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Appendix B2: Performance Measures (Detail Report)

Goal 1:  Strengthen Health Care

Objective A: Make coverage more secure for those who have insurance, and extend affordable coverage to the uninsured

1.A.15 Increase the number of young adults ages 19 to 25 who are covered as a dependent on their parent's employer-sponsored insurance policy

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

The Affordable Care Act requires group health plans and private health insurance issuers offering group or individual health insurance coverage that provides dependent coverage of children, to continue to cover an adult child until the age of 26. This provision went into effect on September 23, 2010, and it is important because it increases the availability of health insurance to a population that historically had a high uninsured rate. Prior to health reform, about 30% of young adults had no health insurance coverage. Recent data show that since September 2010, an estimated 2.5 million young adults gained health coverage as a result of the option to stay on their parent's health insurance plans. CMS’ goal is to increase the number of adult children covered as dependents on a parent’s insurance policy to 8.8 million by 2013. The increased options in the Affordable Care Act will enable young adults to maintain coverage, protecting both their health and financial security. Starting in 2014, there will be even more health coverage options available to young adults when the Affordable Insurance Exchanges, premium tax credits, and Medicaid expansion all begin.

This is a new, interim performance measure. Some historical actuals were used to develop targets for future years. Targets will not be developed beyond 2013, since the Affordable Care Act will offer young adults expanded coverage options in 2014.

Adults 19 - 24 covered on parents insurance

Data Source: Current Population Survey and Medical Expenditure Panel Survey data

Also Supports: Healthy People 2020 - AHS 1.3; AHS-6.4

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1.A.25 Reduce the average out-of-pocket share of prescription drug costs while in the Medicare Part D Prescription Drug Benefit coverage gap for non-Low Income Subsidy (LIS) Medicare beneficiaries who reach the gap and have no supplemental coverage in the gap

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

The Affordable Care Act includes provisions to reduce the out-of-pocket costs of prescription drugs for Medicare beneficiaries, including closing the coverage gap ("donut hole") completely by 2020.

The Affordable Care Act included many changes, to reduce the cost Medicare Part D enrollees are required to pay for their prescriptions in the coverage gap. This is accomplished through a 50% manufacturer discount on brand name drugs and increased Medicare coverage of both brand name and generic drugs in the coverage gap according to a predetermined scale. These discounts are applied at the point of sale. The costs for brand name drugs covered by the 50% manufacturer discounts count toward the annual out- of-pocket threshold (True Out-of-Pocket Costs; TrOOP). One-time rebate checks were also provided for eligible beneficiaries who reached the coverage gap in 2010. With an FY 2010 baseline of 100 percent, the FY 2013 target is set at 55%.

Percent of Out of Pocket Prescription Cost Paid by Medicare Beneficiaries

Data Source: The Prescription Drug Event (PDE) data

Also Supports: The Affordable Care Act.

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1.A.30 Increase the proportion of legal residents under age 65 covered by health insurance by establishing affordable insurance Exchanges and implementing Medicaid expansion

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

Tracking the proportion of residents with health insurance allows CMS to measure its progress towards achieving the goal of providing quality, affordable health insurance to all Americans. As Affordable Insurance Exchanges (Exchanges) and the Medicaid expansion will not be fully in place until 2014, CMS is reporting on the process measure below in the interim. This interim measure tracks CMS’s progress towards setting up the Exchanges, because the majority of actions CMS must take to develop the infrastructure for coverage expansion are related to Exchange establishment. This does not diminish the importance of other work being done in States or the Federal government to implement the Medicaid expansion and other key aspects of the Affordable Care Act.

Exchanges are a keystone of the health insurance reform provided by the Affordable Care Act. The Affordable Care Act provides each State with the option to set up an Exchange, or to have the Federal government set up an Exchange in that State. An Exchange is an organized marketplace to help consumers and small businesses buy health insurance in a way that permits easy comparison of available plan options based on price, benefits and services, and quality. By pooling people together, reducing transaction costs, and increasing transparency, Exchanges create more efficient and competitive health insurance markets for individuals and small employers. CMS will undertake significant work to prepare for open enrollment prior to January 1, 2014, when Exchanges are scheduled to take effect. This measure tracks CMS’ progress toward setting up the Exchanges that are instrumental in expanding health insurance coverage.

In FY 2011, 45 States and the District of Columbia had stakeholder consultation to gain public input in the Exchange planning process.

In FY 2012, CMS is aiming to award all qualifying applications for Establishment Grants within 60 days of receiving the application.

The FY 2015 target is for 93% of legal residents to have insurance coverage.

This is a new performance measure and does not yet have any trends associated with it.

Data Source: Exchange IT system metrics

Also Supports: Healthy People 2020 AHS-1; AHS-1.1

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Goal 1: Strengthen Health Care

Objective B: Improve health care quality and patient safety

1.B.20 Increase percentage of dialysis patients with fistulas as their vascular access for hemodialysis

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

Hemodialysis is the most common treatment for End Stage Renal Disease (ESRD). Approximately 356,000 Medicare beneficiaries currently receive this treatment. Of the vascular access options for hemodialysis, arteriovenous fistula (AVF) is generally the best access. An increased rate of AVF for access would improve quality of life for patients by improving adequacy of dialysis and decreasing emergent treatment of and hospitalizations related to complications and failures of grafts and catheters, thus decreasing program costs. Additionally, it is anticipated that the ESRD survival rate would improve because the complications of grafts and catheters can be fatal.

Quality improvement work continues as the ESRD Networks reach out to providers and hemodialysis patients regarding the most appropriate vascular access methods available to them. CMS is holding ESRD Network Organizations accountable for driving regionally based fistula rates upward as one of their tasks under their CMS ESRD Quality Initiative Statement of Work. In addition, the work of the Fistula First Breakthrough Initiative National Coalition serves as a national coordinating point for pooling the resources of public and private stakeholders together to focus the renal community on this vital topic for all hemodialysis patients. The prevalent AVF rate at the end of FY 2011 was 59.8 percent. This is a 3% increase in one year and exceeds the FY 2011 target by 1.8%

Percent of Medicare Patients with AVF Assisted Dialysis

Data Source: Data is self reported by the dialysis facilities. Dialysis facilities submit directly to the 18 ESRD Networks who then submit directly to CMS through a file transfer.

Also Supports: HHS Healthy People 2020, Objective 1.D.1

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1.B.30 Increase the number of hospitals and other selected health care settings that report into the National Healthcare Safety Network (NHSN)

Lead Agency: Centers for Disease Control and Prevention (CDC)

Healthcare-associated infections (HAI) are a critical public health problem and a leading preventable cause of illness and death in the U.S., affecting approximately 5% of all hospitalized patients and accounting for $28-$33 billion in excess healthcare expenditures annually. HAIs occur in all settings where patients receive medical care, including hospital and non-hospital settings.

CDC's National Healthcare Safety Network (NHSN) is a proven HAI tracking tool and a vital resource for HAI prevention across healthcare settings at the local, state, and national levels. NHSN is CDC’s data source for documenting HAI improvement. This measure tracks progress towards HAI prevention using NHSN participation by all U.S. hospitals and additional healthcare settings.

Based on NHSN data, CDC documented a 15% reduction in central line-associated bloodstream infections (CLABSIs), 8% reduction in surgical site infections (SSIs), and 7% reduction in catheter-associated urinary tract infections (CAUTIs) between 2009-2010.

In December 2011, 5,200 healthcare facilities participated in NHSN. As of March 2012, more than 7,300 healthcare facilities were using NHSN for HAI reporting, including approximately 2,400 dialysis facilities. CDC will continue to accelerate HAI prevention by supporting CLABSI, CAUTI, and SSI reporting in hospitals and blood stream infection reporting in dialysis facilities. CDC will also expand enrollment to additional healthcare facilities in outpatient settings (i.e., ambulatory surgical centers, long-term acute care facilities, rehabilitation centers) and reporting of additional types of HAIs outside of intensive care units in hospitals (e.g., Clostridium difficile (C. difficile) and Methicillin-resistant Staphylococcus aureus (MRSA) infections).

Number of natoinal Healthcare Safety Network Entities Reporting

 

Data Source: National Healthcare Safety Network (NHSN)

Also Supports: HHS Strategic Plan 1.3 and 3.E; Healthy People 2020 Objectives: HAI-1, HAI-2, BDBS-18, BDBS-18.1 and BDBS 18.2; HHS Action Plan to Prevent Health Care Associated Infections

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1.B.50 Increase the number of U.S. healthcare organizations per year using AHRQ- supported tools to improve patient safety culture.

Lead Agency: Agency for Healthcare Research and Quality (AHRQ)

As health care organizations continually strive to improve, there is growing recognition of the importance of establishing a culture of patient safety. According to the Institute of Medicine, "the biggest challenge to moving toward a safer health system is changing the culture from one of blaming individuals for errors to one in which errors are treated not as personal failures, but as opportunities to improve the system and prevent harm.’’ (Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press, 2001.) Achieving a culture of patient safety requires an understanding of the values, beliefs, and norms about what is important in an organization and what attitudes and behaviors related to patient safety are supported, rewarded, and expected.

Recognizing the need for a measurement tool to assess the culture of patient safety in health care organizations, the Quality Interagency Coordination Task Force (QuIC), which was established to facilitate coordination by all Federal agencies involved in health care services, sponsored the development of a hospital survey focusing on patient safety culture. In 2004, the Agency for Healthcare Research and Quality (AHRQ) funded and supervised development of the Hospital Survey on Patient Safety Culture. This tool is designed to assist hospitals in evaluating how well they had established a culture of safety in their institutions by: raising staff awareness about patient safety, diagnosing and assessing the current status of patient safety culture, identifying strengths and areas for patient safety culture improvement, examining trends in patient safety culture change over time, analyzing the cultural impact of patient safety initiatives and interventions, and conducting internal and external comparisons.

Since its release, the Hospital Survey on Patient Safety Culture has been widely implemented across the United States. Currently, AHRQ estimates that over 50% of hospitals have used the instrument. The Joint Commission now requires health care organizations assess patient safety culture. Hospitals administering the AHRQ survey have expressed interest in comparing their results with those of other hospitals as an additional source of information to help them identify areas of strength and areas for improvement. In response to these requests, AHRQ funded the Hospital Survey on Patient Safety Culture comparative database to enable hospitals and units in hospitals to help them determine how well they were doing in establishing a culture of safety in comparison to other similar hospitals or hospital units. The database also facilitates an examination of trends in patient safety culture over time in hospitals and hospital units.

Since the first annual user comparative database report, the number of hospitals and respondents included in the database has grown each year. The program consistently meets or exceeds its performance targets for these tools. In FY 2007, a baseline of 382 research users was established with 885 hospitals in 2010 and 1032 hospitals in 2011 voluntarily reporting to the database. Based on data provided by U.S. hospitals, the Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report displays results from 1,128 hospitals and 567,703 hospital staff respondents. The report also includes a chapter on trending that presents results showing change over time for 650 hospitals that administered the survey and submitted data more than once. Hospitals do not necessarily administer the hospital patient safety culture survey every year, but instead administer it on an 18-month, 24-month, or other cycle. Therefore, the comparative database is a “rolling” indicator. It retains data for up to 3.5 prior years when a hospital does not have new data to submit, replaces older data with more recent data when available, and adds data from hospitals submitting for the first time.

U.S.healthcare organizations per year using AHRQ supported tools

Data Source: http://www.ahrq.gov/qual/patientsafetyculture/

Also Supports: The Affordable Care Act

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Goal 1: Strengthen Health Care

Objective C: Emphasize primary and preventive care linked with community prevention services

1.C.01 Percentage of health centers with at least one site recognized as a patient centered medical home*

Lead Agency: Health Resources and Services Administration (HRSA)

A patient centered medical home (PCMH) is a service delivery model designed to improve the quality of care through enhanced access, planning, management, and monitoring of patient care. HRSA has established a PCMH Initiative to improve the quality of care in health centers and support health center efforts to achieve national PCMH recognition. This measure tracks the increased number of health center sites certified as a PCMH.

In FY 2010 1% of health centers were recognized as patient centered medical homes. This number is expected to reach 13% and 25% in FY 2012 and FY 2013, respectively. The PCMH Initiative to support health centers in their efforts to achieve national PCMH recognition includes funding to cover health center costs associated with surveys for PCMH recognition, technical assistance, and other quality improvement supports.

Percent of health centers recognized as Patient Centered medical homes

Data Source: HRSA/Bureau of Primary Health Care contractors that perform PCMH surveys.

* This is an HHS FY 2012 – FY 2013 Priority Goal indicator. To see more information about HHS Priority goals go to www.performance.gov

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1.C.05 By 2015, identify three (3) key factors influencing the scaling up of research- tested interventions across large networks of services systems such as primary care, specialty care and community practice.

Lead Agency: National Institutes of Health (NIH)

NIH has broadened its portfolio in implementation research by encouraging trans-disciplinary teams of scientists and practice stakeholders to work together to develop innovative approaches for identifying, understanding, and overcoming barriers to implementation of research-tested intervention in service settings. The NIH studies have taken various approaches to examine factors that influence the development, implementation, and dissemination of evidence-based interventions, including scaling-up a mental health intervention in foster care; treating drug abuse and testing a continuum of care for HIV treatment in the criminal justice system; and implementing alcohol screening, intervention, and treatment in primary care.

NIH researchers met the FY 2011 target by identifying three mechanisms for tracking successful implementation within studies to improve the uptake of research-tested interventions in health care settings. This research can help identify the barriers preventing effective implementation of evidence-based practices and distinguish between patient, provider, and system-level outcomes. The results can lead to new theories of implementing programs and novel ways to integrate effective interventions into clinical practice.

One major challenge for large-scale implementation efforts (e.g. implementing effective interventions across health systems, counties and states) is efficiency in gathering and analyzing large amounts of implementation data. Use of information technologies to support data collection is now emerging as a solution that will significantly aid implementation science. For example, using a web-based data platform, NIH investigators are gathering information on the implementation of a child welfare intervention throughout the state of Oklahoma. Investigators have reported data collection rates of over 90% across multiple waves of provider data collection. The same team has also developed a measure to understand mental health and social science provider attitudes surrounding the adoption of evidence-based practices, the evidence-based practice attitudes scale (EBPAS). The study examined the factor structure, reliability, and norms of EBPAS scores. The results suggest that the factor structure and reliability are likely generalizable to a variety of service provider contexts and different service settings.

Another team of researchers, testing implementation strategies for multi-dimensional treatment foster care, has developed a new measure called the Stages of Implementation Completion (SIC), which is capturing the quality of implementation across county level systems. The research team examined the ability of the first three stages of the SIC to predict successful program start-up. The results suggest that completing the SIC stages relatively quickly predicts the likelihood of successful implementation. These and additional efforts are increasing the capacity of researchers to better track the key outcomes of their efforts -- the ultimate impact of empirically supported health interventions.

Data Source: Publications, databases, administrative records and/or public documents.

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1.C.20 Increase percent of pregnant women who received prenatal care in the first trimester.

Lead Agency: Health Resources and Services Administration (HRSA)

Prenatal care is one of the most important interventions for ensuring the health of pregnant women and their newborn babies. Early identification of maternal disease and risks for complications of pregnancy or birth can help to ensure that women with complex problems and women with chronic illness or other risks are seen by specialists. Early high-quality prenatal care is critical to improving pregnancy outcomes. Monitoring timely entry into prenatal care provides an indicator of both access to care and quality of care.

The Federal government has recently moved to the use of a Revised Standard Birth Certificate for reporting birth-related information, including receipt of prenatal care. Not all States have begun to use the revised certificate. In the States (18) using the revised certificate to report 2006 information, 69% of pregnant women received prenatal care in the first trimester. In the States (22) using the revised certificate to report 2007 information, the percentage was 70.8%. In the 27 States that used the revised certificate for reporting 2008 information, 71% of pregnant women received prenatal care in the first trimester.[1]

Percent of women with 1st trimester prenatal care

Data Source: Vital statistics compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC).

Also Supports: This measure aligns with the following Healthy People 2020 objective: Increase the proportion of pregnant women who receive early and adequate prenatal care (MCH-10).

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1.C.22 Sustain immunization coverage in children 19 to 35 months of age for one dose of measles, mumps and rubella (MMR) vaccine.

Lead Agency: Centers for Disease Control and Prevention (CDC)

The Advisory Committee on Immunization Practices (ACIP) recommends ten (10) vaccines for young children. As childhood immunization coverage rates increase, cases of vaccine-preventable diseases decline significantly. The Measles, Mumps and Rubella (MMR) vaccine serves as a proxy for sustaining appropriate coverage levels for routinely recommended childhood vaccines to prevent the spread of disease.

From 2006-2008, MMR coverage among children 19-35 months of age was 92%, but declined to 90% in 2009. In 2010, coverage was 92%, which exceeded the CDC target and the national Healthy People 2010 objective of 90% for MMR coverage.

 Rate of MMR Vaccination

Data Source: Childhood data are collected through the National Immunization Survey (NIS) and reflect calendar years.

Also Supports: Healthy People 2020: IID-7.4

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1.C.30 Increase the proportion of adults that engage in leisure-time physical activity.

Lead Agency: Centers for Disease Control and Prevention (CDC)

Physical activity plays an important role, in maintaining a healthy body weight. Obesity accounts for more than 300,000 deaths per year and is associated with more than $147 billion in annual medical care expenditures. More than 35% of US adults, and 17% of US children ages 2-19 are obese. Increasing physical activity and reducing obesity also contributes to positive health outcomes including reducing the prevelance of chronic diseases such as heart disease, stroke, and high blood pressure. To combat trends in obesity and other related chronic disease risk factors, CDC provides strategies and interventions to improve nutrition and physical activity and promote healthy lifestyles. These strategies include developing and disseminating guidelines/standards, advancing environmental strategies to support healthy eating and active living, and implementing a coordinated approach to community-based and statewide nutrition and physical activity programs.

This performance measure is the inverse of the Healthy People 2020 national health objective to reduce the level of leisure-time physical inactivity among adults by 10%. The proportion of adults that engage in leisure time physical activity increased from 63.8% in 2008 to 67.4% in 2010.

Proportion of adults that engage in leisure-time physical activity

Data Source: National Health Interview Survey (NHIS), CDC, NCHS

Also Supports: This measure is the inverse of Healthy People 2020 objective PA-1.

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1.C.35 Increase the Number of Medicare Beneficiaries Who Receive an Annual Wellness Visit

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

The purpose of this measure is to demonstrate success in increasing beneficiary awareness and utilization of the Medicare Annual Wellness Visit (AWV). If a beneficiary has been enrolled in Medicare Part B for longer than 12 months and has not received either an initial preventive physical examination (IPPE) or an AWV within the past 12 months, the beneficiary is eligible to receive an AWV. The AWV includes elements that focus on (1) assessing health risks, (2) furnishing personalized health advice and referrals as appropriate to health education and preventive counseling services, and (3) creating a screening schedule for the next 5 to 10 years and a list of risk factors and conditions as well as ongoing and/or recommended interventions. Beneficiaries pay nothing for the yearly "wellness" visit if providers accept Medicare, because the Affordable Care Act added this benefit with no copayments or other cost-sharing.

The AWV first became available in January 2011, and we do not yet have sufficient data necessary to set a baseline for CY 2011. In June 2012, CMS will use CY 2011 claims data to set the baseline and CY 2013 target. The CY 2013 target will be based on the total number of Fee For Service Beneficiaries receiving an AWV during CY 2011 plus the number of new AWVs estimated for CY 2013. Future targets will be set based on a cumulative number of new AWV services estimated in total by the end of each fiscal year since CY 2011. Targets will also take into account estimated changes in the beneficiary population and historic data on overall preventive service utilization rates.

Data Source: The Common Working File (CWF) will be the primary data source for this analysis; the claims will undergo final-action to be consistent with the data available in the Integrated Data Repository (IDR) database. The claims will be used to identify Annual Wellness Exams for Original Medicare beneficiaries, using HCPCS code G0438 for Part B FFS initial AWV claims as well as the HCPCS code G0439 for subsequent AWVs. The baseline will consist of the total number of initial AWV in 2011 (the first year of the benefit), and will help inform future target estimates. Targets are based on a cumulative number of initial AWV services estimated in total by the end of each year since CY 2011. CMS will monitor subsequent Part B beneficiary AWV utilization through the CWF (HCPCS G0439) over time and can adjust the calculation to factor in repeat service utilization if most beneficiaries are using the service each year after first receiving it.

Also Supports: HHS Strategic Plan Goal 1.

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Goal 1: Strengthen Health Care

Objective D: Reduce the growth of health care costs while promoting high-value, effective care

1.D.15 Reduce by 25% hospital-acquired central-line associated bloodstream infections (CLABSI) by the end of FY 2013*

1.D.20 Reduce by 20% hospital-acquired catheter-associated urinary tract infections (CAUTI) by the end of FY 2013*

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

Healthcare-associated infections (HAI), a specific type of healthcare acquired conditions (HACs), are among the leading causes of death in the United States, accounting for an estimated 1.7 million infections and 99,000 associated deaths in 2002. Hospital-acquired HAIs are responsible for $28 to $33 billion dollars in preventable healthcare expenditures annually. HAIs are largely preventable and can be drastically reduced to save lives and avoid excess costs. Reduction in incident rates of HAIs has been a targeted priority for HHS as evidenced by the combined strategic and programmatic efforts of multiple Federal agencies over the past four years.

HHS is dedicated to implementing programs geared toward achieving significant and measurable reductions in both HACs and HAIs. The Affordable Care Act provides the framework to make healthcare safer by reducing harm to patients, and CMS shares this endeavor with the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), and the Office of the Assistant Secretary for Health (OASH) as represented in an HHS Priority Goal to reduce the national rate of healthcare-associated infections. Among efforts to reduce these rates are those of CMS’ Quality Improvement Organizations in the 10th Statement of Work, nationwide implementation for prevention of central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) through the use of AHRQ's Comprehensive Unit-based Safety Program (CUSP), CDC-sponsored State- based HAI initiatives, and the combined use of CDC’s web-based NHSN for tracking HAIs. The CLABSI and CAUTI Priority Goal is consistent with the OASH-originated HHS “Action Plan to Prevent Healthcare-Associated Infections,” as well as CLABSI and CAUTI measures included in the Partnership for Patients, launched by Secretary Sebelius in April 2011.

CLABSIs are among the most serious HAIs, resulting in death in 12 to 25% of affected patients while CAUTIs are the most common, making up 40% of all HAIs. While the HHS Priority Goal to reduce CLABSI and CAUTI rates is new, CDC has reported comparable historical data for both. The National Healthcare Safety Network (NHSN) shows a reduction in the CLABSI Standardized Infection Ratio (SIR) from .8 in 2009 to .68 in 2010 (representing number of observed infections divided by the expected), and a decline of CAUTI SIR from 1.0 in 2009 to 0.94 in 2010 (representing number of observed infections divided by the expected). NHSN data also show reductions of 58% in CLABSI in hospital intensive care units from 2001-2009, saving up to 27,000 lives and $1.8 billion in excess medical costs. In 2010 CDC’s nationwide HAI prevention efforts demonstrated a 15% reduction in CLABSI, and a 7% reduction in CAUTI. AHRQ’s Comprehensive Unit-based Safety Program (CUSP) was shown to be a highly effective approach for HAI prevention in the Michigan Keystone Project, in which hospital-acquired CLABSIs were reduced by two-thirds within three months and many intensive care units sustained a zero level of CLABSI for the duration of a three-year observation period. Since 2009, AHRQ has seen considerable success in reducing CLABSI by promoting the use of CUSP nationwide. As of this report, AHRQ has recruited 1,000 hospitals and 1,800 hospital teams across 44 States, DC and Puerto Rico to participate in this effort. The 2-year results in over 1,100 adult ICUs submitting data after the adoption of CUSP, show a >40 percent reduction in their CLABSI rates. Building on the CUSP-for-CLABSI effort, in 2011, AHRQ expanded a 12-State pilot project into a nationwide rollout of CUSP to reduce CAUTIs. This project is likewise expected to contribute significantly to attaining the Department’s HAI priority goal.

By the end of FY 2013, we will leverage the programmatic efforts across HHS to promote synergy and spread of best practices for HAI prevention to help propel us toward this national goal. Additionally, through partnerships and networks with our public and private stakeholders, also engaged in innovative and operational solutions for HAI prevention, we strive to achieve demonstrable improvements in healthcare quality and patient safety through reduction of hospital-acquired CLABSI and CAUTI by 25 percent and 20%, respectively.

Reduce by 25% hospital-acquired central-line associated bloodstream infections (CLABSI) by the end of FY 2013. (Lead Agency - CMS; Measure ID - MCR28.1) 

 

FY 2008

FY 2009

FY 2010

FY 2011

FY 2012

FY 2013

Target

N/AN/A

N/A

N/A

12.5%[1]

(SIR=0.60)

25%

(SIR=0.51)

Result

N/AN/A

SIR=0.68

Oct 31, 2012

March 30, 2013

March 30, 2014

Status

N/AN/A

 (CY) Historical Actual

Pending

Pending

Pending

 

Reduce by 20% hospital-acquired catheter-associated urinary tract infections (CAUTI) by the end of FY 2013. (Lead Agency - CMS; Measure ID - MCR28.2) 

 

FY 2008

FY 2009

FY 2010

FY 2011

FY 2012

FY 2013

Target

N/AN/A

N/A

N/A

10%[2]

(SIR=0.85)

20%

(SIR=0.75)

Result

N/AN/A

SIR=0.94

Oct 31, 2012

March 30, 2013

March 30, 2014

Status

N/AN/A

(CY) Historical Actual

Pending

Pending

Pending


 [1] The Standardized Infection Ratio (SIR) for CY-2010 is 0.68. SIR is calculated by dividing the actual (observed) infections by the expected infections using data gathered through the CDC National Healthcare Safety Network (NHSN). Projected FY 2012 SIR calculation (0.68 x 0.875). Projected FY 2013 SIR calculation (0.68 x 0.75).

 [2] The Standardized Infection Ratio (SIR) for CY-2010 is 0.94. SIR is calculated by dividing the actual (observed) infections by the expected infections using data gathered through the CDC National Healthcare Safety Network (NHSN). Projected FY 2012 SIR calculation (0.94 x 0.9). Projected FY 2013 calculation (0.94 x 0.8).


Data Source: The CDC National Healthcare Safety Network

Also Supports: Healthy People 2020 and the HHS Action Plan to Prevent Healthcare Associated Infections

* This is an HHS FY 2012 – FY 2013 Priority Goal indicator. To see more information about HHS Priority goals go to www.performance.gov

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1.D.25 Reduce all-cause hospital readmission rate

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

In order to reduce Medicare expenditures and improve quality of care, the Affordable Care Act established the Hospital Readmissions Reduction Program for certain potentially preventable Medicare inpatient hospital readmissions. In its first years, this program will cover all-cause readmissions related to inpatient hospital stays for the following three conditions: heart attack, pneumonia and heart failure.

In contrast, this performance measure will apply to readmissions related to all conditions, that is, hospital-wide readmissions. Our target is to reduce all-cause hospital readmission rates by 5 percent per year from 2012 to 2015. The rate of readmissions is calculated as the number of Medicare readmissions to the same or another acute-care hospital that occur within 30 days of discharge from an acute care hospital compared to total Medicare hospital admissions for that time period. The numerator will be the number of Medicare hospital readmissions to any acute care hospital within 30 days of an acute care hospital discharge. The denominator is the total number of Medicare admissions for that time period. The baseline for this performance measure will be set in FY 2012. The readmission rate will be updated annually through FY 2015.

Percent reduction over previous year in all-cause readmissions

Data Source: Medicare claims data. Medicare Provider Analysis and Review file (MedPAR) is the Medicare inpatient claims data file for fee-for-service and Medicare Advantage inpatients submitted by acute care hospitals.

Also Supports: Partnership for Patients, Affordable Care Act

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1.D.30 Improve the accuracy of Medicare Physician Fee Schedule (PFS) payments by identifying, reviewing, and appropriately valuing potentially misvalued codes (i.e. high expenditure or high cost) under the Medicare PFS through the potentially misvalued code analysis process.

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

The purpose of this measure is to achieve more accurate pricing under the Medicare physician fee schedule, consistent with CMS’ goal of moving to a value driven health care system. The Medicare Physician Fee Schedule (PFS) is a payment system used to reimburse practitioners for Medicare services. In this process, each service is assigned a unique code and a relative value unit (RVU), which helps Medicare determine the reimbursement for the services. The Affordable Care Act directs the Secretary of the Department of Health and Human Services (HHS) to examine potentially misvalued services in the Medicare Physician Fee Schedule (PFS) to prevent overpayment. In order to achieve the Centers for Medicare & Medicaid Services’ (CMS) goal of moving to a value driven health care system, it is imperative to have a payment system that provides accurate reimbursement for the services rendered. This measure aims to quantify CMS’ progress in determining which services under the Medicare PFS are misvalued and setting the appropriate RVUs for those services.

CMS is in the process of procuring analytic contractors to identify and analyze potentially misvalued codes. After conducting surveys or collecting data, the contractors will make recommendations on the review and appropriate adjustment of potentially misvalued services, enhancing the current process of reviewing codes with the American Medical Association (AMA) Specialty Society Relative Value Scale Update Committee (RUC). We anticipate that the contractor will be in place in 2012, and will provide a list of codes for which they recommend further review in 2013. Because it is difficult to estimate progress on an undefined target, we will set the baseline for this analysis as the number of codes previously identified through the potentially misvalued codes initiative, which began in 2008. In 2012, we plan to have reviewed and appropriately valued at least 20% of the potentially misvalued codes identified through the potentially misvalued code initiative. In 2013, we plan to have reviewed an additional 20% of the identified potentially misvalued codes, achieving review and appropriate valuation of 40% of the baseline. We note that currently, there are approximately 7,500 codes payable under the Medicare PFS of which only a subset will ultimately be identified as potentially misvalued.

Percent of potentially misvalued codes evaluated

Data Source: The PFS rules and regulations; the Relative Value Scale Update Committee (RUC) database; relevant PFS utilization data available at the time of analysis.

Also Supports: Healthy People 2020, AHS-3, AHS-5, and Provision 3134 of the Affordable Care Act. This initiative will help create a payment system that provides accurate reimbursement for the services rendered, which is essential in the DHHS goal of moving toward a value driven health care system.

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Goal 1: Strengthen Health Care

Objective E: Ensure access to quality, culturally competent care for vulnerable populations

1.E.05 Improve availability and accessibility of health insurance coverage by increasing enrollment of eligible children in Medicaid

1.E.10 Improve availability and accessibility of health insurance coverage by increasing enrollment of eligible children in CHIP.

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

These measures track progress toward achieving the long-term outcome to, “Improve the availability and accessibility of health insurance coverage by increasing enrollment of eligible children in CHIP and Medicaid.  States submit quarterly and annual statistical forms, which report the number of children under age 19, who are enrolled in Medicaid, separate CHIP programs and Medicaid expansion CHIP programs.  The enrollment counts reflect an unduplicated number of children ever enrolled during each year.  The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (P.L. 111-3), which provides CHIP funding through September 30, 2013, provided options for States to expand their Title XXI programs.  The Affordable Care Act provides CHIP funding through FY 2015 and will require the maintenance of eligibility standards for children in Medicaid and CHIP through 2019.  Enrollment in CHIP should be taken in the context of overall children’s enrollment in both Medicaid and CHIP.  Research has shown that the prevalence of children who are eligible but are unenrolled, are lower income and more likely to be Medicaid eligible.

Medicaid:  The FY 2008 baseline enrollment is 29,943,162 children.  In FY 2009, 32,292,253 children were enrolled in Medicaid and in FY 2010, 34,441,217 children were enrolled in Medicaid.  In FY 2011, 35,571,506 children were enrolled in Medicaid, exceeding our target to increase the number of children enrolled in Medicaid by 11 percent (33,236,910 children) over the FY 2008 baseline.   The FY 2012 target is to increase enrollment by 17 percent (35,033,500 children) over the FY 2008 baseline and the FY 2013 target is to increase enrollment by 18 percent (35,332,931 children) over the FY 2008 baseline.  By 2015, Medicaid enrollment is expected to increase by 30 percent (38,805,279) over FY 2008.

Children enrolled in Medicaid

Data Source: Statistical Enrollment Data System

Also Supports: This measure is included in the CMS GPRA plan and also supports Healthy People 2020, AHS-1 and AHS-5.2.

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1.E.15 Number of patients served by Health Centers

Lead Agency: Health Resources and Services Administration (HRSA)

Health Centers are community-based and patient-directed organizations that serve populations lacking access to high quality, comprehensive, and cost-effective primary health care. Monitoring the number of patients served annually by Health Centers is key to assessing performance in increasing access to care for undeserved and vulnerable populations. HHS recognizes the importance of the Health Center Program continuing to enable the provision of access to primary health care services and the improvement of the quality of care in this health care safety net. As funding is available, the Program's long-term strategy includes opening new health centers in areas in the country where they do not currently exist.

Health Centers served 19.5 million patients in FY 2010. This is 0.7 million more than the 18.8 million patients served in FY 2009 and 2.4 million more than the 17.1 million served in FY 2008. Success in increasing the number of patients served has been due in large part to the development of new health centers, new satellite sites, and expanded capacity at existing clinics.

Number of patients served by health centers

Data Source: HRSA Bureau of Primary Health Care's Uniform Data System

Also Supports: Healthy People 2020, AHS-3, AHS-5

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1.E.55 Proportion of adults ages 18 and over who are screened for depression.

Lead Agency: Indian Health Service (IHS)

The Indian Health Service (IHS) lists Depression Screening to help fulfill its mission of raising the physical, mental, social and spiritual health of American Indian and Alaska Native people to the highest level. Depression screening improves detection of mental health needs. Depression is often an underlying component contributing to suicide, accidents, domestic/intimate partner violence, and alcohol and substance abuse. Early identification of depression will allow providers to plan interventions and treatment to improve the mental health and well-being of American Indian and Alaska Native people who experience depression.

The FY 2013 target for depression screening is 53.2%. In FY 2011, the IHS exceeded the target, which was 51.9%, achieving a depression screening rate of 56.5% which became the target for FY 2012. Increased accountability for achieving targets at the regional and local levels will be promoted for IHS operated programs, and a more focused educational campaign will be undertaken for Tribally operated programs to convey the benefits of depression screening. The screening tools and results are incorporated into the IHS Electronic Health Record. The system is now deployed and in operation in over 250 clinical sites across the country.

Percent of adults screened for depression

Data Source: Clinical Reporting System (CRS)

Also Supports: In addition to directly supporting HHS Strategic Plan, Goal 1, Objective E, depression screening also supports the strategic strategies for HHS Strategic Plan, Goal 3.D. The depression screening measure supports the Healthy People 2020, Mental Health and Mental Disorders Objective 11 to increase depression screening by primary care providers.

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1.E.65 Implement recommendations from Tribes annually to improve the Tribal consultation process

Lead Agency: Indian Health Service (IHS)

To renew and strengthen the federal/tribal partnership, it is essential that American Indian and Alaska Native Tribes and the Indian Health Service (IHS) engage in open, continuous, and meaningful Tribal consultation. The IHS lists the target of implementing at least three additional recommendations from Tribes to improve the Tribal consultation process each fiscal year. Tribal consultation is an ongoing process that leads to information exchange, respectful dialogue, mutual understanding, and informed decision making.

The Tribal Consultation measure is a new performance measure in 2010 and does not have any trends associated with it. By the end of FY 2011, the IHS has implemented seven recommendations from Tribes to improve the Tribal consultation process, which include:

  • forming and maintaining the Director’s Tribal Advisory Workgroup on Consultation to guide implementation of recommendations;
  • establishing and maintaining an electronic method (e-mail address consultation@ihs.gov) for Tribes to provide input;
  • developing and maintaining a Tribal Consultation website (under the Director’s Blog);
  • posting all letters to Tribal Leaders on the Director’s Blog and electronically mailing them via listserves as well as information about Tribal workgroups and committees;
  • conducting listening sessions in IHS Areas and meeting individually with Tribes;
  • hosting listening sessions and meetings at national conferences (such as the National Congress of American Indians annual convention and the National Indian Health Board consumer conference); and
  • hosting the first ever national Tribal Consultation Summit to provide a one stop shop for consultation on multiple, critical topics.

Additional tribal recommendations implemented

Data Source: Routine IHS Tribal consultation documentation for HHS consultation report and IHS Director's Activities database

Also Supports: In addition to directly supporting HHS Strategic Plan, Goal 1, Objective 5, the Tribal consultation measure also supports Presidential Executive Order 13175; HHS Tribal Consultation Policy (2010); and the IHS Tribal Consultation Policy (2006).

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Goal 1: Strengthen Health Care

Objective F: Promote the adoption and meaningful use of health information technology

1.F.05 Increase the number of eligible providers who receive an incentive payment from the CMS Medicare and Medicaid EHR Incentive Programs for the successful adoption or meaningful use of certified EHR technology

Lead Agency: Office of the National Coordinator for Health and Information Technology (ONC)

The Medicare and Medicaid EHR Incentive Programs were created through the American Recovery and Reinvestment Act of 2009, Health Information Technology for Economic and Clinical Health Act provisions. The Medicare and Medicaid EHR Incentive Programs were created to accelerate the adoption of electronic health records by providing incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. This measure tracks the number of eligible providers (including professionals and hospitals) that receive payments through either the Medicare or Medicaid EHR Incentive Programs.

From January through September 2011, more than 10,700 providers had successfully completed registration and attestation processes for the Medicare and Medicaid EHR Incentive Programs to qualify for incentive payments. The rate at which providers are registering, attesting, and receiving payment for satisfying eligibility criteria is increasing markedly. By the end of FY 2012, a total of 80,000 payments are expected to be made to providers, and by the end of FY 2013, the number of providers expected to receive payments is 140,000.

Medicare and medicaid EHR Incentive Program Payments

Data Source: Centers for Medicare & Medicaid Services, National Level Repository (NLR).

Also Supports: HHS Priority Goal for FY 2012 - 2013

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1.F.10 Increase the Percent of office-based primary care physicians who have adopted electronic health records (basic).*

Lead Agency: Office of the National Coordinator for Health and Information Technology (ONC)

“Adoption” of an electronic health record for this measure is defined as “basic” adoption as in DesRoches et al. 2008 in the New England Journal of Medicine article Electronic Health Records in Ambulatory Care – A National Survey of Physicians.

Physicians are assessed to have adopted a "basic" electronic health record system when the main site of their practice includes a computerized system capable in the following areas: patient demographics, patient problem lists, electronic lists of medications taken by patients, clincal notes, orders for prescriptions, viewing laboratory results, and viewing imaging results.

The information for this measure is gathered in partnership between the Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) and the Office of the National Coordinator for Health IT (ONC).  Each year since 2008, NCHS has included in its National Ambulatory Medical Care Survey (NAMCS) questions pertaining to electronic health record (EHR) adoption. The data is collected through a mail supplement to the survey and it enables NCHS and ONC to derive nationally representative and state-level estimates of office based physician adoption of EHRs.

In 2008 primary care provider adoption of basic electronic health records (EHR) was estimated to be 20%.  Since then, adoption of basic EHRs has nearly doubled to 39% in 2011.  ONC continues to support the growth and usage of electronic health records and  estimates that the nationwide rate of EHR adoption will reach or surpass 55% by 2013.

 Percentage increase of office based primary care physicians with electronic health records

Data Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey, Electronic Medical Record Supplement

* This is an HHS FY 2012 – FY 2013 Priority Goal indicator. To see more information about HHS Priority goals go to www.performance.gov

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Goal 2: Advance Scientific Knowledge and Innovation

Objective A: Accelerate the process of scientific discovery to improve patient care

2.A.15 By 2015, identify and characterize two molecular pathways of potential clinical significance that may serve as the basis for discovering new medications for preventing and treating asthma exacerbations.

Lead Agency: National Institutes of Health (NIH)

Asthma exacerbations (often called asthma attacks) are a significant cause of morbidity in patients with asthma and represent a significant public health burden. However, not all asthma patients are equally susceptible to them. In order to ensure more effective treatment of those patients who are prone to exacerbations, markers are needed that are associated with their phenotypes and/or sub-phenotypes. Having such markers will aid investigators in their efforts to develop mechanism-based treatments that can be successfully targeted to responsive patient sub-groups.

The FY 2011 target was to characterize cellular and molecular inflammation in the distal lung that may contribute to severe asthma and frequent asthma “attacks”. Scientists met the target and characterized the molecular pathways in fibroblasts (the principal active cells of connective tissue) from two regions of the lung. Their analysis showed differences in gene expression between human distal lung/parenchymal fibroblasts (DLF) and airway fibroblasts that may help explain differences between the two regional fibroblast populations in responses to injury, regeneration, and remodeling in the lung. Their findings suggest that DLF may be the more important fibroblast cell type in processes that may contribute to disease progression and severity in asthma.

Data Source: Publications, databases, administrative records and/or public documents

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2.A.22 By 2015, make freely available to researchers the results of 300 high-throughput biological assays screened against a library of 300,000 unique compounds, and the detailed information on the molecular probes that are developed through that screening process.

Lead Agency: National Institutes of Health (NIH)

The Molecular Libraries Program (MLP) initiative established the Molecular Libraries Probe Production Centers Network (MLPCN) as a nationwide scientific resource to accelerate the discovery of small molecule probes for use in biological research and for understanding disease mechanisms of interest to many NIH Institutes. The MLP is expected to identify small molecules that can be optimized as chemical probes to study the functions of genes, cells, and biochemical pathways, leading to new ways to explore the functions of genes and signaling pathways in health and disease. The program also facilitates the development of new therapeutics by providing early stage chemical compounds that enable researchers in the public and private sectors to validate new drug targets or by serving as starting points that feed into a drug-discovery pipeline. The program also created PubChem - a public database for disseminating the chemical probes and the results of high-throughput screening (HTS) assays which test the biological and physical properties of the molecules.

The FY 2011 target was to increase the rate of depositing bioassays into PubChem to 5 per month. The Molecular Libraries Program (MLP) exceeded annual performance targets for high-throughput screening (HTS) assays, chemistry projects, small molecule probes, and deposition of biological data into the PubChem database. For example, in FY2011 the MLP made the results of 103 HTS assays screened against 300,000 compounds freely available to researchers through PubChem (an average of 8.58 assays per month), along with detailed information on the probes developed through the screening process. In addition, the HTS assay campaigns to date have led to more than 230 chemistry projects and generated 229 small molecule probes. The improvement in the rate of HTS per month is due to two factors. The first is a progressive improvement in the process of assay setup, screening and hit validation by the screening centers. The second is due to improved outreach by the network that has resulted in increased familiarity with the assay and better communication with the assay provider prior to screening. Both factors have resulted in greater efficiency in the time taken to cycle new projects into the centers and aided in avoiding potential screening problems.

To date, the MLP has:

  • Successfully advanced a number of compounds into further development as therapeutic leads for the treatment of cancer and Alzheimer’s disease (http://commonfund.nih.gov/molecularlibraries/);
  • Identified compounds that are selective inhibitors of T.cruzi, a parasite that causes Chagas disease [1]; and,
  • Identified one compound that is currently being tested in Phase I clinical safety studies by a start-up biotech company for the potential treatment of multiple sclerosis.

 [1]Chagas disease is caused by Trypanosoma cruzi, a parasite related to the African trypanosome that causes sleeping sickness.

Data Source: Publications, databases, administrative records and/or public documents

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2.A.30 Increase the number of Effective Health Care (EHC) Program products available for use by clinicians, consumers, and policymakers.

Lead Agency: Agency for Healthcare Research and Quality (AHRQ)

Effective Health Care (EHC) Program products provide evidence on the effectiveness, including benefits and harms, of different treatment options. These products aim to provide objective information to the clinicians, consumers, and policymakers, and are available free to the public on the Effective Health Care website at www.EffectiveHealthCare.ahrq.gov. The products include:

  1. Systematic Reviews that report on available scientific studies to systematically assess the effectiveness and comparative effectiveness of different health care interventions,
  2. Research Reports and peer-reviewed scientific manuscripts that are based on clinical research and studies that use health-care databases and other scientific resources and approaches to explore practical questions about the effectiveness — benefits and/or harms — of treatments or other health care services, and
  3. Summary Guides that provide short summaries of the findings of systematic reviews, written in plain language and tailored to clinicians, consumers, or policymakers.

These products serve to inform and facilitate decision-making on treatments and health care services to be evidence-based as well as identify knowledge gaps and future research needs. The ultimate aim is to help improve care.

In FY 2011, the EHC Program released 24 Systematic Reviews, 9 Research Reports, and 35 Summary Guides; a total of 68 EHC products. This represents an increase from the previous fiscal year of 51 EHC products. It is noted, however, that this target is set annually based on several factors, including the anticipated number of funded projects and the scope of those projects, as such, the projected number of products to be released in FY2012 is 26. Some of the products released to date include:

  • Diagnosis and Treatment of Obstructive Sleep Apnea in Adults
  • Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults-Clinician Guide
  • Treating Sleep Apnea: A Review of the Research for Adults
  • Tratamiento para la apnea del sueño: Revisión de la investigación para adultos
  • Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
  • Comparative Effectiveness of Interventions for Rotator Cuff Tears in Adults – Clinician Guide
  • Treatment Options for Rotator Cuff Tears: A Guide for Adults
  • Opciones para tratar el desgarro de los músculos y tendones del hombro: Guía para adultos con lesiones en el manguito de los rotadores
  • Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update
  • Comparing Medications for Adults With Type 2 Diabetes – Clinician Guide
  • Medicines for Type 2 Diabetes: A Review of the Research for Adults
  • Medicamentos para la diabetes tipo 2: Revisión de la investigación para adultos
  • Registries for Evaluating Patient Outcomes: A User’s Guide: 2nd Edition
  • Identification of Future Research Needs in the Comparative Management of Uterine Fibroid Disease
  • Attention Deficit Hyperactivity Disorder Medications and Risk of Serious Cardiovascular Disease in Children and Youth
  • Prevalence of diabetes, diabetic foot ulcer, and lower extremity amputation among Medicare beneficiaries, 2006-2008
  • Trends in the utilization of erythropoiesis-stimulating agents among Medicare beneficiaries with kidney disease

Number of effective healthcare products

Data Source: All AHRQ systematic reviews are entered into a database, which is used to populate the AHRQ Effective Health Care Program Web site, http://effectivehealthcare.ahrq.gov/.

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Goal 2: Advance Scientific Knowledge and Innovation

Objective B: Foster innovation at HHS to create shared solutions

2.B.05 Increase number of identified opportunities for public engagement and collaboration among agencies

Lead Agency: Immediate Office of the Secretary (IOS)

Enhancing opportunities for public participation and collaboration in HHS activities is a key priority for the HHS Open Government efforts. It is widely understood that to effectively deliver on our mission, we must leverage the collective creativity and wisdom of our stakeholders. Federal Advisory Committees are one key way of ensuring public and expert involvement and advice in Federal decision-making. Another way to involve the public in helping HHS to solve pressing agency problems is through the use of challenges and competitions in which members of the public can participate. Other opportunities include mechanisms such as feedback websites and listening sessions. This quantitative measure is a combined summary of 1) all identified opportunities made available to the public on our “Get Involved” page at http://www.hhs.gov/open/initiatives/index.html and 2) all challenges and competitions that are made available to member of the public at http://challenge.gov/HHS

In CY 2011, HHS exceeded its targets. The Department projected 317 engagement opportunities and identified at 334 opportunities in that year. Based on comments received through the HHS blog on the HHS Open Government website, and basic web analytics such as on-line inputs it appears that HHS’s efforts are increasing visibility of participation and collaboration opportunities. As the HHS Innovation Council continues to assist HHS OPDIVS and STAFFDIVS in understanding the tools available to enhance public participation and collaboration and works with the agencies to implement new authorities under the America COMPETES Act of 2011 (which provides federal agencies with broad legal authority to run public-facing challenges with purse prizes) we should expect to see additional public engagement and collaboration opportunities identified in the future.

Number of activities including public engagement

Data Source: "Get Involved" website http://www.hhs.gov/open/initiatives/index.html and HHS-sponsored challenges listed on the Challenge.Gov website at http://challenge.gov/HHS

Also Supports: HHS Strategic Plan 4.C and Open Government Plan

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2.B.10 Increase number of high-value data sets and tools that are published by HHS

Lead Agency: Immediate Office of the Secretary (IOS)

A high priority for the HHS Open Government Plan is to make HHS data more available to the public. The HHS Data Council is working with the CIO Council to enhance opportunities for publishing data and tools. This information can be used to increase agency accountability and responsiveness, improve public knowledge of the agency and its operations, further the core mission of the agency, create economic opportunity, or respond to need and demand as identified through public consultation. In addition, these data sets can be used by researchers and analysts to add knowledge and understanding to existing health and human service issues. This quantitative measure is based on real time submissions posted at http://www.healthdata.gov.

In CY2011, HHS published 103 datasets bringing the total number of datasets to 282. These results, which exceeded initial projections, were the result of the high quality datasets developed and maintained by HHS agencies; and of HHS Data Council and HHS chief Technology Officer’s outreach efforts to the HHS community and review of potential submissions.

 Number of cumulative datasets published by HHS

Data Source: www.healthdata.gov

Also Supports: HHS Strategic Plan 4.C and Open Government Plan

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2.B.15 Increase the number of participation and collaboration tools and activities conducted by the participation and collaboration community of practice

Lead Agency: Immediate Office of the Secretary (IOS)

Developing new types of effective collaboration and participation initiatives at HHS often involves a focused effort by a select group of individuals. HHS’s approach takes two forms: in some instances these new initiatives have been seeded by members of the HHS OS’s Innovations Team; and in others they have been led by HHS operating and staff divisions. The HHS Innovation Council has a small team of individuals that has made itself available to provide guidance and technical expertise to agencies to a select number of agencies each year. This quantitative measure consists of the major consulting projects undertaken by the HHS Innovations staff and its consulting team.

In CY 2011, all targets were met. Each of the projects is labor-intensive, and thus only a few projects are selected in each year. The eight projects undertaken by the HHS Innovations Staff and its consulting team (in collaboration with relevant HHS operating and staff divisions): 1) launch and development of a Health Indicators Warehouse, available at http://healthindicators.gov/; 2) management of the federal-wide Ideation Community of Practice, including outreach initiatives specifically designed for the HHS community such as a webinar and podcast on the use of ideation tools; 3) development of “Challenge and Competitions Toolkit” available at http://www.hhs.gov/open/initiatives/challenges/index.html; 4) development of data visualization tools for large HHS data sets; 5) launch of two additional rounds of HHSinnovates competition, an HHS-wide competition to identify and promising approaches at HHS (more information about the competition and prior winners can be found at http://www.hhs.gov/open/initiatives/hhsinnovates/gallery.html ); 6) evaluating the feasibility of implementing web 2.0 organization website using open source tools; 7) improving correspondence management at the HHS Executive Secretariat using enterprise-wide systems; and 8) leadership of a Text4Health TaskForce to explore ways in which mobile health messaging could be further utilized as a means of communicating with our stakeholders.

Number of Consultative Projects

Data Source: HHS Innovation Council Administrative records

Also Supports: HHS Strategic goal 4.C and Open Government Plan

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Goal 2: Advance Scientific Knowledge and Innovation

Objective C: Invest in the regulatory sciences to improve food and medical product safety

2.C.05 The average number of days to serotype priority pathogens in food (Screening Only).

Lead Agency: Food and Drug Administration (FDA)

FDA Foods Program scientists are evaluating commercially available instrumentation that can be adapted to support the FDA regulatory mission. CFSAN has advanced two of these technology platforms to Field laboratories, the Bioplex system and the Ibis Biosensor. The instrumentation is laboratory-based and provides broad-range and strain-specific identification of infectious organisms for multiple applications (clinical and environmental). CFSAN has coordinated technology placement and reagent distribution for FDA field use of the Bioplex system and detection method. The Bioplex platform has been validated extensively and is now deployed in nearly all FDA field laboratories as well as in CFSAN and CVM laboratories, providing highly accurate and rapid serotype results for the FDA Foods Program. Coupled with current Salmonella detection and isolation strategies in foods, the technique is enhancing FDA regulatory activities for this pathogen and shortening FDA response time during foodborne outbreaks involving Salmonella. CFSAN researchers will continue to coordinate testing and refinement of the technology for FDA’s needs.

The improvements in sample throughput, along with the high degree of specificity built into this technology, will dramatically improve our response and traceback capabilities. When fully deployed, this technology holds the promise of reducing the time to conduct these analyses from 14 days to less than a week. In FY 2011, FDA exceeded the target by reducing the average number of days to serotype priority pathogens in foods to seven days, two days less than the target of nine days.

Number of Days to Serotype

Data Source: BioPlex and ibis Biosensor systems

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2.C.15 Promote innovation and predictability in the development of safe and effective nanotechnology-based products by establishing scientific standards and evaluation frameworks to guide nanotechnology-related regulatory decisions.

Lead Agency: Food and Drug Administration (FDA)

For the FDA, a science-based regulatory agency whose mission is to protect and promote public health, nanotechnology poses regulatory challenges that are inherent in emerging technologies. Like many emerging technologies, there is the potential benefit that nanotechnology can bring to food, medicine, and other FDA-regulated product areas, but the risks to human and animal health are not yet completely identified or understood. Establishing scientific standards and evaluation frameworks to guide nanotechnology-related regulatory decisions will promote innovation and predictability in the development of safe and effective nanotechnology-based products.

In February 2010, the FDA Nanotechnology Task Force developed and published the agency’s FY 2011 regulatory science research plan for nanotechnology that enables regulatory science studies relevant for the development of safe and effective nanotechnology-based products (http://www.nano.gov/node/581). The Task Force presented the agency’s FY 2011 research plan to the Science Board in a public forum in August 2010, and solicited comments from the Science Board and the public. The Science Board concurred with FDA’s FY 2011 research plan, including supporting studies such as those described above for the responsible development of nanotechnology. In FY 2011, FDA plans to implement its proposed regulatory science research plan for nanotechnology, including developing the CORES (Collaborative Opportunities for Research Excellence in Science) Program to support studies that can serve as a platform for the targets above, building laboratory capacity to assess nanotechnology products, and investing in training and staff development in the area of nanotechnology.

Data Source: FDA Nanotechnology Task Force; National Nanotechnology Initiative (NNI); Science Board to the FDA; FDA staff presentations at public meetings; and manuscripts and other written materials for publication in peer-reviewed journals and other communication forums.

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Goal 2: Advance Scientific Knowledge and Innovation

Objective D: Increase our understanding of what works in public health and human service practice

2.D.10 Increase access to and awareness of the Guide to Community Preventive Services, and Task Force Findings and Recommendations, using page views as proxy for use

Lead Agency: Centers for Disease Control and Prevention (CDC)

CDC systematic reviews of scientific literature form the basis for evidence-based Community Preventive Services Task Force (Task Force) recommendations about effective programs, services and policies for improving health and preventing many chronic and infectious diseases and injuries. To achieve their maximum health impact, Task Force recommendations must be disseminated, adopted and used by public health leaders, practitioners and partners.

This measure tracks awareness and use of Community Guide findings and recommendations. A new survey that will measure use of the Community Guide’s recommendations and findings is currently under development. In the short term a proxy measure—page views of the Community Guide website (www.thecommunityguide.org)—will monitor awareness. CDC will strengthen the way in which we measure how the Community Guide's evidence based recommendations and findings are used.

There were 927, 357 page views in 2011 (baseline). Complementing page views, there were nine reviews completed by CDC in FY 2011, including updates of previous reviews.

Number of Community Guide Website pageviews

Data Source: The data source for this measure is Omniture® web analytics, which is a software product that provides consolidated and accurate statistics about interactions with CDC.gov

Also Supports: HHS Strategic Plan 4.C

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Goal 3: Advance the Health, Safety and Well-Being of the American People

Objective A: Promote the safety, well-being and healthy development of children and youth

3.A.04 Increase the number of states that implement Quality Rating and Improvement Systems (QRIS) that meet high quality benchmarks*

Lead Agency: Administration for Children and Families (ACF)

This developmental measure tracks state progress toward implementing Quality Rating and Improvement Systems (QRIS), which provide information on the quality of early childhood development programs for parents. This measure is part of HHS’ High Priority Performance Goals and supports the Administration’s focus on serving more low-income children in high quality early care and education settings. The measure promotes states’ efforts to effectively implement QRIS by increasing the number of states that meet high quality benchmarks. QRIS is a mechanism by which to improve the quality of child care available in communities and increase parents’ knowledge and understanding of the child care options available to them. QRIS creates pathways to higher quality for child care providers and supports movement up the pathways through training, technical assistance, and compensation and financial incentives tied to professional development. When implemented effectively, QRIS can help improve the overall quality of care available and potentially improve child outcomes as a result.

Since the Child Care and Development Fund (CCDF) is a program that emphasizes parental choice, it is important to improve the overall quality of early care and education across a range of settings in order to improve choices available to low-income parents. Improving access to high quality child care enables parents to work and participate in educational and training opportunities to improve their lives. High quality early care and education programs are especially important for low-income children as they provide a place for learning and social emotional development and can help meet health and nutritional needs. The National Institute of Child Health and Human Development (NICHD) study of Early Child Care and Youth Development demonstrates that enrollment in high quality programs can lead to better performance in school and positive outcomes for children. QRIS has been recognized as a systematic approach for promoting quality of early childhood and afterschool programs, and it is important to track the development and implementation of QRIS across the country. As of the summer of 2011, 25 states have implemented QRIS statewide, and the majority of the remaining states are piloting or planning QRIS. The baseline for measure 2B, once established, will reflect the number of states meeting benchmarks of a high quality QRIS.

The ACF Office of Child Care plans to have baseline data available by summer 2012 as to the number of states/territories that meet high quality benchmarks for child care and other early childhood programs.

Data Source: Biennial CCDF State Plan Preprint, CCDF quality performance report.

Also Supports: This measure also supports HHS Secretarial Priorities "Put Children and Youth on the Path for Successful Futures" and "Promote Early Childhood Health and Development."

* This is an HHS FY 2012 – FY 2013 Priority Goal indicator. To see more information about HHS Priority goals go to www.performance.gov

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3.A.08 Reduce the proportion of grantees receiving a score in the low range on the basis of the Classroom Assessment Scoring System (CLASS: Pre-K)*

Lead Agency: Administration for Children and Families (ACF)

This developmental annual measure supports the current FY 2012-2013 HHS Priority Performance Goal and draws upon research findings that underscore the importance of teacher-child interactions as a demonstrated measure of classroom quality and in promoting children’s social and cognitive development. In response to these research findings, HHS launched a pilot of the Classroom Assessment Scoring System (CLASS: Pre-K) in FY 2009 and began assessing each classroom with the CLASS: Pre-K instrument during onsite monitoring reviews in FY 2010. The Office of Head Start (OHS) is developing an annual performance measure to track the proportion of grantees receiving a score in the low range on the basis of the CLASS: Pre-K with the goal of reducing that proportion over time.

Annual measure 3A is a developmental outcome measure, and the Office of Head Start (OHS) began its baseline data collection in the 2011-2012 school year. OHS will set rigorous performance targets when it has baseline data in fall 2012. Using the data collected for this measure, OHS will be able to provide targeted training and technical assistance to grantees. Research shows that children’s outcomes are not related to classroom quality when classroom quality is below a certain level as measured by the CLASS: Pre-K. In classrooms where teachers were rated showing lower levels of emotional and instructional support on the CLASS: Pre-K, children experienced no benefits from the interactions with their teachers. Focusing on assisting programs move into the moderate and high- range of classroom quality is critical to enhancing children’s school readiness. The Training & Technical Assistance system is key to helping programs to improve their scores on the CLASS: Pre-K. The National Center for Quality Teaching and Learning assists programs in providing effective resources, such as Understanding and Using the CLASS for Program Improvement (http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/teaching/docs/class-brief.pdf), and conducting training. For example, the National Center facilitated a training session with Early Childhood Education (ECE) Specialists on CLASS: Pre-K as a professional development tool. ECE Specialists, who work directly with grantees, assist programs understand their scores and develop strategies and improvement plans for individual teachers.

Data Source: Classroom Assessment Scoring System (CLASS: Pre-K)

Also Supports: This measure also supports HHS Secretarial Priorities "Put Children and Youth on the Path for Successful Futures" and "Promote Early Childhood Health and Development."

* This is an HHS FY 2012 – FY 2013 Priority Goal indicator. To see more information about HHS Priority goals go to www.performance.gov

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3.A.35 Increase the percentage of children receiving trauma informed services showing clinically significant improvement

Lead Agency: Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA is refining and beginning the implementation of its Strategic Initiative on Trauma and Justice. This includes a number of steps to improve its approach to violence and trauma, but one of the key programs of focus is the National Child Traumatic Stress Initiative. This program is ongoing and is being used as a proxy measure for the success of this initiative. It represents a critical outlet to develop, test, and implement evidence-based practices in trauma-related care for children.

Based on data from FY 2010, SAMHSA has made strong progress towards the goal of addressing trauma and violence based on this chosen proxy measure. There has been substantial improvement in the percentage of children showing clinically significant improvement as a result of the services provided by the National Child Traumatic Stress Initiative (NCTSI) in recent years. From FY 2007 to FY 2010, the program has had (approximately 10%) notable increases in the data recorded. This shows that this program is working in the communities that it serves and therefore is improving the outcomes for children with trauma-related mental health issues. Now, when viewing the FY 2011 data, it should be noted that the actual has decreased due to a licensing issue that has now been cleared up; therefore, we expect the actuals for future years to increase to the FY 2011 actuals or above.

Percent of children who improve after trauma informed services

Data Source: Baseline and follow-up data are collected by the NCTSI cross-site evaluator, ICF Macro, using the Core Data Set (CDS), a secure web-based system. Three standardized behavioral/symptomology measures (CBCL, TSCC, and PTSD-RI) are used to assess improvement in children’s outcomes.

Also Supports: HHS Strategic Plan 2.D; 3.A; SAMHSA Strategic Initiative on Trauma and Justice

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Goal 3: Advance the Health, Safety and Well-Being of the American People

Objective B: Promote economic and social well-being for individuals, families and communities

3.B.12 Maintain the IV-D (child support) collection rate for current support.

Lead Agency: Administration for Children and Families (ACF)

The collection rate for current child support (annual measure 20C), an important proxy for the regular and timely payment of support, compares total dollars collected for current support in IV-D cases with total dollars owed for current support in IV-D cases. Over the last decade, the child support program has nearly doubled the amount of total distributed collections, going from $14.3B in FY 1998 to $26.6B in FY 2008—an increase of more than 85%.

Fiscal year 2009 and 2010 data suggest that outcomes in this area weakened, most likely as a result of the slow economic recovery. The total amount of child support distributed as current support in FY 2010 was $20 billion which remains unchanged from FY 2008 and 2009, and was partly attributable to a sharp increase in collections withheld from unemployment compensation benefits. The total amount of current support due in FY 2010 was over $32 billion. This provided a collection rate for current support of 62%, which met the target of 62% for FY 2010. The percent collection rate target for FY 2012 and FY 2013 will remain at 62%. OCSE continues to increase the current support collection rate by working with parents to ensure that they have the tools and resources they need to provide for their children, focusing on new and improved enforcement techniques, and preventing and addressing accumulated child support debt

Child Support Collection Rate

Data Source: Office of Child Support Enforcement (OCSE) Form 157

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3.B.14 Increase the percentage of adult TANF recipients who become newly employed.

Lead Agency: Administration for Children and Families (ACF)

The Temporary Assistance for Needy Families (TANF) measures, taken together, assess the extent to which recipients move from welfare to work and self-sufficiency. Full success requires not only that recipients get jobs, but also that they stay in employment and increase their earnings in order to reduce dependency and enable families to support themselves. This annual measure addresses the rate of job entry for TANF recipients.

In FY 2010, 25.1% of TANF recipients became newly employed. States continue to help TANF adult recipients enter employment, and these efforts have been augmented by other factors including the employment focus of Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), ACF’s commitment to finding innovative and effective employment tools through research, and the identification and dissemination of information on the effects of alternative employment strategies and a range of targeted technical assistance efforts. While these approaches have been helpful in the past, it is now clear how much the weak economy has affected performance on this measure. The employment entry rate for TANF recipients fell in fiscal years 2008, 2009, and 2010. The challenging labor market in many states may make it difficult to achieve the goal of increasing the number of adult TANF recipients that enter the workforce.

The FY 2012 target is to improve by 0.3 percentage points over the FY 2011 actual result; the FY 2013 target is to improve by 0.3 percentage points over the FY 2012 actual result; and the FY 2015 target is to improve to 28.1% (1.9 percentage points over the FY 2009 actual result of 26.5%).

Percentage of Newly Employed TANF Adults

Data Source: National Directory of New Hires (NDNH)

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3.B.20 Increase the percentage of refugees entering employment through ACF-funded refugee employment services.

Lead Agency: Administration for Children and Families (ACF)

This annual performance measure reflects the emphasis of the Office of Refugee Resettlement (ORR) on improving grantees’ ability to assist refugees in entering employment. States (including states providing services under the Wilson-Fish program) with an entered employment rate (EER) of less than 50% are expected to achieve an annual increase of at least 5% over the prior year’s actual percentage outcome. States with an EER greater than 50% are expected to achieve an annual increase of at least 3% over the prior year’s performance. States that reach a high employment and self-sufficiency rate of 85% among employable refugees may choose to maintain their target levels rather than increase them. Although there are no monetary punishments or rewards, ORR has implemented a number of strategies and incentives aimed at challenging states to improve performance for targets that were not achieved. ORR publishes state performance results in the Annual Report to Congress and ORR teams negotiate the targets and provide technical assistance and monitoring to the states to achieve mutually acceptable goals.

In FY 2010, this annual measure exceeded the target of 40.87% with an actual result of 42.13%. The difficult economic climate has made the achievement of employment target for refugees particularly difficult to achieve. In addition, ORR faces challenges in terms of performance on this measure given the changing demographics of the U.S. Resettlement Program, as many populations require extended employment services in order to enter the U.S. labor market and integrate into U.S. society. Many recent arrivals have spent protracted periods of time in refugee camps in countries of first asylum, have experienced intense trauma, and have limited work skills. By FY 2013, the program aims to continue to increase performance to 46.5% by improving ORR’s collaboration with states and Wilson-Fish agencies to better communicate ORR priorities and to share knowledge of best practices that can be transferred across programs. This endeavor includes increasing ORR monitoring activities in which program challenges are followed up with technical assistance and further monitoring. ORR is also intending to work more closely with technical assistance providers to ensure effective guidance to states and Wilson-Fish agencies. ORR plans to work with states and Wilson-Fish agencies to improve data collection procedures and reporting processes.

Percentage of refugees entering employment through ACF-funded refugee employment services

Data Source: Performance Report (Form ORR-6)

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Goal 3: Advance the Health, Safety and Well-Being of the American People

Objective C: Improve the accessibility and quality of supportive services for people with disabilities and older adults

3.C.10 90% of Family Caregiver Support Services clients rate services good to excellent.

Lead Agency: Administration for Community Living (ACL)

ACL's Administration on Aging (AoA) Family Caregiver Support Services enables family members who have a loved one with disabilities or conditions which require assistance to use an array of supportive services including: respite care, information and assistance, support groups, and training. Caregivers are frequently under substantial strain with the responsibilities of caring for their ill relative while also caring for children or other family members while employed. A random sample of caregivers are surveyed to report on the quality and impact of service. This measure is part of a set of measures which also include assuring targeting services to those most in need and tracking program efficiency.

For the past five years 90% or more of caregivers have reported the quality of the service was good to excellent. The Aging Services network is committed to continuing this positive trend in the future. In addition to the general high rating, several specific indicators related to performance quality are consistently high. 89% report the services help them to be a better caregiver; 75% report feeling less stressed due to the services; 94% believe that the care recipient benefits from the caregiver services received.

Percent caregivers reporting service good to excellent

Data Source: National Survey of Older Americans Act Participants

Also Supports: HHS Strategic Plan Objectives 1.E and 3.B

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3.C.15 90% of home delivered meal clients rate services good to excellent.

Lead Agency: Administration for Community Living (ACL)

ACL's Administration on Aging (AoA) funds home delivered meals for elderly individuals who are too ill or too frail to be able to prepare their own meals. Obtaining adequate nutrition is key to recovery from recent illness or hospitalization, and is important in managing chronic conditions including diabetes and heart disease. Nearly 40% of home delivered meal clients have 3 or more Activity of Daily Living (ADL) limitations, the same level of disability that is required for nursing home placement. Eighty 3% of service participants report that the meals help them remain at home and live independently in the community. This measure documents client reported quality and is part of a set of measures which also include assuring targeting services to those most in need and measuring program efficiency.

For the past five years 90% or more of the clients have reported the quality of the service was good to excellent. The Aging Services network is committed to continuing this positive trend in the future. In addition to the general high rating, several specific indicators related to performance quality are consistently high. 93% of home delivered meal recipients said that their meals are delivered always or usually on time; 96% would recommend the service to a friend; 87% report that receiving the meals improves their health.

Percent meal clients rating service good to excellent

Data Source: National Survey of Older Americans Act Participants

Also Supports: HHS Strategic Plan Objectives 1.C; 1.E; and 3.B

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3.C.16 90% of transportation clients rate services good to excellent.

Lead Agency: Administration for Community Living (ACL)

ACL's Administration on Aging (AoA) funds transportation services for elderly individuals who have mobility challenges including those who are no longer able to drive their own car or who don't have access to public transportation. Being able to get to doctor's appointments, grocery stores, senior centers, and other locations enables seniors to continue to be active and engaged in their community. More than 65% of senior transportation users indicated that they use this transportation services to get to their doctor or medical appointments; more than 50% of senior transportation users say that they use the transportation service for the majority of their trips in a month. The transportation service is key to enabling seniors to remain not only in their own home, but to be able to get out, go to appointments so they can remain healthy and connected to their community.

Client reported quality of service has been consistently high, above 90%, for several years. The Administration for Community Living is committed to continuing high quality service in the future. In addition to the general high rating, several specific indicators related to performance quality are consistently above 90%. In the most recent survey of participants 93% said they were always or usually picked up on time; 97% said that their driver was always or usually polite; 96% said that they always or usually arrived on time; 94% said that the transportation service always or usually gets them where they need to go.

Percent transport clients rating service good to excellent

Data Source: National Survey of Older Americans Act Service Participants

Also Supports: HHS Strategic Plan Objectives 1.C; I.E; and 3B.

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Goal 3: Advance the Health, Safety and Well-Being of the American People

Objective D: Promote prevention and wellness

3.D.05 Reduce annual adult's cigarette consumption in the United States (per capita)*

Lead Agency: Office of Assistant Secretary for Health (OASH)

This is a HHS Performance Goal for FY12-13, lead by the Office of the Assistant Secretary for Health and jointly supported by CDC, CMS, FDA, HRSA, IHS, NIH and SAMHSA. Per capita cigarette consumption data, which reflect cigarettes legally purchased for domestic consumption, is a key measure that has been used by researchers in the United States and other countries to objectively measure cigarette use and the impact of tobacco control measures on cigarette use over time.

In the United States, per capita cigarette consumption has been declining since its peak in the early 1960s. In the last 10 years per capita cigarette consumption has declined at an average rate of 5% a year. Continued implementation of the HHS tobacco control and prevention strategy may increase this yearly rate of decline to 6% a year, leading to a targeted reduction of 17% from the 2010 baseline by the end of 2013.

Annual Adult Cigarette Consumption in the U.S. (per capita)

Data Source: The data sources are the Department of Treasury’s Alcohol and Tobacco Tax and Trade Bureau (TTB), and the U.S. Census Bureau.

Also Supports: Tobacco control is one of the Secretary’s Priorities and Strategic Initiatives in the Secretary’s Strategic Plan. In November 2010, the U.S. Department of Health and Human Services issued a Tobacco Control Strategic Action Plan, Ending the Epidemic – A Tobacco Control Strategic Action Plan, outlining a set of comprehensive actions framed around four Healthy People 2020 tobacco control objectives: 1) reduce tobacco use by adults and adolescents, 2) reduce the initiation of tobacco use among adolescents, and young adults, 3) increase successful cessation attempts by smokers, 4) and reduce the proportion of nonsmokers exposed to secondhand smoke. The National Prevention Strategy, released in 2011, includes tobacco control as one of seven priorities across the U.S. Government.

* This is an HHS FY 2012 – FY 2013 Priority Goal indicator. To see more information about HHS Priority goals go to www.performance.gov

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3.D.15 Reduce the proportion of adolescents (grade 9 through 12) who are current cigarette smokers.

Lead Agency: Centers for Disease Control and Prevention (CDC)

More than 80% of adult smokers begin smoking before 18 years of age. This measure focuses on reducing youth smoking, which complements CDC’s focus on reducing adult smoking. Understanding the trends in the prevalence of cigarette smoking among youths enables policy makers to target prevention resources more effectively. CDC provides national leadership for a comprehensive, broad- based approach to reducing tobacco use which involves: preventing young people from starting to smoke; eliminating exposure to secondhand smoke; promoting quitting; and, identifying and eliminating disparities in tobacco use among population groups. It also develops health communication campaigns aimed at informing the public about the health risks associated with tobacco use and secondhand smoke exposure, and reducing disparities in these exposures.

Every two years, CDC analyzes data from the national Youth Risk Behavior Survey (YRBS) to evaluate trends in cigarette use among high school students in the United States. Youth (grades 9-12) cigarette use declined sharply during 1997–2003; however, this decline has slowed over the past several years, fluctuating between 20% and 23% from 2003 to 2007. From 2007 to 2009, youth cigarette use declined slightly from 20.0% to 19.5%.

Proportion of cigarette smoking among U.S. adolescents grades 9 - 12

Data Source: The primary data source for setting and reporting targets is the Youth Risk Behavior Surveillance System (YRBSS), which monitors priority health-risk behaviors and is conducted every other year (odd years). Beginning in FY 2011, the National Youth Tobacco Survey (NYTS) was added as an additional data source, which tracks closely with YRBSS. To obtain data on an annual basis, CDC will conduct the NYTS in the intervening years.

Also Supports: Ending the Epidemic – A Tobacco Control Strategic Plan (HHS), Secretary’s Strategic initiative to Prevent and Reduce Tobacco Use, Healthy People 2020 Objective TU-2.2

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3.D.19 Increase the percentage of adults receiving homeless support services who report improved functioning

Lead Agency: Substance Abuse and Mental Health Services Administration (SAMHSA)

The intent of this measure is to determine overall health status, both physical and emotional\mental health, from the consumer’s perception of his or her recent functioning. Questions are asked specifically about how the consumer was able to deal with everyday life and how frequently the consumer experienced psychological distress within the past 30 days. The K-6 from the National Comorbidity Survey is included as part of the assessment. As of January 2012, grantees have cumulatively provided 9,951 persons with comprehensive and coordinated mental health and related services. Nearly two-thirds of those served have demonstrated improvement in behavioral health functioning.

The baseline for this measure, 68.4%, was set in FY 2008 based on 548 people served that year. In FY 2009, 43 new grants were issued. This drop in outcome is due to the large influx of consumers entering the program in FY 2009. Five new grants were awarded in FY 2010, bringing the grant portfolio that year to 62 grants. Although targets since FY 2009 have not been met, there are improvements each year as new consumers begin to receive housing and wrap around services. In FY 2011, SAMHSA awarded 23 grants designed to ensure that the most vulnerable individuals "who are chronically homeless" receive access to sustainable permanent housing, treatment, and recovery supports. With the expansions occurring in FY 2012, SAMHSA expects to significantly increase supportive services in conjunction with permanent housing

Percentage of Adults who improve functioning after receiving homeless support services

Data Source: Data are collected through standard instruments and submitted through the TRAC on-line data reporting and collection system.

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3.D.36 Decrease underage drinking as measured by an increase in the percent of SPF SIG states that show a decrease in 30-day use of alcohol for individuals 12 - 20 years old

Lead Agency: Substance Abuse and Mental Health Services Administration (SAMHSA)

Underage drinking prevention is a key component of the Strategic Prevention Framework State Incentive Grant (SPF SIG) program, for HHS and for the nation as a whole. The SPF SIG program provides funding to States, Federally recognized Tribes and U.S. Territories to support local communities in preventing the onset and progression of substance abuse and substance abuse-related problems including underage drinking. The SPF SIG program also provides a unique opportunity for States, Tribes, Territories and their communities to build capacity and a prevention infrastructure based on SAMHSA’s Strategic Prevention Framework Over the long term, it is anticipated that the capacity and interventions implemented through the SPF SIG program can make a difference at the state level. This measure will monitor the progress of the program toward the goal of reducing underage drinking.

Performance data has shown that the SPF SIG program has been able to meet or exceed targets related to decreasing past 30-day alcohol use among persons aged 12 to 20 for three consecutive fiscal years. Specifically, data have shown that since FY 2008, over 50% of SPF SIG grantees have observed decreases in past 30-day alcohol use among underage youth. These results are supported by findings from the National Survey on Drug Use and Health (NSDUH), as well as other nationally representative studies (e.g., Monitoring the Future Survey, Youth Risk behavior Survey) which suggest that alcohol use continues to be on a long-term gradual decline among this age group[2][3] [4]."http://www.cdc.gov/healthyyouth/yrbs/pdf/us_alcohol_trend_yrbs.pdf".

In addition to performance data at the state-level, community-level data have shown that over 50% of SPF SIG sub-recipient communities have also observed reductions in past 30-day alcohol use among underage persons aged 12 to 20, as well as reductions in binge drinking and DUI-related arrests. Measuring and monitoring changes at the community-level remains a vital task to understanding and predicting changes in key program outcomes at the state-level.

Percentage of SPF States showing 30-day decrease in Underage Drinking

 


[2]Substance Abuse and Mental Health Services Administration (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: SAMHSA.

[3]Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2011, December 14). National press release, "Marijuana use continues to rise among U.S. teens, while alcohol use hits historic lows." University of Michigan News Service, Ann Arbor, 61 pp.

[4]Centers for Disease Control and Prevention (2010). Trends in the Prevalence of Alcohol Use from the National YRBS: 1991—2009. Atlanta, GA; CDC. Last accessed on January 11, 2012 from  HYPERLINK "ttp://www.cdc.gov/healthyyouth/yrbs/pdf/us_alcohol_trend_yrbs.pdf"

Data Source: National Survey on Drug Use and Health

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Goal 3: Advance the Health, Safety and Well-Being of the American People

Objective E: Reduce the occurrence of infectious diseases

3.E.01 Reducing foodborne illness in the population. By December 31, 2013, decrease the rate of Salmonella Enteritidis (SE) illness in the population from 2.6 cases per 100,000 (2007-2009 baseline) to 2.1 cases per 100,000.*

Lead Agency: Food and Drug Administration (FDA)

Salmonella is the leading known cause of bacterial foodborne illness and death in the United States. Each year in the United States, food contaminated with Salmonella causes an estimated 1.3 million illnesses, including fever and diarrhea, and between 400 and 500 deaths. Salmonella Enteritidis (SE), a subtype of Salmonella, is the second most common type of Salmonella in the United States and accounts for approximately 17% of all Salmonella cases in humans. The most significant sources of foodborne SE infections are shell eggs (FDA-regulated) and broiler chickens (USDA-regulated). Preventing Salmonella infections depends on actions taken to reduce contamination of food by regulatory agencies, the food industry, and consumers, as well as actions taken for detecting and responding to outbreaks when they occur. FDA published a final egg rule, "Prevention of Salmonella Enteritidis in Shell Eggs During Production, Storage and Transportation", on July 9, 2009. This rule requires shell egg producers to implement controls to prevent SE from contaminating eggs on the farm and from further growth during storage and transportation. The regulation also requires egg producers to maintain records concerning their compliance with the egg rule and to register with FDA. The final rule is expected to reduce SE-associated illnesses and deaths by reducing the likelihood that shell eggs are contaminated with SE.

FDA seeks to decrease the rate of SE illness in the population by 10%. The baseline, provided by CDC, is the average annual rate of SE illness in the population from 2007 through 2009. The target is a 10% reduction in that rate, which would result in a rate of 2.3 cases per 100,000 by the end of calendar year 2011. CDC will provide the data to report progress on this goal. The CY 2011 actual data will be available in June 2012.

Number of Salmonella Enteridis Cases per 100,000

Data Source: CDC/FoodNet

Also Supports: This measure also supports Healthy People 2020.

* This is an HHS FY 2012 – FY 2013 Priority Goal indicator. To see more information about HHS Priority goals go to www.performance.gov

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3.E.30 Proportion of racial/ethnic minorities in Ryan White HIV/AIDS-funded programs served.

Lead Agency: Health Resources and Services Administration (HRSA)

Even though new HIV infections among racial/ethnic minorities overall have been roughly stable, compared with non-racial/ethnic minorities they continue to account for a higher proportion of cases at all stages of HIV – from new infections to death. The proportion of the Ryan White program’s service population that comprises racial/ethnic minorities is an indicator of access to treatment for populations disproportionately impacted by HIV/AIDS.

The goal for this measure is that the proportion of racial and ethnic minorities in Ryan White HIV/AIDS-funded programs served exceeds their representation in national AIDS prevalence data, as reported by the Centers for Disease Control and Prevention (CDC), by 5 percentage points. In FY 2009 73% of the Ryan White HIV/AIDS program clients were racial/ethnic minorities compared to 66.4% of CDC-reported AIDS cases. In FY 2010, 72% of Ryan White program clients were racial/ethnic minorities. CDC AIDS data for 2010 are not available for comparison as of this writing. The Ryan White HIV/AIDS Program has historically seen a greater proportion of racial/ethnic minorities than are represented in CDC AIDS data.

Data Source: HRSA HIV/AIDS Bureau's Ryan White HIV/AIDS Program Services Report

Also Supports: Healthy People 2020, HIV-2.

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3.E.35 Reduce the estimated number of cases of healthcare associated invasive Methicillin-resistant Staphylococcus aureus (MRSA) infections.

Lead Agency: Centers for Disease Control and Prevention (CDC)

Healthcare-associated infections (HAIs) are a major public health problem in the U.S. and account for a substantial portion of healthcare–acquired conditions that harm patients receiving medical care. Infections caused by MRSA are associated with high morbidity and mortality. Based on estimates from CDC’s Emerging Infections Program, there were approximately 82,000 invasive MRSA infections in 2010; 82% (67,000)[5] were healthcare- associated. This measure tracks the total number of healthcare- associated invasive MRSA cases reported per year.

In 2009, the Department released the HHS Action Plan to Prevent Healthcare-Associated Infections. The Action Plan identified MRSA prevention as an HHS priority and proposed national 5-year prevention targets and metrics. This new objective to reduce the incidence of healthcare-associated invasive MRSA is consistent with the HHS Action Plan targets and metrics.[6]

Estimated healthcare-associated invasive MRSA infections decreased by almost 7% from 71,828 in FY 2009 to 67,000 in FY 2010.

 Number of healthcare associated invasive MRSA cases

 

[5]Methods for calculation of MRSA results and targets were refined; targets and results are rounded to reflect variability in estimates

[6]Centers for Medicare & Medicaid Services. Hospital-acquired conditions. Baltimore, MD: US Department of Health and Human Services, Centers for Medicare & Medicaid Services; 2010. Available at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/?redirect=/hospitalacqcond/06_hospital-acquired_conditions.asp Accessed August 12, 2013.

Data Source: Emerging Infections Program / Active Bacterial Core Surveillance/Emerging Infections Program Surveillance for Invasive MRSA Infections

Also Supports: HHS Strategic Plan 1.B; Healthy People 2020, HAI-2; HHS Action Plan to Prevent Healthcare Associated Infections

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Goal 3: Advance the Health, Safety and Well-Being of the American People

Objective F: Protect Americans’ health and safety during emergencies, and foster resilience in response to emergencies

3.F.05 Percentage of public health agencies that directly receive CDC Public Health Emergency Preparedness (PHEP) funding that can convene within 60 minutes of notification a team of trained staff that can make decisions about appropriate response and interaction with partners.

Lead Agency: Centers for Disease Control and Prevention (CDC)

Public health agencies must be able to rapidly convene key management staff (within 60 minutes of being notified) to appropriately respond to an emergency. This includes the integration of information and the prioritization of resources to ensure timely and effective coordination within the public health agency and key response partners. The measure requires that all reported examples of staff assembly be unannounced, whereas the previous measure allowed the reporting of both announced and unannounced examples. Since many emergencies provide little to no notice but still require a rapid response, this requirement was added to ensure that all states are able to convene key staff without prior notification.

Since 2009 (baseline), of CDC’s 62 grantees, which include states, territories and four major metropolitan U.S. cities, the proportion of grantees that successfully convened key staff within 60 minutes of notification increased from 68% to 92%, exceeding targets for FY 2010 and FY 2011.

Percent of PHEP Grantees Convening Key Responders in 60 minutes

Data Source: Self-reported data from 62 PHEP grantees.

Also Supports: Healthy People 2020, PREP-2

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3.F.15 Increase the number of new CBRN and emerging infectious disease medical countermeasures under EUA or licensed

Lead Agency: Assistant Secretary for Preparedness Response (ASPR)

ASPR’s Office of Biomedical Advanced Research and Development Authority (BARDA) manages the procurement and advanced development of medical countermeasures for chemical, biological, radiological, and nuclear agents (referred to as CBRN); Project BioShield procurements; and the advanced development and procurement of medical countermeasures for pandemic influenza and other emerging infectious diseases.

Currently there are 8 FDA-licensed seasonal, 7 pandemic H1N1 and 1 H5N1 influenza vaccines available commercially or stockpiled by BARDA. Additionally, there are FDA-licensed vaccines for smallpox and anthrax, and anti-chelating agents for radiation exposure in the Strategic National Stockpile (SNS). Two anthrax antitoxins, a botulinum antitoxin, and a smallpox vaccine for immunocompromised persons, are in the SNS and accessible under Emergency Use Authorization (EUA). BARDA will continue to initiate, monitor, and evaluate programs using established and advanced HHS procurement and program management procedures.

Data Source: ASPR contract files

Also Supports: Public Health Emergency Medical Countermeasures Enterprise Strategic Plan

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Goal 4: Increase Efficiency, Transparency, and Accountability of HHS Programs

Objective A: Ensure program integrity and responsible stewardship of resources

4.A.15 Improve the average survey results from appellants reporting good customer service on a scale of 1 - 5 at the Administrative Law Judge Medicare Appeals level

Lead Agency: Office of Medicare Hearing and Appeals (OMHA)

As part of its program assessment, the Office of Medicare Hearings and Appeals (OMHA) is evaluating its customer service through an independent evaluation that captures the scope of the Level III appeal experience. This measure will assure appellants and related parties are satisfied with their Level III appeals experience based on beneficiary survey results. OMHA is specifically seeking to assess the appellants experiences that characterize the administrative law judge hearing process, including:

  • Being informed of the hearing process and applicable rules;
  • Being informed of the status of their case;
  • Feeling there was a full opportunity to be heard and present their position;
  • Believing the decision was fair, regardless of whether they agree with the outcome.

Survey results are reviewed on an annual basis. On a scale of 1 - 5, 1 represents the lowest score (very dissatisfied) and 5 represents the best score (very satisfied). In FY 2011, OMHA achieved a 4.2 level of appellant satisfaction nationwide, exceeding the 3.4 performance target level. This result indicates the vast majority of appellants were either somewhat or very satisfied with OMHA services, from initiation of cases through closure, as well as with the hearing formats used to adjudicate their cases.

Appellant Satisfaction

Data Source: Appellate Climate Survey

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4.A.20 For Home and Community-based Services including Nutrition and Caregiver services increase the number of clients served per million dollars of Title III OAA funding.

Lead Agency: Administration for Community Living (ACL)

This indicator, increase the number of HCBS (Home and Community Based Services) clients served per million dollars of OAA (Older Americans Act) dollars, addresses performance efficiency at all levels of the National Aging Services Network in the provision of home and community-based services, including caregiver services. Access to and quality of these home and community-based services is foundational to the success of AoA’s programs. The purpose of this measure is to demonstrate the success of the Aging Network in employing available tools to enhance the use of OAA funds. This measure will be monitored in conjunction with consumer assessment of service quality to assure that increased efficiency does not result in declining service quality.

Performance has largely trended upward and performance targets (calculated as percentage increases over the FY 2002 baseline of 6,103 clients served per million dollars of OAA funding) have been consistently achieved. This reflects the success of ongoing initiatives to improve program management and expand options for home and community-based care. Aging and Disability Resource Centers (ADRCs) and increased commitments and partnerships at the State and local levels have all had a positive impact on program efficiency. In FY 2010, 8,438 clients were served. Between FY 2002 and FY 2010 performance has improved by 2,335 or 38%, without benefit of adjustment for inflation. The number of clients served is expected to grow through FY 2013

HCBS Clients Served per million dollars of OAA Funding

Data Source: State Program Report data is annually submitted by States.

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Goal 4: Increase Efficiency, Transparency, and Accountability of HHS Programs

Objective B: Fight fraud and work to eliminate improper payments

4.B.01 Estimate the Payment Error Rate in the Medicaid Program

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

The Payment Error Rate Measurement (PERM) program measures improper payments in the fee-for-service, managed care, and eligibility components of both Medicaid and the Children’s Health Insurance Program (CHIP). The PERM program measures improper payments in a rotating subset of 17 States each year.

CMS met its FY 2010 Medicaid target of 8.4% with an actual rate of 8.1%. This reflects a three year rolling average from 2009-2011. The 17 States that participated in the 2011 cycle were the same States included in the 2008 cycle. The error rate for these States dropped from 10.5 percent in 2008 to 6.7% in 2011. This drop is responsible for the lower three-year rolling error rate reported in FY 2010 and reflects the impact of effective corrective actions to decrease improper payments in fee-for-service claims. CMS will report FY 2011 results in November 2012 for the three-year rolling average of 2010-2012.

Data Source: As part of a national contracting strategy, adjudicated claims data and medical policies are gathered from the States for purposes of conducting medical and data processing reviews on a sample of the claims paid in each State. 

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4.B.02 Estimate the Payment Error Rate in CHIP

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

The Payment Error Rate Measurement (PERM) program measures improper payments in the fee-for-service, managed care, and eligibility components of both Medicaid and the Children’s Health Insurance Program (CHIP).

CMS met its FY 2010 CHIP target on August 11, 2010 to publish a final rule, effective September 10, 2010, as required by the Children's Health Insurance Program Reauthorization Act (CHIPRA). CMS has resumed CHIP measurement with the FY 2011 cycle, and will publish a CHIP error rate in the 2012 AFR. As a result, setting out-year target rates for CHIP is not applicable at this time.

Data Source: As part of a national contracting strategy, adjudicated claims data and medical policies are gathered from the States for purposes of conducting medical and data processing reviews on a sample of the claims paid in each State.

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4.B.20 Increase the percentage of administrative actions taken for Medicare providers and suppliers identified as high risk.

Lead Agency: Centers for Medicare & Medicaid Services (CMS)

The Centers for Medicare & Medicaid Services (CMS) must ensure that correct Medicare payments are made to legitimate providers for covered, appropriate and reasonable services for eligible beneficiaries. Since there is a linkage between billing fraud and enrollment fraud, CMS will perform enhanced provider enrollment reviews to prevent and detect Medicare fraud and to reduce waste, abuse and other improper payments. Although we expect to reduce the number of fraudulent providers that enroll in Medicare, we will also identify high risk providers and suppliers already enrolled in the program through comprehensive claims-based predictive analytics that are focused on fraud indicators and continuously strengthened.

Through predictive analytics and enhanced provider and supplier screening, CMS contractors will focus their activities in the areas where incidence or opportunity for improper payments and/or fraud are greatest. While this risk based approach increases contractors’ efficiency, it also reduces the burden on legitimate providers by focusing the majority of fraud detection and prevention resources on those posing a higher risk of fraud. This approach is designed to shrink the pool of unscrupulous providers over time. As new unscrupulous providers are prevented entry to the program and existing unscrupulous providers lose their billing privileges, the remaining provider pool will be relatively lower risk.

Medicare contractors have been given CMS-developed reporting requirements for data on implementation and operational activities associated with the two different components of CMS work to focus on high risk providers: enhanced provider screening and predictive analytics. As a part of this reporting, contractors will track and report the result of the administrative actions, such as the number of high risk providers whose enrollment applications are denied. The measure focuses on instances where at least one administrative action is taken for each high risk provider or supplier not the total number of administrative actions taken. Examples of administrative actions that could be taken on a high risk provider or supplier include:

  1. Targeted educational intervention with providers and suppliers who are not fully compliant with Medicare provider enrollment standards, but whose deficiencies do not rise to the regulatory threshold for revocation or deactivation.
  2. Any post-enrollment site visit, announced or unannounced.
  3. Pre-payment review of all or some of a provider's claims prior to payment (provider-specific edits) and/or review of claims for particular services most likely to be non-covered, incorrectly coded and/or not medically necessary (service-specific edits).
  4. Post-payment claims reviews, overpayment determinations and recoupment.
  5. Revocation, deactivation, or denial of the provider’s or supplier’s Medicare billing privileges.
  6. Suspension of Medicare payments to providers or suppliers.
  7. Civil monetary penalties assessed against providers and suppliers and/or their exclusion from the Medicare program.

FY 2013 and FY 2014 targets are pending.

Percentage Administrative Actions taken for Medicare providers and suppliers identified as high risk

Data Source: Developmental. CMS proposes to identify high risk providers in two ways:

  1. According to provisions included in CMS-6028-FC: Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Supplies, the Final Rule with Comment, published in the Federal Register on Feb 2, 2011, and
  2. As part of the analytics supporting the National Fraud Prevention Program announced by the Secretary on June 17, 2011. The National Fraud Prevention Program uses a dual strategy of predictive analytics and automated provider screening.

Also Supports: CMS is partnering with HHS’ Office of General Counsel and the Office of the Inspector General, the Department of Justice’s Office of the US Attorney and the Federal Bureau of Investigation to implement the full spectrum of administrative actions ranging from educational intervention through referral to the powerful tools of law enforcement to assist CMS in protecting the integrity of the Medicare Trust Fund.

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4.B.30 Decrease improper payments in the title IV-E foster care program by lowering the national error rate.

Lead Agency: Administration for Children and Families (ACF)

This annual performance measure focuses on reducing erroneous payments in the Title IV-E foster care program. The Children’s Bureau estimates the national payment error rate and develops an improvement plan to strategically reduce, or eliminate where possible, improper payments under the program. State-level data generated from the Title IV-E eligibility reviews are used to develop a national error rate estimate for the program. Eligibility reviews are routinely and systematically conducted by the Children's Bureau in each of the 50 states, the District of Columbia, and Puerto Rico to ensure that foster care maintenance payments are made only for program-eligible children in eligible placements. The eligibility review determines a state's level of compliance in meeting the federal eligibility requirements and validates the accuracy of a state's claims for federal reimbursement of foster care payments. Each eligibility review entails examination of a sample drawn from the state’s overall Title IV-E caseload for an identified six-month period under review, and specifies the number of cases in error, underlying causes of errors, and dollar amount of payment errors across the sample of cases. The fiscal accountability promoted by these reviews has contributed to reductions in case errors and program improvements. Since FY 2000, the Children’s Bureau has systematically conducted more than 170 regulatory foster care reviews, with over 16,000 foster care cases reviewed.

The Children’s Bureau has reported estimates of program improper payments and payment error rate every year since 2005. The national error rate estimate is determined using the data collected in the most recent foster care eligibility review conducted for each state and extrapolating case-level data on errors and improper payments from each state review sample for a specified period under review to each state as a whole and then to the overall program. Using this methodology, the Children’s Bureau annually establishes targets for future improper payment levels that incorporate the latest available review data on each state, develops strategies for reducing improper payments to reach the targets and monitors progress in reducing improper payments. The Children's Bureau has refined the error rate estimation methodology over time and will continue to make improvements.

Although in 2010 and 2011 the program error rate increased by about one quarter percent each year, the IV-E Foster Care program continues to maintain a payment error rate that is about half the 2005 baseline rate. In comparison to the baseline rate of 10.33%, the 2011 payment error rate is 5.25% (90% confidence interval: 4.90% to 5.60%). Examination of the relative contributions of overpayments and underpayments indicates that the overall program improper payments error rate of 5.25% is comprised of 4.58% overpayment rate and 0.67% underpayment rate. Of the 16 states for which updated information was included in the 2011 estimated error rate, 10 demonstrated improved performance, one remained constant (with a 0% error rate). However, five other states declined in their most recent review performance and this had the effect of increasing the national error rate slightly. Four of the states that showed an increased error rate were also determined not in substantial compliance based on the Title IV-E eligibility review because five or more cases out of 80 reviewed were determined in error. Each of these states was required to develop and implement a program improvement plan (PIP) to address each issue identified during the review. Following the completion of the PIP, a secondary review will be conducted in each of those states during which 150 cases will be reviewed. Should any state be found not in substantial compliance following a secondary review, it will be subject to significant financial disallowances.

The fifth state with an increase in the dollar error rate was found in substantial compliance at the conclusion of the IV-E eligibility review, based on the number of cases in error. However, because the onsite review identified a very high rate of claims for unallowable expenditures charged to title IV-E, ACF directed the state to conduct a 100% review of all claims for title IV-E maintenance costs to ensure that only allowable expenditures are claimed. The state has completed that review and has made prior quarter adjustments to its claims to exclude unallowable costs. The state also identified and implemented changes in its information system that will prevent the state from improperly charging Title IV-E foster care for unallowable costs.

Percentage Foster Care Payments in Error

Data Source: Regulatory Title IV-E Foster Care Eligibility Reviews

Also Supports: This measure also supports the HHS Secretarial Priority "Put Children and Youth on the Path for Successful Futures."

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Goal 4: Increase Efficiency, Transparency, and Accountability of HHS Programs

Objective C: Use HHS data to improve the health and well-being of the American people

4.C.05 Decrease the number of months required to produce MEPS data files (i.e. point- in-time, utilization and expenditure files) for public dissemination following data collection (MEPS-HC).

Lead Agency: Agency for Healthcare Research and Quality (AHRQ)

This measure supports the Medical Expenditure Panel Survey (MEPS). The MEPS is the only national source for comprehensive annual data on how Americans use and pay for medical care. MEPS data is being used to increase the awareness of health and human service issues and generate insights into how to improve health and well-being. The provision of timely MEPS online data will make it more easily accessible and usable and accelerate the development and dissemination of accurate, high-quality information. Any reduction in data delivery time imparts greater value to the MEPS data and enhances its utility.

The Medical Expenditures Panel Survey (MEPS) Program continues to meet or exceed all program assessment data timeliness goals. The data delivery schedule maximizes the public good through the use of the most current medical care utilization and expenditure data to inform health care policy and practice. During FY 2011, delivery of the 2009 public use files was accelerated from 10.8 months to 10 months.

Production and Dissemination of MEPS data files

Data Source: MEPS website

Also Supports: Healthy People 2020, HC/HIT/13.1

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4.C.10 Increase the electronic media reach of CDC Vital Signs through use of mechanisms such as the CDC website and social media outlets, as measured by page views at http://www.cdc.gov/vitalsigns social media followers, and texting and email subscribers

Lead Agency: Centers for Disease Control and Prevention (CDC)

The CDC Vital Signs Program was created to provide the latest data and information on key health indicators concerning major public health problems in the United States. Each monthly report provides a call-to-action for federal, state and local health department officials, healthcare professionals, employers, schools, and parents, among other specialized groups, as well as for the general public. The program combines aspects of science, policy, and communication, and describes evidence-based and important ways the public can promote their own health and prevent or ameliorate disease. The public health indicators addressed in the monthly issues of CDC Vital Signs are related to the leading causes of morbidity and mortality in the United States. This includes the five leading causes of death—heart disease, cancer, stroke, chronic lower respiratory diseases, and unintentional injury—and contributing causes of death such as tobacco use, binge drinking, and obesity. These five causes of death combine to represent 85% of deaths from the 10 leading causes.

The concept for CDC Vital Signs was developed late in 2009 and the first issue was published on July 6, 2010. Vital Signs reaches its broad audience through a variety of mechanisms.This measure combines pageviews and the number of social media followers (twitter, email, texting), to present a comprehensive view of the total reach of this publication. Three issues of the publication were released in Fiscal Year (FY) 2010, which reached over 250,000 people. Significant increases were achieved in FY 2011, with over 1 million people reached. Since 2010, the size of the audience exposed to Vital Signs in any form has expanded tremendously due to growing print, broadcast, and cable media interest that has far outpaced expectations; however, this rate of growth is not anticipated in the future due to possible media market saturation. As a result, more level but sustainable growth is expected in 2012 and beyond.

Number of Vital Signs Page Views and Social Media Followers

Data Source: Electronic media reach of CDC Vital Signs is measured by CDC.gov web traffic and actual followers and subscribers of CDC’s social media, e-mail updates and texting service The data source for this measure is Omniture® web analytics, which is a software product that provides consolidated and accurate statistics about interactions with CDC.gov and social media outlets as individuals seek and access information about CDC Vital Signs.

Also Supports: HHS Strategic Plan 2.D; HHS Strategic Plan 3.D; Healthy People 2020 Objective HC/HIT 13.1

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Goal 4: Increase Efficiency, Transparency, and Accountability of HHS Programs

Objective D: Improve HHS environmental, energy, and economic performance to promote sustainability

4.D.05 Increase the percent employees on telework or on Alternative Work Schedule

Lead Agency: Office of the Assistant Secretary for Administration (ASA)

This goal is in concert with implementation of the HHS Strategic Sustainability Performance Plan (SSPP) prepared under Executive Order (EO) 13514, which requires HHS to reduce green house gas (GHG) emissions by technological, programmatic and behavioral changes. This measure manually track the progress towards 20% target of the number employees who avoid commuting at least 4 days per pay period through the use of an alternative work schedule (AWS) and/or regularly scheduled telework.

Increasing the percentage of teleworking employees reduces the vehicle miles traveled, which reduces GHG and other pollutants in our air, soil and water, which can be harmful to human health. Typical commuting causes employee stress and decreases the amount of time employees can devote to other health activities such as physical activity, planning and preparing healthy meals and developing social capital by spending time with family or in the community. Widespread telework coupled with office sharing and swing space can reduce overall facilities costs in rents, waste removal, waste-water treatment and energy use.

This goal was established in Fiscal Year 2010. Currently, information on telework is being collected manually through HHS-wide data calls. An automated system is in the process of being deployed. Results for the first year exceeded the target by 1%. Subsequent years' targets increase to meet the 2015 goal of 20% of employees reducing commute time through telework or Alternative Work Schedule.

Percentage of HHS Employees on Telework or AWS

Data Source: Integrated Time and Attendence System analysis plus data calls for telework.

Also Supports: HHS strategic goal 5.D

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4.D.10 Ensure Power Management is enabled in 100% of HHS computers, laptops and monitors

Lead Agency: Office of the Assistant Secretary for Administration (ASA)

HHS IT contracts have been revised to include power-saving configuration requirements. HHS is measuring the percentage of eligible computers, laptops and monitors with power management including power-saving protocols in the standard configuration for employee workstations. Consistent application of power management will decrease the amount of electricity used by HHS facilities. This is part of HHS' strategic initiative to be good stewards of our energy resources.

The target for this measure is 100% of HHS eligible computers, laptops and monitors have power management. HHS has set aggressive goals to move from the 2010 level of 32% of devices with power management enabled to 100% of devices with power management by 2012 and to maintain that level continuing through 2015. In 2011, 85% of eligible devices were reported in compliance across the department, representing significant progress to achieving 100% in 2012.

 Percent of HHS Devices that have power management to reduce energy usage

Data Source: OCIO HHS administrative data.

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4.D.15 Reduce HHS fleet emissions

Lead Agency: Office of the Assistant Secretary for Administration (ASA)

HHS is committed to replacing gasoline-powered vehicles with alternative fuel vehicles (AFV) in accordance with GSA acquisition guidelines. As a result, the fleet's petroleum consumption and the amount of carbon dioxide released into the atmosphere will decrease.

This goal was established in FY 2010, in alignment with HHS Sustainability Plan and the Presidential Order to reduce greenhouse gases. HHS is aiming to reduce fleet emissions by 2% annually. This measure uses MTCO2e which is Million Tons of Carbon Dioxide equivalents (which is a standard measure of greenhouse gas emissions) as calculated from the Fleet Automated Statistical Tool.

The targets for both 2010 and 2011 were far exceeded. Significant progress was made in a short period of time by Recovery Act funds used to replace conventionally powered vehicles with alternative fuel vehicles, reducing the amount of HHS greenhouse gas emissions. Targets for subsequent periods accommodate an expected increase in the number of HHS fleet vehicles, which may cause a nominal net gain over 2011 results, but still a reduction from baseline levels.

HHS Fleet Emissions

Data Source: PSC data from FAST (Fleet Automated Statistical Tool) collected annually.

Also Supports: Executive Order 13514

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Goal 5: Strengthen the Nation's Health and Human Service Infrastructure and Workforce

Objective A: Invest in the HHS workforce to meet America’s health and human services needs today and tomorrow

5.A.05 Reduce the average number of days to hire

Lead Agency: Office of the Assistant Secretary for Administration (ASA)

The ability to turn around a recruitment request in a timely manner is not only necessary in order to hire highly qualified candidates in today's competitive market, but also a requirement under several Office of Personnel Management (OPM) directives that oblige Agencies to streamline processes and decrease timelines. Serving as the Department’s strategic lead on Human Resources (HR) policies and practices, the Assistant Secretary for Administration’s Office of Human Resources (OHR) set aggressive Agency-wide goals that significantly exceed federal hiring targets given by OPM. To optimize performance, OHR has implemented a number of process and systems improvements that have resulted in better recruitment support for hiring managers. Beginning in FY2012, HHS began transitioning the Department’s HR services to a mission-based, fully integrated operating environment.

Over the past three years, transaction reports have shown steady progress and an overall dramatic decrease in the hiring cycle time as measured from receipt of a complete job requisition package to job offer to a qualified candidate. Nevertheless, preliminary data for the second quarter of FY2012 indicate that processing time has increased to 72 days (compared to 61 days during the previous quarter) as activities related to this year’s major transformation efforts are intensifying. This temporary fluctuation was expected and the Department remains committed to meeting its FY2015 target of 60 days.

Average Number Days to Hire

Data Source: HHS personnel records

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Goal 5: Strengthen the Nation's Health and Human Service Infrastructure and Workforce

Objective B: Ensure that the Nation’s health care workforce can meet increased demands

5.B.05 Number of primary care physicians who complete their education through HRSA's Bureau of Health Professions programs supported with Prevention and Public Health funding.

Lead Agency: Health Resources and Services Administration (HRSA)

This measure tracks efforts, supported by FY 2010 Prevention and Public Health funding, to add to the supply of primary care providers. Primary care is a cornerstone of high quality and cost-effective health care services. The need for primary care providers is growing due, in part, to demographic changes and expansions in health insurance coverage. HRSA's Primary Care Residency Expansion Program anticipates 500 primary care residency program completers that are supported by Prevention and Public Health funding by FY 2015 (cumulative). The FY 2013 target reflects the program's goal to produce 172 physician residency completers.

Since initial grants in this program were made in late September, 2010, there are not yet completers. The first physician residency program completers will be in FY 2013.

Physician residencey completers supported with Prevention and Public Health Funding

Data Source: Grantee reports submitted through HRSA’s Electronic Hand Book.

Also Supports: Healthy People 2020, AHS-4

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5.B.10 Number of physician assistants who complete their education through HRSA's Bureau of Health Professions programs supported with Prevention and Public Health funding.

Lead Agency: Health Resources and Services Administration (HRSA)

This measure tracks efforts, supported by FY 2010 Prevention and Public Health funding, to add to the supply of primary care providers. Primary care is a cornerstone of high quality and cost-effective health care services. The need for primary care providers is growing due, in part, to demographic changes and expansions in health insurance coverage. HRSA's Expansion of Physician Assistants Training Program has the following targets for Prevention and Public Health Fund-supported program completers: 140 physician assistants (PA) completers in FY 2012, 280 PA completers in 2013 (cumulative), and 600 PA completers in FY 2015 (cumulative).

Since initial grants in this program were made in late September, 2010, there are not yet completers. The first physician assistant program completers will be in FY 2012.

Physician Assistants completers supported with Prevention and Public Health Funding

Data Source: Grantee reports submitted through HRSA’s Electronic Hand Book.

Also Supports: Healthy People 2020, AHS-4

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5.B.20 Number of nurse practitioners who complete their education through HRSA's Bureau of Health Professions programs supported with Prevention and Public Health funding.

Lead Agency: Health Resources and Services Administration (HRSA)

This measure tracks efforts, supported by FY 2010 Prevention and Public Health funding, to add to the supply of primary care providers. Primary care is a cornerstone of high quality and cost-effective health care services. The need for primary care providers is growing due, in part, to demographic changes and expansions in health insurance coverage. HRSA's Advanced Nursing Education Expansion Program anticipates the following nurse practitioner (NP) program completers supported by Prevention and Public Health funding: 110 NP completers in FY 2012, 150 NP completers in FY 2013, 600 NP completers in FY 2015 (cumulative).

Since initial grants in this program were made in late September, 2010, there are not yet completers. The first nurse practitioner program completers will be in FY 2012.

Nurse Practitioner completers supported with Prevention and Public Health Funding

Data Source: Grantee reports submitted through HRSA’s Electronic Hand Book.

Also Supports: Healthy People 2020, AHS-4

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5.B.25 Field strength of the NHSC through scholarship and loan repayment agreements.

Lead Agency: Health Resources and Services Administration (HRSA)

The National Health Service Corps addresses the nationwide shortage of health care providers in health professional shortage areas (HPSAs) by providing recruitment and retention incentives in the form of scholarship and loan repayment support to health professionals committed to a career in primary care and service to underserved communities. The NHSC field strength indicates the number of providers fulfilling active service obligations with the NHSC in underserved areas in exchange for scholarship or loan repayment support. As funding is available, the program will continue to maximize this funding to build the primary care workforce.

In FY 2011, the NHSC field strength was 10,279. The field strength was boosted by 2009-2010 Recovery Act funding. Field strength is generally dependent upon variables such as the level of available funding, the number of qualified applicants, and the mix of scholarship and loan repayment support provided. Scholarship recipients do not appear in the field strength while in academic training; however, they do count toward field strength once their service obligation commences.

Active Health Service Corps Providers Serving in underserved communities

Data Source: HRSA Bureau of Clinician Recruitment Service's Management Information Support System (BMISS)

Also Supports: Healthy People 2020, AHS-3, AHS-4, AHS-5

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Goal 5: Strengthen the Nation's Health and Human Service Infrastructure and Workforce

Objective C: Enhance the ability of the public health workforce to improve public health at home and abroad

5.C.10 Increase epidemiology and laboratory capacity within global health ministries through the Field Epidemiology Training Program (FETP). New Residents

Lead Agency: Centers for Disease Control and Prevention (CDC)

This measure tracks the number of new residents that begin CDC's Field Epidemiology Training Program (FETP). This measure allows CDC to track the progress of new programs in graduating well-trained applied epidemiologists.

Since 1980, CDC has developed 46 international Field Epidemiology Training Programs (FETP) serving 64 countries, graduating 2,351epidemiologists. Twenty mature programs are sustained without a need for full-time Resident Advisors. The number of active residents that began training increased from 134 in FY 2009 to 192 in FY 2010. The numbers of programs and thus residents that CDC is supporting varies from year to year as new programs are started and mature programs become sustained. The number of residents per year can also vary because some programs only enroll new residents every two years.

Annual Number of New FETP Residents

Data Source: FETP Annual Program Reports

Also Supports: President's Global Health Initiative

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5.C.15 Increase epidemiology and laboratory capacity within global health ministries through the Field Epidemiology Training Program (FETP). Total Graduates

Lead Agency: Centers for Disease Control and Prevention (CDC)

This measure tracks the total (comprehensive) number of graduates who complete CDC's Field Epidemiology Training Program (FETP). This measure allows CDC to track the progress of new and expanded programs in graduating well-trained applied epidemiologists.

Since 1980, CDC has developed 46 international Field Epidemiology and Laboratory Training programs (FELTP) serving 64countries, graduating 2,351 epidemiologists. Twenty mature programs are sustained without a need for full-time Resident Advisors. For FY 2009, there were 134 active trainees. From 2009-2010, the number of cumulative graduates increased by 185. The numbers of programs and thus residents that CDC is supporting varies from year to year as new programs are started and mature programs become sustained. The number of residents per year can also vary because some programs only enroll new residents every two years.

Number of FETP Graduates since 1980

Data Source: FETP Annual Program Reports

Also Supports: President's Global Health Initiative

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5.C.20 Increase the number of CDC trainees in state, tribal, local, and territorial public health agencies.

Lead Agency: Centers for Disease Control and Prevention (CDC)

This measure tracks the annual number of CDC public health workforce trainees who are assigned to State, Tribal, Local, and Territorial (STLT) public health agencies, filling critical workforce needs in the field while they are in training for careers in public health. In 2009, this measure included the Epidemic Intelligence Service (EIS), Preventive Medicine Residency/Fellowship (PMR/F), Public Health Prevention Service (PHPS), and the Public Health Associate Program (PHAP), formerly known as the Public Health Apprentice Program; the Public Health Informatics Fellowship Program (PHIFP) was added for FY 2010; the CDC-supported Emerging Infectious Diseases (EID) Laboratory Fellowships, CDC/Council of State and Territorial Epidemiologists’ (CSTE) Applied Epidemiology Fellowship, Post-EIS Practicum, PHPS Residency, and Applied Public Health Informatics Fellowship (APHIF) were added to the measure for FY 2011 (data reported in December 2011).

Prevention and Public Health Fund (PPHF) appropriations support some of these placements. In FY 2011, PPHF funds were prioritized to place trainees in STLT public health agencies (219 of the 285 PPHF-supported fellows were placed in the field). Because the allocation of the PPHF funds may change annually, the annual number of CDC field trainees in STLT agencies will fluctuate correspondingly.

In 2009, there were 119 CDC public health workforce trainees assigned to STLT public health agencies; in 2011, that number grew to 309. By the end of FY 2011, these field trainees were on assignment in 43 states, Washington, D.C., Puerto Rico, and three tribal locations. This includes field trainees supported by PPHF funds.

Number of CDC trainees in State, Tribal, Local and Territorial Public Health Agencies

Data Source: Data are compiled annually at the end of the fiscal year to count the total number of trainees in field assignments in state, tribal, local, and territorial public health agencies. In 2009, this measure included the Epidemic Intelligence Service (EIS), Preventive Medicine Residency/Fellowship (PMR/F), Public Health Prevention Service (PHPS), and the Public Health Associate Program (PHAP), formerly known as the Public Health Apprentice Program; the Public Health Informatics Fellowship Program (PHIFP) was added in 2010; the CDC-supported Emerging Infectious Diseases (EID) Laboratory Fellowships, CDC/Council of State and Territorial Epidemiologists’ (CSTE) Applied Epidemiology Fellowship, Post-EIS Practicum, PHPS Residency, and Applied Public Health Informatics Fellowship were added to the measure in FY 2011. Trainees funded by other federal agencies are excluded.

Also Supports: Healthy People 2020, PHI-13

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Goal 5: Strengthen the Nation's Health and Human Service Infrastructure and Workforce

Objective D: Strengthen the Nation’s human services workforce

5.D.05 Increase the number of individuals trained by SAMHSA's Science and Services Program

Lead Agency: Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA has a number of activities that contribute to strengthening the National Health and Human Services Workforce. Of particular note are the Science and Services Activities that disseminate best-practice information to grantees and other prevention practitioners. These specific activities help ensure that SAMHSA’s Services programs build on and/or improve service capacity in ways that are efficient, effective and as sustainable as possible. Science and Service programs are also an essential and cost-effective mechanism of increasing capacity within communities that do not receive grant funds from SAMHSA. While these programs are not always construed as direct services programs, they tend to serve many more persons at a much lower cost and, therefore, play an important role in advancing the field of substance abuse and mental illness prevention and treatment.

The measure used for this collection of activities is the number of participants trained. This measure reflects the total number of participants who attended a SAMHSA-funded training, meeting, or received technical assistance. Results obtained through this measure have remained relatively stable in recent years; however, observed fluctuations may, in part, be attributed to changes in the funding of programs, as well as a shift by some grantees to adopt a 'train the trainer’ approach of providing technical assistance and training.

Number of Individuals Trained

Data Source: SAMHSA Performance Measure Measurement System(s) (TRAC, SAIS, PMART)

Also Supports: Healthy People 2020, PHI-13

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5.D.10 Increase the percentage of Head Start teachers with AA, BA, Advanced Degree, or a degree in a field related to early childhood education.

Lead Agency: Administration for Children and Families (ACF)

Increase the percentage of Head Start teachers with AA, BA, Advanced Degree, or a degree in a field related to early childhood education.

Head Start grantees are required to develop plans to improve the qualifications of staff. Head Start has shown a steady increase in the number of Head Start teachers with an AA, BA, or advanced degrees in early childhood education. The Head Start reauthorization requires that all Head Start preschool center-based teachers have at least an AA degree or higher with evidence of the relevance of their degree and experience for early childhood education by October 1, 2011, thus the goal for fiscal years 2011 through 2013 is to reach 100%. Based on the most recent data as of December 2011, the Program Information Report (PIR) showed that in FY 2011, 88.2% of Head Start teachers had an AA degree or higher, missing the target of 100% but improving over the FY 2010 result. More Head Start teachers have degrees than ever before, and are better equipped to deliver quality instruction to Head Start children. Of the 45,701Head Start teachers in FY 2011, 40,285 have an AA degree or higher; of these degreed teachers, 14,328 have an AA degree, 21,355 have a BA degree, and 4,602 have a graduate degree. Not included in the percentage are an additional 4,510 teachers with a Child Development Associate (CDA) or state credential (no degree) and the 505 teachers who do not have a degree but are enrolled in Early Childhood Education (ECE) degree programs. Of the teachers with a CDA or state credential, 51.9% are enrolled in ECE degree programs. The total FY 2011 figure represents an increase of 1,164 degreed teachers over the previous year.

In September of FY 2008, the ACF Office of Head Start (OHS) made new competitive grant awards to increase career development opportunities for Head Start teaching staff seeking associate and baccalaureate degrees in early childhood education. Ten five-year grant awards, totaling $3 million per year, were made to Historically Black Colleges and Universities, Hispanic-Serving Institutions, and Tribally Controlled Land Grant Colleges and Universities. In June of 2009 all Head Start programs were provided the opportunity to apply for one-time quality improvement funds (available through the Recovery Act) for the purpose of meeting the statutory qualification requirements for teachers and teaching assistants in Section 648A of the Head Start Act.

Percent of Head Start Teachers with degrees realted to Early Childhood Education

Data Source: Program Information Report (PIR)

Also Supports: This measure also supports HHS Secretarial Priorities "Put Children and Youth on the Path for Successful Futures" and "Promote Early Childhood Health and Development."

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Goal 5: Strengthen the Nation's Health and Human Service Infrastructure and Workforce

Objective E: Improve national, state, and local surveillance and epidemiology capacity

5.E.05 Increase the number of new CDC trainees who join public health fellowship programs in epidemiology, preventive medicine, public health leadership and management, informatics, or prevention effectiveness, and participate in training at federal, state, tribal, local, and territorial public health agencies.

Lead Agency: Centers for Disease Control and Prevention (CDC)

This measure is significant because the public health workforce has shrunk by at least 45,000 since 2008; state health departments report shortages of critical disciplines such as epidemiologists, public health nurses, managers, disease investigation specialists, laboratorians, environmental scientists, sanitarians, and informaticians. CDC’s fellowship programs promote service while learning; fellows fill critical workforce needs at CDC and in the field while they are in-training for careers in the field of public health.

This measure includes new CDC-funded trainees in the Epidemic Intelligence Service (EIS), Public Health Prevention Service (PHPS), Public Health Informatics Fellowship Program (PHIFP), Prevention Effectiveness Fellowship (PEF), Preventive Medicine Residency/Fellowship (PMR/F), Presidential Management Fellows (PMF) program, and Public Health Associate Program (PHAP). Data represent the number of new fellows in place at the end of the fiscal year. Targets are set based on the typical, annual class size for each of the fellowship programs included in the measure.

In FY 2009, there were 134 new CDC trainees; that number grew to 212 in FY 2010 and dropped to 197 in FY 2011. The number of trainees fluctuates year-to-year due to fluctuations in CDC programs' ability to financially support the trainees' salaries, benefits, training and other related expenses. Additionally, 2010 data include the inaugural class of PHAP trainees.

Number of New CDC Trainees in Selected Fellowship Programs

Data Source: Data are compiled annually at the end of the fiscal year to count the number of new trainees entering classes in the Epidemic Intelligence Service (EIS), Preventive Medicine Residency/Fellowship (PMR/F), Public Health Prevention Service (PHPS), Public Health Informatics Fellowship (PHIF), Prevention Effectiveness (PE) Fellowship, and Presidential Management Fellows (PMF) programs. As of 2010, Public Health Associate Program (PHAP) trainees are included. Trainees funded by other federal agencies are excluded.

Also Supports: HHS Strategic Plan 5.E; Healthy People 2020, PHI-13

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“Where applicable, HHS includes 2015 targets in this document to align with the period of Strategic Plan. Interim targets for FY 2014 may or may not be included based on program plans.”

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