Performance Improvement 1997. Foreword


The Department is pleased to present Performance Improvement 1997: Evaluation Activities of the U.S. Department of Health and Human Services--the second annual report documenting the evaluation efforts of all the HHS agencies and offices. The report has three audiences: decision makers, who need information on program results; program managers, who want to know how other service programs are operating and how performance can be improved; and the community of researchers, advocates, and practitioners, who will use the program information and evaluation tools.

The mission of the Department of Health and Human Services (HHS) is to enhance the well-being and health security of Americans by providing for effective health and human services and by fostering strong, sustained advances in the sciences underlying medicine, public health, and social services. To accomplish this mission, the Department manages an array of programs in basic and applied science, public health, child and adolescent development; programs that foster economic self-sufficiency and support working families; and programs that finance health, mental health, and social services.

Our programs are in a continuous state of reinvention and refinement, informed by the knowledge generated through our evaluation program. The Health Care Financing Administration (HCFA), for example, has multiple evaluations under way to understand the effects of Medicaid waivers. Policy makers and program managers at the Federal and State levels will be able to use information from these evaluations as they develop health care policy into the 21st century. HCFA also completed a study this year of hospital units for ventilator-dependent patients, described in the second chapter, that illustrates the usefulness of our evaluation knowledge for the larger health and human services community. The study's cost analysis found that these special units successfully demonstrated an integration of care for seriously ill patients that could hold promise for further application in managed care.

Increasingly, our programs are managed in partnership with State and local governments. Evaluation studies are an important tool for helping these partners improve program effectiveness. For example, the Centers for Disease Control and Prevention (CDC) assisted the State of Georgia by examining the effectiveness of a new audit method to improve childhood immunization rates. The study showed that the audits contributed significantly to the State's increase in child immunization rates (from 31 percent to 90 percent between 1994 and 1996). Georgia's audit method has been adopted with substantial success in Colorado, Illinois, and South Carolina. Another example is an evaluation by the Administration for Children and Families that helps States implement the child support guidelines established by the Family Support Act of 1988. This study led to greater consistency of guideline application in such areas as health insurance and day care expenses used in determining child support awards.

Performance Improvement 1997 contains information on projects completed in fiscal year (FY) 1996, HHS agency and office evaluations in progress, and future directions for evaluation. The report is organized into three chapters. Chapter I describes the organization of HHS evaluations--activities, resources, planning and management, and future directions. Chapter II highlights the results from 11 FY 1996 evaluations, selected for their potential application by the health and human services community. Chapter III presents the evaluation activities of the 11 HHS agencies and the Office of the Secretary, including information on their evaluation programs, evaluations completed in FY 1996, evaluations in progress, and future directions. A complete inventory of the 87 HHS evaluation projects completed in FY 1996 is provided in appendix A, and the HHS agency projects currently in progress are listed in appendix B.

We hope that you will find this report useful and informative.

Donna E. Shalala
U.S. Department of Health and Human Services

David F. Garrison
Principal Deputy Assistant Secretary for Planning and Evaluation