FY 2024 Annual Performance Plan and Report - Strategic Goal 3: Objective 3.3

Fiscal Year 2024
Released March, 2023

Topics on this page: Objective 3.3: Expand access to high-quality services and resources for older adults and people with disabilities, and their caregivers to support increased independence and quality of life | Objective 3.3 Table of Related Performance Measures

Objective 3.3: Expand access to high-quality services and resources for older adults and people with disabilities, and their caregivers to support increased independence and quality of life

HHS is investing in several strategies to expand access to high-quality services and resources for older adults, people with disabilities, and their caregivers. HHS enhances system capacity to develop processes, policies, and supports that are person centered and provide quality care for older adults and individuals with disabilities across settings, including home and community-based settings. HHS ensures the availability and equitable access and delivery of evidence-based interventions that focus on research, prevention, treatment, and care to older adults and individuals with disabilities. HHS also supports development and implementation activities to better understand and address the needs of all caregivers across the age and disability spectrum.

The Office of the Secretary leads this objective. The following divisions are responsible for implementing programs under this strategic objective: ACF, ACL, AHRQ, ASPE, CDC, CMS, HRSA, IHS, NIH, OASH, and OGA. In consultation with OMB, HHS has determined that performance toward this objective is progressing. The narrative below provides a brief summary of progress made and achievements or challenges, as well as plans to improve or maintain performance.

Objective 3.3 Table of Related Performance Measures

ACL retired several measures that no longer accurately reflect the work of its programs. One of these measures was Measure ID - 2.6, which includes factors outside of the program’s control.

Under the Developmental Disabilities Assistance and the Bill of Rights Act of 2000 (DD Act), each state and territory has a Developmental Disabilities Protection and Advocacy (P&A) program designated by the state’s governor. The DD Act and other authorizing statutes give the P&A program the authority to advocate for the rights of individuals with disabilities. The DD Act states that each P&A program has the authority to “pursue legal, administrative, and other appropriate remedies or approaches to ensure the protection of, and advocacy for, the rights of such individuals within the State." ³⁵  P&A programs provide a range of legal services and use a range of remedies, including self-advocacy assistance, negotiation, investigation, and litigation, to advocate for traditionally unserved or underserved individuals with developmental disabilities. P&A authorities are critical to preventing abuse and neglect of people with disabilities and safeguarding individuals’ right to live with dignity and self-determination.

The Administration on Disabilities program staff is continuing to work with ACL’s Office of Performance and Evaluation to develop or improve logic models and performance measures for this program. ACL staff are piloting methods for collecting data and working on developing standard methods for analyzing the data to identify trends and results.

Recent projections indicate that arthritis prevalence and arthritis-associated limitations are increasing and confirm that arthritis remains a top cause of morbidity, work limitations, and compromised quality of life. Arthritis affects more than 58.5 million adults, almost 60% of whom are working aged adults (< 65) and is projected to affect 78.4 million adults by 2040. There is strong evidence that physical activity can reduce joint pain, improve function, and halt or delay physical disability among adults with arthritis, but physical activity levels are lower for adults with arthritis than adults without arthritis. Adults with arthritis are more likely to engage in physical activity and self-management education programs when recommended by a health care provider. This strategy and an emphasis on provider recommendations are reflected in CDC’s new state arthritis program and will be reflected in other, future activities of the arthritis program.

Among states funded by the CDC Arthritis Program in 2021, 68.2% of adults diagnosed with arthritis were counseled by a doctor or other health professional to be physically active to help arthritis or joint symptoms. The 2021 target was not met and was lower than the 2019 baseline of 70%. Funded states indicated the pandemic significantly impacted their efforts to reach healthcare professionals and that many providers’ ability to provide physical activity counseling to patients with arthritis were limited due to pandemic-related demands. However, over the last 4 years, funded states reached more than 40,000 adults with low-cost community-based physical activity and self-management education programs that have been effective in improving arthritis symptoms, management, and quality of life for people living with arthritis.

The future targets are consistent with an outcome measure in CDC’s State Public Health Approaches to Addressing Arthritis Notice of Funding Opportunity.

CDC protects people and prevents complications of blood disorders by reducing the prevalence of inhibitors among hemophilia patients and increasing the proportion of very young hemophilia patients receiving early prophylaxis treatment. Through Community Counts, CDC collects data on health issues and medical complications for people living with bleeding disorders, incorporates screening for inhibitors, and monitors treatment use, including prophylaxis, to facilitate best practices that help prevent or eradicate complicated, costly, and debilitating health conditions.

Approximately 15-20% of people with hemophilia develop an inhibitor, a condition where the body stops accepting the factor treatment product (which helps the blood clot properly) as a normal part of blood. The body treats the “factor” as a foreign substance and mounts an immune system response to destroy it with an inhibitor. When people develop inhibitors, treatments to prevent and stop bleeding episodes are less effective. Special treatment is required until the body stops making inhibitors, which can increase hospitalizations, compromise physical function, and exceed $1,000,000 a year for a single patient.

Discovering an inhibitor as soon as possible helps improve outcomes and reduce costs. Although hemophilia care providers widely accept that development of an inhibitor is a serious issue, routine screening for inhibitors is not current practice for local laboratories because of the high cost and the inability to perform the proper tests.

In FY 2021, the prevalence of hemophilia treatment inhibitors was 5.0% which surpassed the FY 2021 target by seven and a half percent. For the second consecutive year, the measure has been exceeded and the continued decrease in inhibitor prevalence demonstrates marked improvement for the population's management of complications.

In FY 2021, AHRQ continued to provide ongoing scientific, administrative and dissemination support to the U.S. Preventive Services Task Force (USPSTF). The Task Force makes evidence-based recommendations about clinical preventive services to improve the health of all Americans (e.g., by improving quality of life and prolonging life). By supporting the work of the USPSTF, AHRQ helps to identify appropriate clinical preventive services for adults, disseminate clinical preventive services recommendations, and develop methods for understanding prevention in adults.

For several years, AHRQ has invested in creating a national measure of the receipt of appropriate clinical preventive services by adults (measure 2.3.7). A necessary first step in creating quality improvement within health care is measurement and reporting. Without the ability to know where HHS is and the direction HHS is heading, it is difficult to improve quality. This measure will allow AHRQ to assess where improvements are needed most in the uptake of clinical preventive services. It will help AHRQ support the USPSTF by targeting its recommendations and dissemination efforts to the populations and preventive services of greatest need. Thus, making sure the right people get the right clinical preventive services, in the right interval. The data from this measure can also identify gaps in the receipt of preventive services and therefore inform the Department’s and the public health sector’s prevention strategies.

AHRQ now has a validated final survey to collect data on the receipt of appropriate clinical preventive services among adults (the Preventive Services Self-Administered Questionnaire (PSAQ) in the AHRQ Medical Expenditure Panel Survey (MEPS)). The survey was fielded in a pilot test in 2015. It is a self-administered questionnaire that will be included as part of the standard MEPS starting in 2018. Additional years of data will allow for AHRQ to track and compare receipt of high priority, appropriate clinical preventive services over time.

The panel design of the survey, which will include the PSAQ in even years, makes it possible to determine how changes in respondents' health status, income, employment, eligibility for public and private insurance coverage, use of services, and payment for care are related. Once data are collected, they are reviewed for accuracy and prepared to release to the public.

In FY 2022, AHRQ completed analysis of the CY2018 (FY 2018/2019) data. It also anticipates the CY2020 (FY 2020/2021) preventive items data will become available, and data collection for the CY2022 (FY2022/2023) will begin. In addition, AHRQ began a project to update the list of high priority clinical preventive services based on the latest available evidence.

In FY 2023, AHRQ anticipates it will begin analysis of the CY2020 (FY2020/2021) data and continue data collection for the CY 2022 (FY 2022/2023) data. The target of 6% (baseline from FY2022) will be maintained. AHRQ will convene an expert panel to update the list of high priority clinical preventive services and a series of technical expert panels to identify strategies to improve uptake of these services.

Endnotes

³⁵  42 U.S.C. 15043

³⁶  CDC established a new data source in FY 2017. Results cannot be compared to previous years.