Performance Improvement 1996. Health Resources and Services Administration

02/01/1996

Contents

Bureau of Primary Health Care Evaluation Strategy: Design of the User and Visit Surveys

Bureau of Primary Health Care User Manual: Uniform Data System

Community and Migrant Health Centers and the Assessment of and Response to Mental Health and Developmental Needs in Primary Care Patients (Three Volumes)

Community Health Centers' Performance Under Managed Care

Development of Integrated Requirements for Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, and Physicians

Enrolling Minorities, Women, and Children/Adolescents Into NIH AIDS Clinical Trials: Models and Practices

Evaluation of Maternal and Child Health Bureau Childhood Injury Prevention Implementation Incentive Grants

Health Services Utilization and Costs to Medicaid of AFDC Recipients in New York and California Served and Not Served by Selected Community Health Centers

HMO Primary Care Staffing Patterns and Processes: A Cross-Site Analysis of 23 HMOs

Impact of FQHC Implementation on Community and Migrant Health Center Revenue and Utilization

Impact of Ryan White CARE Act Title I on Capacity Building in Latino Community-Based Organizations: Findings From a Study of Two Cities

Impact of Ryan White Title III(b) Funding on the Provision of HIV Primary Care

Infant Mortality Among U.S. Women of Mexican Descent: Evaluating the Validity of Current Estimates

Linkages Between Federally Qualified Health Centers and Hospitals: A Guide

National Practitioner Data Bank: User Satisfaction With Reporting and Querying and Usefulness of Disclosure Information for Decisionmaking 1992-94

Performance Indicators for GPRA: Initial Assessment of HRSA Programs (Final Report)

Ryan White CARE Act Title I Strategies for Underserved African-Americans: Methods, Analysis, and Interpretations of Four Cities

Second National Primary Care Conference: Executive Summary

Second National Primary Care Conference: Proceedings--Volume I

Second National Primary Care Conference: Proceedings--Volume II, Case Studies

Uniform Reporting System Field Test

Ryan White Title IV Program for Children, Youth, Women, and Families: National Evaluation

TITLE: Bureau of Primary Health Care Evaluation Strategy: Design of the User and Visit Surveys

ABSTRACT NUMBER: 072

ABSTRACT: This project was a pilot study in preparation for a study of Community Health Centers. The pilot had two components: a personal interview survey of health center users, and a separate, medical record-based study of visits to health centers. HRSA's Bureau of Primary Health Care developed an agreement with the National Center for Health Statistics to assist in the design of the personal health interview survey modeled after the National Health Interview Survey (NHIS) and the medical record-based study of visits based on the National Hospital Ambulatory Medical Care Survey (NHAMCS). The final survey design resulted from visits to seven Community Health Centers to develop, evaluate, and revise the survey instruments and procedures. Lessons learned from the pilot test strengthened the design of the full survey. Based on the pilot test results, a contract for full implementation of the Community Health Center User and Visit Survey was awarded in September 1994. (Final report 28 pages, plus attachments.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: 301/594-4280

PIC ID: 5613

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

TITLE: Bureau of Primary Health Care User Manual: Uniform Data System

ABSTRACT NUMBER: 073

ABSTRACT: This report reviews the existing reporting requirements for grantees of HRSA's Bureau of Primary Health Care (BPHC). It also provides a structure for the Uniform Data System (UDS), which integrates reporting for five primary care programs: the Community Health Center Program; the Migrant Health Center Program; the Health Care for the Homeless Program; the Outreach and Primary Health Services for Homeless Children Program; and the Public Housing Primary Care Program. The study developed a manual for using UDS. UDS consists of two components: the "Universal Report," which has nine tables and is required of all grantees; and the "Grant Reports," which repeat three of the Universal Report tables to provide comparable data on characteristics of users whose services fall within the scope of a project funded under a particular grant. The report notes that UDS will replace other reporting requirements for the programs and that its implementation is planned to facilitate transition to the new system. Instructions for each table are given, as are appendixes dealing with personnel and service definitions. UDS is being implemented, with the first data collection covering calendar year 1996. The first reports are due on March 31, 1997. (Final report 70 pages, plus appendixes.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: 301/594-4280

PIC ID: 5611

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ

TITLE: Community and Migrant Health Centers and the Assessment of and Response to Mental Health and Developmental Needs in Primary Care Patients (Three Volumes)

ABSTRACT NUMBER: 074

ABSTRACT: This study explores the extent to which Community and Migrant Health Centers (C/MHCs) provide screening, assessment, and treatment for the mental health and developmental needs of primary care patients. For this study, 25 health centers in 10 States were chosen to represent geographic diversity and different approaches to Medicaid coverage of mental health services. Structured telephone interviews were conducted at these 25 centers. Case studies written for each State describe selected characteristics of the health center and how the center conducts screening, assessment, treatment, and followup for the mental health and developmental needs of both children and adults. The study found that most of the C/MHCs provide some level of mental health screening and treatment. The study also found that (1) C/MHCs identified a broad range of mental health problems as prevalent in their patient populations and viewed these problems as interfering with the patient's health, quality of life, and ability to benefit from primary care; (2) in response to the mental health needs of their patients, C/MHCs took approaches that were distributed over a continuum from screening to provision of comprehensive mental health services onsite; and (3) States that reimburse for services delivered by a broad range of mental health professionals in different settings facilitate C/MHC delivery of mental health services, either directly or by referral. The final report has been distributed to primary care organizations and primary care associations that can use the successful models to improve the delivery of mental health services in underserved communities. A manuscript is being developed for submission to a professional journal. Volume One contains the final report, while Volumes Two and Three contain appendixes detailing case studies.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: James Macrae

PHONE NUMBER: 301/594-4315

PIC ID: 5617

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Community Health Centers' Performance Under Managed Care

ABSTRACT NUMBER: 075

ABSTRACT: This study examined the effects of managed care on seven Community Health Centers (CHCs) with varying degrees of managed care experience. The sites selected had prepaid managed care arrangements involving some financial risk. The study chose centers with significant managed care enrollment and several years' experience with managed care contracts. An important determinant in choosing the final site cohort was whether the HMOs that had contracted with the selected CHCs were willing to participate in the study. The study found that (1) CHCs perform as well as or better than comparable providers in their network based on key utilization and financial indicators; (2) the CHCs studied offer strong primary care services accompanied by cultural sensitivity that is highly valued by HMOs; and (3) CHCs need to pursue changes in their operations more aggressively to better accommodate managed care. Health centers have used the findings of this report to negotiate with managed care organizations and with State Medicaid agencies. An article on the report has been published in the July 1995 issue of the Journal of Ambulatory Care Management. (Final report 44 pages, plus appendixes.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Bethann Tutunjian

PHONE NUMBER: 301/594-4060

PIC ID: 5596

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Development of Integrated Requirements for PAs, NPs, CNMs, and Physicians (MDs and DOs)

ABSTRACT NUMBER: 076

ABSTRACT: This project developed a personal computer-based model to forecast national integrated requirements for physicians, physician assistants (PAs), nurse practitioners (NPs), and certified nurse-midwives (CNMs) who deliver primary health care services. The Integrated Requirements Model provides estimates of practitioner needs under varying scenarios regarding managed care, insurance coverage, and alternative staffing configurations. The model comes prepackaged with six scenarios based on differing sets of assumptions concerning potential changes in primary care delivery. Users of the model can develop an unlimited number of scenarios by editing the projection measures underlying the assumptions. Study results are being used by the Council on Graduate Medical Education and the National Advisory Council on Nursing Education and Practice to form recommendations for data and education program development. The model is also being used by a number of external entities, including the Utah State Health Department, the Virginia Medical College, and the Wisconsin Consortium for Primary Care. Findings were presented at a conference, and a manuscript is planned for submission to a professional journal. (Final report variously paginated, plus appendix.)

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Edward Sekscenski

PHONE NUMBER: 301/443-6663

PIC ID: 5745

PERFORMER ORGANIZATION: Vector Research, Inc., Ann Arbor, MI

TITLE: Enrolling Minorities, Women, and Children/Adolescents Into NIH AIDS Clinical Trials: Models and Practices

ABSTRACT NUMBER: 077

ABSTRACT: This study qualitatively documented the HRSA-funded Clinical Trials Linkage Projects. This funding was awarded to eight Ryan White Title III(b) sites to increase the enrollment of persons from underserved NIH-sponsored populations (ethnic/racial minorities, women, children, and adolescents) in HIV/AIDS clinical trials sponsored by the National Institutes of Health (NIH). Enrollment was increased by establishing linkages between primary care clinics and clinical trials research sites. Each of the eight sites (called Linkage Projects) were visited. The report concluded that, while the Linkage Projects were successful in establishing a working relationship between a primary care facility and a clinical trials research center, the recruitment efforts depended on the natural constituency of the primary care institution. One of the major recommendations was to expand outreach and education efforts to improve client recruitment for and retention in clinical trials. Based on study findings and related workshops, more than 90 percent of Title III(b) grantees now refer clients to a local clinical trial unit. (Final report 95 pages, plus appendixes.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Deborah Parham

PHONE NUMBER: 301/594-4444

PIC ID: 6099

PERFORMER ORGANIZATION: LTG Associates, Inc., Turlock, CA

TITLE: Evaluation of Maternal and Child Health Bureau Childhood Injury Prevention Implementation Incentive Grants

ABSTRACT NUMBER: 078

ABSTRACT: HRSA's Maternal and Child Health Bureau (MCHB) awarded incentive grants in 1987 and 1988 to seven States to develop programs in childhood injury prevention. This study analyzed and compared the State strategies for establishing and maintaining focal points for injury prevention after Federal funding ended. Site visits to each State included document review and interviews with injury prevention personnel. Findings show that, in general, recipients of the implementation incentive grants exhibited a considerable increase in injury prevention capacity. All seven States increased their dedicated injury prevention staff during the grant period and six have maintained or increased that staffing level. Advocacy for injury prevention has increased. Several respondents credit the MCHB program with enabling them to acquire funding from other Federal and State sources. Most also greatly increased their capacity to collect and use injury morbidity and mortality data, but have not fully incorporated data analysis into the process of planning injury prevention programs. These findings will be used by policymakers and HRSA program personnel in considering future allocations of program funding. Volume one contains the final report, and volume two contains a cross-site analysis report. (Final report 5 pages, plus appendix; cross-site analysis report variously paginated, plus appendixes.)

AGENCY SPONSOR: Maternal and Child Health Bureau

FEDERAL CONTACT: David Maglott

PHONE NUMBER: 301/443-2778

PIC ID: 5599

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

TITLE: Health Services Utilization and Costs to Medicaid of AFDC Recipients in New York and California Served and Not Served by Selected Community Health Centers

ABSTRACT NUMBER: 079

ABSTRACT: This report presents the findings from studies of the use of Medicaid-covered services and costs to Medicaid for Aid to Families With Dependent Children (AFDC) and AFDC-like recipients living in the service areas of four selected Community Health Centers in California and six in New York. The California study was based on calendar year 1989 Medi-Cal eligibility, claims, and payment data, while the New York study used Federal fiscal 1991 Medicaid data. The hypotheses tested in the study were that (1) patterns of use would differ among recipients who use CHCs as their customary source of primary care and those who do not; and (2) regular users of CHCs would experience reduced inpatient hospital care and would incur lower costs to Medicaid. The study confirmed this second hypothesis, finding statistically significant reductions in use (hospital admissions and inpatient days) and costs to Medicaid for regular CHC users, compared with nonusers. In California, regular CHC users incurred costs to Medicaid that were 14 percent lower than for nonusers; if maternity cases are excluded, the costs were 33 percent lower; and for maternity cases alone, the costs were 9 percent lower. In New York, these figures were 24 percent, 30 percent, and 12 percent, respectively. The report concludes that CHCs are cost-effective, perhaps because of organized utilization review, case management, and preventive services.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Judy Rodgers

PHONE NUMBER: 301/594-4343

PIC ID: 6001

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

TITLE: HMO Primary Care Staffing Patterns and Processes: A Cross-Site Analysis of 23 HMOs

ABSTRACT NUMBER: 080

ABSTRACT: This study examined HMO primary care staffing patterns and the decisionmaking processes used to establish them. The study design consisted of onsite interviews with senior health plan officials in 23 HMOs nationwide. The study found that the three key factors that affect how HMOs determine the number of primary care physicians they need are (1) current growth in enrollment and opportunities for further growth; (2) enrollee experience with access; and (3) employer desires and requirements. Although generally successful in recruiting the desired number of primary providers (some plans expressed recruiting difficulties in rural and underserved urban areas), plans report that new graduates who join are not well-prepared for practice in either managed care settings or primary care settings more generally. To address this problem, HMOs typically monitor new recruits closely. The sampled plans included five with Medicaid enrollment at 25 percent or more of total enrollment. The purpose was to investigate how needs for primary care staffing might change if managed care becomes more dominant for low-income populations. Although utilization differs for the Medicaid population--relative to other enrollees, Medicaid enrollees have higher walk-in and no-show appointment rates, higher hospital admission rates, and underutilize preventive health care services--the organizations did not plan their primary care staffing very differently. But HMOs serving Medicaid populations place providers near these enrollees, provide outreach services, and seek providers with experience in treating Medicaid beneficiaries. Findings from this study will improve the ability of HRSA managers and the public health community to forecast work force needs and to ensure an adequate supply of practitioners. (Final report 118 pages, plus appendixes.)

AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301/443-1900

PIC ID: 5606

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ

TITLE: Impact of FQHC Implementation on Community and Migrant Health Center Revenue and Utilization

ABSTRACT NUMBER: 081

ABSTRACT: This study assessed the impact of the Medicaid Federally Qualified Health Center (FQHC) legislation on Community Health Center (CHC) revenue and utilization of services. Multivariate analysis was used to examine the experience of federally funded CHCs between 1989 and 1992. Analyses suggest that the FQHC legislation, in the Omnibus Budget Reconciliation Act of 1989, had a positive impact on health center financing and on access to care for both Medicaid recipients and the uninsured. Study results also suggest that FQHC impact on service utilization differed according to center size. In particular, for smaller centers experiencing significantly higher growth rates for all insurers and for Medicaid users, higher reimbursement rates under FQHC may have provided an incentive to increase the center's Medicaid beneficiaries. Conversely, larger centers experienced significantly greater absolute increases in Medicaid beneficiaries, but not in total user populations. It was also found that centers in States with fast-growing Medicaid programs experienced significantly higher increases in the number of Medicaid beneficiaries than centers in other States. Study results are being used in the program planning process to shape policy directions at the agency and departmental levels, and within States. (Final report 94 pages, plus appendixes; executive summary, 31 pages, separately bound.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Ronda Hughes

PHONE NUMBER: 301/594-4120

PIC ID: 5616

PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD

TITLE: Impact of Ryan White CARE Act (RWCA) Title I on Capacity Building in Latino Community-Based Organizations: Findings From a Study of Two Cities

ABSTRACT NUMBER: 082

ABSTRACT: This study was designed to develop and test a methodology for evaluating whether and how CARE Act Title I funds have helped develop, expand, or enhance HIV/AIDS services to Latino community-based organizations (CBOs). Information for the study was gathered from surveys and key informant interviews conducted at Latino CBOs in two eligible metropolitan areas: San Diego and Boston. The study found that 29 percent of the Latino CBOs in the study areas received Title I funding and that an atmosphere of openness and inclusiveness in the planning process was critical for Latino CBOs to feel that they were full participants. The majority of persons with HIV/AIDS served by the Latino CBOs were Spanish speaking, emphasizing the need for linguistically and culturally appropriate services. Study participants noted that receipt of Title I funding is critical for enhancing and expanding services. Recommendations were for HRSA to (1) develop incentives for eligible metropolitan areas to increase Latino CBO representation on planning councils; (2) create active outreach mechanisms to engage nonmedical agencies; (3) fill data gaps for planning council directors regarding service and capacity needs of communities of color; (4) develop clear guidelines for capacity-building activities that should be funded under the Ryan White CARE Act; and (5) conduct studies that investigate factors that impede or facilitate participation of ethnic minority CBOs in the RWCA planning process. The findings from this study are being used to provide technical assistance to grantees on issues regarding capacity building in both minority and nonminority CBOs.

AGENCY SPONSOR: Bureau of Health Resources Development

FEDERAL CONTACT: Gloria Weissman

PHONE NUMBER: 301/443-3478

PIC ID: 6197

PERFORMER ORGANIZATION: Boston University, School of Public Health; The National Coalition of Hispanic Health and Human Services Organizations

TITLE: Impact of Ryan White Title III(b) Funding on the Provision of HIV Primary Care

ABSTRACT NUMBER: 083

ABSTRACT: The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 authorizes a variety of grants. These grants include AIDS Early Intervention Services grants to community-based primary care facilities under Title III(b). This study assessed the impact of Title III(b) funding in terms of HIV-related services, models of service delivery, and the utilization of Title III(b) funds. The study was based on a mail survey of all organizations participating in the Title III(b) program. Survey data indicate that the client populations served by Title III(b) are changing. Nearly 60 percent of respondents reported serving more women; 29 percent reported serving increased numbers of injection drug users. Fifteen percent of respondents reported increased numbers of African-American or Hispanic clients. Many grantees attribute the shift in population mix to substantial outreach efforts launched under Title III(b). The survey also found that Title III(b) funds have enabled HIV projects to increase the number of sites by nearly 60 percent. In addition, the projects were able to add or expand medical, social, and support services. Funds have also allowed grantees to address and overcome many of the traditional barriers to health care, including inadequate transportation; cultural and language barriers; lack of client financial resources; and client, provider, and community ignorance about and denial of AIDS/HIV. Title III(b) funds have also helped projects establish and maintain linkages with health care and social services, and responding Title III(b) grantees have established collaborative relationships with over 1,300 agencies.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Thomas M. Coughlin

PHONE NUMBER: 301/594-4450

PIC ID: 5597

PERFORMER ORGANIZATION: CDM Group, Inc., Chevy Chase, MD

TITLE: Infant Mortality Among U.S. Women of Mexican Descent: Evaluating the Validity of Current Estimates

ABSTRACT NUMBER: 084

ABSTRACT: Researchers and HRSA policymakers have been puzzled for a number of years by the anomalously low infant mortality rate (IMR) reported for the Mexican-American community. If IMRs are used as measures of medical underservice, the low IMRs for Mexican-Americans will mean that fewer resources will be channeled to areas with large Mexican-American populations. An analysis of NCHS matched birth-death data tapes for 1983-87 indicate that the rate of very low and low birthweight infants for Mexican-Americans (5.7 percent) is about the same as that of non-Hispanic white infants but significantly lower than those of non-Hispanic black infants (13 percent). The difference in IMRs between first and later generation Mexican-American infants indicates that attachment to Mexican culture may be a reasonable explanation for low infant mortality. With the exception of congenital anomalies and short gestation/low birthweight, first generation infants have a lower IMR than later generation infants. The study suggests that ethnic misclassification and underreporting may be less serious problems than some observers believe. The approaches used to analyze the NCHS 1983-87 data are now being applied to the newly available 1988-90 linked birth-death records. Two journal manuscripts are being developed based on this study and the 1988-90 linked birth-death records.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells

PHONE NUMBER: 301/594-4284

PIC ID: 6053

PERFORMER ORGANIZATION: The George Washington University, Center for Health Policy Research, Washington, DC

TITLE: Linkages Between Federally Qualified Health Centers and Hospitals: A Guide

ABSTRACT NUMBER: 085

ABSTRACT: Hospitals and community-based primary health care centers of all types, including Community and Migrant Health Centers (C/MHCs) and other Federally Qualified Health Centers (FQHCs), are increasingly entering linkages that go beyond traditional arrangements in which center physicians have admitting privileges and can follow their patients while they are inpatients in local hospitals. This study suggests both legal and organizational approaches to these new relationships. Four factors have led to these increased linkages: (1) recognition by most providers that their survival is best assured within the system of care rather than as freestanding, limited service providers; (2) pressure from purchasers of care to build integrated delivery systems; (3) implementation of cost-based reimbursement for Medicaid and Medicare beneficiaries in FQHCs; and (4) the presence of new opportunities resulting from State or private financial incentives. Five sites (Albany, Georgia; Plainfield, New Jersey; Blossburg, Pennsylvania; Erie, Pennsylvania; and Seattle, Washington) were selected to collect the experiences of FQHC or hospital networks, ranging in joint activities and organizational forms. The study found that FQHCs and hospitals should determine the purpose of their linkage before they determine the organizational form that will legally embody agreed-upon activities. The report is in the form of a guidebook for staff and board members of FQHCs who are considering linkages with hospitals. Study results are being used to identify legal and financial issues that FQHCs should consider in forming vertical arrangements with hospitals.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Ronda Hughes

PHONE NUMBER: 301/594-4120

PIC ID: 5615

PERFORMER ORGANIZATION: The George Washington University, Center for Health Policy Research, Washington, DC

TITLE: National Practitioner Data Bank: User Satisfaction With Reporting and Querying and Usefulness of Disclosure Information for Decisionmaking 1992-94

ABSTRACT NUMBER: 086

ABSTRACT: This study represents phase II of an evaluation study to assess the impact of the National Practitioner Data Bank (NPDB). Phase I developed the survey instrument under HRSA Contract No. 240-91-0017, Delivery Order No. 240-92-0508. The primary purpose of the Phase II study was to implement the evaluation methodology. NPDB's impact was assessed in terms of its ability to serve as a national repository and to distribute useful information effectively. The telephone survey found that (1) most entities had a high level of satisfaction with NPDB's reporting form and had a favorable reaction toward implementing technical advances; (2) querying entities generally found the information they received to be useful; (3) approximately one-fourth of entities received new information from NPDB responses; (4) three-quarters of malpractice insurers indicated that NPDB had impacted claims resolution between 1992 and 1994; (5) not all State licensing boards received adverse action reports to pass through to NPDB between 1992 and 1994; (6) hospitals are required to query NPDB, but HMOs, State boards, group practices, PPOs, and professional societies had voluntary query rates during the study period of from 7 percent to 58 percent. The report also provides information on costs, disclosures, and decision making based on NPDB information. Study results have been used to design NPDB's second generation system, and have been made available to medical malpractice insurers, State health care practitioner licensing boards, hospitals, and other health care entities that query and report to NPDB, and the general public. (Final report 111 pages, plus appendixes.)

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Robert Oshel

PHONE NUMBER: 301/443-2300

PIC ID: 5609

PERFORMER ORGANIZATION: Walcoff & Associates Inc., Fairfax, VA

TITLE: Performance Indicators for GPRA: Initial Assessment of HRSA Programs (Final Report)

ABSTRACT NUMBER: 087

ABSTRACT: The Government Performance and Results Act of 1993 requires that each Federal agency develop comprehensive strategic plans, annual performance plans that set specific performance goals for each program activity, and annual reports on the actual performance achieved compared with the performance goals. This study assessed HRSA ability to develop and implement a system of performance measurement and management as of summer 1995. The report focuses on individual programs or program clusters identified in the President's budget for fiscal 1996. The study used a literature review, background research, and interviews within HRSA to assess program clusters, programs, and budget line items and to develop a technical assistance plan that identifies what is needed to further help HRSA develop and implement a performance management system. The study found that (1) HRSA's current program structures and measurement efforts form a base for a HRSA-wide measurement system; and (2) indicators common to many programs could be used to measure agencywide performance. The performance measurement strategy should stress (1) primary emphasis on a coordinated, interdependent system of health care resources, rather than a disparate set of programs; (2) links between the measurement strategy, strategic planning, program activities, evaluation planning and findings, and budgeting; and (3) incremental development of the system. This study has served as the basis for technical assistance to all HRSA Bureaus, designed to meet their individual needs in performance measurement. (Final report 68 pages, plus appendixes.)

AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301/443-7718

PIC ID: 5954

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Ryan White CARE Act Title I Strategies for Underserved African-Americans: Methods, Analysis, and Interpretations of Four Cities

ABSTRACT NUMBER: 088

ABSTRACT: This study was intended to provide a better understanding of the local strategies currently being used by Ryan White CARE Act grantees to reach and serve African-Americans living with HIV. A secondary aim of the study was to assess the suitability of using qualitative data collection methods to identify local service delivery strategies that could be applied to other underserved populations. The study was designed to capture the social and organizational contexts in which HIV service strategies emerged in local communities. The study uses indepth, semistructured discussions with key stakeholders, including grantees, service providers, and people living with HIV. Study respondents identified three types of service strategies to increase the number of underserved African-Americans living with HIV: improving administrative procedures, building service capacity, and raising public education and awareness. An essential component of effective strategies was working through and with African-American institutions to develop a comprehensive system of quality care. Study findings will be presented at the 1996 International AIDS and American Public Health Association conferences. (Final report 93 pages, plus appendixes.)

AGENCY SPONSOR: Bureau of Health Resources Development

FEDERAL CONTACT: Moses B. Pounds

PHONE NUMBER: 301/443-6560

PIC ID: 5734

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

TITLE: Second National Primary Care Conference: Executive Summary

ABSTRACT NUMBER: 089

ABSTRACT: This executive summary provides information on the Second National Primary Care Conference, which was held September 11-13, 1994, in Dallas, Texas. The conference was designed to answer questions and to generate understanding on the following primary care topics: (1) the training, composition, and preparedness of the primary care work force; (2) the formation, responsiveness, and comprehensiveness of the primary care delivery system; and (3) the relationship between primary care and special populations. The executive summary describes the events that took place during the conference, and includes summaries of plenary speeches and panel presentations. Copies of the conference program, a list of program participants, and a letter to conferees from First Lady Hillary Rodham Clinton are also included. See also PIC ID 4435, 5750.1, and 5750.2. (Executive summary 47 pages.)

AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation

FEDERAL CONTACT: Pearl Perry

PHONE NUMBER: 301/443-1126

PIC ID: 5750

PERFORMER ORGANIZATION: Social and Scientific Systems, Inc., Bethesda, MD

TITLE: Second National Primary Care Conference: Proceedings--Volume I

ABSTRACT NUMBER: 090

ABSTRACT: This report provides details of the Second National Primary Care Conference, held in Dallas, Texas, on September 11-13, 1994. The report includes (1) a letter to conferees from First Lady Hillary Rodham Clinton; (2) the executive summary; (3) the conference program; (4) the keynote address delivered by the Honorable Richard D. Lamm; (5) plenary speeches presented by Ron J. Anderson, M.D., Paul M. Ellwood, M.D., Neal Vanselow, M.D., and Bruce Vladeck, Ph.D.; (6) a list of program participants; and (7) a list of conference attendees. See also PIC ID 4435, 5750, and 5750.2. (Final report 152 pages.)

AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation

FEDERAL CONTACT: Pearl Perry

PHONE NUMBER: 301/443-1126

PIC ID: 5750.1

PERFORMER ORGANIZATION: Social and Scientific Systems, Inc., Bethesda MD

TITLE: Second National Primary Care Conference: Proceedings--Volume II, Case Studies

ABSTRACT NUMBER: 091

ABSTRACT: This report presents case studies used in panels at the Second National Primary Care Conference held in Dallas, Texas, on September 11-13, 1994. The case studies cover a range of topics, such as the Adirondack Rural Health Network, the California Cultural Competency Task Force, the Changing Role of Academic Health Centers Under Health Care Reform, Linking School-Based Programs and Primary Care, and Using Quality to Build Capitated Delivery Systems, among others. See also PIC ID 4435, 5750, and 5750.1. (Final report 233 pages.)

AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation

FEDERAL CONTACT: Pearl Perry

PHONE NUMBER: 301/443-1126

PIC ID: 5750.2

PERFORMER ORGANIZATION: Social and Scientific Systems, Inc., Bethesda, MD

TITLE: Uniform Reporting System Field Test

ABSTRACT NUMBER: 092

ABSTRACT: In September 1992, HRSA began a year-long field test of a Uniform Reporting System (URS) that was intended to obtain data on the populations reached by Ryan White CARE Act Title I and Title II services providers, and on the types and amounts of services delivered to clients. This study assessed (1) the feasibility of unduplicated, client-level reporting; (2) the value of the resulting information; (3) the level of effort and costs required of all participants; (4) the adequacy of measures; (5) the types and amounts of technical assistance HRSA would have to provide; and (6) the refinements needed in URS data elements or procedures. Analysis of the field test, which included 15 grantees, shows that (1) URS client-level data systems are feasible and valuable; (2) effective implementation of URS client-level reporting would require significant effort by grantees and service providers; and (3) a high level of technical support from HRSA would be needed for full implementation of URS nationwide. Based on these conclusions, HRSA submitted to the Office of Management and Budget a request for approval of mandatory implementation of the Annual Administrative Report calling for aggregated data. HRSA also decided to proceed with client-level URS reporting on a voluntary basis and to establish demonstration sites for client-level URS reporting. Eight Title I and Title II grantees are conducting the demonstration for a 3-year period.

AGENCY SPONSOR: Bureau of Health Resources Development

FEDERAL CONTACT: Robert Baitty

PHONE NUMBER: 301/443-0652

PIC ID: 4916

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ

TITLE: Ryan White Title IV Program for Children, Youth, Women, and Families: National Evaluation

ABSTRACT NUMBER: 093

ABSTRACT: The purpose of this project was to assess the effectiveness of HRSA's Grants for Coordinated Services and Access to Research for Children, Youth, and Families, authorized by Title IV of the Ryan White Comprehensive AIDS Resources Emergency Act. The study was focused on the following questions: Have systems of care been established, improved, maintained, or expanded? Do the systems have the desired attributes? Are the systems reaching and serving intended unserved or underserved target populations? Are multidisciplinary providers accessible, available, and trained to serve the target populations? Are clients receiving the array of medical and social services they need? Has the program had an impact on increasing participation in clinical drug trials? Has the program had a positive impact on client and family satisfaction? Methodologies included review of grant applications, self-study questionnaires from grantees, site visits to 18 grantees, and focus groups in ten sites. Findings confirm that the Title IV program has established, improved, maintained, or expanded systems of care that provide family-centered, culturally competent, and community-based services to the target populations. Multidisciplinary providers are accessible and available, and are specifically trained to meet client needs. Clients reported that they generally receive the array of services they need, though some gaps exist. The program has led to increased participation in clinical trials. Finally, the program has had a significant and lasting impact on client and family satisfaction. Results have supported targeted program planning to fill service gaps identified through this first national snapshot of the Title IV program. Information about barriers to and successes in building models for enhanced access to services and research is being used by other Ryan White programs.

AGENCY SPONSOR: Maternal and Child Health Bureau

FEDERAL CONTACT: David Maglott

PHONE NUMBER: 301/443-2778

PIC ID: 5600

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