Detailed Information on the
Chronic Disease Prevention Assessment

Explicitly tie budget requests to the accomplishments of annual and long-term goals, and present resource needs in a complete and transparent manner.

Independent evaluations of sufficient scope and quality indicate that the program is effective and achieving results.

Measure: Age-adjusted annual rate of breast cancer mortality per 100,000 female population.

Explanation:Reflects Healthy People 2010 target; breast cancer mortality is declining steadily while incidence is increasing slightly. The decline in mortality is attributable in approximately equal parts to earlier detection through mammography screening and improved treatment. Consequently, continued increases in mammography should contribute to a continued decrease in mortality.

Measure: Percentage of women age 40+ who have had a mammogram within the previous two years.

Explanation:Annual (Breast): Based on annual rates of increase in the 1990's, a one-half percent per year increase is considered achievable. Given the recent leveling off in the increase in mammography use since the late 1990s, these projected increases would be challenging, but achievable.

Measure: Age adjusted rate of invasive cervical cancer per 100,000 women ages 20+ screened through the NBCCEDP (excludes invasive cervical cancers diagnosed on the initial program screen).

Explanation:The rate for NBCCEDP declined from 26 in FY 1995 to 15 in FY 2002, but rose to 17 in 2004. According to trend data from NCI's Surveillance, Epidemiology, and End Results Program (SEER) 1992-2002, the rate of invasive cervical cancer for all races combined was declining 2.8% per year; rates were significantly declining for white, black, Asian and Pacific Islander, American Indian/Alaska Native and Hispanic women.

Measure: Age-adjusted annual rate of trachea, bronchus, and lung cancer mortality per 100,000 population.

Explanation:Based on Healthy People 2010 objective and target.

Measure: Per capita cigarette consumption in the U.S. per adult age 18+.

Explanation:Represents at 3% annual change, based on prior trends.

Measure: Proportion of children aged 3 to 11 who are exposed to second-hand smoke* *Exposure to second-hand smoke is defined as serum cotinine concentrations of 0.05 ng/mL or greater.

Explanation:Targets are based on Healthy People 2010 target. Baseline is 2001 - 2002 because NHANES is a 2 year long survey. 2000 actual shown is from 1999-2000. 1994 actual shown is from 1988 - 1994.

Measure: Age-adjusted rate of incidence of End-Stage Renal Disease (ESRD) per 100,000 diabetic population.

Explanation:For decades ESRD incidence was increasing. Since the late 1990s, the rates have declined. One explanation is the addition of newly diagnosed to the denominator. As those with diabetes live longer the incidence of ESRD is likely to increase. The program aims to maintain the current 2002 baseline rate.

Measure: Age-adjusted percentage of persons with diabetes age 18+ who receive an A1C test at least two times per year.

Explanation:The program aims to increase the age-adjusted proportion of persons with diabetes who receive two or more A1C tests by 1 percentage point every year. Baseline is aggregate of 2003 - 2004.

Measure: Age-adjusted annual rate per 100,000 population of coronary heart-disease and stroke related deaths.

Explanation:Both long-term measures are HP 2010 goals in heart disease and stroke. Target measures are based on HP 2010 goals

Measure: Age-adjusted proportion of persons age 18+ with high blood pressure who have it controlled (<140/90).

Explanation:The target (68%) is the revised HP 2010 goal. In order to reach the target, high blood pressure control should increase by approximately 4.5 percentage points per year. Annual targets reflect that increase. 1994 data is for 1988- 1994. Baseline data is for 1999-2002. Targets are for 2 years (i.e. 2004 is 2003 - 2004) For annual targets, data is not available for two to four years after the period measured; eg., 2003-2004 data is available in 2007.

Measure: Age-adjusted proportion of persons age 20+ with high total blood cholesterol (>= 240mg/dL).

Explanation:Although the HP 2010 objective of 17% was reached during 1999-2002, the estimate is expected to increase with the emerging epidemic of obesity. The proposed annual target measures reflect maintenance at the current level of 17%. For targets, data is not available for two to four years after the period measured; eg., 2003-2004 data is available in 2007. Historical data for 1994 is for 1988-1994. Baseline data is for 1999 - 2002. Annual targets are for 2 years (i.e. 2004 target is for 2003 - 2004).

Measure: Age-adjusted percentage of adults age 18+ who engage in no leisure-time physical activity.

Explanation:There has been an absolute decline from 29 to 24% in the past 10 years. Rate of decrease is expected to lessen over the next 10 years, so absolute 3% decline. We never expect to get prevalence below ~15%.

Measure: Estimated average age-adjusted annual rate of increase in obesity rates among adults age 18+.

Explanation:There has been an absolute decline from 29 to 24% in the past 10 years. Rate of decrease is expected to lessen over the next 10 years, so absolute 3% decline. Baseline is for 2002-2004. Historical data is for 1994-1998 and 1998-2002.

Measure: Percentage of youth (grades 9 through 12) who were active for at least 60 minutes per day for at least five of the preceding seven days.

Explanation:Measure is based upon guidelines published in 2005, and therefore was not tracked before then. As more data becomes available, program will be able to develop ambitious targets. Data is close hold as survey results have not yet been released for public consumption.

Measure: Number of financial actions (such as project carryover funds requests from grantees and grantee project re-budgetings) that delay the implementation of grantee and partners' activities.

Explanation:Based upon recent implementation of a Project Officer training course, increased use of Management Information Systems to track these actions, and increased management emphasis on technical assistance, the necessity for these budget actions should decrease over time. Targets reflect a five percent decrease from baseline per year.

Is the program purpose clear?

Explanation: The mission of the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) is clear and unambiguous. The purpose of the program is to: 1) prevent the onset of chronic diseases; 2) identify early the presence of chronic diseases and associated complications and reduce progression of the basic chronic condition and/or associated complication; and 3) improve the care and management of those impacted by chronic diseases. The program provides national leadership in health promotion and disease prevention through 1) collection and analyses of essential information (surveillance and epidemiological studies) and prevention research; 2) development, implementation, dissemination and evaluation of public health interventions, e.g. guidelines, strategies, recommendations, state and local programs, etc.; and 3) capacity expansion within the larger public health system, e.g. state and local health agencies.

Evidence: The mission statement of the program is available on the program's website at http://www.cdc.gov/nccdphp/about.htm#3. The Federal Register notice announcing the establishment of the program includes a thorough discussion of the program purpose and responsibilities. Program documentation can also be found in the Catalog of Federal Domestic Assistance.

Does the program address a specific and existing problem, interest, or need?

Explanation: Chronic diseases such as heart disease, stroke, cancer, and diabetes are leading causes of disability and death in the United States. Although chronic diseases are among the most prevalent and costly health problems, they are also among the most preventable. Effective measures exist today to prevent or delay much of the chronic disease burden and curtail its devastating consequences. Health-damaging behaviors??in particular tobacco use, lack of physical activity, and poor nutrition??are major contributors to obesity, heart disease and cancer, our nation's leading disease burden. The promotion of healthy behavior choices through education and through community and societal policies and practices is essential to primary prevention and reducing the burden of chronic diseases.

Evidence: Every year, chronic diseases claim the lives of more than 1.7 million Americans. Chronic diseases are responsible for 7 of every 10 deaths in the United States. Chronic diseases cause major limitations in daily living for almost 1 of every 10 Americans, or about 25 million people. These diseases account for approximately 83% of the over $1 trillion spent on health care each year in the United States. Numerous reports detailing the burden of chronic disease have been completed by the program, by the Department of Health and Human Services, and outside organizations such as the Institute of Medicine.

Is the program designed so that it is not redundant or duplicative of any other Federal, state, local or private effort?

Explanation: The program focuses and delivers programmatic activities on the broad range of chronic diseases, risk factors, and especially to most vulnerable populations. NCCDPHP is the only organization that integrates public health science with public health programs as a dimension to its activities in chronic diseases. In addition, the program strategically addresses the nation's public health infrastructure, which goes beyond healthcare providers and includes public health professionals, educators, policy makers, healthcare professionals, etc. NCCDPHP partners with both public and private sector organizations that address these issues, but each organization has a focus that is more specific than the integrated structure of NCCDPHP. A number of private sector organizations focus on chronic diseases, but tend to focus on one particular disease or condition. CDC frequently collaborates with a number of private foundations that broadly approach the issues of disease, while NCCDPHP focuses its attention on chronic disease.

Evidence: NCCDPHP collaborates with other federal agencies to ensure that there is no redundancy or duplication of effort. In particular, National Institutes of Health (NIH), Agency for Healthcare Research and Quality (AHRQ), and Health Resources and Services Administration (HRSA) contribute towards many of the same health outcomes that the Center aims to improve, by focusing on clinical research, clinical partnerships, and health care delivery respectively. CDC provides the complementary public health dimension to these clinical activities. NCCDPHP's approach is to support state and local efforts to address chronic diseases and improve associated health outcomes. NCCDPHP achieves this through targeted funding to state and community programs across all program areas. Beyond funding these efforts, NCCDPHP nurtures partnerships with nonprofit organizations, businesses and foundations to leverage available funding. The program coordinates with a multitude of national non-governmental organizations, including the American Cancer Society, the American Heart Association, the American Diabetes Association, and the American Legacy Foundation.

Is the program design free of major flaws that would limit the program's effectiveness or efficiency?

Explanation: There is no evidence of major design flaws that limit the program's efficiency or effectiveness. As authorized by various pieces of legislation, the program's organizational structure and granting mechanisms address major program requirements. Competitive funding is the primary mechanism chosen to carry out the mission, and a "cooperative agreement" granting mechanism is most often used. This allows state and local programs to address the unique challenges and opportunities that face different communities across the country. NCCDPHP funded programs implement evidence-based public health programs that address the needs of populations nationally, as well as in segments of the population with particular chronic disease burdens.

Evidence: The programs use of cooperative agreements allow for effective and efficient use of resources. Cooperative agreements also allow the program to ensure that grantees are working to achieve program performance goals. Evidence includes examples of cooperative agreement documents with grantees. The program has also developed a document to help states and their partners can reduce the prevalence of chronic diseases and their risk factors by instituting comprehensive statewide programs. The recommendations for achieving this vision are based on prevention effectiveness research; program evaluations; and the expert opinions of national, state, and local leaders and public health practitioners. This document is available online at http://www.cdc.gov/nccdphp/publications/PromisingPractices.

Is the program design effectively targeted so that resources will address the program's purpose directly and will reach intended beneficiaries?

Explanation: To best target populations with greatest need and the priorities for chronic disease prevention and health promotion, the program has established and maintains key surveillance systems. These systems are used to evaluate the impact of programs to ensure that resources are being used to achieve the program purpose. Review with independent health professionals, organizations, and stakeholders assure that appropriate public health targets are identified and addressed. The program awards grants to all States, ensuring that the benefits reach widespread populations. 85 percent of the program's funding is disbursed as grants.

Evidence: The program utilizes advanced surveillance and tracking tools, all of which allow the programs to better focus interventions for the populations they are attempting to reach. The program has fifteen surveillance systems, with its four largest systems being the Behavior Risk Factor Surveillance System (BRFSS), Youth Risk Behavior Surveillance System (YRBS), National Cancer Registries, and Pregnancy Risk Assessment Monitoring System (PRAMS). Data from these tracking systems can be found at http://www.cdc.gov/nccdphp/tracking.htm.

Does the program have a limited number of specific long-term performance measures that focus on outcomes and meaningfully reflect the purpose of the program?

Explanation: The program has developed a challenging and ambitious set of long-term outcome measures. The long-term performance measures are based on the NCCDPHP vision, mission, and Performance Framework. The overarching strategic goals from the PART Performance Framework are: Disease Control (Improve health care practices to prevent and delay disability and premature death from chronic diseases), Health Promotion / Risk Factors (Increase healthy personal behaviors to prevent and delay the onset of chronic diseases), and Disparities (Reduce health disparities related to chronic disease).

Evidence: Evidence includes long-term outcome measures that will be included in the FY 2008 GPRA documents. Examples of these measures include reducing the age-adjusted annual breast cancer mortality rate, reducing the age-adjusted annual rate of trachea, bronchus, and lung cancer mortality, and reducing the age-adjusted percentage of adults age 18+ who engage in no leisure-time physical activity.

Does the program have ambitious targets and timeframes for its long-term measures?

Explanation: The program has challenging but realistic quantifiable targets and timeframes for the long-term outcome measures.

Evidence: Targets include a 19 percent decrease in the age-adjusted annual breast cancer mortality rate, a 20 percent decrease in the age-adjusted annual rate of trachea, bronchus, and lung cancer mortality, and a 12 percent decrease in the age-adjusted percentage of adults age 18+ who engage in no leisure-time physical activity.

Does the program have a limited number of specific annual performance measures that can demonstrate progress toward achieving the program's long-term goals?

Explanation: The program has established a limited number of annual performance that are intended to ensure accountability for the program as it works towards the achievement of the long-term outcome goals.

Evidence: The measures include annual performance improvements towards reaching several of the long-term outcome goals, with annual quantitative benchmarks. Included in these annual measures are increases in mammography rates, decreases in per capita cigarette consumption, and increasing physical activity rates among high school students.

Does the program have baselines and ambitious targets for its annual measures?

Explanation: The program has established base-lines and ambitious targets for each of its annual measures. These annual performance measures are linked to the programs long-term measures and also support the program's long-term goals.

Evidence: The targets include annual increase in mammography rates, decreases in per capita cigarette consumption, and increases in physical activity rates among high school students.

Do all partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) commit to and work toward the annual and/or long-term goals of the program?

Explanation: The program commits to having all its partners accept and adhere to both its annual and long-term goals. This commitment is manifested by requirements within RFAs for these measurements, data systems that require and allow information collection directed to the goals, technical and economic assistance to grant recipients to both establish and utilize data systems consistent with the goals, systems that allow careful review of program progress, and periodic site visits by Project Officers to assist recipients in achieving goals. All grantees and partners are committed to work toward goals for chronic disease. During the past year, the program developed new long-term and annual performance goals and measures. NCCDPHP is communicating the new goals, measures, and targets to its partners. Funded partners will be required to work toward achieving the new performance goals of the program.

Evidence: State-based grantees must have measurable program outcomes that are in alignment with one or more of NCCDPHP's performance goals. For example, Program Announcement 03022, Chronic Disease Prevention and Health Promotion Programs (which includes CDC's Tobacco Control Program) requires that measurable outcomes of the tobacco program be in alignment with the following performance goals for NCCDPHP: reduce cigarette smoking among youth; eliminate exposure to second hand smoke; promote cessation among adults and youth; and identify and eliminate tobacco-related disparities among specific population groups. All grant recipients are required to provide measures of effectiveness that demonstrate the accomplishment of the various identified purposes and objectives of the cooperative agreement. These measures of effectiveness are submitted with the application and reported throughout the period of the cooperative agreement by the use of NCCDPHP's MISs. Evidence also includes site visit reports to grantees evaluating progress made towards achievement of the program's goals, and recommendations for improvement were deficiencies are noted.

Are independent evaluations of sufficient scope and quality conducted on a regular basis or as needed to support program improvements and evaluate effectiveness and relevance to the problem, interest, or need?

Explanation: The program receives independent evaluations of sufficient scope and quality on a regular basis to support program improvements and evaluate effectiveness. The program follows OMB guidelines issued in January, 2002, governing the quality, objectivity, and utility of evaluations. This strengthens the program's credibility as a research-focused public health agency. In addition to achieving the 100 percent standard for independent external review of all extramural research in FY 2005 and 2006, the program is implementing this approach to review all intramural programs. Three divisions are conducting reviews in calendar year 2006. These reviews will encompass the scope of programs, including intramural and extramural research. In 2006, the program conducted a comprehensive review of the evidence base for its intervention programs. This review will be used to plan future investments in research and evaluation to increase the impact of NCCDPHP programs. Finally, within the next fiscal year, all Divisions within NCCDPHP will have undergone independent review of intramural programs.

Evidence: Evidence includes a wide range of evaluations conducted by the Government Accountability Office on chronic disease prevention activities. Additional independent reviews have been conducted on the VERB youth fitness campaign and the diabetes prevention and control program. Evidence also includes the schedule of planned reviews of intramural activities within the program.

Are Budget requests explicitly tied to accomplishment of the annual and long-term performance goals, and are the resource needs presented in a complete and transparent manner in the program's budget?

Explanation: The program has made progress in integrating performance and budget. However, the relationship between performance and budget levels is not clearly defined. The program does not quantify or estimate how changes in funding levels could impact performance levels.

Evidence: Evidence includes the GPRA plans and reports and annual Congressional Justification and budget documents provided to OMB.

Has the program taken meaningful steps to correct its strategic planning deficiencies?

Explanation: The agency is taking a comprehensive effort to integrate budget and performance agency-wide. Also, during the past year, the program has articulated a Center-wide performance plan, including long-term measures for assessing progress toward Center goals. Within NCCDPHP, several mechanisms exist to insure adherence to initial strategic planning for all Divisions and programs. Regular Divisional rounds with senior leadership; periodic scientific review; annual program review; use of surveillance systems; external review; etc. - are all mechanisms utilized by the program to improve program direction. In 2006, the program conducted a comprehensive review of the evidence base for its intervention programs. This review will be used to plan future investments in research and evaluation to increase the impact of NCCDPHP programs. Finally, within the next fiscal year, all Divisions of the program will have undergone independent review of intramural programs.

Evidence: Evidence includes the annual budget submissions to OMB and Congress. Evidence also includes new performance measures included in GPRA documents that were the result of the development of a Center-wide performance plan.

Does the agency regularly collect timely and credible performance information, including information from key program partners, and use it to manage the program and improve performance?

Explanation: The program regularly collects performance data from grantees and program partners. This data has allowed the program to establish baselines for the long-term and annual performance measures. The program uses the performance information collected to manage program activities to ensure that goals are achieved.

Evidence: The program collects performance data from several surveillance systems. The program also conducts site visits with grantees to ensure that grantees are working towards performance goals. Information collected by the program is used to guide annual working discussions with State program coordinators concerning program directions and accomplishments. The program has plans in place to make funding decisions for certain program activities based on grantee performance in achieving performance goals.

Are Federal managers and program partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) held accountable for cost, schedule and performance results?

Explanation: Federal managers and other employees' performance plans include elements related to achievement of specific health objectives that are linked to the health objectives funded through grants, cooperative agreements, contracts and Inter Agency Agreements. The health objectives that are funded through grants and contracts require specific reporting time frames related to achievement of the funded health objectives and deliverables via contracts. The grant interim and annual progress reports are directly linked to achievement of the funded health objectives. Awarded contracts required specific task delivery dates that are linked to cost in order to achieve the final contract deliverable. For those grantees that are having trouble achieving the funded health objectives, performance plans are developed that focus on specific activities and strategies to be implemented by specific dates to accomplish the health objectives. The performance plans include timelines for reporting progress, increases in Federal staff and grantee conference calls and site visits, and related cost.

Evidence: The evidence includes executive performance plans for key program leadership. Program announcements for grant funding clearly state that grantees will be accountable for achieving program performance goals. The use of cooperative agreements with States and grantees gives the program enhanced ability to ensure that grantees are working towards and achieving performance outcomes.

Are funds (Federal and partners') obligated in a timely manner, spent for the intended purpose and accurately reported?

Explanation: Funds are obligated in a timely manner and spent for the intended purposes. CDC's Financial Management Office (FMO) ensures that appropriated funds are properly obligated in a timely manner and that mechanisms are in place to ensure that funds are spent for the purpose for which they are intended. The creation of CDC goals action plans will lay out measurable objectives and specific activities that will result in progress toward achieving public health impact. Aligned to these efforts will be the execution spending plans. The spending plans provide CDC with a detailed sketch of CDC estimated resources needed for the fiscal year by quarter. Each plan is then used to control the incurrence of obligations and is subject to strict fund control procedures. Reviews indicate that the agency successfully prevents erroneous payments.

Evidence: Evidence includes standard operating procedures of the budget execution branch at CDC, which explains efforts to ensure that spending plans are executes properly and support agency goals. Spending plans developed at the program level also serve as evidence. The spending plans are used to certify and monitor the status of funds at the program and agency level. Status of funds reports display the funds allotted to the program, and list obligations, commitments, and unobligated balances. CDC uses this information to monitor obligation rates and potential variances. Risk assessments were completed to determine whether they were susceptible to improper payments exceeding $10 million and a 2.5 percent error rate and required to estimate improper payments under the Improper Payments Information Act of 2002 (IPIA) and the related OMB Guidance.

Does the program have procedures (e.g. competitive sourcing/cost comparisons, IT improvements, appropriate incentives) to measure and achieve efficiencies and cost effectiveness in program execution?

Explanation: The program has a new efficiency measure that aims to reduce delays in the program's internal grant processes that impede the disbursement of grant funds. CDC continues to examine agency operations to identify areas where efficiencies may be realized. In addition to competitive sourcing studies to meet the requirements of the President's Management Agenda, CDC has reviewed and reorganized its organizational and reporting structure. Further efforts to increase efficiencies include two restructuring initiatives, covering administrative and business service functions. Goals of restructuring these functions include alignment with and support of CDC's new organizational structure, as well as targeting greater efficiencies through process improvements and standardization across the agency. CDC has completed de-layering the agency to no more than four management layers.

Evidence: Evidence includes the program's new efficiency measure. Also, CDC has completed several competitive sourcing studies over the past three years, covering such services as Animal Care, Facilities Planning and Management, Library Services, Statistical Support, and Writer/Editor functions. CDC has won 13 of the 14 studies completed. Savings realized from competitive sourcing are reinvested in mission-direct public health activities. With the elimination of over 200 "sections", a 33% decrease in the official number of organizational units since 2001 has been achieved. Additionally, CDC's supervisory ratio has more than doubled from 1:5.5 in 2002 to over 1:12.6 in January 2006.

Does the program collaborate and coordinate effectively with related programs?

Explanation: The program collaborates extensively with related Federal, state, local, nonprofit, and private sector programs to achieve its objectives. Many of these collaborations are long-standing; others are relatively new and developed in response to emerging program needs and priorities. In addition to State and local departments of health and education, and their national associations (National Association of Chronic Disease Directors, Directors of Health Promotion and Education, the Association of State and Territorial Health Officials), the program has established Memorandums of Understanding with the key national voluntary health organizations for major chronic diseases, including the American Cancer Society, the American Diabetes Association, the American Heart Association, and the American Stroke Association, to enable close coordination and meaningful collaboration.

Evidence: Evidence includes program collaboration with Federal partners within HHS and the U.S. Department of Education. For over 10 years, the Division of Diabetes Translation has collaborated closely with its NIH counterpart (NIDDK) on research and public and provider education, through the National Diabetes Education Program. In these initiatives, funds are transferred bi-directionally, and several joint research announcements have been released and awarded, including several major clinical trials of diabetes prevention and control. In FY2005, the program was a co-sponsor and funder on a major NIH announcement for research on Obesity and the built environment (see http://grants.nih.gov/grants/guide/rfa-files/RFA-ES-04-003.html). Another example is HRSA, the Health Resources and Services Administration, which requires programs funded by its Maternal and Child Bureau to use and report data from NCCDPHP's Pregnancy Risk assessment and Monitoring Surveillance System (PRAMS). In FY2006, Substance Abuse and Mental Health Services Administration (SAMHSA) also is providing funds ($0.5 million) to support the development and implementation of a module on mental health in the Behavioral Risk Factor Surveillance System. Evidence also includes memorandums of understanding with outside organizations to achieve program goals.

Does the program use strong financial management practices?

Explanation: In April 2005, CDC implemented a new Unified Financial Management System (UFMS). UFMS is an integrated, Department-wide financial system that consistently produces relevant, reliable, and timely financial information to support decision-making and cost-effective business operations at all levels throughout the Department. UFMS replaced the legacy mainframe-based financial system, which was over 15 years old. UFMS provides the program with more real-time financial data, improved financial reports that allow managers to make timely decisions, and streamlined financial processes. UFMS will help the Department continue to achieve unqualified audit opinions. The HHS FY 2005 Performance and Accountability Report noted a material weakness related to the transition to UFMS, but full implementation will eliminate this material weakness.

Evidence: Evidence includes the HHS Performance and Accountability Report. The report stated that system implementations frequently create data conversion and other issues that can lead to difficulties in processing transactions appropriately and preparing accurate reports, and constitute a risk over the next several years. In the interim, substantial "work-arounds," cumbersome reconciliation and consolidation processes, and significant adjustments to reconcile subsidiary records to reported balances have been necessary under the existing systems. Specifically, the report stated UFMS could not produce financial statements, and therefore, CDC continued to use cumbersome processes to crosswalk the unadjusted trial balance to the financial statements increasing the risk of errors. UFMS implementation actively addresses the financial systems issue. CDC anticipates producing system-generated financial statements by the end of first quarter FY 2008 and reducing the manual processes and excessive efforts identified in the FY 2005 report. To date, CDC has implemented reviews, reconciliations, fluctuation analysis, and checks to ensure the accuracy and completeness of the financial statements. CDC has also streamlined the statement preparation outside the central financial system by using automated tools to expedite consolidating financial data.

Has the program taken meaningful steps to address its management deficiencies?

Explanation: The program does not have any major management deficiencies. However, the program continues to take steps to improve any management deficiencies that may remain.

Evidence: The program will continue to monitor the performance of the new financial management system and the impact the system has on resolving weak nesses. NCCDPHP works proactively with CDC's Management Analysis and Services Office (MASO) to implement and evaluate an Internal Controls Program (ICP) to ensure that the operational checks and balances, safeguards, policies, procedures, automated systems, organizational structures (i.e. delegations of authority, separation of duties), etc. used to reasonably assure that: (1) programs achieve their intended results; (2) resources are used consistent with the CDC mission; (3) programs and resources are protected from waste, fraud, abuse and mismanagement; (4) laws and regulations are followed; and (5) accurate, reliable, and timely information is obtained, maintained, reported and used for decision making. In additional to the Internal Controls Program, the program works closely with the Procurement and Grants Program to synchronize budget, goals management, and acquisition & assistance planning for improved business services management. Budget execution and analyses (Status of Funds reviews) are conducted throughout this fiscal year in collaboration with NCCDPHP, FMO and PGO. Each month, representatives from PGO, FMO, PSB and Divisions conduct monthly meetings to check the ongoing status of budget execution to ensure funds are being spent lawfully and as planned, and to make adjustments based upon new needs or problems that have been solved or need to be solved.

Are grants awarded based on a clear competitive process that includes a qualified assessment of merit?

Explanation: Funding Opportunity Announcements (FOA) are developed and reviewed prior to posting on Grants.gov in accordance with existing competitive policies and procedures. The FOA review and approval process encompasses a review of the eligibility and competition aspects of the FOA. The application review and selection processes are designed to identify and fund the applications of greatest merit. All awarded grants are in response to specific and exact RFAs, with specific instructions and guidance. Further, recipients must compete for funding with other applicants who are responding to the same RFA. All extramural research applications are evaluated on merit by independent external subject matter experts. Funding is awarded based on the ranking of applications, and all extramural research announcements are externally peer reviewed. In FY2006, no funds were earmarked for extramural research. The extramural research program conducts outreach to encourage participation by new grantees.

Evidence: The program adheres to the HHS Awarding Agency Grants Administration Manual (AAGAM) review procedures in the conduct of application evaluation and selection. Non-research and research applications are reviewed utilizing the objective and peer review processes respectively, that are described in the AAGAM Chapters 2.04.104C - 1 through 9. In addition, as of FY2006, all CDC research announcements are announced in the NIH Guide for Grants and Contracts, which is available online (at http://grants1.nih.gov/grants/guide/index.html) and in hard copy and consulted extensively by the broad extramural research community nationally and internationally. When a grant project period ends, the criteria for renewal and the renewal process are stated clearly in the funding opportunity announcement, and more than 95% of renewals are announced for competition, so that new applicants of merit will be able to compete fairly with previous grant recipients. In FY2004, through the Health Protection Research Initiative, the program was responsible for 25 investigator-initiated (R01) awards, many to investigators new to CDC and public health, but also 1 institutional research training grant (P30) and 6 mentored research scientist development awards (K01), specifically designed to prepare new investigators for careers in public health research for chronic disease prevention and health promotion.

Does the program have oversight practices that provide sufficient knowledge of grantee activities?

Explanation: The program has clear oversight of grantee activities. Monitoring and oversight of extramural research awards is conducted in accordance with HHS policies and procedures as specified in the AAGAM (Awarding Agency Grants Administration Manual), using the HHS-wide grants management information system, IMPAC II. In accordance with CDC policy on peer review of research, NCCDPHP achieved 100 percent external review of extramural research in FY2005. Award monitoring is the process whereby the programmatic and business management performance of a grant is monitored continuously. Monitoring also includes taking corrective action as needed. These functions are carried out by the Office of Extramural Research (OER), functioning independently of the Center Programs to avoid conflict of interest. In addition, OER provides scientific oversight to grantees. The initial funding opportunity announcement and Notice of Grant Award specify requirements for documentation of grantee progress. Grantees provide written evidence of project progress using the interim progress report once each year and an annual progress report at the end of each budget period. Grantees also submit a final report at the end of the project period.

Evidence: Evidence includes clear specification of program expectations in the RFA so that both the program and grant recipient know exactly what is expected. The program conducts periodic conference calls and at least annual conferences with recipient Principal Investigators and Program Directors to both review and discuss project directions. The program also conducts periodic site visits to grant recipients, and reviews interim and annual progress reports, and sample site visit reports were considered as evidence.

Does the program collect grantee performance data on an annual basis and make it available to the public in a transparent and meaningful manner?

Explanation: The program collects grantee performance data and makes this data available to the public. The collection of data is a critical function of the program to know both where programs need to direct efforts, as well as to evaluate the ultimate impact of these same public health programs. The program supports the collections of large amounts of data relevant to chronic diseases and public health. These data sets provide the source for most, if not all, the information for the nation on chronic diseases. Once validity is insured, this information is available to all the public for use in investigations, study, etc. In almost all written documents of NCCDPHP, as well as during oral presentations, data sites and sources are made transparent and the public is encouraged to utilize the information.

Evidence: Evidence includes the programs GPRA performance plans, which can be found online at (http://www.cdc.gov/od/perfplan/2004/2004perf.pdf.). Data on the program's surveillance tracking systems can also be found online at http://www.cdc.gov/nccdphp/tracking.htm.

Has the program demonstrated adequate progress in achieving its long-term performance goals?

Explanation: The program has been making progress in the areas measured by the NCCDPHP's long-term outcome goals. Since the new long-term targets were established this year, the program will need to continue to work diligently to make additional progress towards meeting these long-term outcome goals.

Evidence: Performance information indicates initial success toward achievement of long-term outcome goals. For example, breast cancer mortality rates decreased by an average of 3 percent annually in the years prior to the establishment of the new baseline for the long-term outcome goal. Recent historical data indicates that mortality rates from lung cancer were decreasingly steadily prior to the establishment of a baseline that will be used to measure progress on the long-term outcome goal.

Does the program (including program partners) achieve its annual performance goals?

Explanation: The program has been making progress in the areas measured by the NCCDPHP's annual performance goals that support the program's set of long-term outcome goals. The program will need to be aggressive to continue to achieve these annual goals in support of the achievement of the new set of long-term outcome goals.

Evidence: Performance information indicates some success in achieving annual performance goals that support the program's long-term outcome goals. For example, in the years prior to the establishment of the baseline for the long-term outcome goal on reductions in breast cancer mortality rates, the percent of women we received a mammography had increased by seven percentage points. Recent data also indicates a significant downward trend in annual per capita cigarette consumption rates.

Does the program demonstrate improved efficiencies or cost effectiveness in achieving program goals each year?

Explanation: The assessment of large extent reflects the adoption of a new efficiency measure and a wide range of efficiency enhancement at the agency in the past year. Examples of efficiency enhancements include: more than doubling CDC's supervisory ratio from 1:5.5 in 2002 to 1:12.6 in January 2006; completing several competitive sourcing studies from 2003 through 2005, with CDC winning 13 of 14 studies; consolidation of 13 IT infrastructure functions, services, staff and fiscal resources into the new Information Technology Services Office (ITSO), which reduced operating costs by 30% and staff by 29% and decreased costs from a baseline of $8,454 per user in 2003 to $6,157 per user for 2005; and, consolidation of multiple business services (budget execution, travel, graphics, and training).

Evidence: Evidence of these improved efficiencies can be found in the annual CDC Congressional Justification, in competitive sourcing studies, the Business Services Consolidation Plan, and the Business Consolidation Update.

Does the performance of this program compare favorably to other programs, including government, private, etc., with similar purpose and goals?

Explanation: There are no other programs at the Federal, state and local levels that cover the breadth of chronic disease prevention, in addition to health promotion.

Evidence:

Do independent evaluations of sufficient scope and quality indicate that the program is effective and achieving results?

Explanation: In general, evaluations of the program's activities indicate that the program is effective and achieving results. Evaluations of the VERB youth physical activity campaign, public health surveillance for behavioral risk factors, and the status of health care disparities generally validated the performance of the program, while some limitations were identified.

Evidence: An evaluation of the VERB program conducted by Westat found that the program surpassed expectations. The evaluation found reduced rated of sedentary children and increases in physical activity among those targeted by the campaign. An evaluation of public health surveillance for behavioral risk factors validated the importance of the surveillance system, but found some shortcomings in the collection of data. A Government Accountability Office review of Federal activities to reduce health disparities identified the programs REACH activities as a promising model for the reduction of health disparities.