Performance Improvement 1998. Office of Public Health and Science

02/01/1998

MISSION: To provide advice on public health and science to the Secretary of Health and Human Services, to provide executive direction to program offices within the Office of Public Health and Science (OPHS), and, at the direction of the Secretary, to coordinate crosscutting public health and science initiatives in the Department.

Evaluation Program

The Office of Public Health and Science (OPHS) provides advice, policy and program coordination, and leadership in the implementation, management, and development of activities related to public health and science, as directed by the Secretary. OPHS helps HHS conduct broad-based public health assessments to better define public health problems and solutions. It assists other components of HHS in anticipating future public health issues and problems and helps ensure that HHS designs and implements appropriate approaches, interventions, and evaluations that will maintain, sustain, and improve the health of the Nation. OPHS provides leadership and policy recommendations on population-based public health and science and, at the Secretary's direction, leads or coordinates initiatives that cut across agencies and operating divisions. In addition, OPHS communicates and interacts, on behalf of the Secretary, with national and international professional and constituency organizations on matters of public health and science. Finally, OPHS's unique role allows it to use its resources to link important HHS programs or fill gaps in areas needing better policy formulation and coordination.

In keeping with its role within the Department, OPHS has developed an evaluation plan that avoids duplication of efforts that might more appropriately and effectively be undertaken by operating divisions of HHS or by the Assistant Secretary for Planning and Evaluation (ASPE). Thus, the FY 1998 evaluation strategy for OPHS focuses on public health and science issues that cut across multiple interests of the operating divisions, and requires a coordinated approach to achieve the most effective results. In addition, OPHS will continue its commitment to carry out every project proposed as part of this year's strategy in collaboration with relevant operating divisions.

OPHS conducts evaluations requested of the Secretary by Congress that are most appropriately managed by staff with medical or health science credentials, and that cannot be assigned to an operating division. Further, evaluations will be conducted to support the Surgeon General and the Assistant Secretary for Health in their respective roles as the Nation's top doctor and senior advisor for public health and science to the Secretary. These roles include the responsibility to assist the Secretary in developing a policy agenda for the Department to address major population-based public health, prevention, and science issues and to provide leadership and a focus for coordination of population-based health, clinical preventive services and science initiatives that cut across operating divisions. In addition, OPHS will conduct evaluations specific to the needs of the programs operated from the offices located within OPHS, such as Women's Health, Minority Health, Disease Prevention and Health Promotion, International Health, and Emergency Preparedness. A portion of the evaluation funds will be made available to the ten HHS Regional Health Administrators.

Summary of Fiscal Year 1997 Evaluations

In FY 1997, OPHS completed five evaluations in an effort to track the impact of the transformation in the Nation's health care system on underserved and vulnerable populations or to improve OPHS program performance. Studies completed this year will better inform the public health and science communities concerning the return on their investment of scarce public health resources and will help shape future budget decisions.

In an effort to quantify investments made by the various levels of government in essential public health services--both personal health services and population-based services--OPHS worked with State and local public health, mental health, substance abuse, and environmental agencies in nine States to define, measure, and monitor pubic health expenditures (6194). Using the essential services framework, the study concluded that expenditures could indeed be determined. Some rather surprising conclusions were reached concerning the source of the largest portion of public health expenditures, indicating that more than 2 out of every 3 dollars spent on essential public health services went for personal health services and that only 1 percent of the total health care expenditures went for population-based health services.

OPHS funded development of a study to identify the types of information and data necessary to successfully protect and monitor the human health hazards of environmental incidences (6322). The study concluded that the Federal government could help State and local public health agencies in environmental surveillance by assuring integration of public health, environmental health, and environmental protection agencies' information. However, any information system developed must be evaluated based on its usefulness to State and local agencies that respond to adverse effects to human health arising from exposure to environmental hazards.

In FY 1997, OPHS asked stakeholders in the Healthy People 2000 process to evaluate the framework of national health goals and disease prevention objectives in anticipation of the development of the Healthy People 2010 plan (6491). By reviewing the successes and failures of the Healthy People 2000 benchmarks, OPHS hoped to make this national framework of performance indicators on health status more results-oriented. In general, participants in the various forums liked the overall structure and content of the Healthy People 2000 document, although some recommended reducing the size of the document for Heathy People 2010 and encouraged the use of new communication avenues for this valuable assessment tool, making it available to a wider range of professionals and community leaders. Both health care purchasers and managed care providers agreed that the number of objectives should be reduced to permit adequate focus on a limited number of problem areas.

Using resources made available through the HHS Regional Health Administrators, one study examined the health and well-being of women in the State of Washington (6684). Through a broad coalition of health care providers, researchers, and activists, as well as focus groups of women from diverse geographical areas, economic levels, and social strata, the report concluded that in general, women in Washington State are living longer and enjoy a better standard of living than women elsewhere in the United States. Although access to health care overall was relatively good, the report indicated that elderly women, those with less than a high school education, and poor women were less likely to use mammography and have regular Pap smears. The report will be used to provide recommendations for addressing several problem areas for Washington women's health.

Finally, in a continuing effort to evaluate program effectiveness, the Office of Minority Health concluded an analysis of sponsored program offices at Historically Black Colleges and Universities (HBCUs) (6246). The evaluation determined that grant funds and technical assistance had achieved the program aims begun in 1992 to increase the involvement of HBCUs in health and social service programs funded by the Public Health Service and other Federal agencies. On campuses where sponsored program offices were funded, there was an increase in proposal submissions and awards. The report indicated a continuing need to invest in both programmatic and administrative infrastructure.

Evaluations in Progress

In reviewing evaluation projects for FY 1997, OPHS gave highest priority to efforts aimed at tracking the enormous transformation occurring in the Nation's health care system. The shifting emphasis on managed care presents new dilemmas about how to ensure that, in the quest to control cost, overall quality of care is not unduly compromised. Ensuring a workforce that is properly trained and fully capable of performing essential public health services in this dynamic health care environment is a task that OPHS must, at a minimum, also monitor. Monitoring this entire process presents new challenges to HHS, OPHS, and their partners in the public health community.

The FY 1997 OPHS evaluation plan emphasized the need for a strong foundation for public health in the 21stcentury. Priorities focused attention on (1) the information systems and workforce that comprise the Nation's public health infrastructure and that are necessary to effectively provide the essential services of public health; and (2) the impact of managed care arrangements on the resources available for this infrastructure and on the health of all Americans, especially those most vulnerable. In support of broader HHS efforts to improve departmental programs, OPHS evaluations also reflect the assessment of various programs and activities funded through PHS.

Several studies were continued from previous years. The Commission on Dietary Supplement Labels, appointed by the President, continued its evaluation of factors relevant to Food and Drug Administration regulation and possible legislation of label claims and statements for dietary supplements as requested by Congress (6193). The National Academy of Sciences also continued its study of dietary reference intakes (6323). In the area of program improvement, OPHS continued supporting an evaluation of a new model of coordinating and integrating HIV prevention and primary care services among high-risk populations (6321), an evaluation of the Minority Health Resource Center (6244.1), and the assessment of the efficiency and effectiveness of the Office of Minority Health's Bilingual/Bicultural Service Demonstration Grant Program (6247). In the area of communication, OPHS is designing and evaluating applications of interactive communications for consumer health information and examining the utility and impact of timed dissemination of public health information from PHS agencies (6327). OPHS continued its support of a study to identify evaluations of school health programs and make available to school boards, administrators, health personnel, and health educators an updated compilation of methodologically sound studies of these programs (6198).

In an effort to track the impact of managed care arrangements on the health care system, OPHS collaborated in a broader study of health systems change (being funded by the Robert Wood Johnson Foundation) to track changes in the public health sector in 12 randomly selected communities over a 4 year period (6325). OPHS also developed a research agenda to address gaps in scientific knowledge related to cultural competence in health care and linking measures to outcomes (6675), and assessed managed care organizations serving racially/ethnically diverse communities to determine the extent and nature of linguistically and culturally appropriate services (6674). When completed, the study will analyze and report the range of services being provided, identify best practices and model approaches, and explain the community and organizational factors conducive to providing linguistically and culturally appropriate services.

In FY 1997, OPHS undertook a project in cooperation with the United Kingdom that examines efforts to address the health concerns of racial and ethnic minorities in the two countries and, for six issue areas, conducts comparative analyses of strategies and approaches to identify strengths and limitations, best practices, lessons learned, and future areas for collaboration. For each of the six issues, a paper incorporating these comparative analyses into an integrated piece suitable for publication is forthcoming (6676).

In a continuing effort to improve the usefulness of Healthy People 2000 objectives, OPHS worked with States and localities to determine their ability to assess health trends in their communities (6488). Although Healthy People 2000 has driven the development of some surveillance and data systems at the national level, the usefulness of this information is dependent on State and local ability to measure objectives locally. Information from this study will be used to develop objectives for Healthy People 2010, in an effort to make them more usable for local performance and health assessment. In this area, OPHS is also assessing linguistically and culturally appropriate community health promotion programs in local health departments to gather the baseline data necessary to support the review of Healthy People 2000 objectives (6798).

The balance of the ongoing evaluation projects funded by OPHS were conducted on a regional basis, examining programmatic impact in significant Presidential or departmental priority areas or in vulnerable or special populations. Specifically, four studies examined effectiveness of services in the area of women's health: preventive health screening among older women (6677), breast and cervical cancer screening in Region X (6682), averted pregnancies and associated cost savings in Region X (6683), and a retrospective study of the preventive health practices of former Title X (Family Planning) clients (6685). Other studies are looking at the impact on public health services of an increased migrant population in northwest Arkansas (6687) and evaluating the impact of the loss of Federal funds in the AoA and ACF programs on the Freely Associated States (6688). Studies reviewing activities concerning Presidential or departmental priorities include an evaluation of an immunization education program for child care centers (6680), a study of males who father children born to teenagers (6681), an assessment of Region IX programs to promote positive images in girls ages 9-14 (6689), and an analysis of local capacity to respond to the health and medical consequences of welfare reform (6686). One project is evaluating the community-based public health practice training program (6678).