Performance Improvement 1999. Evaluations in Progress

02/01/1999

Evaluation Program
The purposes of the Health Resources and Services Administration (HRSA) evaluation program are to enhance strategic and performance planning and reporting, strengthen budget and budget and legislative development, and improve program management. HRSA's evaluation priorities are to (1) develop and support performance measurement, (2) evaluate program effectiveness and impact, (3) assess program implementation, and (4) conduct crosscutting policy analysis, such as environmental assessments.

Performance measurement includes technical assistance and training to strengthen the agency's capacity to respond to the requirements of the Government Performance and Results Act (GPRA), and to lay a foundation for assessing program performance over time. In 1995, HRSA completed a study that established a performance measurement baseline for all operating programs, using a common framework to develop program-specific logic models. HRSA has invested substantial funding over the past four years to provide technical assistance tailored to the needs of individual agency programs. These efforts have been focused on (1) assisting with identification of indicators and measures and development or refinement of data systems; and (2) helping HRSA components to enhance their capacity to plan for, collect, analyze and use the performance information submitted by grantees for program management as well as for preparing GPRA-related documents. One result of this technical assistance was a partnership between the Maternal and Child Health Bureau (MCHB) and the States to develop a set of standard performance measures for the Maternal and Child Health Block Grant that are now being used by MCHB and the States in goal setting, performance reporting, and performance monitoring. Building on these program-specific efforts, work began in 1998 to link the HRSA strategic plan, annual performance plans, and budgets through a set of HRSA-wide performance strategies: eliminate barriers to care; eliminate health disparities; assure quality of care; and improve public health and health care systems. An ongoing project, Crosscutting HRSA-Wide Performance Strategy (PIC 7131), has supported this effort.

Program effectiveness studies assess intermediate and longer-term outcomes or impact of programs in relation to their intended goals. For example, the Impact of Community Health Workers on Access, Use of Services and Patient Knowledge and Behavior (PIC 6355) showed that use of community health workers in HRSA-funded programs led to increased access to care for patients, and to increased knowledge of nutrition and other topics to promote a healthy lifestyle. The ongoing study Effectiveness of the National Health Service Corps (PIC 6357) is assessing the program over time, using retention in primary care and related professions as one measure of effectiveness. The National Evaluation of the Healthy Start Program (PIC 5610), also ongoing, is a multi-year study with both outcome and process components. The final report will present findings on the impact of the program on infant mortality and birth outcomes in Healthy Start sites, compared with matched comparison communities. The final report of the process component, The Implementation of Healthy Start: Lessons for the Future (PIC 5610.1), is included among studies completed in FY 1998. Another ongoing project, Comparison of Services Received and Health Outcomes for Persons Funded by the CARE Act and by Other Sources (PIC 7123), compares demographic characteristics, services needed and provided, and health outcomes between persons receiving CARE Act-funded services and the general treatment population. Finally, the current study, Employment Sites of Nursing Graduates Supported by the Professional Nurse Traineeship Program (PIC 7130), is assessing the impact of a funding preference in the grants process on the achievement of the program objective of increasing access to care in underserved communities.

Environmental assessment concerns the ways in which forces in the larger society affect HRSA programs or progress toward achieving crosscutting goals and objectives. For example, the ongoing project Managed Care and Safety Net Providers (PIC 6815) is examining the impact of Medicaid managed care and other changes in health care coverage on the future viability of safety net providers operating in primary care settings, including grantees of HRSA-funded programs such as Community Health Centers. A completed study, Pacific Partnerships for Health: Charting a New Course for the 21st Century (PIC 7157), outlines health status and access issues for the populations of six island jurisdictions and recommends approaches for improvements. Findings from a current project, A Pilot Study to Identify Infrastructure Building Across HRSA Programs (PIC 6814), will improve HRSA's understanding of the interaction and effects of its programs in the context of health system changes and shifting population needs.

Program management studies provide information for developing and implementing a program.

The completed study, Data Collection and Budget Forecasting Strategies: A Primer for State AIDS Drug Assistance Programs (PIC 7159), produced a primer that will enable the State-administered AIDS Drug Assistance Programs to estimate their expenditures more accurately and, consequently, administer the federal funds more efficiently. The Strategies for the Recruitment, Retention, and Graduation of Hispanics into the Baccalaureate Level of Nursing (PIC 6249) developed a model that can be used by institutions of higher education seeking to increase the proportion of Hispanic Americans admitted to baccalaureate programs as their initial entry into nursing education.

In addition, HRSA supports activities to enhance the quality of evaluation agencywide, such as by funding short courses in evaluation for staff, encouraging presentation of HRSA studies at national conferences, and expanding the capacity of agency staff to provide skilled technical assistance on the framing, design and implementation of studies. Broadening of dissemination of study products through a variety of electronic and other approaches also will continue to be a priority for 1999 and 2000.
 

Summary of Fiscal Year 1998 Evaluations

Community Health Centers

TITLE: ACSC Experience by Usual Source of Health Care: Comparing Medicaid Beneficiaries Who Rely on CHCs with Medicaid Beneficiaries Who Rely on Other Primary Care Providers

ABSTRACT: The purpose of this study was to explore the extent to which Medicaid beneficiaries who rely on Community Health Centers (CHCs) as their main source of primary care are likely to experience hospitalization for ambulatory care sensitive conditions (ACSCs), as compared with beneficiaries who rely on other providers. Medicaid claims data for 1992 from five States were used to provide data on inpatient services, outpatient visits, clinical information and demographics. ACSCs were coded for hospitalization and a list of ICD-9 codes was developed for outpatient ACSC visits. The study sample comprised 16,145 CHC users and 32,594 other Medicaid beneficiaries from the same community as a comparison group. The study found that Medicaid CHC users experienced ACSC hospitalization rates 22 percent lower than those of the comparison group. Medicaid CHC users were 16 percent more likely to have outpatient visits for ACSCs and had lower emergency room use. Finally, outpatient visits were found to be reasonably good markers and performance measures for identifying populations potentially at risk for ACSCs. HRSA is using the study results as a source for a performance measure concerning hospitalization rates for ACSCs. The results have also served as the basis for a current study focused on episodes of care. (See PIC ID 7127)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 6001

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

TITLE: Evaluation of the Impact of the Medicaid Waivers on Consumers and Services of Federally Qualified Health Centers

ABSTRACT: This study assessed the early impacts of Medicaid managed care waivers on federally qualified health centers (FQHCs) as Medicaid providers, and on their consumers. FQHCs have often been primary providers of services to Medicaid recipients in their community and have derived between 30 to 40 percent of their revenues from Medicaid. Therefore, the shift of States to managed care systems for Medicaid beneficiaries can have a significant impact on FQHCs. The study focused on the impact of the first year of Medicaid waiver program implementation on two FQHCs in five States. Site visits were conducted at 10 centers. In addition, data from health plans, primary care associations and State Medicaid programs contributed to the analysis. An exit interview was conducted at some centers, in order to gain consumer perspectives. The study showed that: (1) FQHCs experienced widely varying amounts of change in their population of Medicaid users, from a decrease of 22.7 percent to an increase of 58 percent; (2) managed care placed a new and increased emphasis on the importance of primary care and primary care providers; (3) access to care for FQHC patients, especially adults, improved in many cases; (4) demands on FQHCs by Medicaid enrollees strained the capacity of some FQHCs, resulting in fewer services available to uninsured patients while, in other centers, expanding capacity increased access to services; (5) the financial impact is complex, and is the result of a variety of interacting factors; (6) FQHCs experience a number of administrative and management challenges, such as increasing paperwork demands and complex billing procedures; and (7) consumers were generally satisfied with FQHC services despite changes resulting from managed care. Study results are being used as a source for identifying factors that will affect health centers in future waiver programs, and to inform HRSA program policy and technical assistance.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Julia Tillman

PHONE NUMBER: 301-594-4062

PIC ID: 5738

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
 

TITLE: Medicaid Managed Care and FQHCs: Experiences of Plans, Networks and Individual Health Centers

ABSTRACT: The purpose of this study was to examine and compare different managed care participation strategies among 36 federally qualified health centers (FQHCs) in eight markets, focusing on how FQHCs are responding to Medicaid managed care, their reasons for forming plans and/or networks, and factors contributing to their success in plans and networks and under different participation strategies. The study focused on three strategies: (1) being part of an FQHC-owned or sponsored health plan, (2) being a member of an FQHC network, and (3) being an individual contractor with non-FQHC plans. Findings are based mainly on site visits to four FQHC-sponsored plans, eight FQHC networks, and 24 individual health centers. Market-level information from secondary sources and program data were also used. The study found that: (1) nearly all of the centers in the study had experienced a decline in users, revenues, and/or net income under managed care since 1993, with more centers experiencing losses during 1996 than in the earlier time periods; (2) most centers reported having experienced an increase in the volume and proportion of uninsured users; (3) many centers (but less than half) have improved their facilities and operations, but several have had to make cuts in hours and services. In addition, FQHCs have responded to managed care by choosing to participate in FQHC plans and networks, strengthening their ties with local hospital systems, and expanding their involvement in Medicare and managed care contracts. The manner in which FQHCs chose to participate in managed care did not, in itself, appear to make a difference in effects on the center. During the study period, however, many FQHC plans and networks were just becoming operational. Study results are helping to shape policies for participation of centers in managed care, and for the Health Resources and Services Administration's (HRSA's) technical assistance strategies concerning managed care.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Julia Tillman

PHONE NUMBER: 301-594-4062

PIC ID: 6353

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.
 

TITLE: The Performance of C/MHCs Under Managed Care: Case Studies of Seven C/MHCs and Their Lessons Learned

ABSTRACT: This study examined how Community and Migrant Health Centers (C/MHCs) have performed as managed care providers, how participation in managed care has affected C/MHC operations, and how C/MHCs could be assisted in improving their performance in a managed care environment. It is critical that C/MHCs be successful participants in the managed care market in order to be financially viable sources of care for the uninsured and other vulnerable populations. Visits were made to one site in each of seven States. On-site and telephone interviews with key personnel at managed care organizations (MCOs) that had contracted with the C/MHCs formed the basis of the performance assessment of these centers. On-site interviews with key C/MHC staff were used to develop an organizational assessment, which concerned the effect of managed care on C/MHC decision-making, strategic planning, administrative and financial management practices, demands for information and data collection systems, and clinical operations. Based on data provided by managed care organizations (MCOs) for each C/MHC and the regional network of providers, average C/MHC costs were consistently lower for referrals and pharmacy services, and C/MHCs experienced lower or comparable total hospital and non-maternity admissions. Centers reported higher maternity admissions and maternity days. MCO staff emphasized the centers' strategic importance in the network because of geographic location, reputation in the community, experience with Medicaid beneficiaries, and focus on primary care and prevention. Weaknesses cited for some centers included physician turnover, insufficient extended hours and inadequate 24-hour coverage. Findings are being used in discussions with managed care associations and networks, and to inform program policy and technical assistance.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Julia Tillman

PHONE NUMBER: 301-594-4062

PIC ID: 6354

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

Community Health Workers

TITLE: Impact of Community Health Workers on Access, Use of Services and Patient Knowledge and Behavior

ABSTRACT: In recent years, the Health Resources and Services Administration's (HRSA's) primary care programs have increased their use of community health workers (CHWs) to augment and complement the care patients receive from medical and social service staff members, as well as to help link the community with the providers. Community health workers provide informal community-based health-related services, establishing vital links between community-based health providers and persons in the community. The main purposes of this study were to provide information on the use of CHWs in HRSA-funded primary care projects , and to determine the effects of using CHWs on patients' access to, and proper use of, services, and on patient knowledge and behavior. An annotated bibliography of studies of CHWs was prepared, and documents on 60 HRSA-funded projects utilizing CHWs were reviewed. Fourteen projects were profiled and seven were site visited. During the visits, focus groups were held with clients. The study found that CHWs were effective in helping clients find needed services and in providing services that were previously unavailable or limited. CHWs assisted patients with the proper use of services such as immunizations and breast cancer screening, and provided education programs to increase patient knowledge about a variety of topics such as hygiene, substance abuse, nutrition and domestic violence. CHWs were actively involved in case finding and case management in most programs. In some locations, CHWs provided services (e.g., adult day care) that had been unavailable in the community. Study results have been widely distributed and are being used to inform policy on use of CHWs in HRSA-funded programs.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Remy Aronoff

PHONE NUMBER: 301-443-7577

PIC ID: 6355

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

Expanding Access to Care

TITLE: Pacific Partnerships for Health: Charting a New Course for the 21st Century

ABSTRACT: The U.S.-Associated Pacific Basin consists of six island jurisdictions. Three of these--American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), and Guam--are considered U.S. flag territories. The other three--Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), and Republic of Palau--are independent countries, but are freely associated with the United States. The total population of all these jurisdictions is 454,118. Although the health system and health status measures vary within and among the islands, almost all health indicators for islanders are worse than those for mainland Americans. The purposes of this study were to examine these issues and suggest possible approaches to improve the situation. The study concluded that four approaches should be used simultaneously to improve health: (1) adopt and support a viable system of community-based primary care and preventive services; (2) improve coordination within and between the jurisdictions and the U.S.; (3) increase community involvement and investment in health care; and (4) promote education and training of the health care workforce. The first two of these were given the highest priority. The Health Resources and Services Administration (HRSA) convened the Pacific Basin Health Summit in March 1998 to discuss the agency's role in improving health care in the region. Subsequently, HRSA has implemented several study recommendations including: (1) creation of an intra-agency to improve jurisdictional coordination; (2) use of military hospitals in Guam for care coordination; (3) provision of continuing provider education in epidemiology, substance abuse, mental health, and HIV prevention and treatment; and (4) expansion of community involvement in planning federally-supported projects. Activities stemming from the report and the summit continue with HRSA participation.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Thomas Coughlin

PHONE NUMBER: 301-594-4425

PIC ID: 7157

PERFORMER ORGANIZATION: Institute of Medicine, Washington, D.C.

Health Professions

TITLE: Assessing Ambulatory Primary Care Training: Costs, Methods and Quality

ABSTRACT: The purpose of this study was to create a meaningful data set to estimate the cost of primary care medical education, including training costs for nurse practitioners and physician assistants, in the ambulatory care setting. Although well-developed educational and financial infrastructures support hospital-based education of the health professions, a similar infrastructure for ambulatory care training is nascent. This study addressed whether teaching ambulatory sites have higher costs than non-teaching sites, and whether the productivity of clinicians engaged in ambulatory teaching differs from that of clinicians who are not teaching. An advisory panel of leading investigators and teaching clinicians helped to guide a literature review of the costs of ambulatory training and related data collection analysis. Site-level cost and operations information was obtained from HRSA and external sources. In addition, a survey of 98 ambulatory teaching sites was conducted. The study found that operating costs of teaching ambulatory care sites are about 36 percent higher than costs of similar non-teaching sites. Of this cost differential, about 65 percent is due to costs that are attributable to education, while 35 percent stems from educational infrastructure costs. Like their hospital counterparts, teaching ambulatory care sites tend to be larger and more organizationally complex than non-teaching sites, offering more specialty care and seeing more patients. Educational experiences were diverse, including clinical training, core clerkships, lectures and seminars, and community service projects. Ambulatory care educators identified the following as conditions needed to assure quality in ambulatory training: a strong and interested faculty, a clinically diverse patient base, and the integration of training into day-to-day operations. This study has led to a preliminary project to determine a method for assessing the value added to ambulatory care settings by educational activities.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Emily De Coster

PHONE NUMBER: 301-443-6920

PIC ID: 6358

PERFORMER ORGANIZATION: Northeastern Ohio Universities, Rootstown, OH
 

TITLE: Consortium Development for Health Professions Training in Community-Based Settings

ABSTRACT: The development of academic/community consortia for education and training in the health professions can increase opportunities for students and trainees, enhance the relevancy of training experiences, and benefit both the consortium's academic and community-based participants. This project focused on consortia that train a variety of health professionals in an interdisciplinary manner in community-based settings. The goals of the project were to: (1) identify consortia, (2) determine what types of community-based and academic organizations make up these consortia, (3) determine the extent to which health professions education and training carried out by these consortia are done in an interdisciplinary manner, and (4) identify some of the challenges that face these consortia. This study identified consortia that not only educate and train disciplines other than, or in addition to, physicians, but that also include community-based providers and organizations as partners. The study found that academic-community consortia for health professions education vary considerably in their missions, types of participating organizations, governance structure, educational approaches, and professional disciplines of the trainees. Commonalities among the consortia included shared goals for both education and service delivery, use of a legally binding agreement to finalize commitment from partners, significant funding from Federal, State and private sources, and encouragement of trainees to practice in underserved areas. In addition, several factors that might impede the success of a consortia were identified. Findings are being used to guide program planning to encourage interdisciplinary training. Findings will also be used in providing technical assistance to applicants or grantees regarding important factors to consider in developing consortia.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Jennifer Burks

PHONE NUMBER: 301-443-6865

PIC ID: 6251

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.
 

TITLE: Strategies for the Recruitment, Retention, and Graduation of Hispanics into the Baccalaureate Level of Nursing

ABSTRACT: The Healthy People 2000 objectives for the Nation specify an increase in the proportion of all degrees in the health professions and allied and associated health professional fields awarded to minorities, from the 1985-1986 baseline of three percent to 6.4 percent by the year 2000. Recent data suggest that fewer than two percent of the 2.5 million Americans with current licenses to practice as registered nurses in March of 1996 were of Hispanic background, and Hispanics are seriously underrepresented in baccalaureate nursing programs. Only very slight gains in the admission of Hispanic students into nursing schools have been made since 1972, when the National League for Nursing first began collecting ethnic classification data. The admission rate for Hispanic nursing baccalaureate students has almost consistently remained below three percent. Based on a literature review and in-depth interviews with administrators, faculty and students at eight schools of nursing, this study has developed a model that can be used as a conceptual framework by Institutions of Higher Education (IHEs) seeking to increase the proportion of Hispanic Americans admitted to baccalaureate programs as their initial entry into nursing education. The model explicates promising strategies for the recruitment of Hispanics into baccalaureate nursing programs, retaining them after they are recruited, and assuring their graduation from those programs. It also suggests implementation issues that may arise when these strategies are put into practice.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Ernell Spratley

PHONE NUMBER: 301-443-1915

PIC ID: 6249

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

HIV/AIDS Services

TITLE: A Review and Synthesis of HIV/AIDS-Related Client Level Evaluation Activities Among Ryan White CARE Act Grantees

ABSTRACT: The purpose of this study was to gather information about whether and how Ryan White Comprehensive AIDS Resources Emergency (CARE) Act grantees were evaluating client satisfaction, and how the grantees were improving delivery systems in response to client needs and concerns. The development of new, clinically effective therapies that present challenges in their use has intensified the need for the re-design of HIV services and the increased involvement of people living with HIV/AIDS in managing their own health. A mail survey about assessment of client satisfaction was mailed to 480 grantees in September, 1997. Subsequently, site visits were made to six grantees. An advisory board including representatives of a wide spectrum of HIV/AIDS organizations helped guide the design of the survey and developed criteria for selecting the sites for the six case studies. The study found that grantees assessed client satisfaction most commonly through self-administered surveys, but some conducted group sessions or focus groups. Grantees using the latter methods reported making changes in their delivery systems more frequently than those using surveys. Ninety-three grantees reported making a wide range of changes in response to clients, including involvement of clients in policy and information development, and provision of sensitivity training for clinical and non-clinical staff. The Health Resources and Services Administration (HRSA) is using the findings in its technical assistance concerning client satisfaction and access to care. The National Association of People with AIDS (NAPWA) is using the results in a privately funded project to demonstrate the benefits of consumer involvement in the design and implementation of services.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Moses B. Pounds, Ph.D.

PHONE NUMBER: 301-443-2894

PIC ID: 6362

PERFORMER ORGANIZATION: National Association of People with AIDS, Washington, D.C.
 

TITLE: Data Collection and Budget Forecasting Strategies: A Primer for State AIDS Drug Assistance Programs

ABSTRACT: State-administered AIDS Drug Assistance Programs (ADAPs), funded by the Health Resources and Services Administration (HRSA) under Title II of the Ryan White CARE Act, along with other State and private sector resources, have been thrust to the forefront of the public debate over the cost-efficient provision of public health care services to individuals in this country. Over the last two years, ADAPs in most States have experienced significant growth, both in the number of clients served and in monthly expenditures on pharmaceuticals. This rapid growth has strained the limited resources of these programs and has resulted in many ADAPs being forced to limit access to life-sustaining HIV/AIDS medications by capping overall program enrollment, capping or limiting access to expensive new drug therapies, or developing more restrictive financial and medical program eligibility criteria. The rapidly changing fiscal and treatment environments in which ADAPs now operate have raised many challenges for the State-level or State-contracted administrators of these programs. Good data and good data collection systems are necessary to develop accurate budget projections and to aid in program planning. The purposes of this study were to provide directors of ADAPs with information necessary to assess their current data collection program and to provide practical tools to assist in developing an appropriate budget forecasting model. This study developed a primer on basic data collection and forecasting strategies. The primer addresses the fundamental program need for data to estimate expected monthly expenditures and the cost impact of adding a specific new drug to the ADAP formulary. The products of this study will enable ADAPs to assume greater accountability by streamlining data management strategies and enhancing forecasting capacity.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Annette Byrne

PHONE NUMBER: 301-443-6745

PIC ID: 7159

PERFORMER ORGANIZATION: National Alliance of State and Territorial AIDS Directors, Washington, D.C.
 

TITLE: Evaluating HIV Case Management: Invited Research & Evaluation Papers

ABSTRACT: The purpose of this study is to report on the papers and recommendations of a conference on approaches for evaluating the effectiveness of HIV case management. Case management for HIV services is eligible for funding under the Ryan White Comprehensive AIDS Resources Emergency Act Amendments of 1996 (CARE Act). The expansion of case management has not been accompanied by consistent standards for service delivery, validation of its aims and purposes, comparative analysis of its multiple forms, or systematic investigation of its various service configurations and outcomes. There is evidence that HIV case management is a highly needed service that leads to problem resolution, and that clients who receive case management have high levels of satisfaction with their case manager. However, health services research data about the effectiveness of HIV case management are generally lacking. For this project, a group of health services researchers, case managers, and Federal representatives met to discuss the evaluation and study of the effectiveness of HIV case management. Ten papers were commissioned for presentation at the meeting that, together with a summary introduction, constitute this final report.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Gloria Weissman

PHONE NUMBER: 301-443-3478

PIC ID: 7158

PERFORMER ORGANIZATION: Sociomedical Resources Associates, Inc. Westport, CT

Maternal and Child Health

TITLE: The Implementation of Healthy Start: Lessons for the Future

ABSTRACT: The Healthy Start program was begun in 1991 to demonstrate innovative ways to reduce infant mortality by 50 percent over five years (later changed to 6 years) in areas with some of the highest rates. The National Evaluation of the program includes a cross-site process component and an outcome study of the initial 15 sites. The report summarized here is the final product from the process component. This report features an analysis of the factors that facilitated or impeded implementation in 14 of the 15 original projects. (A separate report will be issued on the Northern Plains project.) Qualitative data from site visits and focus groups of clients and providers were used in conjunction with a client data set and interviews with postpartum women. The study found that program elements include: (1) community involvement through a consortium and other community empowerment strategies; (2) outreach and case management, generally using lay workers for many functions; (3) nontraditional support services, such as transportation and nutrition education; (4) enhanced clinical services, building on an existing delivery system; and (5) community-wide public information campaigns. Clients and providers gave positive feedback about Healthy Start services. This process study found that local communities can, with substantial Federal funding, develop and implement innovative approaches to reducing infant mortality. The extent to which projects were able to manage effectively--that is, to develop and execute sound administrative procedures, recruit and retain a strong staff (especially senior staff) and monitor contractors--made the difference between successful and less-than-successful implementation. The final report of the National Evaluation, due in March 2000, will discuss the issue of whether these projects have led to a measurable reduction in infant mortality. (See PIC ID 5610)

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 5610.1

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, DC

State Children's Health Insurance Program

TITLE: Sampling the States: Local Reflections on State Implementation of State Children's Health Insurance

ABSTRACT: The State Children's Health Insurance Program (SCHIP) was signed into law as Title XXI of the Social Security Act as part of the Balanced Budget Act of 1997. Title XXI provides $24 billion for child health over five years and $50 billion over 10 years in block grants to the States. This study was funded to obtain a grassroots perspective from local advocates, providers, and public health leaders on the impact SCHIP may have on children's health. A formative discussion, using qualitative research methods, was conducted with almost 40 individuals in 10 States which represent more than half of all uninsured children in the Nation. Perspectives were obtained on: (1) State plans for outreach and enrollment; (2) benefits package and design; (3) target populations; (4) the role of local coalitions and the respondent's role; (5) emerging service delivery system issues; (6) the role of safety net providers and linkages among providers; (7) quality of care/quality standards; and (8) thoughts on the program's promise, local concerns and vision. The study found that major system capacity issues, especially for dental and mental health care, were not being addressed aggressively by the States. Care for rural and migrant populations, enrollment of immigrant populations, services for adolescents, and benefit coverage and system redesigns to serve children with special needs or who are chronically ill also will require more attention. In addition, the study found that innovation in the enhancement of service delivery may require greater technical and financial support from the Federal Government, such as through issuance of Federal guidelines that offer increased flexibility and waiver options.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 7068

PERFORMER ORGANIZATION: Coalition for Healthier Cities and Communities, Health Research and Educational Trust, Chicago, IL

Crosscutting

TITLE: Are Consortia/Collaboratives Effective in Changing Health Status and Health Systems? A Critical Review of the Literature

ABSTRACT: The purposes of this study were to: (1) review the evidence of consortium effectiveness; (2) identify factors and developmental stages associated with effective consortia; (3) discuss challenges in, and tools available for, measuring consortium performance; and (4) assess the potential implications for Health Resources and Services Administration (HRSA) programs. The study found few examples of consortia or coalitions that can claim to have effected change in health status or health systems, and that conditions such as strong leadership, excellent planning, community commitment and well-defined goals are needed. However, collaborative efforts may have such valuable byproducts as: (1) expansion of the ability of individuals and organizations to work together, (2) increased levels of trust, and (3) enhanced responsiveness of the organizations to community needs. The study indicated a need for further research to determine how collaborative efforts achieve long-term outcomes, given the requirements for consortia and other collaborative efforts in many Federal programs.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301-443-0371

PIC ID: 7062

PERFORMER ORGANIZATION: Health 2000, Inc., Atlanta, GA

Evaluations in Progress