Performance Improvement 1996. Centers for Disease Control and Prevention

02/01/1996

Contents

Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Final Report

Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Interim Final Report

Effect of Mandated Managed Care for Medicaid Populations on the Practice of Public Health: The Example of Childhood Lead Poisoning Prevention (CLPP)

Evaluation of External Cause-of-Injury Codes: Final Report (Three Volumes)

Evaluation of the Activities of the Medical Examiner/Coroner Information-Sharing Program (MECISP)

Evaluation of the Content and Conduct of Health Examination Surveys

Evaluation of Encarguese de Su Diabetes: Una Guia Para Su Cuidado

Evaluation of the Fatality Assessment and Control Evaluation (FACE) Program: Dissemination Component

Evaluation of the Feasibility of an Injury Risk Factor

Evaluation of the Impact of a Diabetes Guide for Patients

Evaluation of the Impact on Practice of the Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Providers

Evaluation of the Policies, Practices, and Implementation of HIV Education Programs in Schools

Final Report: Assessment of CDC's Press Relations Functions

Final Report: A Blueprint for CDC's Office of Women's Health: Functions, Strategies, and Activities

Final Report: Evaluation of the Operating Processes, Communication Techniques, and Management Approaches in the National Immunization Program (NIP)

Rapid Assessment of Influenza Vaccination in the United States

Report of Completion for the Automated Analysis on National Center for Health Statistics (NCHS) Data

Working With Community-Based Organizations To Advance the Childhood Lead Poisoning Prevention Agenda

TITLE: Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Final Report.

ABSTRACT NUMBER: 037

ABSTRACT: This project develops a comprehensive evaluation strategy to be incorporated into planning, budgeting, and legislative decisionmaking processes of the National Center for Chronic Disease Prevention and Health Promotion. The final report discusses the major findings of a 1993 review of the planning and evaluation environment at NCCDPHP. It finds that (1) getting programs into the field is a higher priority at CDC than is assessing the efficacy and effectiveness of these programs; (2) funding decisions are unrelated to evaluation; (3) there is little connection between planning and evaluation at NCCDPHP or CDC; and (4) a stronger commitment to evaluation is needed. A pilot test of the evaluation strategy developed by the project shows that (1) data transfers between Federal, State, and local levels are costly and imperfect, and they require an approach linked to public health objectives; (2) States are concerned that program performance indicators fail to capture the complexity of the States' problems and accomplishments; (3) a too-detailed and overly specific evaluation methodology poorly assesses State and local implementations of chronic disease prevention programs; and (4) the Government Performance and Review Act and block grant funding will have a substantial impact on NCCDPHP programs. The report recommends a flexible approach to evaluation for NCCDPHP. See also PIC ID 4746. (Final report 95 pages, plus appendixes.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Lisa Daily

PHONE NUMBER: 770/488-5706

PIC ID: 4746.1

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Interim Final Report

ABSTRACT NUMBER: 038

ABSTRACT: This project develops a comprehensive evaluation strategy that can be incorporated into planning, budgeting, and legislative decisionmaking processes at NCCDPHP. This strategy will provide direction on whether Center programs can be evaluated. It will guide decisions about which program components should be evaluated, will provide direction regarding the scope of the evaluation, will clarify the types of data that should be routinely collected to support planning and evaluation activities, and will indicate when and how evaluation results should be fed back into the decisionmaking process. A six-step iterative process was used to develop the Evaluation for Decisionmaking Strategy. The strategy incorporates the views of public health stakeholders and was developed with the advice of NCCDPHP managers, policymakers, and evaluators. The final concept for the strategy attempts to balance the scientific rigor needed for proper evaluations and the flexibility required when dealing with real programs. The strategy links evaluation to the decisionmaking process by defining five program decision points that are associated with stages of program development. These decision points are (1) identification of needs; (2) examination of the policy context; (3) program design; (4) program implementation; and (5) program maintenance. A user's guide is provided to help NCCDPHP planners and evaluators implement the strategy. (Interim report 73 pages, plus appendixes.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Lisa Daily

PHONE NUMBER: 770/488-5403

PIC ID: 4746

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Effect of Mandated Managed Care for Medicaid Populations on the Practice of Public Health: The Example of Childhood Lead Poisoning Prevention

ABSTRACT NUMBER: 039

ABSTRACT: This report examines how the move toward managed care by State Medicaid programs affects the provision of the major service components of CDC Childhood Lead Poisoning Prevention (CLPP) programs. It also examines how CLPP programs have responded to the challenges of managed care. Site visits to Florida, Indiana, Minnesota, Rhode Island, and Tennessee were conducted. The report finds that (1) managed care will affect all components of CLPP programs because it leads to decentralization and privatization of functions that are currently centralized; (2) State and local health departments will spend less time on assurance and more on assessment and policy development under managed care, and they will also have a diminished role in direct service delivery; and (3) many of the changes in the managed care environment may make it difficult to obtain the sort of data needed to perform new functions such as assessment and quality assurance. The report discusses several strategies that CDC can use to adapt to the managed care environment. In general, these strategies are in the areas of (1) maintaining public sector service delivery; (2) building a legal infrastructure, whether this involves a screening law, a reporting law, or an enforcement of protocols and data collection to support enforcement; and (3) funding core public health functions. See also PIC ID 4373 and 4373.2. (Final report 29 pages.)

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: Nancy Tips

PHONE NUMBER: 770/488-7277

PIC ID: 4743.1

NTIS ACCESSION NUMBER: PB 96-144670

PERFORMER ORGANIZATION: MACRO International, Inc., Silver Spring, MD

TITLE: Evaluation of External Cause-of-Injury Codes: Final Report (Three Volumes)

ABSTRACT NUMBER: 040

ABSTRACT: This report evaluates the current system used to classify external causes of injury in order to facilitate the correct use of the International Classification of Diseases "Supplemental Classification of External Causes of Injury and Poisoning" (E-Codes). The study evaluates the E-Code tabular list and alphabetical index and recommends improvements; (2) evaluates existing E-Code coding guidelines and recommends improvements; (3) evaluates E-Code training materials and recommends improvements; and (4) develops and evaluates prototype training materials, including a model training syllabus for E-Code use. E-Code stakeholders were asked to participate in the evaluation by serving on a technical advisory panel. The panel evaluated and recommended changes to the E-Code tabular list and alphabetical index. These changes were field tested by training 138 subjects: medical record department coding staff from eight hospitals (four trauma hospitals and four community hospitals); and health information management students. Test sites in four States were used. The field test demonstrated that experienced coders liked the revisions and could use the new codes with minimal training. Participants praised expanded guidelines, the addition of clarifying examples, the new alphabetic index, and the new tabular list. (Final report three volumes, variously paginated, plus appendixes.)

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Perrianne Lurie

PHONE NUMBER: 301/436-4216

PIC ID: 4742

PERFORMER ORGANIZATION: Center for Health Policy Studies, Columbia, MD

TITLE: Evaluation of the Activities of the Medical Examiner/Coroner Information-Sharing Program (MECISP)

ABSTRACT NUMBER: 041

ABSTRACT: Of all deaths in the United States, about 20 percent are investigated by medical examiner or coroner (ME/C) offices. In all, more than 2,200 jurisdictions are responsible for death investigation and certification. Records from these jurisdictions are timely and detailed, and constitute the ultimate source of information on sudden and unexpected deaths. CDC established MECISP in 1987 to coordinate these data for researchers and public health officials. MECISP's main product is a database containing data collected from ME/C sites. MECISP also produces a biannual directory listing ME/C jurisdictions and summarizing death investigation laws.

This report reviews the activities at MECISP in order to evaluate and suggest improvements to the process of sharing information on death investigation in the United States. The report finds that (1) MECISP's main role is to be a broker between death investigators and people who can best use data from these investigations to improve public health; (2) death investigation data, particularly MECISP data, are underused, because of problems with access, visibility, relevance, coverage, and quality; and (3) correcting these problems requires resources that MECISP does not have, such as staff with technical expertise in the area. The report makes several recommendations, chiefly one that calls for greater resources.

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: Gib Parrish, M.D.

PHONE NUMBER: 404/488-3310

PIC ID: 5350

PERFORMER ORGANIZATION: MACRO International, Inc., Silver Spring, MD

TITLE: Evaluation of the Content and Conduct of Health Examination Surveys

ABSTRACT NUMBER: 042

ABSTRACT: The Third National Health and Nutrition Examination Survey (NHANES III) is the seventh in a series of surveys with health examination components conducted by the National Center for Health Statistics (NCHS) since 1960. The survey asked 30,000 persons about their demographic, socioeconomic, dietary, and health history. An examination component for each participant includes phlebotomy, as well as examinations by a physician, a dentist, specialized interviewers, and health technicians. About 5,000 sample persons are examined each year in two 3-year cycles of data collection. NCHS is considering a design for NHANES-97 that includes recurring 2-year data collection cycles, which will examine a sample of about 7,500 each year (a 50 percent increase). This report (1) explores methods for increasing the sample size by 50 percent; (2) examines the core content of the examination; (3) evaluates other health examination studies; and (4) discusses the feasibility of collecting specified nutrition assessment measures in a setting other than a mobile examination center. For each of these tasks, the report presents objectives, methodology, and major findings and recommendations. This report is available from NTIS only. (Final report two volumes, variously paginated.)

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Natalie Fuller-Dupree

PHONE NUMBER: 301/436-7080

PIC ID: 5512

NTIS ACCESSION NUMBER: PB 95-221974

PERFORMER ORGANIZATION: Westat, Inc., Rockville, MD

TITLE: Evaluation of Encarguese de Su Diabetes: Una Guia Para Su Cuidado

ABSTRACT NUMBER: 043

ABSTRACT: This project evaluated a pilot edition of a Spanish-language diabetes patient guide targeted to Hispanic populations. This guide, "Encarguese de Su Diabetes: Una Guia Para Su Cuidado," was developed by staff of the Division of Diabetes Translation at CDC. The rationale for this evaluation was to ensure that the final guide would be culturally relevant and readable for individuals with at least a sixth-grade level of education. Specifically, the project used focus group discussions to determine the understandability, relevance, usefulness, and adaptability of the guide among diverse Hispanic populations in the United States. The focus group discussions were held throughout the United States. Phase I of the project resulted in a revised Spanish-language version of the guide, and phase II was directed at refining issues related to finalization, production, and distribution of the guide.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Patricia Mitchell

PHONE NUMBER: 770/488-5015

PIC ID: 5352

PERFORMER ORGANIZATION: Casals and Associates, Arlington, VA

TITLE: Evaluation of the Fatality Assessment and Control Evaluation (FACE) Program: Dissemination Component

ABSTRACT NUMBER: 044

ABSTRACT: FACE identifies and investigates fatal occupational injuries, with the goal of preventing them. It identifies work situations at high risk for fatal injury and formulates and disseminates prevention strategies to those who can intervene in the workplace. This report assesses the effectiveness of information dissemination for FACE programs in three States. The report (1) describes communication channels and information users; (2) identifies prevention efforts resulting from information provided by FACE; (3) assesses indicators of changed work behaviors that might be attributed to the program; and (4) assesses the potential effectiveness of specific dissemination strategies within each of the three States. The report finds that (1) employers generally assess the program favorably; (2) some employers are concerned that the inclusion of specific points might cast an unfavorable light on their companies, and that some recommendations are economically or technically unfeasible; (3) most employers who have made workplace changes did so immediately following a fatality, and many reported these changes to other managers in the company; (4) FACE materials are widely used for professional education, public information, advocacy, regulation, surveillance, and vocational training; and (5) organizational and economic influences govern the dissemination of FACE materials. The report concludes that the program is effective and of high quality in each State reviewed.

AGENCY SPONSOR: National Institute of Occupational Safety and Health

FEDERAL CONTACT: Theodore Pettit

PHONE NUMBER: 304/284-5796

PIC ID: 5506

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

TITLE: Evaluation of the Feasibility of an Injury Risk Factor

ABSTRACT NUMBER: 045

ABSTRACT: This report evaluates the feasibility of a national telephone survey as (1) a surveillance system for injury risk factors; (2) a means through which to monitor progress toward injury objectives for the year 2000; and (3) a tool for evaluating injury control programs. A national telephone survey of 5,238 adults was conducted. The response rate for the survey was 54 percent of households determined to be eligible for the study. While telephone response rates have been declining over the past decade, the 29 percent refusal rate for this survey was higher than anticipated. Analyses suggest that neither the sampling methodology nor the survey length were related to problems with response rates; but instead that these problems were related to (1) the perceived (rather than actual) length of the survey; (2) sensitivity of topics; and (3) informed consent procedures.

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Jeffrey Sacks, M.D.

PHONE NUMBER: 770/488-4652

PIC ID: 4522

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Evaluation of the Impact of a Diabetes Guide for Patients

ABSTRACT NUMBER: 046

ABSTRACT: This project provided information to CDC's Division of Diabetes Translation about how different dissemination approaches affected the behavior of providers, and how health care practice was impacted when the guides were presented to primary care practitioners as part of a specialized training seminar at community health centers. The study recommended that (1) programs have a champion at each local intervention site; (2) an adequate market for the intervention be present prior to program implementation; (3) sources of capital be targeted and linked to the unit of analysis; (4) agreements with each intervention site be obtained to ensure necessary levels of human and structural support; and (5) sufficient time be allowed for system change.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Dawn Satterfield

PHONE NUMBER: 770/488-5020

PIC ID: 5934

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

TITLE: Evaluation of the Impact on Practice of the Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Providers

ABSTRACT NUMBER: 047

ABSTRACT: In 1991, CDC's Division of Diabetes Translation published two guides for diabetes care. One, "The Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Providers," was aimed at health care providers. The second, "Take Charge of Your Diabetes: A Guide for Care," was aimed at patients. This project provides information to the Division of Diabetes Translation on the dissemination approaches for the provider guide. Three urban community health centers served as intervention sites. Two of them received the provider guide and a 4-hour education and activation program; one of these two also received the patient guide. The third center received the provider guide without explanation. The project determined how different dissemination approaches affect the behavior of providers, and how health care practice is impacted when the guides are presented to primary care practitioners as part of a specialized training seminar. The report finds no conclusive evidence that the intervention had a strong effect on practitioner behavior. Although there were some improvements, these could not be traced to the intervention. Furthermore, the intervention may not have been strong enough to affect provider behavior, especially given the high staff turnover rates at these centers. (Final report 56 pages, plus appendixes.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Dawn Satterfield

PHONE NUMBER: 404/488-5020

PIC ID: 4108

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

TITLE: Evaluation of the Policies, Practices, and Implementation of HIV Education Programs in Schools

ABSTRACT NUMBER: 048

ABSTRACT: This project evaluated the progress and activities conducted by the 71 HIV education programs funded by CDC's Division of Adolescent and School Health (DASH). These programs are funded through cooperative agreements with State and local education agencies. Data elements were obtained from reading the program file documents and were abstracted for each funded year of the 5-year period, 1987-92, for each program. A database was composed from these elements that will allow CDC to answer specific evaluation questions regarding the development of programs and the extent to which CDC policies and guidelines were followed during the funding period.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Peter Hunt

PHONE NUMBER: 404/488-5343

PIC ID: 6070

PERFORMER ORGANIZATION: MACRO International, Inc., Atlanta, GA

TITLE: Final Report: Assessment of CDC's Press Relations Functions

ABSTRACT NUMBER: 049

ABSTRACT: CDC's News Division within the Office of Public Affairs (OPA) was established in 1987 to handle inquiries from the press. The volume of calls to this office has more than doubled between 1991 (8,000 inquiries) and 1994 (more than 20,000 inquiries), but the number of press officers available to respond to calls has remained constant. This report examines OPA's News Division and its relationship with CDC centers, institutes, and offices (CIOs) and with the press. The key finding is that the News Division is understaffed for the volume of calls. The report also finds that some CIOs recognize that OPA is overwhelmed, yet they are pleased with the services it provides; others are generally dissatisfied and desire more proactive media relations services. Reporters say that they have difficulty reaching the News Division and that their inquiries are not answered in a timely way. Furthermore, a review of external press offices finds that OPA staff handle more than twice the number of inquiries than do staff of comparable organizations. The report recommends that (1) communications technology such as voice mail, batch faxing, electronic mail, and automated tracking of press inquiries be instituted; (2) staffing levels be increased to 9 or 10 press officers; (3) internal policies and procedures guiding current and future activities be developed; and (4) individual CIO needs be determined and met.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Helen T. Kuykendall

PHONE NUMBER: 404/639-3286

PIC ID: 5915

PERFORMER ORGANIZATION: MACRO International, Inc., Silver Spring, MD

TITLE: Final Report: A Blueprint for CDC's Office of Women's Health: Functions, Strategies, and Activities

ABSTRACT NUMBER: 050

ABSTRACT: CDC established the Office of Women's Health (OWH) in 1994. This report identifies the role, functions, strategies, activities, and benchmarks for OWH. The report maintains that OWH has five key functions: (1) leadership; (2) advocacy; (3) internal coordination; (4) external relationship building at the national, State, and local levels; and (5) research and program development. The report also discusses the guiding principles of OWH and suggests how it should position itself in light of these principles. For example, the report stresses that OWH must have the goodwill of other offices within CDC, and suggests that the Associate Director for Women's Health be made a member of CDC's senior management team in order to highlight the vital role OWH will play. The report suggests that OWH (1) create a vision at CDC for women's health; (2) increase the visibility of women's health programs within CDC and to external audiences; (3) develop formal, systematic communication mechanisms for internal exchange of information about CDC's women's health activities; (4) facilitate coordination and collaboration between CDC and other Public Health Service offices that deal with women's health; and (5) dedicate allocated funding to support projects that address priorities and gaps in women's health efforts. The report also discusses such issues as building relationships, staffing, and priorities for the coming year. (Final report 24 pages, plus appendixes.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Wanda Jones

PHONE NUMBER: 404/639-7230

PIC ID: 5913

PERFORMER ORGANIZATION: MACRO International, Inc., Silver Spring, MD

TITLE: Final Report: Evaluation of the Operating Processes, Communication Techniques, and Management Approaches in the National Immunization Program (NIP)

ABSTRACT NUMBER: 051

ABSTRACT: Three events have placed significant demands upon CDC's National Immunization Program: (1) the measles outbreak in the late 1980's and early 1990's, which brought the importance of childhood immunization to the forefront of public attention; (2) the President's Childhood Immunization Initiative (CII) of 1994, which made the immunization of preschool children a key health priority; and (3) mandates to eliminate indigenous cases of specific vaccine-preventable diseases and to increase vaccine coverage to at least 90 percent among 2-year-old children. An increase in the NIP operation budget of 160 percent and a staff increase of approximately 50 percent occurred between fiscal 1993 and 1995. This report examines NIP's management structure and style, its communication and decisionmaking processes and strategies, its patterns of authority, and its delegation of work and responsibility. The report offers recommendations in the following areas: (1) strategic planning, (2) day-to-day management, and (3) staff issues. (Final report 43 pages, plus appendixes.)

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: Victoria Westberg

PHONE NUMBER: 404/639-8204

PIC ID: 5916

PERFORMER ORGANIZATION: MACRO International, Inc., Silver Spring, MD

TITLE: Rapid Assessment of Influenza Vaccination in the United States

ABSTRACT NUMBER: 052

ABSTRACT: This project determines the 1992-93 and 1993-94 influenza vaccine coverage in sites where CDC plans to conduct active surveillance for Guillain-Barre syndrome (GBS). This determination should permit CDC to (1) assess whether receipt of influenza vaccine in these years was associated with an increased risk for GBS; (2) determine whether a change in recommendations for influenza vaccination is warranted; and (3) provide insight into usage patterns of influenza vaccination.

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: Robert Chen

PHONE NUMBER: 301/402-3497

PIC ID: 5894

PERFORMER ORGANIZATION: MACRO International, Inc., Atlanta, GA

TITLE: Report of Completion for the Automated Analysis on National Center for Health Statistics (NCHS) Data

ABSTRACT NUMBER: 053

ABSTRACT: This project was intended to improve the analysis of NCHS data. The project evaluated NCHS's present analytical methods and developed a prototype automated data analysis system, the Automated System for Survey Information and Statistical Tools (ASSIST). During the project, ASSIST was used as a communications tool between NCHS analysts and the contractor staff to explore and assess data access. NCHS also considered the accessibility of the data to users whose computing expertise ranged from novice to expert. The prototype was also used in (1) evaluating and assessing problems associated with multiple data set storage; (2) determining the requirements for the use of data across data systems; and (3) determining whether both user and provisional data should be employed. (Final report five pages.)

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Marcus Sanchez

PHONE NUMBER: 301/436-7904

PIC ID: 3575

PERFORMER ORGANIZATION: American Management Systems, Inc., Arlington, VA

TITLE: Working With Community-Based Organizations To Advance the Childhood Lead Poisoning Prevention Agenda

ABSTRACT NUMBER: 054

ABSTRACT: As public health services evolve, CDC must recognize that at least three important changes in emphasis must occur within its CLPP programs. These three changes are (1) a shift from direct service delivery to assessment, policy development, and quality assurance; (2) a shift from secondary prevention to primary prevention; and (3) a new goal of coordinating the care and followup of lead-poisoned children and their families.

Joining into partnership with community-based organizations (CBOs) may help ease the impact of these changes. This report is intended to help CLPP grantees and local health departments build better relationships with CBOs and to provide suggestions as to how they can broaden their mission to include a community-based prevention agenda. The report gives examples of successful collaborations and concludes that (1) grantees may have difficulty finding appropriate CBOs to work with, since not all CBOs will be interested in preventing lead poisoning; (2) CBOs have a different accountability and organizational structure than public sector organizations and may have different working styles; (3) grantees should choose long-established CBOs with good records in the community; (4) CBOs, like the public sector, must compete for limited resources; and (5) CBOs may have high staff turnover and little institutional memory. See also PIC ID 4743 and 4743.1. (Final report 22 pages.)

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: Nancy Tips

PHONE NUMBER: 404/488-7277

PIC ID: 4743.2

NTIS ACCESSION NUMBER: PB 96-144688

PERFORMER ORGANIZATION: MACRO International, Inc., Silver Spring, MD