guidelines on preconceptional
and interconceptional care.
With
projects re-competing for funding every four years,
projects have adjusted their service areas from areas
that no longer need Healthy Start services because
they have been successful in order to incorporate
other neighborhoods where there is a significant need
for the program. Some variation in results occurs
when successful neighborhoods are phased out at the
end of a four year grant period and new high risk
neighborhoods are added.
DISCUSSION
OF RESULTS AND TARGETS
Long-Term
Objective: Expand the availability of health care,
particularly in underserved, vulnerable, and special
needs populations.
12.1.
By 2013, reduce the infant mortality rate (IMR) among
Healthy Start program clients to 4.28 per 1,000 live
births.
(Baseline
- 2004: 7.65 per 1,000 live births)
12.2.
By 2013, reduce the neonatal mortality rate among
Healthy Start program clients to 2.70 per 1,000 live
births.
(Baseline
- 2004: 4.83 per 1,000 live births)
12.3.
By 2013, reduce the post-neonatal mortality rate among
Healthy Start program clients to 1.58 per 1,000 live
births.
(Baseline
- 2004: 2.82 per 1,000 live births)
Long-Term
Objective: Promote the effectiveness of health care
services.
12.III.A.1.
Increase annually the percentage of women participating
in Healthy Start who have a prenatal care visit in
the first trimester.
Healthy
Start focuses intensive outreach efforts on enrolling
hard-to-reach, high-risk women in prenatal care.
The percentage of women participating in Healthy Start
who had a prenatal visit in the first trimester fell
from 70 percent in 2004 to 66 percent in 2005, which
was below the target. This reduction was expected
due to a major resurgence in barriers to early access
to prenatal care. (See section below on “Targets
Substantially Exceeded or Not Met.”) Because of the
commitment of the Healthy Start projects to reach
out to high risk women, the FY 09 target remains at
75%. (Note: Due to a significant difference in the
definition of when prenatal care begins, the Healthy
Start performance measure cannot be compared to HEDIS
national estimates of entry into prenatal care.)
12.III.A.2.
Decrease annually the percentage of low Birth
weight infants born to Healthy Start program
participants.
Healthy
Start is designed to reduce adverse perinatal
outcomes, such as low Birth weight (LBW) and
infant mortality, by helping communities identify,
plan and implement a diverse range of interventions
to support and improve perinatal delivery systems
in project communities. Low Birth weight is
associated with an increased risk of infant
death. The percentage of low Birth weight babies
born to Healthy Start clients in 2003 was 10.5%
and showed a reduction to 10.1% in 2005. During
the same period, the percentage of LBW births
increased nationally with the national LBW rate
for African-Americans actually increasing from
13.7% in 2004 to 14.0 in 2005. The FY 09 target
of 9.6% has been adjusted to reflect the national
trend.
12.II.B.1.
Increase annually the number of community members
(providers and consumers, residents) participating
in infant mortality awareness public health information
and education activities.
(Baseline
– 2004)
Each
of the Healthy Start projects has committed to reducing
disparities in perinatal health and infant mortality
by transforming their communities, strengthening community
based systems to enhance perinatal care and improving
the health of the young women and infant in their
vulnerable communities. This measure demonstrates
the participation of community members in infant mortality
awareness activities. In 2005 the number of community
members estimated to
participate
in public health information and education activities
increased to 333,225, up from 300,000 in 2004. The
target for FY 09 is 350,000.
12.E.
Increase the number of persons served by the Healthy
Start program with a (relatively) constant level of
funding.
(Baseline
– 2002: 288,800 ($343/participant))
The
program proposes to demonstrate its efficiency by
serving more persons each year with a (relatively)
constant level of funding. In 2005, the number of
persons served by the Healthy Start program was 503,411,
up from 288,800 in 2002 and exceeding the target.
The target for FY 09 is 485,000 because of expected
year-to-year fluctuations.
TARGETS
SUBSTANCIALLY EXCEEDED OR NOT MET
Measure:
Increase annually the percentage of women participating
in Healthy Start who have a prenatal care visit in
the first trimester.
FY
05 Target: 75%
FY
05 Result: 66%
Healthy
Start was not successful in meeting its target of
entry into prenatal care of 75% due to a resurgence
of barriers to access to care, such as changes in
financing of prenatal care at the State level, a shortage
of obstetric providers due to professional liability
litigation and malpractice coverage factors, and a
growing trend among obstetric providers to delay the
first prenatal health care visit until early in the
second trimester. Along with the resurgence of these
factors, the competitive cycle during that year involved
75% of the projects with many projects adjusting their
project areas to include new neighborhoods where there
was a significant need for the program and eliminating
neighborhoods where they were successful. Further,
Hurricanes Rita and Katrina affected projects such
as those in the Mississippi Delta, New Orleans, Florida
resulting in the displacement of families served by
the projects along with their providers.
Healthy
Start is working with individual projects on identifying
the challenges in their local communities as well
as sharing among projects successful strategies to
improve access. A learning collaborative will be
established to further assist projects in strengthening
their project. The program is also identifying and
synthesizing evidence-based practices that contribute
to improved perinatal outcomes that it will disseminate
to the HS communities.
FAMILY-TO-FAMILY
HEALTH INFORMATION CENTERS
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Promote access to, and appropriate
use of, health care information |
15.
III.
C.2 |
Proportion
of families with CSHCN who received services
from the Family-to-Family Health Information
Centers reporting that they were better able
to partner in decision making at any level
(Developmental) |
|
|
|
|
|
a |
TBD |
TBD |
|
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
15.
III.C.1 |
Number
of families with CSHCN who have been provided
information, education and/or training from
Family-to-Family Health Information Centers
(Developmental) |
|
|
|
|
|
a |
TBD |
TBD |
|
|
Appropriated
Amount
($
Million) |
|
|
|
|
|
$3.0 |
$4.0 |
$5.0 |
|
Note:
a
Data will be available for FY 07 in 2008. The FY
07 data will serve as the baseline for setting FY
08 and FY 09 targets.
INTRODUCTION
The
performance measures for the Family-to-Family Health
Information Centers will help the program track progress
in meeting the HRSA objective to promote access to
and appropriate use of health care information and
the Maternal and Child Health Bureau’s goal to provide
national leadership through a strategy of promoting
family leadership in MCH service delivery, evaluation
and program/policy development. Performance
measure information will be used as a continuous quality
improvement strategy, which is an evidence-based approach
to ensure high levels of customer satisfaction and
system efficiency. The Program will also use results
to identify and address technical assistance needs
and any changes that need to be made with respect
to data collection and analysis.
DIscussion
of results and Targets
15.III.C.1.
The number of families with CSHCN who have been provided
information, education and/or training from Family-to-Family
Health Information Centers. (Developmental)
This
developmental measure will capture annual progress
on the extent to which 30 Family-to-Family Health
Information Centers provide information, education
and training to families and the impact of center
services on the ability of families to partner with
providers and policy makers. Technical assistance
pertaining to data sources, strategies and use of
the Family Voices Solutions Database is being provided
on an ongoing basis. This technical assistance is
via monthly conference calls, and one-on-one assistance
with the National Center for Family Professional Partnerships
which provides support for this group of grantees.
Thirty centers are currently collecting data for FY
07 which will be available by June, 2008. This data
will establish a baseline from which FY 08 and FY
09 targets can be established. It is expected that
follow-up data from this group of grantees will available
beginning in 2009.
Three
types of information are captured in this measure:
1) information that is provided via direct one-on-one
contact around a family health or access issue in
person or by telephone to families with Children with
Special Health Care Needs (CSHCN); 2) educational
material that is provided to families, and 3) training
to families during conference sessions, workshops
and other activities.
15.III.C.2.
The proportion of families with CSHCN who received
services from the Family-to-Family Health Information
Centers reporting that they were better able to partner
in decision making at any level. (Developmental)
This
measure will capture partnering in decision making,
the enhanced ability of families to be better able
to document and discuss health issues, ask questions
and communicate with providers in making decisions
around their children's care and in their preparation
to be able to participate in systems building efforts
in communities and on a State level (task forces,
advisory committees, etc.). Outcomes, to be obtained
through follow-up telephone calls and surveys of a
sample of families served by the Centers, will be
tracked. A contractor is being used to: assist program
with a workgroup of selected grantees and the National
Center for Family Professional Partnerships, in assessing
grantee capacity to collect impact data; develop a
technical assistance plan based upon this assessment;
and develop strategies for grantees to collect this
data that will be consistent across all grantees.
On-going technical assistance is being provided. |