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Office of the Assistant Secretary |
Policy Information Center |
HEALTH RESOURCES AND SERVICES ADMINISTRATION
MISSION: To improve the Nation's health by assuring equitable access to comprehensive, quality health care for all.
Evaluation
Program
The purposes of
the Health Resources and Services Administration (HRSA) evaluation program are
to enhance strategic and performance planning and reporting, strengthen budget
and budget and legislative development, and improve program management. HRSA's
evaluation priorities are to (1) develop and support performance measurement,
(2) evaluate program effectiveness and impact, (3) assess program
implementation, and (4) conduct crosscutting policy analysis, such as
environmental assessments.
Performance measurement includes technical assistance and training to strengthen the agency's capacity to respond to the requirements of the Government Performance and Results Act (GPRA), and to lay a foundation for assessing program performance over time. In 1995, HRSA completed a study that established a performance measurement baseline for all operating programs, using a common framework to develop program-specific logic models. HRSA has invested substantial funding over the past four years to provide technical assistance tailored to the needs of individual agency programs. These efforts have been focused on (1) assisting with identification of indicators and measures and development or refinement of data systems; and (2) helping HRSA components to enhance their capacity to plan for, collect, analyze and use the performance information submitted by grantees for program management as well as for preparing GPRA-related documents. One result of this technical assistance was a partnership between the Maternal and Child Health Bureau (MCHB) and the States to develop a set of standard performance measures for the Maternal and Child Health Block Grant that are now being used by MCHB and the States in goal setting, performance reporting, and performance monitoring. Building on these program-specific efforts, work began in 1998 to link the HRSA strategic plan, annual performance plans, and budgets through a set of HRSA-wide performance strategies: eliminate barriers to care; eliminate health disparities; assure quality of care; and improve public health and health care systems. An ongoing project, Crosscutting HRSA-Wide Performance Strategy (PIC 7131), has supported this effort.
Program effectiveness studies assess intermediate and longer-term outcomes or impact of programs in relation to their intended goals. For example, the Impact of Community Health Workers on Access, Use of Services and Patient Knowledge and Behavior (PIC 6355) showed that use of community health workers in HRSA-funded programs led to increased access to care for patients, and to increased knowledge of nutrition and other topics to promote a healthy lifestyle. The ongoing study Effectiveness of the National Health Service Corps (PIC 6357) is assessing the program over time, using retention in primary care and related professions as one measure of effectiveness. The National Evaluation of the Healthy Start Program (PIC 5610), also ongoing, is a multi-year study with both outcome and process components. The final report will present findings on the impact of the program on infant mortality and birth outcomes in Healthy Start sites, compared with matched comparison communities. The final report of the process component, The Implementation of Healthy Start: Lessons for the Future (PIC 5610.1), is included among studies completed in FY 1998. Another ongoing project, Comparison of Services Received and Health Outcomes for Persons Funded by the CARE Act and by Other Sources (PIC 7123), compares demographic characteristics, services needed and provided, and health outcomes between persons receiving CARE Act-funded services and the general treatment population. Finally, the current study, Employment Sites of Nursing Graduates Supported by the Professional Nurse Traineeship Program (PIC 7130), is assessing the impact of a funding preference in the grants process on the achievement of the program objective of increasing access to care in underserved communities.
Environmental assessment concerns the ways in which forces in the larger society affect HRSA programs or progress toward achieving crosscutting goals and objectives. For example, the ongoing project Managed Care and Safety Net Providers (PIC 6815) is examining the impact of Medicaid managed care and other changes in health care coverage on the future viability of safety net providers operating in primary care settings, including grantees of HRSA-funded programs such as Community Health Centers. A completed study, Pacific Partnerships for Health: Charting a New Course for the 21st Century (PIC 7157), outlines health status and access issues for the populations of six island jurisdictions and recommends approaches for improvements. Findings from a current project, A Pilot Study to Identify Infrastructure Building Across HRSA Programs (PIC 6814), will improve HRSA's understanding of the interaction and effects of its programs in the context of health system changes and shifting population needs.
Program management studies provide information for developing and implementing a program.
The completed study, Data Collection and Budget Forecasting Strategies: A Primer for State AIDS Drug Assistance Programs (PIC 7159), produced a primer that will enable the State-administered AIDS Drug Assistance Programs to estimate their expenditures more accurately and, consequently, administer the federal funds more efficiently. The Strategies for the Recruitment, Retention, and Graduation of Hispanics into the Baccalaureate Level of Nursing (PIC 6249) developed a model that can be used by institutions of higher education seeking to increase the proportion of Hispanic Americans admitted to baccalaureate programs as their initial entry into nursing education.
In addition, HRSA supports activities to
enhance the quality of evaluation agencywide, such as by funding short courses
in evaluation for staff, encouraging presentation of HRSA studies at national
conferences, and expanding the capacity of agency staff to provide skilled
technical assistance on the framing, design and implementation of studies.
Broadening of dissemination of study products through a variety of electronic
and other approaches also will continue to be a priority for 1999 and
2000.
Summary of Fiscal Year 1998 Evaluations
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TITLE: ACSC Experience by Usual Source of Health Care: Comparing Medicaid Beneficiaries Who Rely on CHCs with Medicaid Beneficiaries Who Rely on Other Primary Care Providers
ABSTRACT: The purpose of this study was to explore the extent to which Medicaid beneficiaries who rely on Community Health Centers (CHCs) as their main source of primary care are likely to experience hospitalization for ambulatory care sensitive conditions (ACSCs), as compared with beneficiaries who rely on other providers. Medicaid claims data for 1992 from five States were used to provide data on inpatient services, outpatient visits, clinical information and demographics. ACSCs were coded for hospitalization and a list of ICD-9 codes was developed for outpatient ACSC visits. The study sample comprised 16,145 CHC users and 32,594 other Medicaid beneficiaries from the same community as a comparison group. The study found that Medicaid CHC users experienced ACSC hospitalization rates 22 percent lower than those of the comparison group. Medicaid CHC users were 16 percent more likely to have outpatient visits for ACSCs and had lower emergency room use. Finally, outpatient visits were found to be reasonably good markers and performance measures for identifying populations potentially at risk for ACSCs. HRSA is using the study results as a source for a performance measure concerning hospitalization rates for ACSCs. The results have also served as the basis for a current study focused on episodes of care. (See PIC ID 7127)
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Barbara Wells, Ph.D.
PHONE NUMBER: 301-594-4463
PIC ID: 6001
PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD
TITLE: Evaluation of the Impact of the Medicaid Waivers on Consumers and Services of Federally Qualified Health Centers
ABSTRACT: This study assessed the early impacts of Medicaid managed care waivers on federally qualified health centers (FQHCs) as Medicaid providers, and on their consumers. FQHCs have often been primary providers of services to Medicaid recipients in their community and have derived between 30 to 40 percent of their revenues from Medicaid. Therefore, the shift of States to managed care systems for Medicaid beneficiaries can have a significant impact on FQHCs. The study focused on the impact of the first year of Medicaid waiver program implementation on two FQHCs in five States. Site visits were conducted at 10 centers. In addition, data from health plans, primary care associations and State Medicaid programs contributed to the analysis. An exit interview was conducted at some centers, in order to gain consumer perspectives. The study showed that: (1) FQHCs experienced widely varying amounts of change in their population of Medicaid users, from a decrease of 22.7 percent to an increase of 58 percent; (2) managed care placed a new and increased emphasis on the importance of primary care and primary care providers; (3) access to care for FQHC patients, especially adults, improved in many cases; (4) demands on FQHCs by Medicaid enrollees strained the capacity of some FQHCs, resulting in fewer services available to uninsured patients while, in other centers, expanding capacity increased access to services; (5) the financial impact is complex, and is the result of a variety of interacting factors; (6) FQHCs experience a number of administrative and management challenges, such as increasing paperwork demands and complex billing procedures; and (7) consumers were generally satisfied with FQHC services despite changes resulting from managed care. Study results are being used as a source for identifying factors that will affect health centers in future waiver programs, and to inform HRSA program policy and technical assistance.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Julia Tillman
PHONE NUMBER: 301-594-4062
PIC ID: 5738
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Medicaid Managed Care and FQHCs: Experiences of Plans, Networks and Individual Health Centers
ABSTRACT: The purpose of this study was to examine and compare different managed care participation strategies among 36 federally qualified health centers (FQHCs) in eight markets, focusing on how FQHCs are responding to Medicaid managed care, their reasons for forming plans and/or networks, and factors contributing to their success in plans and networks and under different participation strategies. The study focused on three strategies: (1) being part of an FQHC-owned or sponsored health plan, (2) being a member of an FQHC network, and (3) being an individual contractor with non-FQHC plans. Findings are based mainly on site visits to four FQHC-sponsored plans, eight FQHC networks, and 24 individual health centers. Market-level information from secondary sources and program data were also used. The study found that: (1) nearly all of the centers in the study had experienced a decline in users, revenues, and/or net income under managed care since 1993, with more centers experiencing losses during 1996 than in the earlier time periods; (2) most centers reported having experienced an increase in the volume and proportion of uninsured users; (3) many centers (but less than half) have improved their facilities and operations, but several have had to make cuts in hours and services. In addition, FQHCs have responded to managed care by choosing to participate in FQHC plans and networks, strengthening their ties with local hospital systems, and expanding their involvement in Medicare and managed care contracts. The manner in which FQHCs chose to participate in managed care did not, in itself, appear to make a difference in effects on the center. During the study period, however, many FQHC plans and networks were just becoming operational. Study results are helping to shape policies for participation of centers in managed care, and for the Health Resources and Services Administration's (HRSA's) technical assistance strategies concerning managed care.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Julia Tillman
PHONE NUMBER: 301-594-4062
PIC ID: 6353
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc.
Washington, D.C.
TITLE: The Performance of C/MHCs Under Managed Care: Case Studies of Seven C/MHCs and Their Lessons Learned
ABSTRACT: This study examined how Community and Migrant Health Centers (C/MHCs) have performed as managed care providers, how participation in managed care has affected C/MHC operations, and how C/MHCs could be assisted in improving their performance in a managed care environment. It is critical that C/MHCs be successful participants in the managed care market in order to be financially viable sources of care for the uninsured and other vulnerable populations. Visits were made to one site in each of seven States. On-site and telephone interviews with key personnel at managed care organizations (MCOs) that had contracted with the C/MHCs formed the basis of the performance assessment of these centers. On-site interviews with key C/MHC staff were used to develop an organizational assessment, which concerned the effect of managed care on C/MHC decision-making, strategic planning, administrative and financial management practices, demands for information and data collection systems, and clinical operations. Based on data provided by managed care organizations (MCOs) for each C/MHC and the regional network of providers, average C/MHC costs were consistently lower for referrals and pharmacy services, and C/MHCs experienced lower or comparable total hospital and non-maternity admissions. Centers reported higher maternity admissions and maternity days. MCO staff emphasized the centers' strategic importance in the network because of geographic location, reputation in the community, experience with Medicaid beneficiaries, and focus on primary care and prevention. Weaknesses cited for some centers included physician turnover, insufficient extended hours and inadequate 24-hour coverage. Findings are being used in discussions with managed care associations and networks, and to inform program policy and technical assistance.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Julia Tillman
PHONE NUMBER: 301-594-4062
PIC ID: 6354
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Impact of Community Health Workers on Access, Use of Services and Patient Knowledge and Behavior
ABSTRACT: In recent years, the Health Resources and Services Administration's (HRSA's) primary care programs have increased their use of community health workers (CHWs) to augment and complement the care patients receive from medical and social service staff members, as well as to help link the community with the providers. Community health workers provide informal community-based health-related services, establishing vital links between community-based health providers and persons in the community. The main purposes of this study were to provide information on the use of CHWs in HRSA-funded primary care projects , and to determine the effects of using CHWs on patients' access to, and proper use of, services, and on patient knowledge and behavior. An annotated bibliography of studies of CHWs was prepared, and documents on 60 HRSA-funded projects utilizing CHWs were reviewed. Fourteen projects were profiled and seven were site visited. During the visits, focus groups were held with clients. The study found that CHWs were effective in helping clients find needed services and in providing services that were previously unavailable or limited. CHWs assisted patients with the proper use of services such as immunizations and breast cancer screening, and provided education programs to increase patient knowledge about a variety of topics such as hygiene, substance abuse, nutrition and domestic violence. CHWs were actively involved in case finding and case management in most programs. In some locations, CHWs provided services (e.g., adult day care) that had been unavailable in the community. Study results have been widely distributed and are being used to inform policy on use of CHWs in HRSA-funded programs.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Remy Aronoff
PHONE NUMBER: 301-443-7577
PIC ID: 6355
PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.
TITLE: Pacific Partnerships for Health: Charting a New Course for the 21st Century
ABSTRACT: The U.S.-Associated Pacific Basin consists of six island jurisdictions. Three of these--American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), and Guam--are considered U.S. flag territories. The other three--Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), and Republic of Palau--are independent countries, but are freely associated with the United States. The total population of all these jurisdictions is 454,118. Although the health system and health status measures vary within and among the islands, almost all health indicators for islanders are worse than those for mainland Americans. The purposes of this study were to examine these issues and suggest possible approaches to improve the situation. The study concluded that four approaches should be used simultaneously to improve health: (1) adopt and support a viable system of community-based primary care and preventive services; (2) improve coordination within and between the jurisdictions and the U.S.; (3) increase community involvement and investment in health care; and (4) promote education and training of the health care workforce. The first two of these were given the highest priority. The Health Resources and Services Administration (HRSA) convened the Pacific Basin Health Summit in March 1998 to discuss the agency's role in improving health care in the region. Subsequently, HRSA has implemented several study recommendations including: (1) creation of an intra-agency to improve jurisdictional coordination; (2) use of military hospitals in Guam for care coordination; (3) provision of continuing provider education in epidemiology, substance abuse, mental health, and HIV prevention and treatment; and (4) expansion of community involvement in planning federally-supported projects. Activities stemming from the report and the summit continue with HRSA participation.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Thomas Coughlin
PHONE NUMBER: 301-594-4425
PIC ID: 7157
PERFORMER ORGANIZATION: Institute of Medicine, Washington, D.C.
TITLE: Assessing Ambulatory Primary Care Training: Costs, Methods and Quality
ABSTRACT: The purpose of this study was to create a meaningful data set to estimate the cost of primary care medical education, including training costs for nurse practitioners and physician assistants, in the ambulatory care setting. Although well-developed educational and financial infrastructures support hospital-based education of the health professions, a similar infrastructure for ambulatory care training is nascent. This study addressed whether teaching ambulatory sites have higher costs than non-teaching sites, and whether the productivity of clinicians engaged in ambulatory teaching differs from that of clinicians who are not teaching. An advisory panel of leading investigators and teaching clinicians helped to guide a literature review of the costs of ambulatory training and related data collection analysis. Site-level cost and operations information was obtained from HRSA and external sources. In addition, a survey of 98 ambulatory teaching sites was conducted. The study found that operating costs of teaching ambulatory care sites are about 36 percent higher than costs of similar non-teaching sites. Of this cost differential, about 65 percent is due to costs that are attributable to education, while 35 percent stems from educational infrastructure costs. Like their hospital counterparts, teaching ambulatory care sites tend to be larger and more organizationally complex than non-teaching sites, offering more specialty care and seeing more patients. Educational experiences were diverse, including clinical training, core clerkships, lectures and seminars, and community service projects. Ambulatory care educators identified the following as conditions needed to assure quality in ambulatory training: a strong and interested faculty, a clinically diverse patient base, and the integration of training into day-to-day operations. This study has led to a preliminary project to determine a method for assessing the value added to ambulatory care settings by educational activities.
AGENCY SPONSOR: Bureau of Health Professions
FEDERAL CONTACT: Emily De Coster
PHONE NUMBER: 301-443-6920
PIC ID: 6358
PERFORMER ORGANIZATION: Northeastern Ohio Universities,
Rootstown, OH
TITLE: Consortium Development for Health Professions Training in Community-Based Settings
ABSTRACT: The development of academic/community consortia for education and training in the health professions can increase opportunities for students and trainees, enhance the relevancy of training experiences, and benefit both the consortium's academic and community-based participants. This project focused on consortia that train a variety of health professionals in an interdisciplinary manner in community-based settings. The goals of the project were to: (1) identify consortia, (2) determine what types of community-based and academic organizations make up these consortia, (3) determine the extent to which health professions education and training carried out by these consortia are done in an interdisciplinary manner, and (4) identify some of the challenges that face these consortia. This study identified consortia that not only educate and train disciplines other than, or in addition to, physicians, but that also include community-based providers and organizations as partners. The study found that academic-community consortia for health professions education vary considerably in their missions, types of participating organizations, governance structure, educational approaches, and professional disciplines of the trainees. Commonalities among the consortia included shared goals for both education and service delivery, use of a legally binding agreement to finalize commitment from partners, significant funding from Federal, State and private sources, and encouragement of trainees to practice in underserved areas. In addition, several factors that might impede the success of a consortia were identified. Findings are being used to guide program planning to encourage interdisciplinary training. Findings will also be used in providing technical assistance to applicants or grantees regarding important factors to consider in developing consortia.
AGENCY SPONSOR: Bureau of Health Professions
FEDERAL CONTACT: Jennifer Burks
PHONE NUMBER: 301-443-6865
PIC ID: 6251
PERFORMER ORGANIZATION: The George Washington University,
Washington, D.C.
TITLE: Strategies for the Recruitment, Retention, and Graduation of Hispanics into the Baccalaureate Level of Nursing
ABSTRACT: The Healthy People 2000 objectives for the Nation specify an increase in the proportion of all degrees in the health professions and allied and associated health professional fields awarded to minorities, from the 1985-1986 baseline of three percent to 6.4 percent by the year 2000. Recent data suggest that fewer than two percent of the 2.5 million Americans with current licenses to practice as registered nurses in March of 1996 were of Hispanic background, and Hispanics are seriously underrepresented in baccalaureate nursing programs. Only very slight gains in the admission of Hispanic students into nursing schools have been made since 1972, when the National League for Nursing first began collecting ethnic classification data. The admission rate for Hispanic nursing baccalaureate students has almost consistently remained below three percent. Based on a literature review and in-depth interviews with administrators, faculty and students at eight schools of nursing, this study has developed a model that can be used as a conceptual framework by Institutions of Higher Education (IHEs) seeking to increase the proportion of Hispanic Americans admitted to baccalaureate programs as their initial entry into nursing education. The model explicates promising strategies for the recruitment of Hispanics into baccalaureate nursing programs, retaining them after they are recruited, and assuring their graduation from those programs. It also suggests implementation issues that may arise when these strategies are put into practice.
AGENCY SPONSOR: Bureau of Health Professions
FEDERAL CONTACT: Ernell Spratley
PHONE NUMBER: 301-443-1915
PIC ID: 6249
PERFORMER ORGANIZATION: CDM Group, Inc. Chevy Chase, MD
TITLE: A Review and Synthesis of HIV/AIDS-Related Client Level Evaluation Activities Among Ryan White CARE Act Grantees
ABSTRACT: The purpose of this study was to gather information about whether and how Ryan White Comprehensive AIDS Resources Emergency (CARE) Act grantees were evaluating client satisfaction, and how the grantees were improving delivery systems in response to client needs and concerns. The development of new, clinically effective therapies that present challenges in their use has intensified the need for the re-design of HIV services and the increased involvement of people living with HIV/AIDS in managing their own health. A mail survey about assessment of client satisfaction was mailed to 480 grantees in September, 1997. Subsequently, site visits were made to six grantees. An advisory board including representatives of a wide spectrum of HIV/AIDS organizations helped guide the design of the survey and developed criteria for selecting the sites for the six case studies. The study found that grantees assessed client satisfaction most commonly through self-administered surveys, but some conducted group sessions or focus groups. Grantees using the latter methods reported making changes in their delivery systems more frequently than those using surveys. Ninety-three grantees reported making a wide range of changes in response to clients, including involvement of clients in policy and information development, and provision of sensitivity training for clinical and non-clinical staff. The Health Resources and Services Administration (HRSA) is using the findings in its technical assistance concerning client satisfaction and access to care. The National Association of People with AIDS (NAPWA) is using the results in a privately funded project to demonstrate the benefits of consumer involvement in the design and implementation of services.
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: Moses B. Pounds, Ph.D.
PHONE NUMBER: 301-443-2894
PIC ID: 6362
PERFORMER ORGANIZATION: National Association of People with AIDS,
Washington, D.C.
TITLE: Data Collection and Budget Forecasting Strategies: A Primer for State AIDS Drug Assistance Programs
ABSTRACT: State-administered AIDS Drug Assistance Programs (ADAPs), funded by the Health Resources and Services Administration (HRSA) under Title II of the Ryan White CARE Act, along with other State and private sector resources, have been thrust to the forefront of the public debate over the cost-efficient provision of public health care services to individuals in this country. Over the last two years, ADAPs in most States have experienced significant growth, both in the number of clients served and in monthly expenditures on pharmaceuticals. This rapid growth has strained the limited resources of these programs and has resulted in many ADAPs being forced to limit access to life-sustaining HIV/AIDS medications by capping overall program enrollment, capping or limiting access to expensive new drug therapies, or developing more restrictive financial and medical program eligibility criteria. The rapidly changing fiscal and treatment environments in which ADAPs now operate have raised many challenges for the State-level or State-contracted administrators of these programs. Good data and good data collection systems are necessary to develop accurate budget projections and to aid in program planning. The purposes of this study were to provide directors of ADAPs with information necessary to assess their current data collection program and to provide practical tools to assist in developing an appropriate budget forecasting model. This study developed a primer on basic data collection and forecasting strategies. The primer addresses the fundamental program need for data to estimate expected monthly expenditures and the cost impact of adding a specific new drug to the ADAP formulary. The products of this study will enable ADAPs to assume greater accountability by streamlining data management strategies and enhancing forecasting capacity.
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: Annette Byrne
PHONE NUMBER: 301-443-6745
PIC ID: 7159
PERFORMER ORGANIZATION: National Alliance of State and
Territorial AIDS Directors, Washington, D.C.
TITLE: Evaluating HIV Case Management: Invited Research & Evaluation Papers
ABSTRACT: The purpose of this study is to report on the papers and recommendations of a conference on approaches for evaluating the effectiveness of HIV case management. Case management for HIV services is eligible for funding under the Ryan White Comprehensive AIDS Resources Emergency Act Amendments of 1996 (CARE Act). The expansion of case management has not been accompanied by consistent standards for service delivery, validation of its aims and purposes, comparative analysis of its multiple forms, or systematic investigation of its various service configurations and outcomes. There is evidence that HIV case management is a highly needed service that leads to problem resolution, and that clients who receive case management have high levels of satisfaction with their case manager. However, health services research data about the effectiveness of HIV case management are generally lacking. For this project, a group of health services researchers, case managers, and Federal representatives met to discuss the evaluation and study of the effectiveness of HIV case management. Ten papers were commissioned for presentation at the meeting that, together with a summary introduction, constitute this final report.
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: Gloria Weissman
PHONE NUMBER: 301-443-3478
PIC ID: 7158
PERFORMER ORGANIZATION: Sociomedical Resources Associates, Inc. Westport, CT
TITLE: The Implementation of Healthy Start: Lessons for the Future
ABSTRACT: The Healthy Start program was begun in 1991 to demonstrate innovative ways to reduce infant mortality by 50 percent over five years (later changed to 6 years) in areas with some of the highest rates. The National Evaluation of the program includes a cross-site process component and an outcome study of the initial 15 sites. The report summarized here is the final product from the process component. This report features an analysis of the factors that facilitated or impeded implementation in 14 of the 15 original projects. (A separate report will be issued on the Northern Plains project.) Qualitative data from site visits and focus groups of clients and providers were used in conjunction with a client data set and interviews with postpartum women. The study found that program elements include: (1) community involvement through a consortium and other community empowerment strategies; (2) outreach and case management, generally using lay workers for many functions; (3) nontraditional support services, such as transportation and nutrition education; (4) enhanced clinical services, building on an existing delivery system; and (5) community-wide public information campaigns. Clients and providers gave positive feedback about Healthy Start services. This process study found that local communities can, with substantial Federal funding, develop and implement innovative approaches to reducing infant mortality. The extent to which projects were able to manage effectively--that is, to develop and execute sound administrative procedures, recruit and retain a strong staff (especially senior staff) and monitor contractors--made the difference between successful and less-than-successful implementation. The final report of the National Evaluation, due in March 2000, will discuss the issue of whether these projects have led to a measurable reduction in infant mortality. (See PIC ID 5610)
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.
PHONE NUMBER: 301-443-3070
PIC ID: 5610.1
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, DC
State Children's Health Insurance Program
TITLE: Sampling the States: Local Reflections on State Implementation of State Children's Health Insurance
ABSTRACT: The State Children's Health Insurance Program (SCHIP) was signed into law as Title XXI of the Social Security Act as part of the Balanced Budget Act of 1997. Title XXI provides $24 billion for child health over five years and $50 billion over 10 years in block grants to the States. This study was funded to obtain a grassroots perspective from local advocates, providers, and public health leaders on the impact SCHIP may have on children's health. A formative discussion, using qualitative research methods, was conducted with almost 40 individuals in 10 States which represent more than half of all uninsured children in the Nation. Perspectives were obtained on: (1) State plans for outreach and enrollment; (2) benefits package and design; (3) target populations; (4) the role of local coalitions and the respondent's role; (5) emerging service delivery system issues; (6) the role of safety net providers and linkages among providers; (7) quality of care/quality standards; and (8) thoughts on the program's promise, local concerns and vision. The study found that major system capacity issues, especially for dental and mental health care, were not being addressed aggressively by the States. Care for rural and migrant populations, enrollment of immigrant populations, services for adolescents, and benefit coverage and system redesigns to serve children with special needs or who are chronically ill also will require more attention. In addition, the study found that innovation in the enhancement of service delivery may require greater technical and financial support from the Federal Government, such as through issuance of Federal guidelines that offer increased flexibility and waiver options.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.
PHONE NUMBER: 301-443-3070
PIC ID: 7068
PERFORMER ORGANIZATION: Coalition for Healthier Cities and Communities, Health Research and Educational Trust, Chicago, IL
TITLE: Are Consortia/Collaboratives Effective in Changing Health Status and Health Systems? A Critical Review of the Literature
ABSTRACT: The purposes of this study were to: (1) review the evidence of consortium effectiveness; (2) identify factors and developmental stages associated with effective consortia; (3) discuss challenges in, and tools available for, measuring consortium performance; and (4) assess the potential implications for Health Resources and Services Administration (HRSA) programs. The study found few examples of consortia or coalitions that can claim to have effected change in health status or health systems, and that conditions such as strong leadership, excellent planning, community commitment and well-defined goals are needed. However, collaborative efforts may have such valuable byproducts as: (1) expansion of the ability of individuals and organizations to work together, (2) increased levels of trust, and (3) enhanced responsiveness of the organizations to community needs. The study indicated a need for further research to determine how collaborative efforts achieve long-term outcomes, given the requirements for consortia and other collaborative efforts in many Federal programs.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Jessica Townsend
PHONE NUMBER: 301-443-0371
PIC ID: 7062
PERFORMER ORGANIZATION: Health 2000, Inc., Atlanta, GA
Evaluations in Progress
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TITLE: Analysis of CHC User/Visit Survey: Selected Conditions
ABSTRACT: This study is analyzing portions of the User/Visit Study (See PIC ID 5737) data in order to describe the process of care and outcome measures for Community Health Center (CHC) users with selected health conditions, in relation to their insurance status. The data on CHC users and visits are nationally representative and were gathered so as to be comparable to national estimates maintained by the National Center for Health Statistics (NCHS) through two periodic surveys: The National Health Interview Survey, and the National Ambulatory Medical Care Survey. Data collection was completed in 1995. In the current project, CHC users with diabetes and hypertension are being compared to users who do not have these conditions, and to the general population. Quality of care rendered by the CHC is also being assessed. A third analysis concerns care of CHC users who are uninsured. The Health Resources and Services Administration (HRSA) will use the findings in shaping program policy. An article based on each analysis will be submitted to a peer reviewed journal to facilitate broad dissemination of the results.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Jerrilynn Regan
PHONE NUMBER: 301-594-4283
PIC ID: 6805
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, DC
PROJECTED DATE OF COMPLETION: 2/4/99
Community Health Centers and National Health Service Corps
TITLE: Construction and Pretest of the Year 2000 User/Visit Survey
ABSTRACT: In 1997, the Health Resources and Services Administration (HRSA) completed a study (PIC ID 5737) to obtain nationally representative data about the users of Community Health Centers (CHCs) and the services provided to them. This study permitted a comparison of the CHC estimates with estimates derived from the National Health Interview Survey and the National Ambulatory Medical Care Survey administered by the National Center for Health Statistics (NCHS). The current study is developing the sampling frame and revising and pilot testing questionnaires in preparation for a second User/Visit Survey in the year 2000. The year 2000 survey will be the first in which information will be collected on National Health Service Corps (NHSC) users and visits. The HRSA's intent is to conduct this survey every few years to evaluate change over time within the CHC and NHSC programs, and in comparison with the general U.S. population as reflected in the NCHS estimates. Findings from the year 2000 survey itself will be used to measure program performance as required by the Government Performance and Results Act (GPRA).
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Jerrilynn Regan
PHONE NUMBER: 301-594-4280
PIC ID: 7128
PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC
PROJECTED DATE OF COMPLETION: 9/30/99
TITLE: Effect of Medicaid Managed Care Beneficiary Enrollment and Autoassignment Practices on FQHCs and Their Patients
ABSTRACT: Under most Medicaid managed care programs, beneficiaries who do not select a plan are automatically assigned to one. This study is describing the impact of enrollment and autoenrollment (automatic assignment) policies and practices under mandatory Medicaid managed care on federally qualified health centers (FQHCs), FQHC networks and plans, and their patients. Autoenrollment practices are of interest to the Health Resources and Services Administration (HRSA) because of their possible implications for cultural and linguistic competence of providers, and for existing patient/provider relationships. This study is reviewing autoenrollment rates experienced across the U.S. in Medicaid waiver programs, and is examining Medicaid service areas where FQHCs have experienced high levels of patient dislocation due to State autoassignment and enrollment policies. Potential uses of the findings are: (1) to improve the accuracy and helpfulness of information on plans and providers given to beneficiaries, so that they will be better able to choose a plan; (2) develop strategies for improving the enrollment process; (3) identify common interests among the States, managed care plans, FQHCs and beneficiaries; and (4) generate collaborative problem solving between public and private policymakers.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Dana Jones
PHONE NUMBER: 301-594-4058
PIC ID: 6803
PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.
PROJECTED DATE OF COMPLETION: 3/31/99
TITLE: Evaluation of the Effectiveness and Impact of Community and Migrant Health Centers: Implementation Phase
ABSTRACT: This comprehensive evaluation of the effectiveness and impact of Community Health Centers (CHCs), begun in 1994, has two components. The content of care component will assess CHC clinical performance and suggest indicators of targets of opportunity for improving patient health status. The Medicaid analysis portion of the study is using Medicaid claims data from seven States (one with Medicaid managed care) to examine three questions: (1) Is there a difference in case mix between Medicaid beneficiaries using CHCs and beneficiaries using other providers of primary care? (2) Are there differences in utilization and expenditures between CHC users and non-users, and what is the effect of adjusting for case mix on these differences? (3) How do CHC characteristics contribute to differences in use and expenditures among CHC users? The findings from this study will identify opportunities and challenges for health centers in both fee-for-service and managed care settings. (See PIC ID 4918)
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Elizabeth Darling
PHONE NUMBER: 301-594-4308
PIC ID: 4918.1
PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD
PROJECTED DATE OF COMPLETION: 8/31/99
TITLE: Evaluation of the Relationship Between Enabling Services and Patient Access and Outcomes
ABSTRACT: Community and Migrant Health Centers (C/MHCs) provide extensive enabling services to facilitate access to care for vulnerable populations. These services, which include transportation, translation, case management, health education, nutrition counseling and outreach, are not typically reimbursed under managed care. The purpose of this study is to analyze the types and levels of enabling services provided by C/MHCs, how these services have changed over time, and whether enabling services improve outcomes and reduce costs. Study findings will be used to inform national program expectations and to guide C/MHCs in structuring their enabling services to maximize access to primary care and preventive services.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Vilma Cokkinides, Ph.D.
PHONE NUMBER: 301-594-3730
PIC ID: 7126
PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD
PROJECTED DATE OF COMPLETION: 12/15/99
TITLE: Health Status Outcomes for the Bureau of Primary Health Care: A Pilot Study Assessing Physiologic Measures Through Medical Record Review
ABSTRACT: Through a review of medical records, this study will assess changes in health status among a sample of adult patients of Community Health Centers (CHCs). The conditions selected for evaluation are hypertension and diabetes mellitus. The methodology addresses: (1) the definition of a CHC "user"; (2) confirmation of a diagnosis; (3) patient stratification by severity and/or onset of the condition; (4) expected attrition rates; (5) inclusion of insurance/payer status as a control variable; (6) the time frame in which the two conditions will be measured; (7) protocol for sampling medical records; (8) development of an index of co-morbidities; (9) preparation of a taxonomy of CHC site characteristics; and (10) the appropriate instrument for extracting pertinent data. This project continues the HRSA's systematic effort to identify health status outcomes that may be used to measure the effectiveness of primary care programs.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Barbara Wells, Ph.D.
PHONE NUMBER: 301-594-4463
PIC ID: 6802
PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA
PROJECTED DATE OF COMPLETION: 10/31/99
TITLE: Health Status Outcome Measures for the Bureau of Primary Health Care: Examination of Episodes of Care for Diabetes, Hypertension, Asthma and Other Ambulatory Care Sensitive Conditions Using State Medicaid Research Files
ABSTRACT: A consensus conference in December, 1995 recommended the use of Medicaid data to examine changes in utilization patterns for Community Health Center (CHC) patients diagnosed with ambulatory care sensitive conditions (ACSC). These are conditions which frequently can be managed with timely and effective treatment in outpatient settings, thus preventing the need for hospitalization. The purpose of this study is to compare episodes of ambulatory care for CHC users to those of non-CHC users when both have been hospitalized with a primary diagnosis of diabetes, hypertension, asthma, or other ACSC, as well as when neither has been hospitalized. A previous study (See PIC ID 6001) showed that Medicaid beneficiaries who received most of their care from CHCs had a lower hospitalization rate for ACSCs than did non-CHC users. Findings of the current study will improve understanding as to why CHC users experience lower hospitalization rates for ACSCs, and may have different patterns of ambulatory care use. Findings should also identify the major strengths and limitations of the State Medicaid Research Files for examining episodes of care for a comparison of CHC users and non-CHC users.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Barbara Wells, Ph.D.
PHONE NUMBER: 301-594-4463
PIC ID: 7127
PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD
PROJECTED DATE OF COMPLETION: 6/30/00
TITLE: Design for Evaluation of the NY Medicare Graduate Medical Education Payment Demonstration and Related Provisions in P.L. 105-33. BBA of 1997
ABSTRACT: The purpose of this study, which is jointly sponsored by the Health Resources and Services Administration (HRSA) and the Health Care Financing Administration (HCFA) and managed by HCFA, is to develop: (1) a design for evaluating a demonstration financed by the HCFA in 1997 in selected New York State teaching hospitals, and (2) recommendations for evaluating Phase II of the demonstration, along with related provisions of the Balanced Budget Act (BBA). The 42 hospitals in the current demonstration volunteered to reduce the number of resident physicians in training by 20 percent or more over a five-year period, while maintaining or increasing the proportion in their primary care program. In return, the HCFA provides transition payments of $400 million over six years. The hospitals repay the payments if they fail to meet their reduction targets. The BBA provides similar options for hospitals in other States and modifies the transitional payment policies by eliminating payment for the first five percent reduction in the full-time equivalent residents. Evaluation objectives include: (1) performance in meeting targets for reductions, (2) impact on access and efficiency, and (3) potential spillover effects on non-participating hospitals.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Jessica Townsend
PHONE NUMBER: 301-443-0371
PIC ID: 7132
PERFORMER ORGANIZATION: Health Economics Research, Inc. Waltham, MA
PROJECTED DATE OF COMPLETION: 6/1/99
TITLE: Employment Sites of Nursing Graduates Supported by the Professional Nurse Traineeship Program
ABSTRACT: Professional Nurse Traineeship (PNT) grants are awarded to eligible institutions for the support of students in advanced nursing education. Traineeships are then awarded by the institutions to individuals enrolled in masters and doctoral programs to prepare for practice as advanced practice nurses. These funds are distributed to institutions based on a formula that incorporates three statutory funding factors. The factor to be studied is the statutory general funding preference which is given to institutions that demonstrate either (1) a high rate of placing graduates in medically underserved communities (MUCs), or (2) a significant increase in the rate of placing graduates in such settings. Comparisons of employment sites of graduates in school receiving the preference with those of graduates in schools not receiving the preference will indicate the significance of a funding preference in promoting program objectives of increasing access to care in underserved communities. The data collected through this study will help to formulate programmatic and policy recommendations designed to strengthen and increase the effectiveness of the PNT program.
AGENCY SPONSOR: Bureau of Health Professions
FEDERAL CONTACT: Ayah E. Johnson, Ph.D.
PHONE NUMBER: 301-443-6315
PIC ID: 7130
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, DC
PROJECTED DATE OF COMPLETION: 4/28/00
TITLE: Effectiveness of Diverse Methods of Technical Assistance to Historically Black Colleges and Universities
ABSTRACT: The participation of Historically Black Colleges and Universities (HBCUs) in program activities is vital to the mission of the Health Resources and Services Administration (HRSA), given the traditional focus of HBCUs on providing outreach to low-income and minority communities for a wide range of educational and professional opportunities. However, HBCUs have often reported the need for a clearer understanding of the requirements associated with HRSA solicitations and approaches to meeting those requirements. This study will assess the relative merits of providing programmatic technical assistance through regional workshops, against provision through institution-specific guidance on site. This evaluation will help to highlight those technical assistance approaches that can enhance the participation of HBCUs in HRSA grant/contract programs.
AGENCY SPONSOR: Bureau of Health Professions
FEDERAL CONTACT: Roscoe Dandy, Dr.P.H.
PHONE NUMBER: 301-443-6582
PIC ID: 7123
PERFORMER ORGANIZATION: Institute for College Research Development and Support, Silver Spring, MD
PROJECTED DATE OF COMPLETION: 12/31/99
TITLE: Comparison of Services Received and Health Outcomes for Persons Funded by the CARE Act and by Other Sources
ABSTRACT: The purpose of this study is to compare demographic characteristics, services needed and provided, and health outcomes between persons receiving CARE Act-funded services and the general treatment population. Increasing demands for accountability, shifts in the populations affected by the HIV epidemic, and the development of effective combination therapies have been associated with increases in the number of people living with HIV who will need care for longer periods of time. While a great deal is known about the types of services and providers supported under the CARE Act, the demographic characteristics of, and services used by, patients are less clear because of a lack of client-level reporting mechanisms. The findings of this study will help to develop an empirical basis for program accountability and performance measurement.
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: Richard Conviser, Ph.D.
PHONE NUMBER: 301-443-3075
PIC ID: 7123
PERFORMER ORGANIZATION: Johns Hopkins Medical Institutions, Baltimore, MD
PROJECTED DATE OF COMPLETION: 7/31/99
TITLE: Development of Estimates of Unduplicated AAR Client Counts Based on Client Level Demonstration Projects
ABSTRACT: This study is developing a method for estimating unduplicated counts of clients served by Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Title I and Title II grantees. Grantees use the Annual Administrative Report (AAR) to submit data about the demographic characteristics of organizations providing services under these Titles. Grantees obtain these data directly from providers, who provide unduplicated counts of the people they serve. However, since clients often visit multiple providers, duplication in counts inevitably results as grantees aggregate data across providers. Reliable estimates of unduplicated counts of CARE Act clients will provide a basis for preparing accurate budgets, performance plans, and other documents, and will provide a clearer picture of the scope of the population served by the CARE Act.
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: John Milberg
PHONE NUMBER: 301-443-8729
PIC ID: 6808
PERFORMER ORGANIZATION: Harvard Pilgrim Health Care Boston, MA
PROJECTED DATE OF COMPLETION: 7/31/99
TITLE: Evaluation of Managed Care and Vulnerable Populations
ABSTRACT: This study concerns participation in and impact of Medicaid managed care on providers (and the populations they serve) funded under two Health Resources and Services Administration (HRSA) programs: the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, and the Maternal and Child Health Block Grant. The findings will be used to improve technical assistance and develop policies to better support these providers in managed care settings.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Alexander Ross, Sc.D.
PHONE NUMBER: 301-443-1512
PIC ID: 6816
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.
PROJECTED DATE OF COMPLETION: 9/1/99
TITLE: Managed Care and the Safety Net Providers
ABSTRACT: This study is examining the impact of Medicaid managed care and other systemic changes in health care coverage on the future integrity and viability of safety net providers operating in primary care settings, including those funded by the Health Resources and Services Administration (HRSA). These HRSA programs include Community and Migrant Health Centers, Maternal and Child Health programs, and the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act programs. The study also includes public hospitals and health departments. Findings and recommendations will be disseminated nationally through a variety of mechanisms, including publication of the report and a series of public forums and workshops.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Alexander Ross, Sc.D.
PHONE NUMBER: 301-443-1512
PIC ID: 6815
PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine Washington, D.C.
PROJECTED DATE OF COMPLETION: 9/1/99
TITLE: National Evaluation of the Healthy Start Program
ABSTRACT: The Healthy Start program was launched in 1991 by the Health Resources and Services Administration (HRSA) of the U.S. Public Health Service to demonstrate innovative ways to reduce infant mortality in areas with some of the highest rates. The National Evaluation consists of a cross-site process study and an outcome study of the 15 original sites. The final report of the process evaluation, "The Implementation of Healthy Start: Lessons for the Future," was completed in FY 1998 (See PIC ID 5610.1). The outcome evaluation is assessing infant mortality and birth outcomes, including improvements in the adequacy of prenatal care, and the incidence of low and very low birth weight and pre-term deliveries compared to matched comparison communities. The final report will also include findings from a Survey of Postpartum Women, and from special reports on Fetal and Infant Mortality Reviews, Health Education, and Case Management. Study results will be used to improve the Healthy Start projects funded subsequently, and will be shared with the public health community for application in other settings.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.
PHONE NUMBER: 301-443-3070
PIC ID: 5610
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.
PROJECTED DATE OF COMPLETION: 3/30/00
TITLE: Effectiveness of the National Health Service Corps
ABSTRACT: The purpose of this project is to evaluate the effectiveness of the National Health Service Corps (NHSC), including examination of the various mechanisms for training and recruiting providers, placing them in underserved areas, and retaining them in primary care and related professions. Prior studies have tended to define NHSC "effectiveness" narrowly, e.g., using retention at a particular site as a measure. Current and alumni clinicians and administrators of sites staffed with NHSC clinicians are providing information for the study. Study findings will be used in policy development and program management, and in developing the proposal for new authorizing legislation, needed as of October 2000.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Richard Niska, M.D.
PHONE NUMBER: 301-594-4204
PIC ID: 6357
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.
PROJECTED DATE OF COMPLETION: 4/30/00
State Children's Health Insurance Program
TITLE: An Analysis of Implementation Issues Relating to CHIP Cost-Sharing Provisions for Certain Targeted Low-Income Children
ABSTRACT: Title XXI of the Social Security Act permits State Children's Health Insurance Programs (CHIP) to impose cost sharing on beneficiaries, when the program is not an expansion of the State's Medicaid program. Under Medicaid, cost-sharing for services to children is prohibited. This project analyzes cost-sharing models that can be used by States to track cumulative out-of-pocket expenditures for State CHIP activities and employer-based health insurance plans that participate in CHIP; and reviews findings from studies that examine the relationships among health insurance premiums, cost-sharing arrangements, and enrollment and utilization by low income families. Findings will inform guidance for States in designing cost-sharing provisions for the CHIP plans.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Marcia K. Brand, Ph.D.
PHONE NUMBER: 301-443-4619
PIC ID: 7129
PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.
PROJECTED DATE OF COMPLETION: 4/30/99
TITLE: The Impact of the State Children's Health Insurance Program on Selected Community Health Centers and Maternal and Child Health Programs
ABSTRACT: This study is assessing: (1) the effect of the State Children's Health Insurance Program (CHIP) on the insurance status of children served by selected Community Health Centers (CHCs) and Maternal and Child Health (MCH) programs, and (2) the impact on the extent to which these children enter or remain in care at selected CHC and MCH sites. Issues to be addressed include: (1) the insurance history of children who have used or are new to the site; (2) the continuous nature and time span of the coverage; (3) insurance characteristics of, and source of care for, children who are no longer users; and (4) the characteristics of sites relative to their ability to enroll and/or retain newly insured children. Previous analysis of CHC encounter files documented significant volatility in coverage, with patients going on and off coverage as many as five times in a given year. Study findings will provide a framework for future investigation, develop a transferable methodology for use by States and sites, and help to assess the extent to which CHIP has affected the insurance coverage of children served by CHCs and MCH programs.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Vilma Cokkinides, Ph.D.
PHONE NUMBER: 301-594-3730
PIC ID: 7125
PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.
PROJECTED DATE OF COMPLETION: 9/30/00
TITLE: A Pilot Study to Identify Infrastructure Building Across HRSA Programs
ABSTRACT: This pilot study has two purposes: (1) to describe how Health Resources and Services Administration (HRSA) programs contribute to the development of a health care infrastructure at the local level, and (2) to test the use of a site visit methodology to gather this information. Site visits to Boston, Cleveland and Phoenix are providing information on interactions among HRSA programs--that is, whether multiple programs combine in a mutually reinforcing fashion, operate independently, or work at cross-purposes. Among other topics, the study is also exploring whether the impact of HRSA investments is larger due to the presence of several programs, and is seeking suggestions from the field about ways that HRSA program management may be improved. Findings will improve HRSA's understanding of the interaction and effects of its programs in the context of health care system changes and shifting population needs, and will contribute to performance measurement.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Jessica Townsend
PHONE NUMBER: 301-443-0371
PIC ID: 6814
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.
PROJECTED DATE OF COMPLETION: 3/31/99
TITLE: Crosscutting HRSA-Wide Performance Strategy
ABSTRACT: Beginning in 1995, the Health Resources and Services Administration (HRSA) has conducted an extensive series of projects to identify meaningful performance indicators and develop related data sources as required by the Government Performance and Results Act (GPRA). Building on earlier program-specific work, this study is developing a structure for arraying performance goals and accompanying measures across the agency. Results will be used initially in drafting the FY 2001 performance plan and budget.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.
PHONE NUMBER: 301-443-3070
PIC ID: 7131
PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA
PROJECTED DATE OF COMPLETION: 9/30/99
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