Performance Improvement 2002. Office of Public Health and Science



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 difficulties and solutions. It assists other components of HHS in anticipating future public health issues 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.

OPHS’ evaluation strategy 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. OPHS evaluations support the Assistant Secretary for Health in the respective roles as the Nation’s top doctor and senior advisor for public health and science to the Secretary. OPHS also conducts evaluations specific to the needs of the programs operated from the offices located within OPHS, such as emergency preparedness, women’s health, minority health, disease prevention and health promotion, and research integrity. Some evaluation funds are made available to the ten HHS Regional Health Administrators. In keeping with its role within the Department, OPHS does not undertake evaluations more appropriately and effectively undertaken by operating divisions of HHS or by the Assistant Secretary for Planning and Evaluation (ASPE).

Completed Evaluations

Data Analysis and Support for President’s Race Initiative

The President’s Advisory Board on Race submitted a report of its deliberations to the President in the summer of 1998. A “chart book” on the current state of race relations was prepared in conjunction with the Board’s activities. The White House also commissioned the National Academy of Sciences to prepare detailed summaries of the research literature related to race, including health. This project identified data sources and data elements for detailed univariate and multivariate analyses, evaluated the quality and error structure of the data, conducted analyses to understand the persistent health disparities for racial and ethnic minorities and disseminated the results through a variety of mechanisms.
PIC ID: 7014; CONTACT: Olivia Carter-Pokras, 301-443-9923; PERFORMER: National Center for Health Statistics, Rockville, MD

National Standards for Culturally and Linguistically Appropriate Services in Health Care

In 1997, the OMH undertook the development of national standards to provide a much-needed alternative to the current patchwork of independently developed definitions, practices, and requirements concerning culturally and linguistically appropriate services (CLAS). The purpose was to develop national CLAS standards that would support a more consistent and comprehensive approach to cultural and linguistic competence in health care. The first stage of the project involved a review and analysis of existing cultural and linguistic competence standards and measures, the development of draft standards, and revisions based on a review by a national advisory committee. The second stage focused on obtaining and incorporating input from organizations, agencies, and individuals that have a vital stake in the establishment of CLAS standards. In this final version, there are 14 CLAS standards organized by themes, such as culturally competent care, language access services, and organizational supports for cultural competence. Within this framework there are three types of standards of varying stringency: mandates, guidelines, and recommendations. The CLAS standards reflect input from a broad range of stakeholders, including hospitals, community-based clinics, managed care organizations, home health agencies, and other types of health care organizations; physicians, nurses, and other policymakers; purchasers of heath care; accreditation and credentialing agencies; educators; and patient advocates, advocacy groups, and consumers.
PIC ID: 7260; CONTACT: Guadalupe Pacheco, 301-443-5084; PERFORMER: IQ Solutions, Inc., Rockville, MD

In-Progress Evaluations

Role of Health Plans in Community-Level Health Improvement

The purposes of this project are to identify the potential for health plans’ participation in community-level health improvement activities, and to examine the incentives and barriers that will affect their decisions to take part in community-based health efforts.
PIC ID: 6492; EXPECTED COMPLETION: FY 2002; CONTACT: Matthew Guidry, 202-401-7780; PERFORMER: Partnership For Prevention, Washington, DC

Scientific Evaluation of Dietary Reference Intakes

The National Academy of Sciences, Institute of Medicine, Food and Nutrition Board is conducting a multi-phase scientific evaluation of human nutrient requirements that: (1) evaluates requirements and dietary and supplement intake data for nutrients and non-nutrient food components, (2) develops Dietary Reference Intakes (DRIs) where data are available, (3) provides guidance for how these values should be used in various applications of clinical and public health importance, and (4) identifies research needs. Multi-agency participation is facilitated by an OS/OPHS requirements contract and interagency steering committee. OPHS evaluation funds have supported completed reports on folate and other B vitamins (9/96 to 3/98); dietary antioxidants and related compounds (9/97 to 12/99); micronutrients (9/98 to 12/00); applications of DRIs in dietary assessment (9/99 to 7/00); on macronutrients (fat, carbohydrate, protein (9/99 to 6/02) and in electrolytes (sodium, potassium, chloride) and water (9/01 to 3/03).
PIC ID: 6323; EXPECTED COMPLETION: FY 2003; CONTACT: Kathryn McMurry, 202-401-0751; PERFORMER: National Academy of Sciences, Institute of Medicine, Washington, DC

Assessing the Impact of Language Barriers and Interpreter Services on Cost & Quality of Health Care

This project will study the impact of providing and not providing language assistance services to limited-English proficient (LEP) populations in the context of health care delivery. The project will include an examination of data from actual clinical encounters between physician/patients, design/development of a tool or instrument that can readily identify the nature and extent of medical errors due to language barriers (for LEP populations), initial creation of a model to estimate the impact of these errors on cost and quality of care, and comparisons of error frequency, cost and benefits, impacts, and outcomes between varying levels of interpreter services (no interpreters, untrained interpreters, and medically trained interpreters).
PIC ID: 7711; EXPECTED COMPLETION: FY 2003; CONTACT: Valerie Welsh, 301-443-9923; PERFORMER: Massachusetts General Hospital, Boston, MA

Assessment of State Laws, Regulations and Practices Affecting the Collection and Reporting of Racial and Ethnic Data by Health Insurers and Managed Care Plans

Not having racial and ethnic (r/e) data collected by health insurers and managed care organizations (MCOs) has led to a dearth of r/e data to assess the health status, access to and quality of health services for minorities, as well as the inability to monitor progress towards eliminating racial and ethnic disparities. This project includes a comprehensive review of: (1) the extent to which MCOs and health insurers can collect and report information on the applicants and enrolled members by race and ethnicity; (2) existing interpretation of State laws and regulations governing these entities; (3) parameters and overlap of civil rights versus insurance and managed care laws; and (4) practices of the state officials and these entities at the state level. A database search will be conducted in all 50 States and the District of Columbia to search for State laws and regulations which allow, require and/or prohibit the collection of r/e data. The findings developed in this project will clarify needed steps to develop a system to monitor progress towards the elimination of health disparities, one of the Nation’s health promotion and disease prevention goals for the next decade.
PIC ID: 7479; EXPECTED COMPLETION: FY 2003; CONTACT: Violet Ryo-Hwa Woo, 301-443-9923; PERFORMER: National Health Law Program, Washington, D.C.

Cultural and Linguistic Competence Research Agenda Project

This project would revise and promote an agenda of cost, quality, and outcome-related research on language and cultural competency, including research that would explore issues related to cost-effectiveness, clinical efficiency, and the validation of different methods and models of linguistic and culturally competent interventions, including medical interpretation, translation, and cross cultural provider and program assessment, training, and programming. Drawing on the expertise of researchers, policymakers, and providers already interested in linguistically and culturally competent care (complemented by experts in cost, quality, outcomes research), it would produce not just a onetime report, but sponsor and maintain an online research clearinghouse/networking site for regularly updated and synergistically developed information.
PIC ID: 7497; EXPECTED COMPLETION: FY 2002; CONTACT: Guadalupe Pacheco, 301-443-5084; PERFORMER: Center for the Advancement of Health, Washington, DC

Development and Testing of Cultural Competency Curriculum Modules

The purpose of this project is to develop and test curriculum modules that equip family practitioners with cultural and linguistic competencies. The curriculum modules will be anchored in the principles and concepts established in the National Standards on Culturally and Linguistically Appropriate Services (CLAS) in Health Care which provide the framework for developing the necessary and relevant competencies to increase the quality and effectiveness of health delivery systems and to ensure that health care is not impeded by cultural or linguistic barriers.
PIC ID: 7713; EXPECTED COMPLETION: FY 2003; CONTACT: Guadalupe Pacheco, 301-443-5084; PERFORMER: American Institutes for Research, Washington, DC

Development of Uniform Information/Data Set and Collateral Products for Assessing Impacts of OMH-funded Activities

The contractor will conduct a comprehensive analysis of past and current Office of Minority Health (OMH) funded activities including OMH grant programs, cooperative agreements, and personal services contracts to determine the current types of information/data collected and available from them. The contractor will then develop a uniform set of information/data elements that OMH grantees/partners could be encouraged to collect for OPHS and OMH GPRA performance measurement purposes. A project advisory group of federal and non-federal individuals will be utilized. This project will identify a uniform set of information/data that should be provided by the recipients of OMH funding in order for OMH to be able to demonstrate the “returns for the public’s investment.” The project is to include, but is not limited to, examinations of the findings of the recently completed evaluation of OMH’s Bilingual/Bicultural Services Demonstration Program, work being done within OMH to develop a statistical data progress report, and the related experiences and successes of other DHHS entities--building upon these efforts rather than “reinventing the wheel.” OMH anticipates that as a result of this contract, it will be able to implement a process for obtaining the information/data necessary to demonstrate that the various grant/funded programs supported by OMH make a difference that matters to and resonates with policy and budget decision makers. Collateral technical assistance documents related to the uniform data/information set will also be developed.
PIC ID: 7097; EXPECTED COMPLETION: FY 2002; CONTACT: Violet Ryo-Hwa Woo, 301-443-9923; PERFORMER: Development Services Group, Inc., Bethesda MD

Feasibility Study and Design to Assess Consumer Perceptions of and Experiences with the Provision of CLAS in Their Health Care Delivery System

The purpose of this project is to assess the feasibility of, and develop a plan for, conducting a study of the nature and extent of culturally and linguistically appropriate services (CLAS) from the perspective of the consumers/patients served in targeted delivery settings or communities across the country. The study instrument used for the CLAS in Managed Care Organizations (MCOs) study currently in progress will be used as a basis for the instrument to be used in the consumer/patient study. It is expected that, at a minimum, the instrument will need to be modified to address the perspectives and experiences specific to consumers/patients and will likely require translations of survey protocols and instruments, bilingual interviewers, and/or focus groups and pilot testing.
PIC ID: 7710; EXPECTED COMPLETION: FY 2002; CONTACT: Valerie Welsh, 301-443-9923; PERFORMER: Health Systems Research Associates, Chevy Chase, MD

Implementing Culturally and Linguistically Appropriate Services (CLAS) in Health Care

The purpose of this project is to implement a pilot project that will report on guidelines and processes for implementing the Culturally Linguistically and Appropriate Services (CLAS) standards among health care organizations. The project will document both enabling factors and potential barriers to the implementation of the CLAS standards. Additionally, the pilot project will measure the impact of implementation of the CLAS standards by a major managed care organization (MCO) on both its provider and patient populations. The data collected from the CLAS implementation experience through the pilot test and other processes will be analyzed and the trends, best practices, and lessons learned will be identified and presented in the final report.
PIC ID: 7714; EXPECTED COMPLETION: FY 2003; CONTACT: Guadalupe Pacheco, 301-443-5084; PERFORMER: Macro International, Inc., Calverton, MD

National Assessment of CLAS in Local Public Health Agencies Serving Racially/Ethnically Diverse and Vulnerable Populations

This project proposes to conduct a survey of a national sample of local public health agencies (LPHAs) serving communities or areas with high concentrations of vulnerable and/or racially and ethnically diverse populations to identify the nature and extent of culturally and linguistically appropriate services (CLAS) being provided by these agencies. This survey is intended to result in meaningful national baseline data on the nature and extent of CLAS being provided by LPHAs across the country, especially in communities in need.
PIC ID: 7712; EXPECTED COMPLETION: FY 2003; CONTACT: Betty Hawks, 301-443-5084; PERFORMER: COSMOS Corporation, Bethesda, MD

National Assessment of Culturally and Linguistically Appropriate Services in Managed Care Organizations

This project will conduct a survey of a national random sample of managed care organizations (MCOs) serving racially/ethnically diverse communities. The survey will identify the nature and extent of culturally and linguistically appropriate services (CLAS) being provided by these health plans. It is intended to inform and educate health service executives and managers about the nature and importance of CLAS, encourage policies and practices in support of CLAS for all Americans, and establish meaningful national baseline data on the nature and extent of CLAS being provided across the country. This is especially important in communities where language and cultural differences create access barriers and barriers to quality of care. It is expected that the end products will include an analysis and report of the range of such services, an identification of best practices and model approaches, and an explication of the community and organizational factors conducive to the provision or inhibition of CLAS.
PIC ID: 6674; EXPECTED COMPLETION: FY 2003; CONTACT: Betty Hawks, 301-443-5084; PERFORMER: Cosmos Corporation, Bethesda, MD 20824

National Youth Sports Program Evaluation

The purpose of this initiative is to evaluate the scope and design of the National Youth Sports Program (NYSP) as well as study potential program effects on the knowledge, attitudes, and behaviors of youth participating in the Year 2001 summer program. Activities include conducting a complete review of the NYSP; selecting five program sites to review as case studies; designing and pilot testing pre- and post-student survey instruments; and developing a report on the qualitative review of the NYSP and the pilot survey findings.
PIC ID: 7709; EXPECTED COMPLETION: FY 2002; CONTACT: Joyce Heinonen, 301-594-0769; PERFORMER: Inter-University Program for Latino Research, Notre Dame, IN