Performance Improvement 2000. Health Resources and Services Administration


MISSION: To improve the Nation’s health by assuring equitable access to comprehensive, culturally competent, quality health care for all.

Evaluation Program

The Health Resources and Services Administration’s (HRSA) evaluation program is designed to enhance strategic planning, strengthen budget and legislative development, and improve program performance. HRSA’s evaluation priorities are to (1) develop and strengthen performance measurement and information management systems, (2) assess program implementation and identify opportunities for improvement in strategies and management, (3) determine the effectiveness of HRSA programs and strategies, and (4) conduct environmental assessments, such as analysis of crosscutting policies and issues impacting HRSA and its varied constituencies.

Performance Measurement and Information Systems–This area includes assistance, training, and support to strengthen the agency’s capacity to respond to the requirements of the Government Performance and Results Act (GPRA) and to build information systems that are needed for effective program planning, management and evaluation. HRSA has relied heavily on a completed study that established a performance measurement baseline for all operating programs, using a common framework to develop program-specific logic models. HRSA continues to invest substantial funding to provide assistance tailored to the specific needs of individual agency programs. These efforts have focused on (1) assisting with identification and verification of indicators and measures and development or refinement of information systems, and (2) helping HRSA components enhance their capacity to plan for, collect, analyze, and use information submitted by grantees for program management as well as for GPRA reporting. One result of this 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 and in performance monitoring and reporting. The Bureau of Primary Health Care’s work on Development and Testing of Emergency Department Utilization as a Measure of Performance for the Health Care for the Homeless Program (PIC 7415) is another example of activities in this priority area. Another project begun in 1998, Crosscutting HRSA-Wide Performance Strategy (PIC 7131), builds on program-specific efforts to link the HRSA strategic plan, annual performance plans, and budgets through a set of HRSA-wide performance strategies which are to: eliminate barriers to care, eliminate health disparities, assure quality of care and improve public health and health care systems.

Program Implementation and Management–These studies provide information for developing, implementing, and modifying HRSA programs and strategies. A 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. 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. A 1999 study, Assessment of Domestic Violence Interventions and Staff Training Protocols in Community-Based Primary Health Care Settings (PIC 7284), is examining the characteristics of existing domestic violence protocols and related training and referral patterns with a view to recommending how other Bureau of Primary Health Care-funded programs can develop effective domestic violence interventions.

Program Effectiveness–Studies in this area assess the intermediate and longer-term results or impact of programs in achieving specified objectives and 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 study of Effectiveness of the National Health Service Corps (PIC 6357) is assessing the program over time, using retention in primary care, continued service in underserved areas, and other indicators as measures of effectiveness. The National Evaluation of the Healthy Start Program (PIC 5610) is a multi-year study that uses outcome and process measures to assess the impact of the program on infant mortality and other birth outcomes in Healthy Start sites as compared to matched comparison communities. Another example is the ongoing study of the Impact of RWCA Title I Funding on HIV Services Utilization and Health Outcomes in Las Vegas, Nevada and Norfolk, Virginia, which is examining how Title I grants affect the availability, accessibility, quality, continuity and integration of care, and HIV-related morbidity in these metropolitan areas that are newly eligible for RWCA funding.

Environmental Assessment–This area of study addresses the ways in which major policy initiatives and/or other forces in HRSA’s external environment affect HRSA’s programs, clients, or progress toward achieving strategic goals and objectives. For example, the ongoing project, Managed Care and Safety-Net Providers (PIC 6815), examines the impact of Medicaid managed care and other changes in health care coverage on the future viability of safety-net providers, including HRSA-funded Community Health Centers. A 1999 study of the Cost Implications of Providing 12 Months’ Continuous Coverage for Children Under Public Health Insurance Mechanisms (PIC 7236) assesses the effect of policies to extend eligibility for Medicaid or SCHIP on the administrative and service costs of caring for children. Recently completed, A Pilot Study to Identify Infrastructure Building Across HRSA Programs (PIC 6814) has provided information on the influence of market changes on HRSA programs and how HRSA programs synergistically interact to contribute to the development of a health care infrastructure at the community level.